Therapy for Adults Molested As Children: Beyond Survival, Second Edition

273 Pages·1996·5.42 MB·English

by  John Briere

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