Resurrection After Rape Community Group
Discussion, question-and-answer, general social support, and journal processing for progress-oriented rape survivors. No crisis, no damaging or triggering conflicts--this is for individuals who want to contribute to collective, cooperative action toward the goal of making actual PROGRESS through rape trauma. Much of this work is based on the book "Resurrection After...
Next week will be the fourth and final training in Oklahoma through the OCADVSA state coalition. These have been wonderful events, even if they leave me exhausted (thus my rarer postings on DS). Frankly, these have been the first intensive training programs *ever* for Oklahoma therapists in treating rape trauma; until this month there were only 90-minute breakout sessions at annual conferences and such. So the opportunity to meet and personally training hundreds of mental health professionals from across the state has been amazing! I'd like to journal more of the details later, but a few things have come out of the trainings so far that might make for interesting discussions. Here are the topics and questions that seem to have the most interest for therapists, and wondered if they also have interest here:
*Is there a way to manage reactions to triggers, when the person isn't precisely aware of what the actual trigger even was in the first place?
*Are the techniques for recovery different with male survivors than female?
*Borderline personality disorder and complex PTSD - what's the current state of scholarship?
*Do early-life family/parenting dynamics have an effect on recovery in adulthood?
*When someone has done so much therapy that they know this stuff backwards and forward but still have pain about their trauma, what can they do?
*How can an idealistic student or new therapist become trained in rape trauma treatment skills? Currently there is NO mentorship program here, and NO specialists offering courses or individualized apprenticeship supervision specific to sexual trauma treatment. As a result, someone who is without a supervisor SPECIFIC to this topic is, well, out of luck as far as opportunities to learn these skills in depth. So how does the methodology get passed on? (I had a LOT of question s about this. There were even doctors of psychology who attended, even though they did not get credit, simply because they had never had an opportunity for in-depth personal training on treatment of rape trauma! If our PhD's are desperate for it, that should indicate that the field has a serious lack of mentorship/supervision opportunities)
*How do I know if my sexual behavior is just the result of "unusual" personal preference, or a reflection of trauma-based behavior?
*What is the difference between group and individual treatment for rape trauma?
*When should a therapist be strictly clinical and academic, and when should s/he instead be more personally empathetic, and even emotional, in counter-transference during therapy?
*How should a therapist handle times when s/he has made a blunder with a client, and wants to manage the issues but doesn't want to ruin their credibility as a competent professional with the client?
*How does a therapist respond to the client who is suspicious of the therapist's motives for being in this work? (example: "Are you doing this just for vicarious intrigue into our life pain?")
*How do patients perceive the rare moments when their painful life narratives bring up evident and tender emotions in the therapist? When a therapist displays truly empathetic emotion toward the client, how does it feel to the client?
These are the things that the attendees at these conferences are bringing up over and over. Sometimes I get the best questions in private during the breaks, especially when it is apparent that the questioner--in addition to being a mental health professional--is also a survivor, and is asking for personal reasons.
*Is there a way to manage reactions to triggers, when the person isn't precisely aware of what the actual trigger even was in the first place?
*Are the techniques for recovery different with male survivors than female?
*Borderline personality disorder and complex PTSD - what's the current state of scholarship?
*Do early-life family/parenting dynamics have an effect on recovery in adulthood?
*When someone has done so much therapy that they know this stuff backwards and forward but still have pain about their trauma, what can they do?
*How can an idealistic student or new therapist become trained in rape trauma treatment skills? Currently there is NO mentorship program here, and NO specialists offering courses or individualized apprenticeship supervision specific to sexual trauma treatment. As a result, someone who is without a supervisor SPECIFIC to this topic is, well, out of luck as far as opportunities to learn these skills in depth. So how does the methodology get passed on? (I had a LOT of question s about this. There were even doctors of psychology who attended, even though they did not get credit, simply because they had never had an opportunity for in-depth personal training on treatment of rape trauma! If our PhD's are desperate for it, that should indicate that the field has a serious lack of mentorship/supervision opportunities)
*How do I know if my sexual behavior is just the result of "unusual" personal preference, or a reflection of trauma-based behavior?
