Therapy in the Danger Zone

Breaking the Cycle of Family Trauma

Therapy in the Danger Zone

This article first appeared in the March/April 2010 issue.

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.

The family ate up all of my structural and psychoeducational interventions. They particularly loved the role playing, especially the session in which they got to put words to experiences that had previously seemed completely beyond their understanding or control, like drawing their family with and without boundaries and then telling stories about the differences. With my family systems focus, I soon got a picture of what had made the abuse possible. Horribly neglected as a child, Tanya had been a desperately insecure young woman looking for a knight in shining armor. She found him in Joe, who certainly appeared to fit the role—a physically imposing, reassuring figure, someone who even made his living as a policeman protecting the community. It isn’t surprising she saw him as her ticket out of her own abusive family to a better life.

Over the first several months of therapy, Tanya seemed to make great strides. She got a job, became a much more competent parent, signaling to Laura that she no longer had to be the “parentified child,” a favorite label of systemically hip structural therapists at that time. Tanya dutifully contacted a divorce attorney to begin exploring the avenues for divorce and, as the weeks went by, I began to feel more and more confident about my work. Maybe I really did know what I was doing after all.

Everything seemed to be falling into place when I received an emergency call informing me that Joe would be released from jail in two weeks. I was also told that, since Tanya and the children were under a court order of protection and supervision, he wouldn’t be allowed within 360 yards of anyone in his family. It didn’t make sense to me that the courts would let Joe anywhere near the family, yet the implied restraint, however shaky, eased my mind somewhat. What was most important to me was that, since he wasn’t going to be allowed anywhere near his family, I still wouldn’t have to meet this monster. So I tried to calm down the now-panicky family, assuring them that the laws would keep them safe. I was confident that the newly empowered Tanya would rise to the challenge of having Joe loose on the streets.

Then, right before my eyes, the family structure that we’d worked so hard to put in place began to fall apart. Even as I tried to consolidate the changes Tanya and her children had made and validate their newfound strengths, I began to suspect that something was wrong. Laura started drinking and refused to follow any of the rules that we’d worked so hard together to establish. Tanya and the kids began to miss sessions, and, when they did come, Tanya seemed distant and preoccupied. As the children’s grades declined and Tanya began missing work, I felt a distinct sense of disconnection between us.

As it turned out, the family knew something I didn’t. Within 48 hours of his release from prison, Joe had bought a mobile home and parked it on a side street 360 yards from the family home. I soon discovered that, despite her protestations to the contrary, Tanya had never really planned to divorce Joe. In fact, she’d been talking to him daily and had even approved his plan to buy the mobile home. Faced with this return to the old family dynamics, Laura took the car and ran away. I felt utterly betrayed. Angry and deeply confused by what was happening, I wished that I, too, had the option to run away. It was as if we were back to the very beginning of the treatment.

With the family backsliding in this way, I began to wonder what to do about Joe. My colleagues all assured me that he’d disappear if we pretended he didn’t exist. After all, how could Tanya give up her newfound independence and competency? How could she still want a relationship with this dreadful man? But despite this advice, it was clear to me that Joe wasn’t going away. He was back in the center of the family and I had to see him.

The problem was that nothing in my training had prepared me to work with a man 20 years my senior who’d sexually and physically abused his family members. Nevertheless, I asked Tanya for his phone number and invited him to come in to meet me. I had no idea what I was going to do in the session, so I simply told myself all I needed to accomplish was to be able to stomach talking to him, and to get him to come back for a second session. That was the extent of my treatment plan.

When the day came for our first meeting, he sat in the waiting room, a huge, scowling presence, who, nonetheless, was impeccably neat. As he stood up to walk with me into the session room, I felt a shiver run down my spine. All of a sudden, meeting him seemed like a terrible idea—there’s no way, I found myself thinking, that this devil can change into a human being. Once we were alone together, having no real idea how to treat a perpetrator, I had no choice but to sit and listen, trying to discover his humanity, something that he himself had seemed to misplace repeatedly in his treatment of his family.

