When a Child Has Been Abused

Towards Psychoanalytic Understanding and Therapy

Frances Thomson-Salo, Laura Tognoli Pasquali

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429835667
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

This important and wide-ranging book explores the world of a child or young person who has been abused or neglected. It seeks to understand their world, to ease the pain from which they suffer, and to heal the wounds that the abuse has left.

Examining how abuse always takes place in the context of relationships, and involves a misuse of power that causes a traumatic overwhelming of the child or adolescent, abuse also evokes strong countertransference. This affects interventions, particularly when clinicians struggle with feelings of which they may feel ashamed. A difficulty in coming to terms with and addressing child abuse relates to unconscious factors which, by freezing the emotional area surrounding the abuse (or by blinding the area of personality), makes some thoughts unthinkable.

Considering traditional and novel ways of helping children who feel they have been maltreated, the book offers suggestions for individual treatment as well as describing the successful work carried out with child refugees. It also offers a glimpse into what child psychoanalysts interpret and do with children who feel a parent hates them.

Part I

Mainly clinical

1 A comprehensive approach to child abuse

Jordi Sala

Not being a specialist in the field of child abuse, what I can offer you is a clinical and psychoanalytic overview of the subject, as one of many possible frameworks that might help us to approach the implicit dynamics triggered by maltreatment and abuse. We are familiar with Klein’s statement that all a child needs from the outset is ‘food, love and understanding’ (Klein, 1946, 1959) for a mind that is more or less sane to develop. But we know this is not always what they receive.

We assume that the birth of a mind is the result of an encounter between mother and child. As we know, these first encounters in life constitute a very complex situation from which the nascent mind will gradually emerge, differentiating what belongs to them from what belongs to others. And the very first steps of this process, we assume, are made through contact with the mother, both corporeal and mental, thanks to which, unconnected parts of the body/mind experience with another (mother) are held together, leading to a progressively more coherent body/mind self (Bick, 1986; Gaddini, 1981; Stern, 1985), wherein boundaries are of great psychological significance. But contact with a primal object may be either more or less adequate or pernicious. Let us consider, from the outset, that maltreatment and abuse represent ‘a kind of contact’ with no regard for child’s needs, a contact that violates the very frontiers of the body/mind self. In considering this, what inevitably springs to mind is trauma, with its effects and its dynamics.

Contact, thus, is a very sensitive matter since it has the power to stir sensations, to mediate emotions and phantasies and to build a relationship through which a mind is created or (might be) destroyed. Let me mention here Shengold (1992), who describes the syndrome of ‘soul murder’ as the deliberate attempt to interfere with the child’s separate identity, joy in life and capacity to love, caused by seduction, overstimulation, cruelty, indifference or neglect. In child abuse, contact is generally used for the gratification of an adult’s perverse sexual desire and/or to placate their anxieties by putting them violently into the child’s body.

We presuppose, according to Bion (1962a, 1962b), that there is an inborn expectation in the baby of something good outside that will provide for their needs. When this expectation on the part of the infant is met through experience with the mother that is good, we hypothesise, this experience becomes a central part of the very nucleus of the self, and hence the core of the sane part of the personality as a whole. The self coheres around repeated and anticipated experiences with its good object. This, of course, can be described in other ways: such as, for example, that the adequate sharing, by the caregiver, of an infant’s inner experiences (and expectations), leads the infant to feel known and results in increased feelings of security and attachment, protecting against feelings of alienation and aloneness (Stern, 1985).

However, in the case of violent and disruptive experiences with a bad object in reality, the infant’s expectations do not meet with a (good) realisation, nor even with absence of realisation in the form of frustration/deprivation, but rather a ‘counter-realisation’, so to speak, of being overwhelmed. An incomprehensible intense ‘something’ intrudes upon the child’s body/self, turning upside down the natural structure wherein the child’s need for projection can be mostly contained and transformed. According to Bion (1962a), with the reversal of the containing function the ‘development of an apparatus for thinking is disturbed and instead there takes place a hypertrophic development … of an apparatus for ridding the psyche of accumulations of bad internal objects (beta elements)’ (pp. 306–10).

In abuse, a child’s needs and expectations are not properly met. Instead, somatosensory intrusions, of a traumatic character, non-conceptualised, non-articulated in an inner or interpersonal dialogue, are likely to produce severe damage in the structure of the self, either in the form of fragmentation, thought disturbances, affective disorders, unmanageable anxieties and the like, often promoting the use of dissociation and the hosting of an unacknowledged aggression. This is true of all victims of child abuse, whether they are a physically, emotionally or sexually abused child. Davies and Frawley (1992), from their own and others’ investigations into the consequence of child abuse, confirm the recurring connection between childhood trauma, particularly physical and sexual trauma, and the process of dissociation. The authors see dissociation, in this case, as an organisation of the mind in which traumatic memories are split off from associative accessibility to conscious thought. Rather than being repressed and forgotten, they alternate in a mutually exclusive pattern with other conscious ego states. Dissociation becomes the only means to survive when the defenceless child cannot escape or fight against the abuser, as is so graphically expressed in adult terms by a very young victim of child sexual abuse: ‘While I was being raped I left my body, floating out of it and up to the ceiling … out of the room’ (Rhodes, 2016, p. 28).

