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Object Relations in Severe Trauma: Psychotherapy of the Sexually Abused Child
Building upon the theoretical work of Ferenczi, Fairbairn, and Berliner, the author describes four basic relational patterns in the lives of abused the reliving of abusive relationships, either as victim or as perpetrator; identification with the aggressor; masochistic self-blame; and the seeking of object contact though sex or violence. The interweaving of these patterns creates what Dr. Prior calls "relational dilemmas." According to him, these four basic relational patterns are held in place by the child's profound fear of falling into primitive states of unrelatedness and consequent annihilation anxiety. For example, the abused child believes that victimization by or identification with the bad object, no matter how horrible that may be, is preferable to the psychic disintegration that complete nonrelatedness creates. Dilemmas of this nature tear apart the child's psyche, leading to unstable and tormented models of self, other, and relationship.
Object Relations in Severe Trauma provides sensitive understanding of childhood traumatization and a conceptual and technical framework for the treatment of patients―both children and adults―who have suffered from it.
Object Relations in Severe Trauma provides sensitive understanding of childhood traumatization and a conceptual and technical framework for the treatment of patients―both children and adults―who have suffered from it.
- GenresPsychologyNonfiction
204 pages, Hardcover
First published January 1, 1996
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August 17, 2009
Clinical psychologist Stephen Prior specializes in treating boys who have been severely traumatized by sexual abuse. In this book he theorizes about the psychological impact of such abuse, and recommends a mode of treatment for these very difficult, untrusting patients. He uses case studies to illustrate his experience and ideas.
This book outlines an object relational theory of the consequences of the sexual traumatization of children. It is based on the intensive psychotherapeutic treatment of seriously disturbed boys who had suffered multiple forms of neglect and abuse. To understand the suffering of these children and to create forms of treatment suited to them, I found that I had to develop a theory as I went along, for there were no existing conceptualizations that explained the distress of these children or their treatment. Using object relations theory, I have attempted to characterize the ways in which neglect and abuse distort fundamental needs and the psychic structures in the child.
Dr. Prior identifies four factors that “constitute the basic psychological dynamics of these children.”
*Re-enactment—the “relentless reliving of abusive relationships, either as victim or as perpetrator.” This is Freud’s “repetition compulsion,” in which people who have been traumatized “act out” (relive under different circumstances) the trauma over and over again, taking either their original position as victim, or switching to the aggressor (abuser) position which they have learned equally well. Prior: “These patterns of victim-victimizer often become painfully transparent in the child’s play, in which there is constant alternation between perpetrator and victim roles.”
*Identification with the Aggressor—identifying with (trying to become like) the abuser as a “basic mode of psychological defense” [against annihilation-anxiety:]. This comes under the heading, “If you can’t beat them, join them.” The abuse is so painful psychologically that it is better to identify with and imitate the aggressor than continue to remain a passive victim. However, “when the child identifies with the aggressor, he must take on himself every anger and judgment he feels toward the abuser.” “The abused person fears being abused again but also fears becoming an abuser. He fears that he will become like the abuser and traumatize others.”
*Self-blame—the “unshakable conviction of being the cause of the abuse, deserving the abuse, and being utterly bad.” “Many abused children develop a spontaneous conviction that they literally contain a ‘bad self’ that can take possession of them and must therefore be driven out and destroyed.” If the child did not blame himself, he would have to blame the abusing parent. This is intolerable because the parent often represents the child’s sole human contact, and to blame the parent might drive him/her away and leave the child alone and unprotected in a hostile world—which threatens him with “annihilation anxiety.”
*Relating through Sex and/or Violence—feeling that such a “bad” child as himself does not deserve love, he relates to others the way he has been related to by the abuser—through sex and/or violence. This is the only form of human contact he knows: accounts of loving relationships are just fairy tales. Prior: “Most abusers in fact offer the child violence or violent sexuality in place of love. They do not give the child sexual love at all but sexual hate.” “The masochistic attitude is the bid for affection of a hating love object.” “The central motive is the finding of human connectedness on the only terms offered.”
The relational dynamics that hold sway over the abused child are reflected in deeply held beliefs [evolved by the child:] in order to comprehend the suffering and distorted relationships he has had to endure. To cope with the vulnerability and terror of his situation, the abused child typically comes to believe that he caused the abuse and deserves it as well. Male children in particular also defend against powerlessness and vulnerability through identification with the aggressor. This defense provides only the most temporary of respites, for it carries in its wake the dread of doing to others what was done to oneself and immense guilt for any impulse or act in the aggressor role. The horror of these dilemmas is compounded by the child’s conviction that the only way to have love is through abuse…the wish for contact is experienced as the wish for a violent or sexual relationship that would be retraumatizing. The child then starves in the midst of poisonous objects: longing to internalize, but afraid that he will internalize something toxic. The search for relatedness in ways that repeat the abusive relationship, painful as it is for the child, serves to protect the child from falling into archaic anxieties. Sadomasochistic relationships serve to prevent regression to an object-less state of total isolation and exposure to the most primitive and disorganizing fears.