There’s no doubt that therapy with a perpetrator is a scary business on several levels beyond the straightforward issue of physical safety. The hardest part is that to create a compassionate therapeutic relationship, we have to acknowledge our own dark side, our own ability to do evil. This didn’t mean that I had to imagine committing the same violations that he had, but it did mean I had to acknowledge to myself what horrible acts I might be capable of committing under certain circumstances. I had to understand how someone could convince himself that the awful things he’d done hadn’t really hurt anyone.

As I sat with Joe in our early sessions, I wasn’t focused on change at all. My only goal was to try to see the world through his eyes. Over the weeks as I got to know him, feeling anxious and repelled most of the time, I found myself sometimes feeling compassion as I came to understand how his life had been shaped by his own abuse. Then I’d be filled with self-disgust for feeling sympathetic to a person who’d done such terrible things. These emotional ups and downs were exhausting.

I never forgot what Joe had done and what he still might do, and yet I also began to see, behind his hardened look and blank eyes, a deeply traumatized man, who, in many ways, was no different from Tanya, or his son and daughter, for that matter. Joe’s father, intent on “making him a man,” had repeatedly beaten him with belts, sticks, wooden spoons—basically anything he could get his hands on—as his mother and siblings had looked on. He was sexually abused by a minister whom he’d turned to in search of a mentor during his after-school hours. Finally, as soon as he could, he enlisted in the Marines and went to Viet Nam.

As a Marine, part of a lead fighting force that, as Joe taught me, prides itself on being first in and last to leave (if you leave at all), he saw devastating brutality in Viet Nam, which only confirmed his view that the world was a dangerous place, where you had to fight
for everything to survive. Returning from Viet Nam more broken than when he’d left, he met Tanya, the lost little girl who needed a way out of her family. He swept her off her feet and into his own dark web of demons and heroes, to which she contributed her own. With all this in the background, they started a family.

Tanya couldn’t take care of herself—she really didn’t have a self—so it was impossible for her to care for and love Joe or to protect her children. Although Joe vowed that he wanted to be a good father and not repeat any of his own father’s mistakes, out of his own intense neediness, he began to focus on Laura at an early age, to the exclusion of everyone else in the family. She became his confidante, his pal, his main source of comfort. In the beginning, he’d fall asleep next to her when he put her to bed, but over time, his narcissism overpowered his sense of moral obligation. First he asked for physical comfort—snuggling, back rubs, kisses—which he believed he deserved. Then he progressed to sex, seeing his own behavior through a distorted lens, which had enabled him to abuse her for years. He’d convinced himself that he was comforting Laura, providing her with the love and warmth they both desired. When she showed no signs of protest, he chose to interpret this as an invitation to continue. He told me he just blocked out the voices that had told him to stop, or that he’d swear to himself he’d stop and, like an addict, find himself beginning it all over again the next day.

Joe was the first of many clients over the years who’ve taught me how people who feel driven to extremes can persuade themselves that it’s okay to do whatever they need to in order to survive, no matter what the price to other people. Even when it isn’t a matter of immediate survival, some people will do anything to maintain or regain a sense of value and power that helps them feel safe or gratified. To do therapy with people like Joe effectively, therapists must come to believe that good and evil can exist simultaneously in the same person.

I’ve since learned that a family like Joe and Tanya’s can begin to make the crucial distinction between a chronic state of overarousal and vigilance and “reality” only once a sense of physical and psychological safety has been established. Only after this first stage is it even possible to focus on changing dysfunctional mind-sets, counterproductive behavior, and destructive family patterns. With the court’s permission, I was able to include Joe in family sessions (it took another year for him to receive permission to see the family outside of therapy) and began to concentrate the treatment on creating age-appropriate rules and roles.

Tanya and Joe had to learn how to coparent effectively, how to discipline without abuse, and how to validate their children. I had them read parenting books and practice responses in session. The entire family played games in which they had to cooperate and learn to value each other’s opinions and ideas. There were sessions in which, with much rehearsal, they shared stories about their personal histories of violence and the impact it’d had on their lives. Slowly a new quality of empathy and compassion for one another emerged in their interactions.

