Interesting Psychotherapy Articles

May 15, 2017, 07:46 AM

Countertransference and the Treatment of Trauma
By Constance J. Dalenberg, PhD

Quote:

The Search for a Tie to Reality
What happened-really happened.
What happened-really happened.
What happened-really happened.
I believe with perfect faith That I will have the strength to believe that
What happened-really happened.
(Carmi, 1977, p. 102)

The question of belief also can arise when the client or ther- apist feels the terror of loss of reality testing. Here, the client is indeed asking the therapist to affirm a truth, to state that the trauma occurred. However, again the client might not be seeking-as an end point-the therapist's view of the truth of the trauma. Rather, "Do you believe me?" here could mean "Tell me I am not crazy" or "Tell me that I know truth from fiction." Herman (1992) wrote that a sense of unreality in the therapist might be the first sign in the relationship that the client has an unspoken trauma history. Nonetheless, as Courtois (1999, p. 303) argued in her indispensible text on memory of sexual abuse, "in the absence of memory, neither transfer- ence or countertransference, no matter how compelling, should be interpreted as always indicative of past abuse.''

Chronic doubts in the reliability of their own perceptions appear to be the fate of many who experience chronic trauma. (See Shay [1994] for a discussion of this symptom as exhibited by war trauma victims and Davies and Frawley [1994] for a discussion of the same symptom in incest vic- tims.) Countertransference withdrawal or avoidance, or over- reliance on a "blank-screen" approach, can further under- mine a client's sense of reality. Almost 70 years ago, Ferenczi argued that a therapist's "cool" and "unemotional" attitude is inappropriate when “events are of a kind that must evoke, in anyone present, emotions of revulsion, anxiety, terror, ven- geance, grief, and the urge to render immediate help. . . . The patient prefers to doubt his own judgment rather than be- lieve in our coldness” (Ferenczi, 1932, pp. 24-25).

The therapist who empathizes (consciously or uncon- sciously) with this aspect of the wish to believe might seek to concretize the trauma prematurely to gain some hold on reality. This is particularly true when bizarre or implausible elements enter the trauma account-which is likely for a va- riety of reasons (Dalenberg, 1996b; Everson, 1997). The study of the frequency and meaning of these disclosures was one focus of the Child Disclosure Study series. In this research, a ”gold standard” sample (n = 142) was located-abuse ac- counts supported by evidence from medical exams and po- lice reports. Supportive medical evidence, a perpetrator con- fession, and (in 80% of the cases) some physical or eyewitness evidence was available for all children in the gold standard sample. In the comparison sample, a questionable account group, none of the children’s accounts were sup- ported by medical evidence, eyewitness or physical evidence, or a perpetrator confession.

Children’s disclosures of sexual abuse also were rated as severe and nonsevere. ”Severe abuse” was defined as abuse containing force or oral-genital contact, repeated abuse, or abuse by a family member with frequent access to the child. Abuse labeled ’honsevere” involved single, nonviolent inci- dents of molestation by perpetrators who were not likely to be attachment figures in the child’s life. Fantastic elements (those judged unbelievable or highly implausible by raters independent of the evidence) were more than four times more likely to occur in children known to have experienced severe trauma (the gold standard severe group) than in those known to have experienced milder incidents of punishment or molestation or those in the questionable account sample (Dalenberg, 199613). Thus, ”unbelievable” accounts of abuse are likely to be characteristic of the most serious and dan- gerous cases, leading to the frightening conclusion that the most serious cases might be most difficult to prosecute. Sim-ilar descriptions of lapses in reasoning in adult traumatized populations are given in the literature on attachment (Main, Van Ijzendoorn, & Hesse, 1993, as cited in Shaver & Clark, 1994) in portrayals of “D-like” adults (who typically have abuse or trauma backgrounds). D-like individuals are de- scribed as showing ”lapses in the monitoring of reasoning” when responding to questions regarding potentially trau- matic events. This description is said to apply particularly when participants were asked to discuss abuse or the deaths of important others. Bizarre elements or lapses in reasoning not only distance the therapist (in an observable way in our Child Disclosure Study research), but also leave the therapist feeling disoriented, confused, and uncomfortable.