*What is the difference between group and individual treatment for rape trauma?
*When should a therapist be strictly clinical and academic, and when should s/he instead be more personally empathetic, and even emotional, in counter-transference during therapy?
*How should a therapist handle times when s/he has made a blunder with a client, and wants to manage the issues but doesn't want to ruin their credibility as a competent professional with the client?
*How does a therapist respond to the client who is suspicious of the therapist's motives for being in this work? (example: "Are you doing this just for vicarious intrigue into our life pain?")
*How do patients perceive the rare moments when their painful life narratives bring up evident and tender emotions in the therapist? When a therapist displays truly empathetic emotion toward the client, how does it feel to the client?
These are the things that the attendees at these conferences are bringing up over and over. Sometimes I get the best questions in private during the breaks, especially when it is apparent that the questioner--in addition to being a mental health professional--is also a survivor, and is asking for personal reasons.
I don't know enough about BPD to say anything of any consequence or validity. I live PTSD. To me, PTSD seems like reflexes in overdrive. Silly statement when it is so much more than a reflex-type thing, but, that is how it seemed to first affect me. It may be classified, for want of a better place TO classify it, as a personality disorder, but, it has it's roots in the trauma. Without trauma, I do not believe PTSD could exist in us.
I don't believe trauma is necessarily the precipitating factor for BPD (but I am not sure). Surely a person with BPD can or may have trauma in their background, which could possibly even mask the caregiver's ability to properly diagnose them...but, that is just me supposing. In BPD, I know there are specific traits attached to the person's personality, that affect their appropriateness in deciphering the actions of others, not necessarily with 'cause', so to speak. Matt is so good with this kind of thing, surely he will have the answer he gave the clinicians at his teachings, and maybe that will clear up the questions you have Mayday. No matter what...BPD vs PTSD, don't beat yourself up with the words or descriptions of a 'label'.
None of us is a 'disease'. None of us is 'sick'. None of us is 'broken'. Each of us is hurt, and hurts can be helped with proper care. I have symptoms of PTSD...I choose to treat those symptoms. I do not choose to qualify the disorder by claiming it as a tangible thing that has a list of symptoms I may or may not encounter. I don't look too deeply at that 'list'...I follow my heart, and when a thing troubles me, I get help with that thing. My therapist may call it PTSD, or even severe PTSD. I call it a consequence to overcome, and I work toward that end. HUGS mayday!
Oh, and the 'cause and effect' comment. BPD, nor any personality traits we may have or exhibit - none of them can be the cause of our rapes. Rapist's cause rape, not victims of rape. So, no matter how many traits of BPD you think you may have had, not a single one of them caused you to be raped - not one!
I had posted a rather lengthy (laugh here...like, Leitha? Lengthy? Surely not!) comment to your post, then I retracted it, because I simply don't have expertise with BPD, and my PTSD experience is, well, lived out, not based on in-depth studies. In other words, I'm no expert, and have no real right to my words here, except as opinion. So, I took it all back. One thing I don't want to take back is this:
mayday, you mention 'cause and effect', and I will speak to that. BPD, PTSD....no matter what alphabet you link it to, nothing in your "behavior" caused you, or I , to be raped. The rapist caused that. There is nothing you did, not one single thing, that caused your rape.
Matt is usually away from DS on weekends with his family, and he has been away because of his training sessions. I am sure when he gets back, he'll see this post and respond...and he will clear this issue with BPD/PTSD up, as that is a thing he is great at. Don't get hung up on it though. Deal with whatever symptoms you have, regardless of the alphabets....take care of you. That's all any of us really needs to do anyway, right? HUGS mayday.
