Healing from Childhood Abuse, Trauma and Neglect (Part 1)

When searching for counselling and therapy to heal the wounds of trauma, childhood abuse, and/or childhood neglect one can be faced with an overwhelming myriad of choices.   Most treatment techniques (both  medical and psychological) that are studied scientifically take into  account that a significant percentage of those being studied get better spontaneously simply because they believe they are being given help  (called the placebo effect).

A number of new approaches that take into account the recent discoveries of neuroscience, made possible by modern brain imaging techniques, have been shown either scientifically (in placebo controlled randomised blind or double-blind studies) or anecdotally (based on empirical observations and patient/client reports) to be highly effective in a shorter period of time than conventional "talking only" therapy. All of these approaches, of course, need to be integrated by a skilled and experienced clinician, into an overall treatment style and plan that will include talking therapy as well as a healthy respect for the power of the therapeutic relationship and the need for the therapist to earn the client's trust by creating safety.

Below I list some of the approaches that have been shown to be effective  with survivors of adult trauma and childhood physical, sexual, and emotional or psychological abuse, plus a link to another blog entry I wrote on effective  approaches for those suffering from the effects of "poor affect regulation",  commonly caused by emotional neglect or the unavailability of reliable  soothing in early childhood.  I only list those methods that I have personally learned and tried and observed to be effective, and the reasons (if known) that they work. 

Affect regulation treatment approaches are also useful with survivors of trauma and/or childhood abuse. The basis for this is  described in a separate blog entry (Learning to Comfort and Soothe) as they are more generic therapy approaches used for a broader range of problems and causes.  Since writing that entry, I have been learning about "memory reconsolidation" which claims that rather than going through the painstaking process of learning to "regulate" out of control feelings, one can "re-write" the implicit memory itself so that feelings become self-regulating, as they would have been if the original "dysfunctional implicit memory" hadn't been laid down in the first place. I will explore this in depth in another blog entry (coming as soon as I finish writing it).

I mention anecdotal or scientific (placebo-controlled) in brackets next to the name of each approach to identify the type of documentation of  effectiveness. I include approaches that have primarily anecdotal evidence because it is extremely difficult to measure approaches to complex trauma and dissociation in a laboratory setting.  In my opinion, there are too many uncontrollable variables once you try to measure treatment effects with this population, especially since it isn't ethical to in any way limit access to anything that might help simply because it could confound the scientific evidence of your study.  The DNMS, Sensorimotor Psychotherapy,  and Ego State Work, for example, have ample anecdotal evidence presented in scientific journals as controlled case studies, and are based upon modern scientific insights into the brain,  but that is not the same as evidence based on rigorously controlled scientific studies.

Ego State Therapy (anecdotal)

Founders: John and Helen Watkins

The concept of segmentation of personality into discreet parts of self has been around for many years, but has only recently been validated scientifically by new brain scanning technologies. These technologies, by measuring blood flow patterns in the brain, demonstrate how ego states are formed by neural clusters repeatedly firing together (and therefore "wiring together"). 

Such neural nets form the basis for most implicit learning - such as learning how to ride a bicycle - a skill that improves and eventually "clicks" as the neurons, which fire together in the same pattern whenever riding is practised, form a network with a particular skill set. When such a neural net forms in the context of a relationship, it will develop a unique point of view and way of behaving.

Ego states exist as a collection of perceptions, cognitions and emotions in organised clusters. An ego state may be defined as an organized system of behaviour and experience, whose elements are bound together by a common principle. Ego states may also vary in volume. A larger ego state may include all the various behaviours activated in one's occupation, whereas a smaller ego state might be formed around a simple action, such as using a mobile phone. They may encompass current modes of behaviour and experiences or include many memories, postures, feelings, etc., that were learned at an earlier age.

The human mind is a collective "family of self" within a single individual. How well these "family" members get along, and how effectively they cooperate can vary considerably from individual to individual. 

This segmentation has been called many names over the years, depending upon which psychological theory is being used. In Freudian language we are all divided into Ego, Id and Superego; Jungians refer to "complexes" which are described almost identically to ego states; Transactional Analysts talk about the internal Parent, Adult and Child; and Psychosynthesis refers to "sub-personalities." Ego states exist on a continuum of separateness, with the most extreme dividedness being caused by the most extreme early relational trauma.

Although everyone has ego states, those states formed in response to loving supportive experiences do not tend to require psychotherapeutic intervention. When ego states are more split off and engage in internal battles, Ego State Therapy can be employed to help resolve some of these conflicts, often using techniques found in conflict resolution, group or family therapy, to enable a kind of internal diplomacy. This approach has demonstrated that complex psychodynamic problems can often be resolved in a much shorter period than with analytic therapies. 

