Adult Survivors of Child Abuse

by Alan Brandis, Ph.D.

Adults who were abused as children typically have one or more problems to contend with, depending on the type and severity of abuse, including: difficulty trusting or being close with others; suspiciousness or paranoia; suppressed or acted-out rage; depression which may include suicidal "gestures" such as self-mutilation or actual suicide attempts; anxiety or panic attacks; and dissociation, which can include "flashbacks," "regression," and other alterations in consciousness, and which can, in severe cases, result in Multiple Personality Disorder.

Functional (that is, self-supporting and independent-living) abuse survivors often have a difficult time even getting to therapy, since they fear being vulnerable and can't believe that anyone would want to help them or could understand them. They often live isolated lives, going through the motions of life without getting much enjoyment from it. They may have a "secret" side of themselves which they keep separated from their public persona and daily life, in which they act out versions of their childhood abuse experiences, such as by picking up strangers and having violent or abusive sexual encounters. These experiences reinforce their shame and guilt, and keep them convinced that they are not worthy of help.

Abuse survivors often have difficulty with uncontrollable feelings which overwhelm them and render them non-functional for days or weeks at a time. These episodes may be triggered by something which reminds them of their childhoods, such as a conflict with an abusive boss or contact with a parent, or may be triggered by a place, a smell, or a feeling.

Adults with such serious symptoms often require several interventions at once, including individual psychotherapy, Gestalt Therapy, group therapy, a support group experience, medication for depression or dissociation, and other lifestyle changes. There are several techniques that can help the patient deal with "flashbacks" and traumatic memories if they arise spontaneously, including Hypnosis, Neuro-Linguistic Programming, and Biofeedback.

Adult survivors often have problems with drugs or alcohol, and these issues need to be addressed immediately since progress in other areas can only be made and maintained if "checking out" with chemicals is no longer an option.

Some therapists use hypnosis, sodium amytal ("truth serum") or other techniques to help adult survivors "recover" "buried" memories of abuse. We do not believe in such approaches, for several reasons. First of all, we respect the unconscious and trust it to remember events when the patient is ready and able to deal with that information. Second, there is evidence that "recovered" memories are unreliable because the therapist's expectations can easily, unconsciously, influence the patient during the procedure. Third, such procedures take the responsibility for healing away from the patient, and place the therapist in a position of power over the patient, rather than next to the patient as a partner in exploring and discovering the information together. Fourth, the recovery of such memories before the patient's healing has progressed can often lead to a breakdown, requiring hospitalization and perhaps a period of extended disability. We prefer to help the patient build strength and the ability to deal with the real world.

Therapy for adult survivors will usually address the worst and most disabling symptoms first, while providing emotional support and a "safe harbor" for the person who feels that life is overwhelming him or her. Psychological Testing can often help determine the exact nature of the underlying problems, and can reduce the time it takes to develop a comprehensive treatment plan. It can also provide valuable information to the Psychiatrist if medication is being considered, and can significantly reduce the time spent in trying different medication regimens until one is found that works.