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Balancing the Power Dynamic in the Therapeutic Relationship

Section 6
Obstacles to Healing Progress

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♦ Cognitive Dysfunction
As you know, people who have been severely traumatized often have difficulty maintaining attention and concentration. Capturing the essence of the "intrusive" phase, or post-traumatic stress disorder, cognitive dysfunction refers to intrusive thoughts, flashbacks, nightmares, and unwanted images that may be so vivid they seem to be occurring in the present. Mary was continually tormented by such intrusive, unbidden cognitions. She was unable to work or carry on a social life.

Barbara Noel writes, "I was a wreck. As each day and night went by, I couldn't shake the pictures in my mind. I barely slept. Just when I'd find a comfortable place in my pillow, I'd sit up again, recalling the events of the sexual encounter with my therapist."

♦ Recollection
I refer to the third, or final, phase of therapy as "recollection." The client's shame lessens or eliminates their energy and initiative. Mary stated, "I can't get over it." The goal is to assist the client to regain his or her assertiveness, self-esteem, self-respect and self-control. Once this has started to occur, at some level survivors are more ready to move out into the world and reconnect with others.

This may mean renewing or repairing relationships, increasing intimacy with loved ones, making new friends, or getting involved with other survivors. Survivors often look back at their helplessness and powerlessness in the abusive situation and are proud of the courage, strength, and adaptability that enabled them to escape and then transcend their abuse.

3 Obstacles to Healing
However, there are many obstacles to the process of healing. They can involve the survivor's own issues with shame, embarrassment, and self-blame; lack of support by the victim's family; lack of community support for the victim; and even silencing.

♦ Obstacle 1: Shame
After her abuse, Mary felt consumed by guilt and shame. She withdrew from relationships and believed that the people she dated viewed her as withdrawn and secretive. She could not confide in friends or colleagues as she felt the information could be used against her. Subsequent therapists did not believe that she had been abused.

Mary found that finding a health care professional who believed her, and wanted to help in a way that would be best for her, to be an extremely difficult task. She saw six therapists ranging from one to about a dozen visits before our sessions began. With one male therapist, she thought she might be victimized again. Two therapists she felt did not seem to believe her. Three did not want to get involved, which varied from mild disinterest to outright rejection. Thus, Mary's attempts at lodging complaints were met with resistance and procrastination.

♦ Obstacle 2: Minimizing
Another obstacle Mary experienced (common to abuse victims) is she minimized it at first, knowing that others have suffered worse. Lastly, she let it develop a life of its own by letting the abuse affect current work and personal relationships.

Other abuse victims I have worked with describe similar experiences, commonly going through a long period when they submerged all or most of their feelings and thoughts about the abuse. Then, related to stresses or life changes, they found themselves suddenly bombarded by a variety of symptoms including severe anxiety, guilt, shame, panic attacks, nightmares, depression, plummeting self-esteem, various physical symptoms, poor concentration, and feelings of alienation.

♦ Obstacle 3: Depression
Others have experienced more immediate effects developing during the abuse or shortly after termination. Severe depression, eating disorders, alcoholism, and drug abuse, as you know, are among the problems suffered. Mary described severe depression and alcoholism. She began to lose weight during the time that she was being sexually exploited by her therapist. During this period her career was irreparably damaged.

Looking back over that extremely painful time, she states, "Everything was out of control. I couldn't concentrate, couldn't sleep, couldn't think, and couldn't plan. My emotions were all over the place. I was divorced, my career was shattered. It seemed like the only thing I could control was my eating."

Mary went through a period when she felt that some of her treatment had been helpful, and in the end, viewed the relationship with the mental health professional as destructive. She stated, "I really think he saw my vulnerability and took advantage of it. I felt like an object."

♦ A Series of Traumatic Events
As you know for many abuse victims, their abusive experience sets into motion a series of terrible losses or traumatic events. These included loss of employment or destruction of career; marital breakup; deterioration in relationships with children; disastrous remarriages or abusive relationships; financial problems; poverty; loss of homes or other accommodation; and loss of physical or mental health, to hospitalization in some cases.

Younger abuse victims, as you know, feel that they have lost their innocence or youth; Some feel that impaired trust has sabotaged their ability to enter into intimate relationships, and have consequently deprived them of the opportunity to have children. In the same way that a rock dropped into a pond causes ever-widening concentric ripples, so an abusive experience with a mental health professional can affect every aspect of the victim's lifestyle, relationships, health, and well-being.

♦ 3 Phases of Healing
The three phases of healing for the survivor of abuse are:
1. Remembering the trauma,
2. Getting in touch with the feelings, and
3. Developing a survivor rather than a victim mentality.

Since the immediate stress has been removed when the client leaves the abusing therapist, other strategies included catharsis, cognitive restructuring, and behavioral contracting.
Reviewed 2023

Peer-Reviewed Journal Article References:
Dworkin, E. R., Newton, E., & Allen, N. E. (2018). Seeing roses in the thorn bush: Sexual assault survivors’ perceptions of social reactions. Psychology of Violence8(1), 100–109.

Meier, S. T. (2019). Elevated trait anxiety: Obstacle to progress with female clients? Professional Psychology: Research and Practice, 50(1), 33–38.

Phelps, K. W. (2010). Review of Beliefs and illness: A model for healing [Review of the book Beliefs and illness: A model for healing, by L. M. Wright & J. M. Bell]. Families, Systems, & Health, 28(1), 70–71.

Scoglio, A. A. J., Marine, S. B., & Molnar, B. E. (2020). Responder perspectives on justice and healing for sexual violence survivors. Psychology of Violence. 

What are three phases of healing for the survivor of abuse? To select and enter your answer go to Test.

Section 7
Table of Contents