Joe went into a group with other vets who were violent in their families. Tanya was in a mother’s group. Laura and Don were in groups, too. In the vet group and in the offender group he subsequently joined, Joe was forced to confront his abusive history. He learned to identify feelings in his body that were red flags for his rage or sexual arousal, so he didn’t have to act them out. He found ways to verbalize his sense of powerlessness and lack of control and identified means of achieving a sense of mastery that weren’t violent or abusive.

Over the more than three years we worked together, I was introduced to the unavoidable reality that successful trauma treatment is a complicated spiral of lessons learned and forgotten and relearned—a movement toward change that alternates with the magnetic pull to the old and familiar, no matter how dysfunctional it may be. With Joe, Tanya, and their children, every time there was a crisis or another change that needed to take place, I discovered over and over, we had to slow down, restore a sense of safety, and explore what needed to happen to make positive change possible. For example, when Laura started seriously dating someone and spending more time away from the family, Tanya became depressed and Joe’s anger started escalating, so they were no longer coparenting. We got together and discussed what Laura’s newfound independence meant for everyone else in the family—a conversation that would have been inconceivable in the past. Once everyone’s private fears were acknowledged, it became possible to consider what Laura’s beginning to move out of the family meant for each member of the family.

I knew the treatment of the family was entering its last phase when, instead of saving all their problems “till we get to Mary Jo’s,” they began regularly coming to sessions reporting on how they’d already handled their difficulties during the week. Joe and Tanya would describe how they’d dealt with Don’s conflict with a teacher or had used the communication skills they’d practiced with me in sessions over and over again to actually resolve a marital dispute. By the time our family therapy together stopped, I’d become a consultant—and an appreciative witness to their progress, rather than a teacher or interventionist. Nevertheless, Joe’s individual therapy took much longer because he had more troubling demons to tame. Before it was safe to remove the support that regular therapy provided, he needed to be able not only to take responsibility for understanding the roots and consequences of his abusive behavior, but also to show that he had the emotional balance and newfound skills to create a new story for himself and his family. The last stage of his treatment was developing his own relapse-prevention plan to identify and highlight what the danger signals that he was reverting back to old patterns were and what he’d do to reach out for help if he found himself slipping.

I learned so much from Joe and Tanya, not only about therapy with traumatized people, but about myself. With them and with many other families like them, I began to realize that, while trauma work isn’t for everyone, it was a calling for me. Even though many nights in my early years as a therapist, I woke up startled, wondering how I’d be able to tolerate the awful stories I was hearing in my office every day, I became more and more confident that I have what it takes to help traumatized people confront the past and move forward into the future, however unsteadily. Instead of being intimidated by the intensity and the difficulty of this work, I soon found, when I dealt with less complex and demanding cases, I missed the deep sense of engagement that trauma work provided.

The Reunion

In the years since I worked with Tanya, Joe, Laura, and Don, the field of trauma treatment has seen many important advances. We now know so much more about the neurobiology of trauma and have a vast range of techniques for helping trauma sufferers. We’re certainly more able to recognize the constricting patterns of fight, flight, and numbness that trauma leaves in its wake, and to understand which cognitive-behavioral and neurobiological interventions are likely to work best with what kinds of clients, as well as how to combine individual, couple, group, and family modalities in our treatment protocols. But in spite of all our advances, I believe that, from most clients’ viewpoint, the healing pathway isn’t so different from what Tanya and Joe experienced in the late 1970s, when the trauma treatment field was still in its infancy.

Five years ago, as part of a long-term follow-up project at my center, I contacted Tanya and Joe, Laura and Don. Laura was 41; Don, her younger brother, was 38; Tanya and Joe were both in their late sixties. Although my colleagues and I had been doing the follow-up interviews with clients for many years, I’d never felt like I did on the day this family came in—I was feeling the same anxious anticipation I’d experienced 30 years earlier. Not having seen them since we concluded therapy, I wondered what they’d look like. Had they spiraled back to all of their old ways? I even found myself secretly wondering whether they’d have as special a place in their hearts for me, as I had for them.

At our first sight of each other, we all began to cry, and we kept crying, laughing, and telling stories for the next four hours, as if we were at a family reunion rather than a clinical interview. They kidded me about how young and naive I’d been when we first met. So I asked why they’d kept coming back. We didn’t have a choice, they said, only half kidding, but added that, in spite of my rawness, they felt a visceral connection—they liked me. I was funny and I seemed to care. And most important to Joe and Tanya, I never gave any clue that I saw either of them as terrible people.

