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It would seem that what can be damaging is the merging of the damaged adult's mind with the vulnerable and immature child's mind, where there has been an active intrusion into the child's bodily and mental boundaries. Laplanche (1987) has emphasized that there is always a seduction by the adult of the child, as the child is relatively helpless and immature at first and has to confront the adult's mind. His notion of a primary seduction has, however, nothing to do with a sexual assault. Primary seduction describes a situation 'in which an adult proffers to a child verbal, non-verbal and even behavioural signifiers which are pregnant with unconscious sexual signification' (p. 126).
Though the child is, of course, immature, nonetheless the kind of evidence now coming from child development research (see, for example, Stern, 1985) shows that infants are in many ways exquisitely adapted to their situation, that of actively and even creatively eliciting care from the parent. Babies are very active, aware of their surroundings, and constantly making sophisticated discriminations about their caretakers. They even seem to learn through their emotions and through their relationships. Learning takes place through shared affect in the context of a relationship, one in which the baby is not some passive and helpless partner. For example, experiments closely observing mother-baby interactions show that the baby's reactions are imitated by the mother, as much as the baby imitates her. That is, the baby conveys meanings to the mother as much as the mother conveys meanings to the baby.
However, Laplanche emphasizes how the adult unconsciously conveys sexual meanings, which the baby cannot yet adequately comprehend and, in this sense, there is seduction. Presumably, if there is then an actual seduction of the growing child, then there is damage to the quality of the child's subsequent relating, and an impairment in the capacity to deal with the signifying environment.
The children at the Cassel Hospital often seem haunted by their abuse and unable to free themselves from its consequences without considerable help. As others have repeatedly observed, such children often show a number of pathological features. For example, they may be unable to concentrate on a task for long; appear over-stimulated with poor impulse control; have a haunted and driven quality in their relating and a tendency to be aggressive and testing of boundaries; they sometimes show inappropriate sexual behaviour; they may go in and out of confusional states when they become very anxious, particularly about being abandoned; they have difficulty in trusting adults; and, in more ordinary terms, they can be very intrusive and irritating in their behaviour. The parent-child relationships are usually pathological, with varying degrees of disorganized attachment patterns. There is often role reversal, in which the children try to control the parent and are over-solicitous, while the parents have problems in maintaining ordinary child-adult boundaries. The children may have a build-up of emotional tension with which the parent cannot deal, which then leads to an outburst of frustration and despair. These episodes may be accompanied by the projection of primitive fantasies between child and adult, in which there is a mix-up of child and adult elements. The children may be confused about their own identity and also trying to expel the 'malignant' projections coming from the adult. This kind of repetition may be evidence of an earlier failure to help the children build up integrating experiences.
A frequent simple finding in the parents is that they consistently show great difficulty in being emotionally attached to their children, with inhibition of the capacity to play. They are often inconsistent, at times cut off and self-absorbed. Suicidal feelings in them may be triggered off by the threat of experiencing vulnerability. Acting rather than understanding is a common means of communicating for both parents and children, which often makes the treatment of both very demanding and at times exhausting. This is particularly the case when the staff may have to be the ones who feel the child's pain and vulnerability for the parent. There often seems to be a need for the children to make a particular kind of powerful emotional impact on their parents and other caretakers, especially when the parents are impervious to the child's emotional needs. The children may be trying desperately to get the parents to acknowledge their needs, while also attacking them for having failed them. Many of these children have had to suffer in solitude, and have had to bear, on their own, horrific experiences.
Research at the Cassel Hospital has, so far, indicated that adults who have had abusing experiences in childhood and who respond to these experiences by an inhibition of reflective self-function are less likely to resolve their abuse, and are also more likely to manifest borderline pathology (Fonagy et al., 1996). Their diminished capacity for self-reflection seems to make them unlikely to seek the kind of self-reflective help offered by psychoanalysis; instead, they will look for environmental solutions to their difficulties. From the effect of our treatment programme, the indications are that if the abused child or adult has access to a relationship which can help them deal with the emotional impact of their abuse, they can to some degree resolve the experience; they may then be protected from severe borderline pathology.
a sense, the treatment experience provides a setting for the possibility of
just such a resolution of past abuse. Indeed, the treatment of the abused child
is perhaps less concerned with the issue of recovered memories of the past as
such than in confronting the emotional impact of the abuse, and the effect of
the abuse on the mind's emotional functioning. Not infrequently, this issue arrives
in an analysis when the patient makes a particular kind of emotional impact on
the analyst. It would be too simplistic to describe the situation as being one
in which the analyst becomes the abuser in the transference, though not untrue,
it seems too gross a description of what may take place. Rather, the analyst almost
inevitably proves to be a failure, there is a breakdown in usual functioning;
a failure of nerve or some lapse in concentration. The reasonably empathic atmosphere
may suddenly deteriorate, with the ready creation of misunderstandings, which
may leave the analyst feeling that he or she has somehow mistreated the patient.
Rather as in the treatment of abused children outlined above, the abused adult
will re-create the emotionally absent parent, the parent who could not bear the
child's pain and vulnerability and who has left the child with a sense that the
environment has fundamentally failed him or her, and that there is a kind of breach,
or unbridgeable gap, in the parenting experience. An unbridgeable gulf may suddenly
appear between patient and analyst, which either party may be tempted to deal
with by some kind of precipitous action, such as termination. Bearing the unbearable
is an issue in any analysis, but with the abused adult it somehow becomes acutely
relevant. Other themes may include the familiar one of testing of the analytic
boundaries and overemphasizing the role of the abuse, by, for example, tapping
into the analyst's wish to find answers rather than accept uncertainty. Finally,
the pre-abused child's body may become idealized, while the postabused body may
become a source of persecution. The patient's body, which obviously experienced
real intrusion and damage, may feel unintegrated.
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