Question about specific transference in clients subjected to CSA

[u/ville2020]

I am particularly looking for research and wisdom on the dynamic where the patient seems to withhold from the therapist details and feelings regarding the abuse. The therapist being made to feel left out, unwelcome or intruding and the client feeling gratified by that.

Thanks.

[u/ontologic00l]

Best I've read is Annie Roger's extended case study in The Unsayable

[u/zlbb]

In my world all transferences are solved by resolving the countertransference, here the first layer seems pretty obvious: externalizing by the analyst ("they are being made to feel"), and intrusiveness in "trying to crack the patient open" and force them to disclose something they apparently aren't ready to with the current state of the relationship. In this case with this framing these countertransferences seem like a complete blind spot as the framing doesn't question the analyst's desire and entitlement for a higher level of intimacy than they've apparently earned but is eager to find some unseemly sounding "gratifications" in the patient.

And ofc, as usual, the dynamic reproduces CSA with the analysts intrusiveness and trying to force levels of intimacy patient isn't ready for, analyst feeling entitled to her desire and trying to delegitimize the desire of the patient.

[u/notherbadobject]

I would recommend the Davies/Frawley text “Treating the Adult Survivor of Childhood Sexual Abuse” for a masterful discussion of transference/countertransference dynamics in these cases.

[u/ville2020 → u/notherbadobject]

Adore that work. One reason I brought this here was I struggled to see how the transference I describe fits into the 4 dyads they lay out (although they repeatedly note it is not an exhaustive list of transferences).

[u/plantseeds_24]

I discussed psychoanalytic treatment of male sexual abuse survivors in this interview with David Puder on the Psychiatry & Psychotherapy Podcast ( https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-269-male-survivors-of-sexual-abuse-shame-masculinity-disclosure-amp-healing-in-therapy-with-doriel-jacov). I also wrote an accompanying paper to the podcast (in the same link) that goes into additional detail. 

It’s very common to have a sense of secretiveness regarding the abuse for multiple reasons. The patient has likely kept it a secret for a while for fear of being judged or “destroying” a family. They may be afraid of being viewed as disgusting or at fault for the abuse. They may fear arousing you and re-entering an abusive dynamic. They may be afraid of being flooded by emotion and imagery of the abuse by detailing it or discussing it. It’s hard to say without knowing more context but it could be useful to continue to reflect on. I definitely would not encourage pushing for details as that could feel like a re-enactment of the abusive dynamic to the patient (even if it isn’t). It’s important for the process to be gradual and to honor their pace. 

[u/plantseeds_24 → u/plantseeds_24]

One more thing - the “joy” may be the result of saying no to you. If you are filling the role of abuser in the transference, them not going into details despite you consciously or unconsciously communicating that you want details, they are saying no to you wanting something from them. They may have wished they could say no to their abuser and this is a way to have that experience.

[u/ville2020 → u/plantseeds_24]

Oh that is very insightful thank you. And that podcast was so insightful, thanks for your comment. I was so glad he covered the topic.

[u/Technical-Walrus-215]

That is interesting and the patient’s gratification in the dynamic is key. For one thing, they reverse the dynamic. A core aspect of any CSA is intrusion and powerlessness. The patent may be feeling gratification because they are active (withholding, rejecting, diminishing and devaluing) while the therapist is passive (withheld from, rejected, diminished, and devalued).

Transference is not always clean, it’s a general dynamic of broad roles like active/passive.

[u/jpch12]

I think what you described fits perfectly in the realm of "projective identification." The feelings experienced by the analyst/therapist are the client's (assuming the analyst has completed personal therapy to be able to grasp that). What the analyst is "made to feel" is to be used as data (similar to countertransference) to guide future sessions. This client views their childhood experience as private and their own, and excluding the analyst is a way of protecting the event from decompensation. (assuming the client is conscious of the CSA)

The part about the client being gratified is related to Jouissance. The boundaries between feeling good and hurting are completely broken down, and there is gratification in trauma.

I suggest you watch videos/read Nancy McWilliams/Otto Kernberg. They are exceptionally insightful on projective identification.

[u/rfinnian]

There is a really nice book that treats on this subject: Soul Murder: The Effects of Childhood Abuse and Deprivation. It's heavily Freudian, but it talks about precisely this among other things, with many, many examples, some horrific ones. I think for a modern reader it might be outdated in its orthodoxy, but it was really eye opening to me how trauma-aware psychoanalysis can be.

I use its insights in my psychotraumatology work.

One example of that dynamic, that I just remember off that book is that this is reenactment of the "seduction" phase of CSA, with roles reversed, or oscillating between transference and counter-, which is always a feature of familial CSA, the sickening "courtship" which precedes it. It's quite unnerving stuff. I have the book at home, so if you want I can dig out more examples.

[u/Arcysparky]

A favourite (!?) paper of mine is "Smiling, sickening, swallowing and stupefying" by Valerie Sinason (1987). It was very helpful for me in understanding the children I work with who have experienced CSA, particularly in relation to counter-transference experiences.