Healthcare Training Institute - Quality Education since 1979
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Helpless Victim Versus Guilty Perpetrator
In his work with traumatized and delinquent children, Fairbairn ( 18) noted that they were unable to cognitively process traumatic experiences and needed to maintain an idealized image or fantasy of their parents as safe and loving, i.e. as a "good object." Traumatized children are prone to sacrifice their self-esteem in an attempt to maintain an unconscious fantasy of the idealized parent, i.e. the child becomes the "bad object" so as to maintain the fantasy of the parents as the "good object" ( 19). Among adults undergoing trauma, such as kidnap victims, this process of taking on excessive responsibility for the traumatic actions of one's perpetrator has been labeled Stockholm Syndrome ( 20).
In order to regain self-esteem, the negative self-image can become projected or repressed, but is nevertheless manifested by chronic dysphoria, suicidality, and self-destructiveness. Self-image and patterns of interactions become split between innocent victim versus guilty perpetrator. In the victim role the patient can appear helpless, passive and dependent, or enraged and self-righteous. In the perpetrator role, the patient is depressed, guilt-ridden, suicidal, or self-destructive.
Freud was the first to observe this pattern of traumatic reenactment and labeled it the repetition compulsion ( 21). Freud also pointed out that this tendency towards traumatic reenactment plays out in the patient-therapist relationship. It is common for therapists during the first two stages to experience countertransference feelings of helplessness, guilt, hopelessness, and frustration, and to have wishes to rescue, direct, or control the patient. The most common trap for therapists is to infantilize patients by assuming they are helpless and totally incompetent and by giving excessive advice or reassurance ( 12). The therapist thereby creates a traumatic reenactment of loss of autonomy. Patients react to this approach with either an infantile regression or a passive-aggressive rebellion, e.g. sabotaging efforts to gain employment.
Janus: The person in the business office required all this I.D. before she would take my request seriously. I needed to prove to her that I was a legitimate person.
Janus begins by describing a conflict with a person who is demeaning to her and then generalizes it to other relationships in her life. She is now in the helpless victim role. I provide an internalizing question to increase her awareness of the other side of her split self-image as a guilty perpetrator. The patient readily recognizes the internal conflict, stating "Is moi?"
Janus: I don't know why I'm so jealous of my sister and am thinking it's really immature of me. I just need to get over this and find my place in this world regardless of my sister and all her fan club. It's just that I don't like the fact people don't acknowledge all I've gone through, but give sympathy and assistance to her. It makes me mad. At a party my mother was telling me, 'it's so awful what (my sister) went through with her husband.' And I was like, "what about what I'm going through with my husband!" And then she spoke of how my husband is on the worship team at Church and 'maybe he's changed.' I just wanted to deck her.
Therapist: It's definitely a sensitive spot, because that's exactly what you are struggling with. Is my husband just this nice earnest guy who is trying to reform? Is it just my attitude that's the problem? Do I have any right to be angry and any value in myself? And so, it's a very sore spot.
Anger, guilt and self-destructive behaviors greatly diminish. Some patients describe, "finding a voice," as they become able to appropriately assert themselves to resolve day-to-day conflicts and problems. Importantly, by becoming more aware of her conflicts, Janus was finally able to successfully remove herself from the highly traumatic relationship with her husband and obtain a divorce.
An important landmark in treatment was the development of empathy. During the twin tower bombings, the patient was surprised to find tears on her face. She stated that it represented the first time she was able to cry for someone else, instead of for just herself. Even three weeks before that incident, she had stated in a session, "I feel like I exist for the first time in my life."
Reflection Exercise Explanation
Reflection Exercise #1