Case Study

Rewriting the Story

Entering the World of the Abused Child

Magazine Issue
January/February 2014
Using Intersubjectivity to Help Abused Children

Sadly, children who’ve suffered abuse and neglect at the hands of their parents are often convinced that their mistreatment was justified. As a result, they typically grow up with a pervasive sense of shame, struggling with emotional regulation, cognitive and reflective functioning, and the inability to experience positive emotions. It isn’t surprising, then, that these children are often unlikely to be cooperative participants in therapy or easily engaged with new parents and teachers.

Therapists must therefore work to discover the children under the symptoms—those who lived before the abuse, who survived in the face of it, and who can begin to emerge after being accepted and embraced by those who’ve come to love them. To have a positive impact on these children, caretakers and therapists must offer them a different felt experience of who they are. As Daniel Stern, Colwyn Trevarthen, and other child psychologists have shown us over the past 30 years, the most powerful means of achieving this is through congruently communicating, both verbally and nonverbally, how they see these children and mirroring the children’s emotional experiences. That process is called intersubjectivity, and it’s the primary way that children develop a stable representation of self. For example, parents who communicate anger and indifference raise children who experience themselves as bad and unlovable. If those children are to change their primary experience of themselves, they need parents—and possibly therapists—who express the experience of joy that they’ve brought into the world, love for their previously unseen selves, and admiration for their perseverance.

Jake’s Story

Jake was 9 years old when he first came to see me. He’d had a rough start in life, full of physical, emotional, and verbal abuse, mostly from his father, while his mother looked the other way so that she wouldn’t be abused also. At age 4, he was put in foster care and moved twice until, at age 8, he was adopted by Peter and Stephanie. After a few months of relative calm, he began to exhibit the behaviors that had been common in his three previous foster homes. He argued a great deal, seldom acknowledged being in the wrong, and never expressed any kind of sadness, fear, or regret. His hair-trigger temper often resulted in long bouts of screaming and swearing, especially at Stephanie. Although he had some interests, especially riding his bike and constructing elaborate Lego buildings, he didn’t seem to enjoy engaging in many other activities. In fact, Peter reported that if they spent the day together building something or swimming, at the end of the day, Jake would complain that he hadn’t had any fun and would seem preoccupied with the one incident that didn’t go his way.

When children come into therapy with me, I seek to discover how they formulate their own life stories, knowing that much of what I’m likely to hear about them initially comes from others, especially their parents. My goal as a therapist is to help children begin to more actively become the authors of their own stories, increasingly aware of their own possibilities, hopes, and dreams. To do that, I try to help them reexperience their lives as I communicate my support and my emotional responses to the events we discuss, including my sadness and compassion for the hard parts of their stories, my joy and excitement for their courage and perseverance, and my interest in their strengths and vulnerabilities.

As I get to know more about their inner lives, I give expression to my discoveries, although these expressions are mostly nonverbal—a sympathetic modulation in my voice, or a change in the look on my face, that indicates my connection with them. As they sense my affective responses, they begin to experience a new, more positive sense of self, which gives them a solider foundation to move forward in life’s journey. The possibility of moving past the old terror and shame opens up for them.

My first sessions with children usually feature a relaxed, rhythmic dialogue as I wonder about this and that and get engaged with whatever is on their mind, always curious about what it means to them. I also gently introduce difficult topics that they might initially avoid, accepting whatever they say or don’t say about them. In this way, I make sure they feel safe in the knowledge that there’s nothing in their story or inner life that would cause me to judge them or see them as “wrong.”

Initially, my sessions with Jake included both of his parents, but only Peter, his adoptive father, could attend our fifth session with him. In this session, I asked Jake if he recalled what event had brought him into foster care when he was 4 years old. He was unsure and agreed to hear what the social worker had told me. Jake had been at home with his biological father, Stan, and had been running around, showing off for a neighbor sitting with his father at the kitchen table, when he’d accidentally bumped the table, spilling coffee on his father. His father had jumped up, sworn at Jake, and slapped him so hard across the face that he’d fallen to the floor. His father had kept screaming as he dragged Jake into the hall closet and locked the door. When the neighbor challenged Stan’s behavior, Stan threw him out of the house, at which point the neighbor called the police. The police arrived an hour later to find Jake still locked in the closet. When Stan refused to cooperate with them, they took Jake to the social worker’s office, and from there he went into foster care. In the end, his parents refused to accept the services offered to enable Jake to return home, so he was eventually adopted.

When I asked Jake how he made sense of what happened, he replied simply, “I was bad.”

I suggested instead that the judge placed him in foster care not because he was bad, but because his father had abused him. Jake replied that his father wouldn’t have abused him if he hadn’t been bad. As often happens with abused children, Jake had incorporated his father’s reaction to him as an objective reality and a self-judgment.