Oh, and I apologize for posting so very many words to this discussion. But, I want you to know how much it has helped me to do it. I have been consumed with the season, the impending anniversary, my fears, but while I was writing to this discussion, none of that mattered. I was lost in this post, and.....oh my gosh, it was Heavensent. I hope you all can forgive the abundance of my words. :0)
take care,
L
I know what you mean though. I actually argued a point with my therapist about self-blame vs legitimate responsibility....still not sure who is winning, as it is an on-going argument. You see, I know what I knew back then. I know that I knew nothing of what happened to me during the rape, BUT, once I understood it, well, choices after that point become whose responsibility??? So, I get it that you want to gather some blame and legitimize it. I mean, that makes more sense than a world out of control with sexualized lunatics taking what they want, right?
Searching through texts for lists of symptoms...finding ones that fit (or seem to fit) you, and deciding upon a diagnosis IS NOT the way to do this. You are compounding the problem to take on BPD as a diagnosis. I don't mean it can't be BPD, I just mean, this isn't the way to decide that it is. Again, that qualified, certified, licensed professionals are asking these questions screams loudly that the answers aren't that simple.
Risky behaviors are indicative of many behaviors outside of BPD. The numerous, unprotected, painful sexual encounters I engaged in as a very young teen could certainly be considered 'risky'....but, I didn't recognize it as such. To me, it was a thing I had learned, and I was acting it out, again and again, never once thinking of any risk. I was on a mission, or so I thought.
This 'cause and effect' thing we talked about - that is what Dr. Chandler and I discuss, rather frequently. I have issues letting go of the self-blame. Maybe us talking about it is helping me see the reality of it. I had a sucky childhood. I had no one to trust with my rape account. And, one critical choice I made which allowed me to be an easy target for my rapists was borne out of a fearful homelife, and loneliness....but fearfullness, nor loneliness raped me - two men and a woman DID, and it was THEIR choice to do so. Your behavior that you find fault in is NOT the cause of your rape. It CANNOT be the cause, because a rapist IS the cause...and, in that stream of thought, the effect of HIS actions is what you now struggle with, and we call that PTSD. Are you borderline? I don't know. Do you meet the criteria for PTSD? Probably. Do either of those diagnoses have a hill of beans effect on your being raped - ABSOLUTELY AND EMPHATICALLY NO!
That your curiosity is aroused by this discussion is a good thing, because you need to keep searching until you find blame...for your rapist! I know the naturalness of wanting to understand how this could happen, and following that back to your choices...but, no matter what you are using as a tool to determine this blame as your's - it isn't. It just is not. Dig at it until you can realize that. The blame belongs to the rapist. Period.
I've been REALLY busy these days, so please don't mistake my fewer-than-usual posts here as any sort of detachment. I'll try to keep up, and I really appreciate all your work together.
To start with one of these topics...I've found that when I've made mistakes with clients, it can actually be a very therapeutic and positive time in our relationship (yes, "Relationship" is the right term for the therapist-client connection) if we are able to talk honestly about it. We therapists are human and fallible, and trying to impose any standard that seeks perfection from us is just misguided. What we need to watch for are the differences between mistakes that come from being human, versus deliberate acts of spite, exploitation, or harm. And there's not a fine line between these; they are very distinct from each other.
But when I've made mistakes, my willingness to acknowledge and apologize can become a truly powerful moment in our relationship. I find that there are therapists who, unfortunately, resist doing this because they feel they must appear to be authoritative to clients, or to warp any error into an "I meant to do that" event.
But here's the hard part: sometimes we therapists don't see our own mistakes at first. We rely on our clients to be honest with us, too. Suppose a client feels we have erred with her, but neglects to confront us. Sadly, we both lose a chance to really heal our relationship. Many therapists have experienced this: things seem fine, no hint of discord, and then suddenly they are faced with an enraged (or vanished) client--with no opportunity to ever honestly confront the matter, or chart a new course in important work! Which is a shame, because nearly all of my clients can tell you of times I have erred, and they have felt frustrated by it, but our mutual willingness to confront these events and work through them together have been SO vital to positive outcomes. Any therapist who is presumed to be above reproach is doomed.
