Therapy for Adults Molested As Children: Beyond Survival, Second Edition PDF
Preview Therapy for Adults Molested As Children: Beyond Survival, Second Edition
Therapy for Adults Molested as Children John Briere, PhD, is Associate Professor in the Departments of Psychiatry and Psychology at the University of Southern California School of Medicine, and a clinical psychologist at the Department of Emergency Psychiatric Services of LAC-USC Medical Center. He is author or editor of five books, two psychological tests, and numerous articles in the areas of child abuse, psychological trauma, and interpersonal violence. Dr. Briere is on the editorial boards of several scholarly journals and is on the board of directors of the Amer- ican Professional Society on the Abuse of Children (APSAC) and the International Society for Traumatic Stress Studies (ISTSS). He consults to local, national, and international agencies on the topics of trauma, violence, and research methodology, and regularly presents work- shops on the assessment and treatment of psychological trauma. Therapy for Adults Molested as Children Beyond Survival Revised and Expanded Edition JOHN BRIERE SPRINGER PUBLISHING COMPANY Copyright © 1996 by Springer Publishing Company, Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, Inc. SPRINGER PUBLISHING COMPANY 11 West 42nd Street New York, NY 10036-8002 www.springerpub.com 10th printing-05 06 07 / 12 11 10 Library of Congress Cataloging-in-Publication Data Briere, John. Therapy for adults molested as children : beyond survival / John Briere. — Rev. and expanded. p. cm. Includes bibliographical references and index. ISBN 0-8261-5641-X 1. Adult child sexual abuse victims—Mental health. 2. Psychotherapy. I. Title. RC569.5.A28B75 1996 616.85' 83690651—dc20 96-8221 CIP Printed in the United States of America Contents Foreword by Christine A. Courtois, Ph.D. vii Acknowledgments xi Introduction 1 Chapter 1 The Lasting Effects of Sexual Abuse 5 Chapter 2 Hysteria, Borderline Personality 35 Disorder,and False Memory Syndrome Chapter 3 The Core Effects of Severe Abuse 51 Chapter 4 Philosophy of Treatment 72 Chapter 5 Vagaries of the Therapeutic 88 Relationship:Transference and Countertransference Chapter 6 Specific Therapy Principles and 111 Techniques v vi Contents Chapter 7 The Specific Problem of Client 138 Dissociation During Therapy Chapter 8 Teasing the Dragon: The Fruits of 152 Confronting Severe Abuse Chapter 9 Group Therapy 169 Chapter 10 Client Gender Issues 182 Chapter 11 Therapist Issues 202 Appendix 217 References 227 Index 247 Foreword It is an honor to have been invited to write the foreword to the second edition of Therapy for Adults Molested as Children. I have long been an admirer of Dr. John Briere. He is an individual of integrity as well as a productive scholar and gifted clinician. Throughout his career, Dr. Briere has been dedicated to learning and teaching about adults abused as children. He has advanced professional knowledge of the characteristics and needs of this population through numer- ous research studies and publications and has used this knowledge to develop an innovative model of treatment. This model was first published in 1989; in this second edition, it is substantially revised and updated. In addition to describing the theory and strategy for the treatment of adult survivors, it offers sound clinical guidance for a wide variety of process and content issues that tend to emerge during this therapy. In recent years, both the prevalence and the toll of child sexual abuse have been acknowledged as never before. The sexual abuse of children is alarmingly prevalent in North America, its aftereffects diverse and tenacious. Sexual abuse, especially when incestuous or otherwise occurring within an established relationship where sex- ual contact is proscribed, is now recognized as a traumatic stressor with high potential for post-traumatic consequences at the time of the abuse and later in life. Its occurrence in childhood (and often vn viii Therapy for Adults Molested as Children over the course of childhood) has major developmental implica- tions: the child's psychosexual, physical, and interpersonal devel- opment is compromised resulting in an idiosyncratic pattern of developmental delays, fixations, and/or accelerations. These effects have often been ascribed diagnoses that, in effect, blame the victim for her reactions without an adequate understanding of their origin. New diagnostic conceptualizations are now emerging that take abuse as well as developmental impact into account. The adult survivor of sexual abuse who seeks treatment often does so without having received either acknowledgment or help at the time of the abuse or subsequently. He or she presents with a diverse array of post-traumatic, affective, characterological, and rela- tional issues at least partially derived from the abuse that have likely compounded over time. Thus, the clinician is presented with what is often a formidable treatment challenge of numerous symptoms and a client whose self and relationship capacities were influenced and distorted by exploitation. An unfortunate complication is the fact that most practicing clinicians (even the most recent graduates) have had little or no formal training in identifying and treating post- abuse trauma as part of their professional education. Complicating the matter even more is the controversy currently surrounding the treatment of adults who report a history of abuse. Critics allege that therapists are behaving irresponsibly by naively overbelieving their clients' accounts of abuse or, worse yet, are suggesting and creating false memories of abuse as an explanation of their clients' symp- toms. This work was originally published as a sourcebook to guide clin- icians in their treatment of abuse survivors. This second edition builds upon the first and provides additional direction, much needed during this time of controversy and as large numbers of adults reporting abuse histories continue to seek treatment. In the first part of the book, research-based information about the lasting effects of sexual abuse is presented. These effects are discussed not only as symptoms but in a more conceptually sophisticated way as multi-faceted core issues. A discussion of the philosophy of treat- ment follows. Dr. Briere advocates an abuse-focused perspective from which to understand the client and orient the treatment; how- ever, this approach is not free-standing and is presented along with Foreword ix other therapeutic perspectives, grounded in the established tenets of psychotherapeutic practice. One of the major strengths of this book is its integrationist approach—a traumatic stress perspective is blended with psychodynamic, object relations, self-psychology, and cognitive-behavioral perspectives and strategies. Additionally, the therapy is oriented towards moving the client beyond victim- ization towards personal growth and improved functioning. Dr. Briere is careful to note that an abuse-focused perspective does not mean that the therapist is solely oriented towards abuse and trauma-related issues to the exclusion of all others. Rather, this perspective holds that abuse can have a profound impact on current psychological functioning that must not be minimized or negated but instead must be recognized and worked with. The remainder of the book addresses some of the most common and vexing technical, relational, and process issues in the treatment of this population. These are some of the issues most often implicated in ineffective or problematic treatment, the very issues that the therapist was most likely not trained to anticipate, recognize, or work with. These include management of the treatment frame, traumatic transference and countertransference issues (including those that are specifically gender-related), common abuse-related issues and reenactments, assessment and treatment planning related to traumatic symptoms, sequencing, stabilization before uncovering, and titration to the client's emotional capacity and tolerance. Special attention is given to technical aspects of work with incomplete/dissociated/repressed memory. The clinician is advised to maintain a position of neutral- ity especially with those clients who struggle with uncertainty about their history yet to be open to the possibility of unremembered or partially remembered abuse as well as to the client's pain. The final chapter is devoted to a discussion of the impact of ther- apy of adult survivors on the clinician. Although this therapy can be very satisfying, it holds an unusually high number of challenges and pitfalls. It can result in overidentification and rescuing, burn- out and abandonment, and even revictimization by the uninformed or misguided therapist. These and other difficulties that attend this work are now supplemented by anxieties generated by the false memory controversy. Therapists must stay informed about new developments in this rapidly changing field, must monitor personal
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