We assume that investing the body with meaning is of critical importance. Just to give two examples:

1 Being poorly stimulated might trigger phantasies, in the child’s mind, either of not being wanted or only poorly loved, as having little or no value at all in the eyes of another.

2 In the case of a disorganised and confusing experience of contact, violence done to the body of the infant might make them believe, at one (representational) level, that they are unworthy and bad. But more disturbingly, at a deeper level it might create a violent, fragmented and disorganised mind, which might later cohere around identification with the aggressor. It is this latter scenario that I hope to illustrate later from the experience of Christian.

What I mean by these two examples is that the first meaning of a child’s life comes from the interaction with his caregiver, an adult that supplies meaning to one’s existence, both in body and mind. In this regard, it is worth recalling, just in passing, Laplanche’s views on the seduction theory regarding the consequences of asymmetry between infant and caregiver, indicating that the sexual message always originates in the adult, by which we should understand that the foundational moment of the self is in the (sexual/libidinal) investment that the (m)other puts on the infant (Laplanche, 1997). But a mother/adult, we hope, is able to distinguish love and respect for the child’s needs from her own sexual investment and phantasies.

But, what happens when the adult’s phantasies are allowed to impinge upon the child? And what is the difference between investing in phantasies and acting them out? What kind of phantasies does the abuse trigger in the child? Here we think of various severe consequences such as confusion between adult/child, inner/outer world, phantasy/reality, with the subsequent collapse of the symbolic; but also, we find play and thinking pervaded with sexual and/or aggressive connotations; deprivation of affective needs inflicted with deception and treachery; omnipotence and promiscuity on the child’s side based on triumph and rivalry in oedipal terms; and the constant presence of guilt and shame during later life. All this can be summed up by saying that child (sexual) abuse robs a child of his or her most precious properties: childhood itself, intimacy, security and trust.

For all sexually abused children a fundamental rule has been broken. The natural role of an adult as guardian and protector has been abandoned, the stronger has exploited and damaged the weaker and the child has lost unequivocal faith in the existence of an adult world that is by and large benign and favourable to development.

(Skelton, 2006)

Maltreatment of children

This is now a subject often addressed in psychoanalysis. Over the past decades, there has been agreement in differentiating between physical, emotional and sexual abuse on the one hand, and neglect on the other. We need adequate terms to identify a problem to begin to recognise and therefore address it appropriately. But we also need a frame of reference where the phenomenon can be contemplated. Maltreatment of children is more frequent than is generally recognised. We often take for granted, without much thought, the assumption that parents or adults are going to be caring and concerned unless they are mentally ill.

And certainly, in the case of mental illness we are more likely to be alert to the presence, and consequences, of abuse and neglect in the family, and thus able to set in motion therapeutic actions to prevent and help abused or neglected children. For in these cases,

abused children often have to contend with a host of other difficulties as well; child disability or ill health, parental history of being a child victim of abuse, parental emotional impairment, parental substance misuse, domestic violence, poverty. This wide range of child, family, and parental adverse circumstances all interact and influence each other. [However, we must not forget that] the consequences of child abuse and child sexual abuse are equally protean, and appear to be influenced by the environment and the availability of good experiences with other parents or carers.

(Jones & Ramchandani, 1999, cited in McQueen et al., 2015, p. 27)

But abuse and neglect often occur in silence. Young-Bruehl (2005) argues that the chief obstacle to the discovery of child abuse and neglect is precisely a shared belief that parents/adults, as such, in what we assume to be the normal population, are more likely than not to fulfil their responsibilities as parents/adults – particularly their child’s expectation that they will be loved. But if this belief is taken for granted, we remain blind and deaf to abuse, overlooking certain hints that the abused child might send out to those around them in forms that are more or less disguised.

Contact and boundaries need to be considered in their particular nature: that is, taking into account the quantity, intensity and quality of the contact, whether it is excessive or defective, adequate or inappropriate, benign or malign. But if we specifically consider the abuse perpetrated on children, we also need to be attentive to: when it is done (precocity), what is done (the kind of abuse) and by whom (inside or outside of the family/confidence circle). The extent to which the personality will be affected depends on the particular combination in each child. And once again we find ourselves in the area of trauma.