The unknown triggers issue: Frankly, I had to admit a lack of insight on this one. I was asked this in a workshop this week, and I wish I had had better information. I think that over time we can begin to see patterns in triggers and slowly come to discern what they are, and I think that doing the stuck point work after writing one's story is a HUGE step toward locating and processing triggers. Because of new scientific knowledge about why triggers happen (*see Amygdala info in RAR), I don't believe there are random triggers; I believe that something specific is causing them, even if we don't know exactly what they are yet. And sometimes we are tempted to look only at sensory information for triggers (what we heard or felt), and we forget that many other factors can trigger (times of year, scent, etc.)
The BPD issue is so complex that it should probably have its own thread. But I have found that a lot of PTSD from sexual trauma is misdiagnosed as BPD, because the symptoms seem so similar (self-injury, dissociation, labile mood, suicide attempts, risk-taking behaviors). I have also seen it happen the other way around (and even made this mistake as well): missing a real diagnosis of BPD because the PTSD symptoms were more prominent and seemed to improve much more easily during treatment. Now, I don't make a diagnosis of clients, but there have been times that I was informed of a clients' diagnosis ("this is a BPD patient") and had doubts about it, believing (wrongly) that such diagnosis was an erroneous one, when it was actually spot-on. Fortunately, I use a treatment method (Dialectical Behavior Therapy) in such cases that works REALLY well with PTSD from rape trauma, and it also the predominant method for working with BPD, so the method still works even if I miss--or mistakenly de-emphasize--the BPD itself. So the clinical outcomes remain very positive. But more on BPD and trauma later; it's too complex an issue for a few posts.
Given the 80% overlap between BPD and trauma (especially recurring early-life sexual trauma), there seems to be something that truly connects BPD and suppressed grief, but I'm not comfortable with the common misguided notion that survivors of such early-life sexual trauma are going to become BPD. Good research also shows that there are three essential components to "build" BPD: 1) genetics (yes, we can even identify which gene seems to carry these traits!); 2) family dynamics (this notion comes from psychoanalytic and object-relations theories of BPD); and 3) early sexual trauma. Current literature suggests that each of these ingredients must mesh to produce the BPD, and I like that criteria because it helps filter out the prejudiced misuse of the diagnosis for punitive labeling of difficult and complex treatment cases.
I have started typing so many posts lately and frankly, I just can't finish them. My mind just stops and I cancel them out. It has been very frustrating.
But, why now? Why do I just now realize that this funk I have been in is because of a horrible event in my life? Why did I just connect the dots?
BTW, is it just me or is April-May a trigger time fore a large cluster of people? So many DS people, and so many former clients, have all remarked that these two months are particularly prominent as trauma dates. There should be a study of this!
And when I begin to work ,with my clients on journaling their rape stories, they want to know why I encourage them to include all details--sight, sound, touch, taste, smell, memory--in their accounts. While they know that there is a ration ale for this, they still want to be reassured that these instructions are truly for their own well-being, and not for some type of psychological voyeurism on my part. One client even asked, with total sincerity, whether there was any reason to be concerned that I "get off" on hearing these stories (after all, I've worked with over 500 rape victims, so something must be keeping me invested--is it the right reason?). Needless to say, there is something powerful that happens during the process itself when they share their stories and then SEE my reactions that completely eradicates those fears. I can't describe it; you have to see it, but it's the heartfelt look of respect and emotion she sees. It's not something that can be faked or acted out; either a therapist feels this work or s/he doesn't.
