Academic journal article American Journal of Psychotherapy

Beyond Attachment: Psychotherapy with a Sexually Abused Teenager

Academic journal article American Journal of Psychotherapy

Beyond Attachment: Psychotherapy with a Sexually Abused Teenager

Article excerpt

When children are abused they utilize strategies already in place to cope with stress. These strategies develop during early life within the family and may be part of the unconscious framework formed within attachments and relationships. The case presented illustrates a teen-aged girl who was the victim of sexual abuse and experienced depression, PTSD and substance abuse. This paper describes the psychodynamic psychotherapy used to examine the patient's coping skills, which predated the abuse, and how these coping mechanisms were used to ameliorate her symptoms.

KEYWORDS: psychodynamic psychotherapy; emotional conditioning; worldview violations; terror management

INTRODUCTION

All people develop ways of coping with life stressors beginning as children. These ways of coping can be overwhelmed by horrific events, which may lead to psychological symptoms. Yet, a child's life is underway, with some coping strategies in place, before a stressful event (or series of events) takes place. In this paper the first question asked is theoretical: What is it about our early lives that prepare us, for better or worse, for what comes after a period of abuse? The second question for exploration is: How does psychodynamic psychotherapy address pre-existing coping strategies? The third question: How does the psychotherapeutic exploration help the child heal?

Early coping strategies develop in the context of relationships. Attachment, beginning in infancy, forms the framework for later relationships with primary caregivers and others (Bowlby, 1969/1980). As portrayed by Fonagy and colleagues, attachment is key because it leads to the development of reflective functioning and mentalizing abilities (Fonagy, 2001; Fonagy, Gergely, Jurist and Target, 2002). One way in which trauma affects the self is by disturbing attachment and mentalization, resulting in psychopathological consequences. However, attachment theory alone does not suffice in explaining disruptions in development. We also know that some degree of role formation, personality development and emotional conditioning serve as filters and guides, and, if there is abuse, will contribute to how a child processes and attempts to cope with the abuse (Kernberg, Weiner, & Bardenstein, 2000; Homer Martin, MD, personal communication, 2006; Adams, 1994; Adams; 1996; Adams-Tucker & P. Adams, 1984). This paper examines two theories, Emotional Conditioning Theory and Terror Management and Worldview Violations Theory, which extend beyond attachment theory, and create and uphold these early coping strategies.

EMOTIONAL CONDITIONING THEORY

Emotional conditioning refers to the unconscious role (thought and behavior pattern) acquired early in a child's life, by age 3 years. Its origin derives from classical Pavlovian behavioral conditioning: one stimulus becomes associated with a second stimulus in a cueing fashion (Pavlov, 1927). It is a form of unconscious learning by association that results in conditioned responses that can be either physical or emotional in scope. The conditioned response is involuntary and occurs automatically when a stimulus is presented. Two events occur together and are automatically associated. No new behaviors are learned.

Subsequent to Pavlov, Burrhus F. Skinner, a behaviorist psychologist, created the theory of operant conditioning in which the individual performs an activity and is then rewarded for the activity by a reinforcer or reward. Operant conditioning thus increases the likelihood the activity will reoccur in the future. (Skinner, 1974) According to this theory the individual operates on his environment via reinforcement.

The Austrian ethologist, Konrad Lorenz, added to conditioning theory. He observed geese in naturalistic settings during early periods of development and offered a theory of imprinting. This theory concerned irreversible learning very early in development. Young birds raised with humans imprinted upon, or were conditioned to, people, instead of to other birds, as love objects (Lorenz, 1973). …

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