What are “the most primitive and disorganizing fears? Prior quotes D.W. Winnicott:
“…it is necessary…to think of the baby as a person who…is all the time on the brink of unthinkable anxiety.”
And the forms of this “unthinkable anxiety? Fear of literally going to pieces, fear of falling forever, fear of having no relationship with the body, and fear of having no orientation in the world.
Prior states his own contribution to the theoretical work on children traumatized by sexual abuse:
If there is anything new in what I have said, it is that identification with the aggressor and the repetition of abusive relationships are held so strongly because these form a defense against a more or less complete disorganization of the psyche. The child feels in the depths of himself that possession by the bad self, no matter how horrible this is, is preferable to a state of complete psychic disintegration.
My fundamental suggestion, then, is that we understand severely traumatized children as having internalized object relations that are intolerable, inconsistent, unstable, and unlivable.
Following Winnicott, Prior insists that the primary focus in treating abused children should be to create a safe environment in which, without losing the love of the therapist, the child can express his rage over what has happened to him—which allows him to integrate the hitherto split-off (“bad child”) rage into his core personality. It also allows him to start identifying with the “good” (loving, nurturing) therapist rather than with the abusive parent—a process reminiscent of what Transactional Analysis calls “reparenting.”
Successful treatment requires integrating of the Bad Self and the experiences, impulses and relational patterns encoded in this identity, no matter how difficult this may be.
Damon could integrate the “bad,” split-off parts of himself (the destructive oral aggressiveness of Count Dracula) only when he saw that I could accept this “bad” self.
Therapy for such children requires that the negative introjects be metabolized, not expelled or destroyed as the child may wish. The therapeutic process of metabolization requires that the therapist actively enter into this negative domain and eventually interpret the child’s transferential fears and longings…. Greater integration of the spilt-off bad self overcomes a basic and rigid form of splitting, and it thus allows for the tolerance of depression and the possibility of internalization of good objects.
The agonizing choice the child faces, between identification with the aggressor and annihilation anxiety, requires treatment in which containment allows for the regression he must make to primitive anxieties. When this occurs, the child can come to a new stance toward himself and others and can internalize something good from the therapist. When the child can find a safe place and a place of nurturance with another person and inside himself, a significant change has been brought about. Reasonable hope for the child’s future is then a possibility.
Prior makes a final comment on contemporary society:
It is one of the more painful ironies of contemporary therapeutic practice that at the very time we are learning so much about the healing power of relationship, our institutions and ideologies so often prevent these relationships from occurring.
Though Prior is no stylist, this short book is a good read for those who are particularly interested in trauma and/or sexual abuse, and also for those generally fascinated with the far (and sometimes all too close) reaches of human nature. As Prior says, “We are all disturbed.”
This book outlines an object relational theory of the consequences of the sexual traumatization of children. It is based on the intensive psychotherapeutic treatment of seriously disturbed boys who had suffered multiple forms of neglect and abuse. To understand the suffering of these children and to create forms of treatment suited to them, I found that I had to develop a theory as I went along, for there were no existing conceptualizations that explained the distress of these children or their treatment. Using object relations theory, I have attempted to characterize the ways in which neglect and abuse distort fundamental needs and the psychic structures in the child.
Dr. Prior identifies four factors that “constitute the basic psychological dynamics of these children.”
*Re-enactment—the “relentless reliving of abusive relationships, either as victim or as perpetrator.” This is Freud’s “repetition compulsion,” in which people who have been traumatized “act out” (relive under different circumstances) the trauma over and over again, taking either their original position as victim, or switching to the aggressor (abuser) position which they have learned equally well. Prior: “These patterns of victim-victimizer often become painfully transparent in the child’s play, in which there is constant alternation between perpetrator and victim roles.”
*Identification with the Aggressor—identifying with (trying to become like) the abuser as a “basic mode of psychological defense” [against annihilation-anxiety:]. This comes under the heading, “If you can’t beat them, join them.” The abuse is so painful psychologically that it is better to identify with and imitate the aggressor than continue to remain a passive victim. However, “when the child identifies with the aggressor, he must take on himself every anger and judgment he feels toward the abuser.” “The abused person fears being abused again but also fears becoming an abuser. He fears that he will become like the abuser and traumatize others.”
*Self-blame—the “unshakable conviction of being the cause of the abuse, deserving the abuse, and being utterly bad.” “Many abused children develop a spontaneous conviction that they literally contain a ‘bad self’ that can take possession of them and must therefore be driven out and destroyed.” If the child did not blame himself, he would have to blame the abusing parent. This is intolerable because the parent often represents the child’s sole human contact, and to blame the parent might drive him/her away and leave the child alone and unprotected in a hostile world—which threatens him with “annihilation anxiety.”
*Relating through Sex and/or Violence—feeling that such a “bad” child as himself does not deserve love, he relates to others the way he has been related to by the abuser—through sex and/or violence. This is the only form of human contact he knows: accounts of loving relationships are just fairy tales. Prior: “Most abusers in fact offer the child violence or violent sexuality in place of love. They do not give the child sexual love at all but sexual hate.” “The masochistic attitude is the bid for affection of a hating love object.” “The central motive is the finding of human connectedness on the only terms offered.”