This leads to the next topic: how do clients feel when they see the therapist emotionally moved by this work? In my experience, clients actually feel profoundly respected and valued. The truth is, I have pretty strong filters when it comes to these issues: I have heard 500+ detailed narratives of rape, but I don't have dreams about them, or go home and continue mentally working on them, or turn clients into crusades. But once in a while, something does slip through the filter and does bring up softer emotions for me. And sometimes, clients can see this. They will tell their stories in group, for example, and see those emotions manifest in me.
This brought up a few concerns for myself at first. I wanted to know whether it would embarrass my clients, or cause them to feel they had wounded me with their stories. And I wanted to be sure I wasn't feeling this way because something was wrong with my candidacy to do this work. So I did what therapists are supposed to: I checked my blind spots and let others become my second set of eyes and ears.
I asked my clients (much later) how they had felt to see my own emotions after hearing their stories--were they embarrassed? Did they fear I was in over my head, or beyond the limit of my professional competence? In years and years of this work, not one has ever uttered any such critique. On the contrary, they have all given me very positive feedback: "It made me feel respected" and "I felt like you truly care, and this isn't just a paycheck for you" and "it was the first time I felt someone else grieve with me for my loss, and it made me feel human again."
There are times that it is important to be firm and authoritative in this work, but there are also times when it is necessary to be a human being in connection to other humans. Remaining in an aloof, stoic clinically-detached posture would have been VERY wrong in those moments. Rape has, as one of its unique wounds, the power to cause the victim to feel uniquely destroyed and separated from any connection to all other life. Rape victims have a dual fear that everyone knows they are spoiled, and that nobody knows them at all. So part of rape recovery work is beyond worksheets and sessions and "how do you feel about that?" therapy; it requires the essential, deep, and re-humanizing sense of connectedness between the client and therapist. This is what transference and counter-transference are MEANT to accomplish, and sadly I see many therapists miss this potent moment of possible healing because they fear the display of their own emotions, lest the client become anxious by them, when the reverse it true: the client finally feels her anxiety about loneliness begin to fade.
I once asked a former client why she felt her work was successful, hoping for critique and insight into what I'd done right and what to do differently. She looked me in the eye and said very bluntly, "I never doubted that you love us. I mean that in the right way: without being forward or pushy with it, it is just clear to me that you really cared about me, and I never had to doubt it. I knew that you felt invested in the work, and in me, and that it would keep you from abandoning me or rejecting me even when I made mistakes." This, incidentally, was one of the clients who had resisted, debated, and stubbornly refused so many of my efforts along the way, until she had realized that my work with her wasn't about finishing a case and getting paid, but about participating in a very reverent work together.
And when I begin to work with my clients on journaling their rape stories, they want to know why I encourage them to include all details--sight, sound, touch, taste, smell, memory--in their accounts. While they know that there is a rationale for this, they still want to be reassured that these instructions are truly for their own well-being, and not for some type of psychological voyeurism on my part. One client even asked, with total sincerity, whether there was any reason to be concerned that I "get off" on hearing these stories (after all, I've worked with over 500 rape victims, so something must be keeping me invested--is it the right reason?). Needless to say, there is something powerful that happens during the process itself when they share their stories and then SEE my reactions that completely eradicates those fears. I can't describe it; you have to see it, but it's the heartfelt look of respect and emotion she sees. It's not something that can be faked or acted out; either a therapist feels this work or s/he doesn't. Frankly, we have too few therapists who can and will do this, and shouldn't squander the ones who can.
This leads to the next topic: how do clients feel when they see the therapist emotionally moved by this work? In my experience, clients actually feel profoundly respected and valued. The truth is, I have pretty strong filters when it comes to these issues: I have heard 500+ detailed narratives of rape, but I don't have dreams about them, or go home and continue mentally working on them, or turn clients into crusades. But once in a while, something does slip through the filter and does bring up softer emotions for me. And sometimes, clients can see this. They will tell their stories in group, for example, and see those emotions manifest in me.
