Some Clients Challenge our Capacity for Compassion
By Noel Larson
My grandchildren often call me a dinosaur as I stumble along through the 21st-century digital world they navigate so easily. I pretty much like being a dinosaur, attached to my old-fashioned ways of doing things—except for the part about being extinct. Nevertheless, that’s sometimes how I feel when the therapists I supervise start talking about all the new trauma treatment approaches they’re learning, as if relationship-based verbal therapy is no longer relevant.
At the core of my work is the ability to connect with clients and form a bond grounded in compassion, empathy, and close attunement to the unfolding of the therapeutic relationship. That’s something that most therapists find relatively easy to do with the usual trauma clients—hyperaroused people who don’t have much difficulty communicating their vulnerability and emotional sensitivity. But it can be a lot tougher to remain nonjudgmental and receptive with dissociative clients, who are quick to challenge, criticize, diminish, and resist the clinician’s attempts to be helpful. Such individuals may appear void of tender emotions like sadness, fear, anxiety, and especially love. And then there are some even further out on the extreme of the human spectrum: deeply troubled, unattached people, who victimize others and may have done horrific things that test the capacity of even the most openhearted therapist’s ability to extend compassion and acceptance. But it’s in working with this population that we can learn fundamental lessons about trauma work and the possibility of transformation, even for those whose cruelty and indifference to the suffering of others seem to take them beyond the reach of psychotherapy.
We know now, without a doubt, that trauma affects the developing nervous system. When the primary caregiver is unwilling or unable to regulate an infant’s stress through attunement, the child suffers extreme anxiety, even terror. The child who doesn’t get the message that everything’s going to be all right can grow up unable to regulate his or her own affect. Without attunement, the infant’s brain has two major options: hyperarousal or dissociation. A hyperaroused child’s world is dominated by hypervigilance, emotional reactivity, and vulnerability to intrusive imagery. A more dissociative child experiences the numbing of emotions, diminished sensation, disabled cognitive processing, and lack of empathy. Chronic victimizers are overrepresented in this latter category.
Throughout my career, countless people have asked me how I can work with clients who’ve committed sexual abuse, murdered their wives, or broken their children’s bones and spirits. My answer has always been the same: all I have to do is remember and feel in my heart the traumatized children my clients once were. If I can find within myself empathy for their own traumatizing childhood experiences, I can discover a way to put aside my own horror and revulsion at their behavior and access the qualities within myself that I’ve learned are central to fostering healing in others.
Making the Connection
Early in my career, when I first began doing group therapy with incarcerated female sex offenders, I wasn’t sure I’d be able to open my heart to them. I was working with a dozen women in group therapy, all of whom had sexually abused children, most of them their own. In the hours they spent recounting their histories, it was easy to understand how they’d ended up as they had. One woman, named Selena, told the group that after her dad had left her mother when she was five, she’d lived in a car with her mom for several years. To support herself and her child, the penniless mother had turned tricks in the car for money for food, even allowing Selena to be sexually abused by men who preferred children to adults.
Eventually, Selena was removed from her mother’s custody and placed in foster care, only to be sexually abused by her foster father. When she turned 17, she ran away from home with an older man and had two children, a boy and a girl. Over time, her husband began molesting their young daughter and threatened to leave her without any means of support if she refused to become sexually involved with their young son so he could watch. She complied until the abuse of her children came to the authorities’ attention. At 23, she was sentenced to 12 years in prison.
We now know how the basic capacities that make human relationships possible can be arrested when a child is traumatized. This was chillingly borne out for me one morning when I asked each woman to tell the group her age—not her chronological age, but how old she currently “felt” herself to be. The responses ranged from ages 2 to 15. Later, as my cotherapist and I processed the session, we realized that each woman’s “felt” age was within a year or two of her own sexual abuse as a child, as well as within a year or two of the age of her victim. So the 19-year-old who said, “I’m two years old,” had been sexually abused as a toddler, and went on to sexually abuse a neighbor’s two-year-old boy. And the 18-year-old, who, in a fit of jealousy, violently raped a 14-year-old girl with a broken coke bottle, had been gang-raped herself as a 12 year old, causing substantial damage to her genitals. Her brother, a member of the gang, had set up the rape to solidify his position in its leadership.