Working with Trauma:Early Deconfusion work

Posted on 25 August, 2013 at 14:09 Comments comments (201)
Thank-you to everyone who has commented and given me such positive feedback after my 1st blog.
Most of the comments have been around my work with The Women's Rape and Sexual Abuse Centre.
This comment in particular touched me:
"I enjoyed reading about your experiences so far. Working with women who have been traumatically abused in so many ways is such special and compassionate work."
I reflected on how we can quickly lose sight of the work we do as therapists when immersed in the day to day routine of trauma. This does discount for the therapist and woman the "special and compassionate work" created and contained within the therapeutic relationship.
I have found that working with women who have experienced such a physical and psychological assault on the self early in life have a fundamental drive to seek healing.
Of course many do contact the service but a mixture of waiting time for a first appointment and an ebbing away of motivation or a passing of immediacy means they are perhaps not as ready as they thought to start the work.
I have had a number of woman who felt ready but their expectations of healing being done to them or for them couldn't sustain the reality of how hard the work will be for them and dropped out. Their honesty about their lack of readiness or underestimation of what the work would entail is truly touching. With these clients letting them know that the door is always open for them to return and although they are not ready today, this may change in the days and weeks ahead and whenever they feel ready they can get back in touch.
I have found that the pace of the work is key in working with traumatised clients who decide the time is right to begin their work with me. Although they feel ready they have strong injunctions not to trust or be close to others, understandable given the level of abuse they have endured from those who they trusted and were close to. This requires significant sensitivity, which I underestimated initially, in the length of time it can take to build the therapeutic alliance before work can even start.
I began to pay more attention to the therapeutic alliance when I shared audiotapes of my work with my supervisor and peers. I struggled with trying to find examples of therapeutic work that demonstrated a shift or even progress. Little nuggets' did exist but were of such subtlety that I felt frustrated, what was on tape didn't see to reflect how far we had come together.
My supervisor shed light on the clients vulnerability, level of abuse and trauma and the internal struggle of the clients Child  ego state to get close enough to me whilst weathering the unremitting cruelty of their Parent ego state. Sometimes neither of us were strong enough to hold on and hold out to the relationship especially in the early days when I was gaining experience. I simply didn't have the level of potency as a neophyte. My supervisor offered me a permission to accept this slow steady patience in the process and to recognise readiness when this came. Often the client's readiness can be felt as well as seen, the countertransference felt and experienced in a change in body posture and the contours of the face, subtle signs of relaxation and acceptance.
Gaining experience in therapeutic enquiry of the client's inner world and the countertransferential feelings around their Child and Parent dialogue increased my confidence and potency. Demonstrating empathy for the Child's dilemma in continual oppression and the possible cost of disloyalty. The deconfusion of the Child moves hand in hand with decontamination of the Adult ego state. I believe in transactional terms with survivors of abuse deconfusion of the Child occurs very early in the therapeutic work. The Child ego state has to believe and be enabled sufficiently to cathect enough energy to meet the power of the Parent. The therapist acts as a Nurturing Parent during this emergence of the Free'ing Child.
This stage of treatment can take several months and for some clients longer. The Adult ego state may be so small and vestigial and the power differential between the Parent and Child so great that to try and move on too quickly will upset the status quo and fragile equilibrium which has allowed the client to function thus far. 
I realise I have meandered into Transactional Analysis terminology during this blog. I make no apology for this but attach some references which may help put some of the concepts into context for you.
Berne, E. (1961) Transactional Analysis in Psychotherapy.
Berne, E. (1966) Principles of Group Treatment
Berne, E. (1972) What do you say after saying hello
Crossman, P. (1966) Permission and Protection. Transactional Analysis Bulletin 5(19)  p152-154
Tilney, T. (1998) Dictionary of Transactional Analysis