The fantastic and bizarre elements of trauma accounts in children can result from a child’s misunderstanding, confu- sion between nightmares and reality, or traumatic halluci- nations (cf. Dalenberg, Hyland, & Cuevas, in press; Everson, 1997). These distortions, however, are not limited to children. Adults can show short-term reality distortion after trauma- an effect that research in our laboratory has shown dissipates more slowly for patients who also were traumatized in child- hood (Straws, 1996). These elements add to the therapist’s sense of disorientation, because they often appear within an otherwise credible trauma story.

Dissociation, a key trauma symptom about which so much has been written (cf. Putnam, 1997; Spiegel, 1994), also con- tributes to the client’s and the therapist’s sense of unreality and need for confirmation. The therapist’s dissociation to the client’s trauma or the patient’s dissociation to the memory of trauma create fundamental feelings of fragmentation in the self. The need for reality testing for such clients (or in such states) becomes quite concrete. Reaching for reality might in- clude reaching for a statement from the therapist about the past.

May 15, 2017, 07:07 PM

Radically Open DBT vs DBT

TrailRunner14 · May 17, 2017, 07:20 PM

https://healingfromcomplextraumaandp...-hope-lucario/

This was so real to me.

May 19, 2017, 11:03 AM

Power in Psychotherapy and Counseling

stopdog · May 20, 2017, 05:16 PM

Health care workers of all ilk should read some of these:
Narcissistic Doctors - The Narcissistic Life

https://scholarblogs.emory.edu/sick/...or-narcissism/

http://www.cmu.edu/dietrich/sds/docs...Narcissism.pdf

Narcissistic Doctors Intimidate Their Patients | The Narcissist In Your Life
http://thenarcissistinyourlife.com/n...heir-patients/

Or these:
https://www.theguardian.com/society/...-own-illnesses

http://blogs.aafp.org/cfr/freshpersp...igma_of_mental

https://www.madinamerica.com/2013/10...-ill-suicidal/

kecanoe · May 21, 2017, 07:52 PM

Quote:

Originally Posted by stopdog

Health care workers of all ilk should read some of these:
Narcissistic Doctors - The Narcissistic Life

https://scholarblogs.emory.edu/sick/...or-narcissism/

http://www.cmu.edu/dietrich/sds/docs...Narcissism.pdf

Narcissistic Doctors Intimidate Their Patients | The Narcissist In Your Life
Narcissistic Doctors Intimidate Their Patients | The Narcissist In Your Life

Or these:
https://www.theguardian.com/society/...-own-illnesses

http://blogs.aafp.org/cfr/freshpersp...igma_of_mental

https://www.madinamerica.com/2013/10...-ill-suicidal/

Most of those links don't work, at least not for me. The only one that worked was thenarcissistinyourlife

stopdog · May 31, 2017, 08:58 AM

Integrative psychology videos
Integrative Psychotherapy Videos

Jun 05, 2017, 03:56 AM

Case Study: Negative Countertransference towards a patient

TrailRunner14 · Jun 08, 2017, 09:31 AM

https://healingfromcomplextraumaandp...ogether-again/

Jun 14, 2017, 07:50 AM

ACE IQ by the WHO, expanded version of the first Adverse Childhood Experiences (ACE) study

Jun 16, 2017, 05:02 AM

http://greatergood.berkeley.edu/arti...nted_by_trauma

stopdog · Jun 25, 2017, 10:17 PM

"I’ve heard it said that shrinks aren’t simply screwed up, they’re shrinks because they’re screwed up. Where did I hear that? Why, from shrinks themselves"

How To Tell If Your Therapist Is Crazy (Part One) ? Iron Shrink

Jun 26, 2017, 10:27 PM

https://courageousjourneys.com/uncat...-relationship/

This is the article I've been trying to find back - where it says that "During therapy the therapist holds the position of power. Once therapy is over it shifts to the client." I like how that makes me feel.