Self Empowerment: Actualizing the Power Within

To experience empowerment we must act on a sense of self worth, value and give voice to our own needs, and give equal validity to our own needs as to others'. As we develop a sense of empowerment, we begin to discover that a conflict of needs actually can present us with a creative challenge to imagine solutions that can empower all parties involved (rather than fearing that a conflict of needs must necessarily result in a "win-lose" battle).  I offer the following vignette as an example:

Mary does child care every night so John can go out with the "boys".  Mary becomes more and more resentful of John and their young children.  Finally, Mary initiates an assertive "conflict".  She says:

"I understand that you work hard all day and need time in the evenings to relax and unwind, but I've never pointed out to you that for you to relax and unwind by going out every night, you are counting on me to stay home with the kids, which is what I do all day.  So I don't get to relax and unwind and I become more resentful toward you and the kids and unpleasant to be around.  I need escape time too.  I'd like us to work out a way that we can both get what we need."

John agreed that Mary had become very unpleasant to be around (and didn't hesitate to tell her so.)  But after a number of arguments, they came around to agreeing on an experiment.  The experiment was that once a week John would go out while Mary watched the children, once a week Mary would go out while John watched the children, and once a week they both went out while Mary's mother watched their children.  The other two evenings they all stayed home as a family.  After two weeks of this experiment, not only did Mary feel better, but John felt better as well because he was feeling closer to his children and getting less resentment from his wife--and he still had time to see his friends.

The word "compromise" does not adequately describe the process of creating a "win-win" solution.  Compromise implies that neither side really gets what they want, whereas in "win-win" solutions, both sides get as much if not more than they wanted originally.  Assertiveness means acting from a place of respect – for self and other – and assuming equal value to the needs of self and other.  This presents many dilemmas that can also be seen as possibilities.  Power--the power of creative problem solving and acting--is mobilized rather than suppressed.

Power

Traditionally power has meant different things for men and women, taking on more positive connotations for men.  Think of the following words, first for men and then for women.  Pay attention to the feelings they evoke:

Men	Women
Powerful	Powerful
Aggressive	Aggressive
Forceful	Forceful
Ambitious	Ambitious
Assertive	Assertive
Competitive	Competitive
Authoritative	Authoritative

      

1. Women have traditionally been expected to defer to men, and have internalized the dominant cultural expectations of females as submissive and powerless

and

 2. There is something wrong with the present system of power distribution for all people, which we, as women, may be particularly sensitive to, having so deeply learned to respect the importance of other people's needs.

 As we endeavor to compete with men as their equals, some of us feel there is something sour about climbing up a ladder on top of other worthy people's heads, something deceitful about the notion of inferiority and superiority in our fellow human beings. We see that to gain others must lose, and having been relegated to losing for thousands of years, we may not feel comfortable inducing that experience in others.

When some people have less power than others do because external forces (e.g. money, status, physical strength, military force) block them, many problems arise for both the "winners" and the "losers".  The "losers" become afraid to express their needs because they fear (often rightfully) that what little they have will be taken from them.  They then become afraid to even feel their needs, to admit to themselves that they want something.  They become immobilized.  And, in certain critical ways, they stop growing; cease to thrive; development (the Power from Within) is blocked. The "winners" then miss out on the experience of sharing with equals and become self-preoccupied.  Their development is also blocked.

Let's consider these questions:

1. How do we reclaim our rights to power and effectiveness in the world without doing so at the expense of others?

2. How can we, as women, integrate the profound knowledge we gain from mothering and being nurtured by our mothers -- i.e., that we are each special, unique, and worthy in our own right, into a culture where value is so often seen in material terms?

We may want to begin by developing our own vocabulary to describe our experiences and perceptions.  Without words to communicate our experiences, we are trapped and limited.  If power only means the power to force others to do our will, we will feel that power is foreign to us, awkward and unfamiliar.  But power means many things, and many aspects of power can feel right for us.

I offer the following words and phrases to begin reclaiming our own vocabulary taken from Simos 1987 - (see below*)

 Power Over: the ability to force others to do your will through physical or financial coercion.  The power inherent in social or economic positions, or physical size or strength, regardless of skill or ability.

 Shared Power: power whose goal is to uplift or teach others to bring them to parity, as with a parent/child, teacher/student, or psychotherapist/client relationship

 Referred Power: the power others give us because they value, respect, and/or are attached us

 Expertise Power: the power others give us because they count on our knowledge and judgment

 Power With: the power to be effective interpersonally, to persuade, to inspire (not “command” or force) respect

Power From Within: the power of growth and development inherent in all living things.  It is the power to change, to overcome obstacles, to face our own fears, to learn new skills, to fail, and to try again.

Power can be used to destroy or create, to belittle others and over-inflate the self, or to belittle the self and over-inflate others.  We may call the use of power to harm or belittle the self passive power, and to harm or belittle others aggressive power. In contrast, assertiveness can be seen as the use of power to enhance and respect both self and other.  Assertiveness training, then, can be a way for women to reclaim their rights to power and effectiveness in the world without doing so at the expense of others.