Rather than try to argue with Jake that he wasn’t bad, I allowed myself to feel what I sensed he’d experienced, and I communicated it back to him. “Wait a second, Jake,” I said. “I’m trying to imagine what happened. You were 4 years old! A little fellow, tiny—not big like you are now. You were excited that this nice neighbor was giving you a lot of attention, running around and having a good time being silly. Four-year-olds are often that way. And you were running, and you bumped the table, and the coffee spilled on your dad, and you heard your dad screaming at you. Your dad! And you probably wanted to say, ‘I’m sorry, dad! I didn’t mean to do it!’ But you might not have been able to say that because he hit you with his big hand, and you fell on the floor.”

I continued to describe what had happened, validating the terror of Jake’s experience and concluding by saying, “How scary, sad, and lonely for you when you were just a little boy! You thought it was because you were a bad boy, and that must have made it even harder.”

As I told Jake’s story, there were tears in my eyes, and the intensity in my voice conveyed his pain and fear. As Jake took in my experience of this traumatic moment, his face softened, and he seemed confused and sad. For a while, he was quiet, motionless, and reflective. As Peter put his arm around him, Jake leaned into him and quietly began to cry. Seeing that Peter also had tears in his eyes, I asked Peter to share his experience. He spoke of how sad he was that his son had been hurt like that, how he’d be sure that no one would hurt him like that again, how he’d never hit him or treat him that way, and how—no matter what Jake does—he’d never think that Jake deserved to be treated that way. Then he pulled Jake even closer and held him for a long time in silence.

When mirroring a child’s unvoiced experience, it’s always important to observe closely how he or she responds. If Jake had indicated in any way that my account didn’t match his experience, I’d have responded differently, and if he hadn’t wanted me to continue, I’d have stopped. Since I didn’t know his father’s motives and wanted to be sure Jake was free to decide for himself why his father had been abusive, I was careful not to express judgment that his father had been a bad man who hadn’t loved him. I simply gave my empathic reaction to that event, hoping to allow Jake the freedom to begin to create his own meanings for that terrifying experience as he was taking in this new, more validating input.

My goal in focusing on difficult past experiences in this way is to expand children’s ability to give expression to how they think, feel, and remember and what they wish for. Whenever they disagree with me, I welcome their reaction and express pleasure that they have the self-awareness to see things differently and the courage to say so. As a therapist, I try to convey how their stories have affected me, so I can help them reexperience the earlier events in the context of much healthier relationships. In this case, Jake’s ongoing relationships with his adoptive parents, and with me, enabled him to see himself differently from how Stan had seen him, not just around this event, but many others as well.

As Jake began to experience himself as less “bad,” he became able to address his current anger and defiance in a more open, puzzled, and remorseful way. He began to see how he often thought that the limits his adoptive parents set confirmed his perceived badness rather than expressed their desire to keep him safe and teach him appropriate behavior. In a later session with Stephanie, his adoptive mother, we talked about an incident a few days before when Jake had sworn at her because she wouldn’t let him go outside. I asked Jake why he thought his mother had said no to him.

“She didn’t care what I wanted to do,” he asserted.

With intensity, conveying a new understanding about his behavior, I said, “Oh, Jake, if you thought that your mom didn’t care about what you wanted, that what you wanted wasn’t important to her, of course you’d be upset with her. As if what you want isn’t important to your own mom!”

After a brief silence, in which he seemed absorbed by what I’d said, I added quietly, “Why don’t you tell her, Jake? Why not say, ‘Mom, sometimes I don’t think you care about what I want. Sometimes I even think that you might not like me. And that’s why I get mad at you’”

He then managed to say, quietly and with anxiety, “Mom, sometimes when you say no to me I think you don’t like me and what I want doesn’t matter to you. And that’s why I get mad. I feel as if you don’t like me, and then I don’t like you.”

Taking his hand, Stephanie said, “If you really think that I don’t like you when I tell you that you can’t do things, then I certainly understand why you’d be angry with me. But it makes me sad to think that you don’t feel how much I love you, especially when I have to say no, even when I know it’ll upset you.”

At this point, Stephanie hugged Jake, and they both became tearful. A few minutes later, Jake quietly described how often he’d heard Stan, his biological father, swear and threaten his biological mother, adding that he was afraid that he was like Stan and would act like him when he was older. After I expressed how difficult I imagined it was for him to believe that about himself, I told him that I saw him as a boy with courage and a big heart, who was learning to love his new parents and allow them to love him. I suggested quietly that he might discover himself becoming more and more like his new dad, Peter, in the days and years ahead.

