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Therapy in the Danger Zone

Therapy in the Danger Zone

Breaking the cycle of family trauma

by Mary Jo Barrett

Although it was 32 years ago, I can still remember my first therapy case like it was yesterday. Fresh out of grad school, on the first day of my first job, I was handed a child protective services report by my supervisor. As I read it, the fear and nausea set in. Nothing about my education or life experience to this point had prepared me for the world I was entering.

The father, a Chicago cop named Joe, who for years had beaten his wife and son, and had sexually abused his daughter, Laura, since she was 11, was clearly a monster, whom I was thankful I'd never have to meet. On her 16th birthday, Laura had finally gone to her mother's room, the family car keys in hand, and said, "Either him or me. Get him out of here or I'm gone!" The mom, Tanya, called the child protection unit of the Department of Children and Family Services and reported Joe, who was immediately arrested. Nevertheless, as a parting shot, he broke Tanya's ribs and smashed her face with the butt of his gun.

On the day of our first appointment, I went to the waiting room to greet Tanya, who was sitting there alone because she hadn't been able to get her children to come with her. A small, fragile-looking woman, she barely looked at me as I approached. On this cold December morning, she was wearing a long skirt with pants underneath, which reminded me of how my friends and I used to dress in grade school. Looking at this grown woman in her ridiculous, childlike outfit, I wondered to myself, "Why would anyone dress like that?"

I'd fantasized that Tanya was a cold, distant, cruel woman with no capacity to love or attach, but she looked so lost and beaten down that my heart immediately went out to her. All my initial anger—how could she let this happen in her family? what kind of a mother was this?—disappeared. In my sheltered, middle-class upbringing, I'd never met anyone like her. As she began to talk in her tiny, hesitant voice, never looking at me, she seemed to be saying that she was incompetent in every way, and, taking in this defeated, tongue-tied woman, I secretly found myself agreeing with her. At the same time, I had an overwhelming urge to take care of her. But where to start?

Having met Tanya, most of the hypothetical possibilities I'd imagined seemed irrelevant. It was evident to me as I talked to her that she could take care of neither herself nor her children, as long as she was so filled with fear and uncertainty. She needed a safe place, where she and the kids could begin to talk about the nightmare they'd lived through and learn how to rebuild their lives.

I assured Tanya that we'd start off by slowly getting to know each other and that she could trust me to bring the kids in as we proceeded. Only then would we be able to develop the goals of therapy together. With no experience to draw on and no real guidance in what to do, I decided that the best way to begin was by listening to this beleaguered family with absolutely no feeling of judgment, and that nonjudgmental attention would be the foundation for everything we did.

While I was coming to this case without the least background in treating abuse or trauma, this was the 1970s and I ­wasn't alone—no one talked about sexual abuse or domestic violence in clinical case discussions then. It wasn't until the early 1980s that the mental health field began to recognize the existence of trauma outside the scope of war, terrible accidents, or disasters. When we did acknowledge that awful things like violence, abandonment, and neglect happened in families, we didn't connect the treatment of the emotional fallout from those experiences to what we'd already learned about treating trauma, because we were still focused on the idea that trauma resulted from war and natural disasters.

A few years later, with the publication of DSM-III, the diagnosis of post- traumatic stress disorder would be applied to Viet Nam vets, but not families. Most social work and psychology schools didn't have courses on how to treat trauma or child abuse or neglect. Rather, therapists focused on the symptoms that we thought we knew how to address—the acting-out child, poor marital communication, eating disorders. We prided ourselves on the practicality of our interventions and on not getting lost in wild-goose chases that led us to ignore the presenting problems.

I'd been trained in structural and strategic family therapy, which I considered to be the hub of therapeutic innovation and the most exciting practice specialty of the time. Naturally I applied structural/strategic treatment principles in my work with Tanya and her children. I "joined" with them and created safety in every way I could think of. I sought to restructure the family based on principles of hierarchy and adaptability. I clarified rules, roles, and transgenerational patterns. I saw each of the family members individually, so that they could tell their story in privacy and I could bear witness to the circumstances of their lives. Then we met in family sessions to work on the practical issues of daily life, like learning better ways to communicate and recognizing Tanya's authority as the head of the household.

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