This brought up a few concerns for myself at first. I wanted to know whether it would embarrass my clients, or cause them to feel they had wounded me with their stories. And I wanted to be sure I wasn't feeling this way because something was wrong with my candidacy to do this work. So I did what therapists are supposed to: I checked my blind spots and let others become my second set of eyes and ears.
I asked colleagues of min e what they thought about this: "Most of my clients' stories are filtered for me, but sometimes one gets through to my heart and brings up emotions for me (counter-transference). Does that mean I'm wrong for this work?" The answer I got every time: "No, it means you're RIGHT for this work." If such things happened with every narrative, it would mean there is something going on that I need to attend to and change, but the fact that my heart is not stone to my clients is essential.
I asked my clients (much later) how they had felt to see my own emotions after hearing their stories--were they embarrassed? Did they fear I was in over my head, or beyond the limit of my professional competence? In years and years of this work, not one has ever uttered any such critique. On the contrary, they have all given me very positive feedback: "It made me feel respected" and "I felt like you truly care, and this isn't just a paycheck for you" and "it was the first time I felt someone else grieve with me for my loss, and it made me feel human again."
There are times that it is important to be firm and authoritative in this work, but there are also times when it is necessary to be a human being in connection to other humans. Remaining in an aloof, stoic clinically-detached posture would have been VERY wrong in those moments. Rape has, as one of its unique wounds, the power to cause the victim to feel uniquely destroyed and separated from any connection to all other life. Rape victims have a dual fear that everyone knows they are spoiled, and that nobody knows them at all. So part of rape recovery work is beyond worksheets and sessions and "how do you feel about that?" therapy; it requires the essential, deep, and re-humanizing sense of connectedness between the client and therapist. This is what transference and counter-transference are MEANT to accomplish, and sadly I see many therapists miss this potent moment of possible healing because they fear the display of their own emotions, lest the client become anxious by them, when the reverse it true: the client finally feels her anxiety about loneliness begin to fade.
I once asked a former client why she felt her work was successful, hoping for critique and insight into what I'd done right and what to do differently. She looked me in the eye and said very bluntly, "I never doubted that you love us. I mean that in the right way: without being forward or pushy with it, it is just clear to me that you really cared about me, and I never had to doubt it. I knew that you felt invested in the work, and in me, and that it would keep you from abandoning me or rejecting me even when I made mistakes." This, incidentally, was one of the clients who had resisted, debated, and stubbornly refused so many of my efforts along the way, until she had realized that my work with her wasn't about finishing a case and getting paid, but about participating in a very reverent work together.
Yes, I believe many therapists are afraid to take that leap for fear of losing "control" of the client/therapist relationship. It is sad.
Of course, a good subsequent question would be, "WHY did they choose to make this their job, if they don't care?" I mean, nobody becomes a social worker for the money, right?
Suppose one were to ask a social worker, "Are you sure it's okay to love your patients? And why do you, anyway?"
My answer would be, "I love them because they are worthy of love. And instead of asking me why I do, why aren't you asking a thousand other social workers why they DON'T? Why did we get into this work in the first place, if it's not to see the good in the people we serve?" I think the hang-up is that people warp the word "love" and feel uncomfortable with it in a clinical setting. And truthfully, I'm not casual about using the term; in fact, I rarely ever do precisely because people can misunderstand it (or alternately, they can understand my pure intent just fine, but distort my use of the word as a way to injure me professionally if they become angry with the relationship later). When it comes to this work, what I mean to express is a reverent sense of respect and recognition of the other person's immense worth, and my desire to help sustain that worthiness. It has nothing to do with attraction, violating boundaries, or inappropriate regard for the person I am serving.
I agree with thrtherain that many therapists have anxiety about losing "control" over things. Frankly, I've found the best relationships happen when I'm not trying to be "in control" (in a paternal way), but instead working with my clients as a partner. We call it "clinician-client collaboration" in academic language. Very, very rarely do I have to take on an authoritative demeanor in sessions, and it's only been when someone is causing harm to another in group through insensitive treatment.