The relational dynamics that hold sway over the abused child are reflected in deeply held beliefs [evolved by the child:] in order to comprehend the suffering and distorted relationships he has had to endure. To cope with the vulnerability and terror of his situation, the abused child typically comes to believe that he caused the abuse and deserves it as well. Male children in particular also defend against powerlessness and vulnerability through identification with the aggressor. This defense provides only the most temporary of respites, for it carries in its wake the dread of doing to others what was done to oneself and immense guilt for any impulse or act in the aggressor role. The horror of these dilemmas is compounded by the child’s conviction that the only way to have love is through abuse…the wish for contact is experienced as the wish for a violent or sexual relationship that would be retraumatizing. The child then starves in the midst of poisonous objects: longing to internalize, but afraid that he will internalize something toxic. The search for relatedness in ways that repeat the abusive relationship, painful as it is for the child, serves to protect the child from falling into archaic anxieties. Sadomasochistic relationships serve to prevent regression to an object-less state of total isolation and exposure to the most primitive and disorganizing fears.
What are “the most primitive and disorganizing fears? Prior quotes D.W. Winnicott:
“…it is necessary…to think of the baby as a person who…is all the time on the brink of unthinkable anxiety.”
And the forms of this “unthinkable anxiety? Fear of literally going to pieces, fear of falling forever, fear of having no relationship with the body, and fear of having no orientation in the world.
Prior states his own contribution to the theoretical work on children traumatized by sexual abuse:
If there is anything new in what I have said, it is that identification with the aggressor and the repetition of abusive relationships are held so strongly because these form a defense against a more or less complete disorganization of the psyche. The child feels in the depths of himself that possession by the bad self, no matter how horrible this is, is preferable to a state of complete psychic disintegration.
My fundamental suggestion, then, is that we understand severely traumatized children as having internalized object relations that are intolerable, inconsistent, unstable, and unlivable.
Following Winnicott, Prior insists that the primary focus in treating abused children should be to create a safe environment in which, without losing the love of the therapist, the child can express his rage over what has happened to him—which allows him to integrate the hitherto split-off (“bad child”) rage into his core personality. It also allows him to start identifying with the “good” (loving, nurturing) therapist rather than with the abusive parent—a process reminiscent of what Transactional Analysis calls “reparenting.”
Successful treatment requires integrating of the Bad Self and the experiences, impulses and relational patterns encoded in this identity, no matter how difficult this may be.
Damon could integrate the “bad,” split-off parts of himself (the destructive oral aggressiveness of Count Dracula) only when he saw that I could accept this “bad” self.
Therapy for such children requires that the negative introjects be metabolized, not expelled or destroyed as the child may wish. The therapeutic process of metabolization requires that the therapist actively enter into this negative domain and eventually interpret the child’s transferential fears and longings…. Greater integration of the spilt-off bad self overcomes a basic and rigid form of splitting, and it thus allows for the tolerance of depression and the possibility of internalization of good objects.
The agonizing choice the child faces, between identification with the aggressor and annihilation anxiety, requires treatment in which containment allows for the regression he must make to primitive anxieties. When this occurs, the child can come to a new stance toward himself and others and can internalize something good from the therapist. When the child can find a safe place and a place of nurturance with another person and inside himself, a significant change has been brought about. Reasonable hope for the child’s future is then a possibility.
Prior makes a final comment on contemporary society:
It is one of the more painful ironies of contemporary therapeutic practice that at the very time we are learning so much about the healing power of relationship, our institutions and ideologies so often prevent these relationships from occurring.
Though Prior is no stylist, this short book is a good read for those who are particularly interested in trauma and/or sexual abuse, and also for those generally fascinated with the far (and sometimes all too close) reaches of human nature. As Prior says, “We are all disturbed.”
October 17, 2016
I was required to read this book for a psychology course. This book was challenging to read at certain times, but this was mostly due to personal reasons.
Mr. Prior is a wonderful, thoughtful, and passionate psychologist and this clearly comes through in his writing. This book was extremely insightful in regards to showing the readers the many complicated and destructive ways that severely traumatized children behave. Most importantly this book helps to show that children who experience such travesties in life CAN grow up to live a healthy, fulfilling, and productive life. This, however; can only be done with therapy, especially with specialist who understand the traumas of sexual and neglect abuse.
I highly recommend this book. I especially think that it should be required reading for anyone who has to work with children.
Mr. Prior is a wonderful, thoughtful, and passionate psychologist and this clearly comes through in his writing. This book was extremely insightful in regards to showing the readers the many complicated and destructive ways that severely traumatized children behave. Most importantly this book helps to show that children who experience such travesties in life CAN grow up to live a healthy, fulfilling, and productive life. This, however; can only be done with therapy, especially with specialist who understand the traumas of sexual and neglect abuse.
I highly recommend this book. I especially think that it should be required reading for anyone who has to work with children.
Displaying 1 - 2 of 2 reviews