Laura, who was working as a schoolteacher, reported being happily married to a man who worked in the computer industry. I felt a bit sad when she told me matter-of-factly that they’d decided not to have children—a decision that, when I asked about it, she thought might be connected to the lingering impact of her own abuse. As she explained it, “I’ve never really developed much of a tolerance level, and kids take a lot of tolerance.” Nevertheless, her career brought her in daily contact with children, and both she and her husband agreed that not having their own children was a good decision.

Don was in a long-term committed relationship with a man the family embraced. Tanya and Joe, both real estate agents, were still married and assured me there had been no physical abuse since the therapy. They regretted that they had no grandchildren, and calmly told me that they believed it was a result of their poor parenting. The once disheveled Tanya looked especially good. She’d become an exercise enthusiast, walking and doing yoga regularly. She reminded me that many times in sessions, when things would escalate, I’d make everyone stop and take deep breaths. Tanya said she still thought of those moments often when she was doing yoga.

Both Tanya and Joe admitted that they still had a great deal of shame over what they’d done to their kids. While everyone expressed some sense of accomplishment at how they’d survived and made their way through life, they agreed that they weren’t a very close family. They stayed in touch, but saw each other only on holidays and all felt, in their own ways, that there would always be a cloud over their heads.

They said that they wanted me to know that what stood out for them about the experience of therapy with me was that it had provided them with hope, something they’d never experienced before. I asked what had produced this hopefulness, since it was abundantly clear to both them and me at the time that I often had no idea what I was doing. First and foremost, they recalled, it was my constant focus on safety—something that was new to them. “Do you feel safe with me? Do you feel safe with each other?” I kept asking. Safety had been my mantra.

They also talked about how energizing our sessions were; in spite of all the difficult things we discussed, we regularly had fun together. They remembered the games we played, particularly the time we’d gone bowling together. The humor in our sessions, especially my ability to laugh at myself, created a positive energy and a sense that none of us needed to worry about being perfect.

For the entire family, the experience of therapy had been like school. Because of Joe and Tanya’s history, neither really knew how to be parents or spouses. Consequently, they’d welcomed the skills and solutions they’d learned—how to make “I” statements, how to fight fair. They talked about how they’d learned in therapy to be parents for the first time. They were deeply moved that even after hearing the worst about them, I still liked them and believed they could be different. They felt empowered when I asked them what they needed without assuming that I already knew. That helped them feel respected and heard and motivated to achieve their goals.

Near the end of that long interview, I asked Laura if she’d ever worried about whether she’d end up in an abusive relationship or would somehow pass on her own legacy of trauma. She looked surprised and said, “Don’t you remember that session?”

I asked timidly, “What session?”

“The session when you asked us each to write down our recipe for a loving family in which no one was hurt,” she said. “And, maybe to make it fun, you asked each of us to make out a recipe card, and then you laminated what we wrote and gave them back to us.”

She opened her purse and took out a tattered and torn 3-by-5 laminated card—her own recipe for the good life. Written 25 years before, it was derived from her experience of therapy and drawn from her own deepest sources of teenage wisdom at a time when her life—at least her prospects for any kind of happiness—was, in some ways, at stake. All these years later, she still carried her recipe with her everywhere:

– 1 cup – of no alcohol

– 2 tbs. – of having lots of fun together

– ½ cup – of going to church and practicing what was preached

– 3 tbs. – of following the rules of good communication

– 1 cup – of respecting each other’s boundaries and following the rules we all learned

– As many pinches as necessary of whatever it takes to keep us safe.

“That was my recipe for a healthy family,” she concluded. “I knew I’d only marry a man who had all those ingredients and could help me follow that recipe. I learned that here, and I’ve never forgotten it.”

Mary Jo Barrett

Mary Jo Barrett, MSW, is the founder and director of Contextual Change and coauthor of Treating Complex Trauma: A Relational Blueprint for Collaboration and Change and The Systemic Treatment of Incest.