These two intersubjective experiences shared among Jake, his parents, and me were among the few dozen or so similar experiences within my office that occurred over the next nine months. And these experiences were among the few thousand that occurred during that time at home. Jake’s sense of self became open and alive, receptive to a new kind of relationship with the people who were coming to know and love him. Each new experience reduced the hold of his rigid view of himself, which had emerged in interactions with his abusive parents. The certitude of shame that Jake had used to explain the abuse became riddled with doubt, and he now had room for new discoveries, along with new social, emotional, and reflective skills. Where there had been shame, pride was emerging—and confidence, joy, and love.

Will the Jake embedded in shame return? Under stress, especially threats of conflict or separation from his primary attachment figures, he risks being pulled back into those early years; however, as the new Jake continues to develop meaningful relationships with other adults and friends, the risk is likely to decrease. Therapy isn’t magic, but when it succeeds, it provides new templates, enabling abused children to develop the expectation that they’ll be seen, accepted, and appreciated, rather than carry forward the destructive legacy of shame and self-hatred with which they started life.

Case Commentary

By David Crenshaw

I don’t think it’s possible to read the account of Dan Hughes’s work with 9-year-old Jake without being deeply moved. Every child therapist should take note when Hughes states, “Therapists must work to discover the children under the symptoms—those who lived before the abuse, who survived in the face of it, and who can begin to emerge after being accepted and embraced by those who’ve come to love them” (in Jake’s case, his adoptive parents).

That said, I was struck by a possible contradiction between the stated goal of the therapy and the method employed. Hughes states, “My goal as a therapist is to help children begin to more actively become the authors of their own stories.” But in my experience, young children like Jake need to process traumatic experiences in a manner consistent with their cognitive and emotional level at the time of their original trauma (in Jake’s case, age 4). Often, they’re unable to remember and share these events through a sequential, verbal narrative. When Jake said, “I’m not sure” when asked what had triggered his father’s fury, he was probably correct. With young children, trauma may be experienced less as a specific event than as a sense of overwhelming terror associated with failure of primary attachment figures to provide safety and security.

In helping traumatized children find their own voice and discover the meaning of events they may not be able to put into words, I often rely on nonverbal trauma narratives created by children in the form of pictures in the sand tray, symbolic play in the family doll houses, puppet play, artwork, or dramatic play enactments. Recently, I worked with a traumatized child around Jake’s age so agitated that his teachers allowed him to pace in the back of the classroom the entire school day. Once this child started playing in the sand in my playroom, however, he didn’t move for 45 minutes. The soothing sensory experience of moving his hands through the sand not only enabled him to remain calm during the entire session, but also led him to tell the story of his traumatic removal from his home in depth. While Hughes’s empathy and compassion clearly had a powerful impact on Jake, I was left wondering whether less reliance on verbal communication might have created an even stronger bond and furthered the ultimate aim of empowering Jake to become the author of his own story.


Illustration © Sally Wern Comport

Dan Hughes

Daniel A. Hughes, Ph.D., is a clinical psychologist in the treatment of children and adolescents who have experienced abuse, neglect, trauma and attachment disorganization. He helped to develop Dyadic Developmental psychotherapy, an attachment-focused treatment model that relies on the theories and research of attachment and intersubjectivity. He is known for creating the PACE Model which facilitates play, acceptance, curiosity and empathy when working with children. 

Dr. Hughes is the author of several books including, Building the Bonds of Attachment, 2nd edition (2006), Attachment-Focused Family Therapy Workbook (2011), and co-wrote Brain-Based Parenting: The Neuroscience of Caregiving for Healthy Attachment. He has provided training and consultations to therapists, social workers and parents throughout the U.S., Canada, UK, and Australia and provides regular trainings across the United States and Europe. Dr. Hughes received his Ph.D. in Clinical Psychology from Ohio University.


David Crenshaw

David A. Crenshaw, PhD, ABPP, is Clinical Director of the Children’s Home of Poughkeepsie.  He is Past-President of the New York Association for Play Therapy, a Board-Certified Clinical Psychologist; a Fellow of the American Psychological Association, a Fellow of the Division of Child and Adolescent Psychology, a Fellow of the Academy of Clinical Psychology, and a Registered Play Therapy Supervisor.  He was honored with the Excellence in Psychology Award in 2009 and has received two Lifetime Achievement Awards: in 2012 by the Hudson Valley Psychological Association, and in 2018 by the NY Association for Play Therapy.  He is the author/editor/co-editor of 17 books, over 100 book chapters, and journal articles on child aggression, play therapy and child trauma, his books co-edited with Cathy Malchiodi are What to Do When Children Clam-Up in Psychotherapy and a book co-written with Eliana Gil titled Termination Challenges in Child Psychotherapy.