Jul 12, 2017, 05:38 AM

// controlling parents keep controlling their children way into adulthood. They can’t rely on physical methods to control them anymore, but years of controlling and manipulative behavior already took its toll on the person, so usually pushing the person’s psychoemotional buttons is enough to make them comply. Guilt-tripping, shaming, silent treatment, gaslighting, playing a victim, and similar tactics usually does the work. //

https://blogs.psychcentral.com/psych...ng-upbringing/

Jul 16, 2017, 09:48 AM

Quote:

Originally Posted by QuietMind

// controlling parents keep controlling their children way into adulthood. They can’t rely on physical methods to control them anymore, but years of controlling and manipulative behavior already took its toll on the person, so usually pushing the person’s psychoemotional buttons is enough to make them comply. Guilt-tripping, shaming, silent treatment, gaslighting, playing a victim, and similar tactics usually does the work. //

https://blogs.psychcentral.com/psych...ng-upbringing/

thanks for this QM. this really rings true for me "People who were raised in a controlling manner often develop people pleasing tendencies because they were groomed to see themselves as being below others and to put others first. They literally learned that their main function was to serve."

Jul 16, 2017, 10:00 AM

Quote:

Originally Posted by artemis-within

thanks for this QM. this really rings true for me "People who were raised in a controlling manner often develop people pleasing tendencies because they were groomed to see themselves as being below others and to put others first. They literally learned that their main function was to serve."

Same for me!

precaryous · Jul 18, 2017, 07:45 AM

Study suggests depression linked to abnormal brain wiring

https://psychcentral.com/news/2017/0...ng/123390.html

Jul 21, 2017, 04:49 AM

Not sure what I think of this article written for therapists

http://www.continuingedcourses.net/a.../course084.php

Jul 21, 2017, 01:36 PM

I found this part useful in helping me to try and understand what's happening between me and my t.

What might a therapist contribute to perverse transference love? Nothing, we hope. But let us not forget that enactment requires the cooperation of the two persons in the therapeutic setting. As therapists begin to feel the burden of their therapeutic work – especially if they do not lead a balanced, wholesome life – their anger and aggressive urges can taint their maternal erotic countertransference love. It can even disappear in the face of growing dislike or actual hate of a client (Schaeffer, 2007).

Jul 27, 2017, 02:51 AM

https://counsellinginnorthumberland....and-red-flags/

Jul 27, 2017, 07:13 PM

The Darker Side of Therapy - Ten Ways to Deal with Dependency

feileacan · Aug 06, 2017, 02:13 PM

This is actually a book:
Into the Darkest Places: Early Relational Trauma and Borderline States of Mind by Marcus West - https://www.amazon.com/Into-Darkest-.../dp/178220122X

It has been by far the best trauma book I've read recently that has helped to make a lot of sense in what happens with me in my therapy. I actually found out about this book because my analyst obtained it to his library (I suspect largely because of me). This book has also given me hope that the task I'm tackling in therapy (I grew up with no emotional connection with anyone, with knowing nothing about love and care, by believing that I'm completely alone in the world) is not totally impossible and it is possible to make sense of my trauma.

precaryous · Aug 09, 2017, 09:09 PM

Hmm
Childhood Trauma- Your Gut Remembers...

https://www.hyperbiotics.com/blogs/r...-gut-remembers

awkwardlyyours · Aug 12, 2017, 07:01 PM

Quote:

Originally Posted by feileacan

This is actually a book:
Into the Darkest Places: Early Relational Trauma and Borderline States of Mind by Marcus West - https://www.amazon.com/Into-Darkest-.../dp/178220122X

Thank you so much for posting about this book -- I'm a little more than halfway through it and having a real shock of recognition.

Aug 27, 2017, 02:09 AM

Working with Clients' Dissociation
Some good points in this video: Dissociation = client feels a threat internally or externally. Therapist should acknowledge it, process and unpack the need to dissociate with client. Dissociative ability will never be taken away. Dissociation is usually learned very young, because a child could not physically escape a traumatising situation.

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