At this point, it is pertinent to refer to Alvarez (1992), who suggests that we are more or less familiar with the possibility of working on trauma on integrative lines (where the traumatic material is recovered, thought, fantasised and dreamt about), or the alternative encapsulation of all circumstances connected to trauma. But a third and more serious possibility needs to be taken into account: namely, the situation where ‘trauma influences ongoing developmental processes, such as memory, cognition, learning and, of course, personality’ (p. 157). And she goes on to argue that in severe and chronically sexually abused children, we should think of a theory of forgetting as opposed to a theory of remembering, so as to enable the child to think about his trauma in tiny and manageable digestible doses. This implies having respect, in treatment, for the child’s own pace: ‘Maybe each single aspect of the abuse, bits and pieces of the experience, particularly if it was chronic may need to be digested one step at a time’ (p. 154). In his autobiography, Instrumental, a memoir of madness, medication and music, James Rhodes (2016) describes very vividly how the sexual abuse he suffered from the age of 5, for five years uninterruptedly, penetrated the core of his self and remained there forever, as a stain that marked him as evil, disturbing almost every minute of his daily life, both in mind and in body, with unbearable and unavoidable symptoms that often made him think of himself as mad and unable to build a proper and caring loving relationship.

I had sex young. It was bad. I am bad … It’s one of those hideous face-blot stain things that children stare at and adults look away from. It is just there all the time and nothing I do can or will erase it. I know all the time that there is nowhere I can put it, no way I can frame or reframe it, nothing I can do with it to make it bearable or acceptable … He [the abuser] took my childhood away from me. He took my child away from me, he took fatherhood away from me.

(p. 26)

Now, after the unfolding of this rough scheme on the subject of child abuse, I would like to illustrate some of the ideas put forward here with two clinical examples of my own, taken from my clinical practice in a public mental health department in Barcelona: first the case of a 5-year-old physically abused child, and then one session, approaching the end of a family psychotherapy, where child abuse of one of the family members is uncovered.

Vignette 1: Christian (a schizophrenic mother and her son’s disorganised psychosis): long-term consequences

I saw Christian for the first time when he was 5 years old, and met with him weekly until he was 7 years old. At that time, a severe disorganised type of infantile psychosis was diagnosed. He was unmanageable, continuously confronting parents, teachers and children of his age, with no respect for limits, switching from warm and caring contact on the adult’s lap to uncontainable physical and verbal violence if he was frustrated. The grandmother, who had custody of the child, was at her wits’ end with him. In the sessions, the child could tolerate no boundaries, and spent most of the time abusively trying to gain control of me, often physically. Some months after the beginning of treatment I met his mother and some things began to fall into place: his mother was giving him contradictory orders continuously, and the child paid absolutely no attention to her. The mother chased him around my office, smacking him, shouting that he was bad and had no respect for her. It quickly became obvious that the mother was severely ill, having been diagnosed with schizophrenia. I later found out that the father, who was suffering many complications due to his obesity, was extremely passive, had learning difficulties and was totally out of touch with the world of feelings. During the child’s treatment, the mother had to be hospitalised in a psychiatric ward and for some time, on weekdays, the child was looked after in a psycho-educative institution.

Eleven years later he came to our mental health department referred by the Young Court Authority. A psychotherapeutic approach was assessed. He was 18 and was visited by a colleague in our department for a short period of time, until he disappeared leaving no trace. A psychotherapeutic treatment was indicated as alternative to penal punishment. He was sent for disorderly behaviour, threats, mugging, burglary and addiction to cannabis. The professional who was dealing with him considered him unfocused, theatrical, extravagant, and wondered about the possibility of delusional activity. He was fascinated by firearms and explained how the first time he had killed a pigeon he felt remorseful, but that a little later, with a friend, he had tortured a cat to death. He asked to see me, and we exchanged words briefly in the waiting room. He said, affectionately, ‘Do you remember me? I was really bad back then. I don’t know how you put up with me!’ In the short time that we spoke, he explained to me that he had come for therapy after being arrested for theft, and that during the intervening years he had been in the care of social services, and had been institutionalised in a centre run by the General Delegation for Child and Adolescent Care, because his grandmother was too elderly to look after him. He reminded me that his mother was ill and that he had not had news of his father for years.

The lapse of time showed how the maltreatment and neglect that Christian had suffered as a child, in a family setting characterised by mental illness, had taken their toll in the young adult. Eleven years later, his identifica...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• About the editors and contributors
• Acknowledgements
• Series editor foreword
• Introduction
• part I: Mainly clinical
• part II: Protecting the care systems to prevent burnout
• part III: Legal aspects Task and role of the judiciary in child abuse
• Index