There are multitudes of circumstances and conditions that could be deemed abusive. Vera Kong considers the potential taboos around abuse that can present challenges to the therapeutic journey…
Processing the potential taboos around abuse in therapy can be one of the most challenging yet transformative experiences for both therapists and clients. Reflecting on my early days of foundation course training in London, I recall a profound moment. Our main tutor discussed a study linking childhood sexual abuse with 'befriending' and 'people-pleasing' as survival strategies. A heavy silence filled the room, underscoring the discomfort and taboo surrounding this topic even among aspiring therapists.
Having transitioned from the NHS to private practice, I've often encountered similar silences and discomfort, not only among colleagues but also clients. Specialising in the therapeutic treatment of complex trauma, I frequently confront these taboos head-on. I was fortunate to have been trained by Dr Janina Fisher, who I recall saying in one of her seminars that "childhood abuse, among many things, can be regarded as the punishing of a child's distress," and that "neglect can manifest itself through the ignoring of distress."
Of course, there are multitudes of other circumstances and conditions that could be deemed abusive. So with this in mind, what are potential taboos around abuse that can present challenges to the therapeutic journey?
Common taboos in processing abuse experiences in therapy
1. Therapist's Self-Regulation: A critical aspect of addressing abuse in therapy is the therapist's ability to regulate themselves. Clients with highly adverse backgrounds often express concerns about being a burden or needing to take care of their therapist. A grounded and robust therapeutic presence is essential in creating a safe container for discussing difficult abuse experiences. Pat Ogden, in her work on sensorimotor psychotherapy, emphasises the importance of the therapist's embodied presence and ability to remain attuned and regulated.
2. ‘Victims’ and ‘Perpetrators’: Survivors of abuse often internalise blame and see themselves as perpetrators, while actual perpetrators may distort their narratives to appear as victims. This complex dynamic can create significant barriers to healing. Understanding these distorted beliefs and gently challenging them within the therapeutic relationship is crucial. Janina Fisher's approach to trauma treatment highlights the importance of acknowledging and integrating these fragmented parts of the self.
3. Overlooking Personal Pain: Some people may adopt strong, independence-oriented personas, feeling they can handle more than they should and often overlooking their own pain. This coping mechanism of ‘skipping hurt’ can lead to social withdrawal and a reluctance to seek help when abuse is a chronic everyday occurrence. Recognising and validating these experiences in therapy is vital for breaking through the taboo and fostering healing.
4. Minimizing the Impact of Abuse: Many survivors minimise the impact of their abuse, feeling that ‘others have suffered worse’. I hear the latter sentence so often in session, I have lost count. This tendency to downplay the abuse can hinder the healing process. Creating a space where clients feel their pain is acknowledged and validated is essential for effective therapy.
5. Societal Judgment and Estrangement: Many survivors fear societal judgment and potential estrangement from family members if they disclose their abuse. This fear can create significant barriers to seeking help and processing trauma. Addressing these concerns in therapy involves creating a safe, non-judgmental space where clients feel supported in navigating these complex dynamics.
6. Fear of Making it Worse: Clients often worry that discussing faint memories of abuse might make their situation worse. They fear that bringing up these memories could lead to increased distress or destabilisation. However, reclaiming these perspectives holistically, with the body in mind, can foster better mental health and choicefulness in adulthood. Integrating these fragmented memories helps clients gain a clearer understanding of their past and how it influences their present, promoting a sense of empowerment and resilience.
The Role of Sensorimotor Psychotherapy in Healing Trauma
Sensorimotor psychotherapy, developed by Pat Ogden, offers a holistic approach to processing abuse trauma by integrating body, mind, and spirit. This modality recognises that trauma is not just a psychological experience but also a physical one. The body often "keeps the score," holding onto trauma in ways that traditional talk therapy may not address. Through body-based interventions and mindfulness techniques, sensorimotor psychotherapy helps clients release stored trauma and develop new, healthier patterns of response.
Dr. Bessel van der Kolk, in his seminal work "The Body Keeps the Score," underscores the importance of addressing the physical manifestations of trauma. By incorporating practices that attend to the body, therapists can help clients achieve a more comprehensive and lasting recovery.
In my private practice, I have an 'open door' policy when it comes to taboos. "Bring it" is my motto because ultimately, breaking through shame and old, closeted narratives can lead to profound personal growth and a deeper sense of personal integration.
Written by Vera Kong, a sensorimotor psychotherapist, for The Practice Rooms