Recommend this on Google Plus  

 * new vocabulary words taken from Miriam Simos (Starhawk) Truth or Dare, Harper & Row Publishers, New York, 1987

 Suggested Reading

Jean Baker Miller, M.D. (1976). Toward a New Psychology of Women. Boston: Beacon Press

Pamela Butler (1981) Self-Assertion for Women. New York: Harper & Row Publishers

Margaret McIntosh () Feeling Like a Fraud a Work In Progress Paper of the Stone Center for Developmental Studies at Wellesley College, Wellesley, Mass., 02181

Miriam Simos (Starhawk) (1987) Truth or Dare. New York: Harper & Row Publishers 

Myths and Truths about "Happy Couples"

                                        by Judy Lightstone © January 2012

This article is partially based on extensive laboratory and longitudinal scientific research about couple satisfaction in long term relationships as presented in the book The Marriage Clinic, by John M. Gottman, published by WW Norton & Company in 1999.  Please see this book for more resources.

Most of us know by now that the fairy tale happily ever after stories are full of holes. Dashing men on horses don't usually rescue helpless women and live happily ever after in real life.  But most of us don't know how inaccurate our current popular expectations and beliefs are about what makes "marriage" work are (and by this I mean any long term committed romantic relationship).  

Mostly we look around at such things as divorce statistics and see that a lot of them don't work  This assessment is also unfair, given that this doesn't include long term committed relationships outside of marriage, nor does it consider that relationships may last several decades and still be included in divorce statistics. Most importantly, the numbers don't tell us what allowed some relationships to last and others to break up, and they don't tell us how much overall satisfaction existed in those relationships that stayed together or broke up.

Many of the following cultural myths perpetuate some of the problems that bring couples to counselling.

MYTHS
1. Arguing = trouble.
2. Distance = trouble.
3. Opposites attract.
4. Flattery will get you nowhere.
5. You have to agree on the BIG issues (like children, sex and money).
6. People divorce because they “grow apart”.
7. Couples divorce because they get older and change physically.
8. The more sex the better.
9.  A fat woman will lose her man.
10. Both partners have to be equal in a good marriage.

TRUTHS

1. Fighting per se is not necessarily a problem.  If there is basic mutual respect, the ability for partners to cool down and soothe each other afterward, and lots of good stuff in the "emotional bank account", the tendency to fight is more a result of personality style than trouble in the relationship.  In his book The Marriage Clinic, John Gottman talks about the "emotional bank account"  and the "fondness and admiration system" in which he describes the ability of a couple to draw on "stores" of good feelings that have been deposited there by each partner.  It is the ratio of negative interactions and positive interactions -he advises the ratio should be at least 5 (positive) to 1 (negative) -that is more of a predictor of a satisfying relationship than the number of arguments.  Some couples like to handle problems directly, and if each of the two people are this way, then they may resolve their problems more quickly and with less bitterness if they approach them head on.

2. Other couples are more avoidant and have a similar level of tolerance for putting off confrontations.  It is the compatibility of problem solving style between the two people rather than the style itself that is more predictive of failure. When two people prefer to avoid conflict together they don't necessarily get into trouble unless this escalates to avoidance of positive regard for one another.  If they can accept each other's differences and remain loving toward one another they may be able to avoid conflict for a long time.  It is more a problem if one is a conflict avoider and the other is a conflict confronter.  This difference can be worked out (although sometimes help from a therapist is required) if there's a lot of overall positive regard.

3.  Differences may make the courtship stage of a relationship more exciting, but they can make a lasting relationship more difficult.  Not all differences are alike, however.  The most important differences that can cause trouble are: difference in conflict style (see above), differences in mutual respect for each other's life dreams (note I did not say the dreams had to be alike, only the amount of respect accorded the other person for his/her dreams), differences in libido (sexual drive), differences in lifestyle (e.g. degree of accumulation vs. simplicity desired), etc.  All of these differences can be worked out in a healthy relationship and don't necessarily signal danger - they just make things harder rather than easier.

4. Some would say the solution to all marital difficulties is honesty - always saying what is on your mind because that is the Truth.  But in my practice I have seen this become an excuse for disrespect and contempt, and these are the things that will cause ruptures rather than healing.  True, people need to be able to express themselves freely to their partners, but this doesn't mean there is no room for tact.  And what may feel "honest" at one moment, may feel irrelevant at another.  Flattery, if that means complimenting your partner frequently, showing your affection regularly in symbolic or romantic ways, and bragging about her or him to others - will get you everywhere.  I don't mean saying things that aren't ever true, but focussing on the positive and building up credit in that emotional bank account makes a huge difference in how well your relationship will weather rockier times.

5.  There isn't a couple around today that doesn't have some "BIG" issue that it can't resolve.  There are too many choices and options available today to assume they must all be agreed upon in each romantic partnership.  Gottman estimates that 60% of all problems couples encounter are ultimately irresolvable.  Once again, the issue isn't the problem itself,  it's how couples learn to manage perpetual problems over the long haul.  This point is critical to understand.  As in other areas of life, many problems stay with us a long time- some throughout the life span - what matters is how we cope with this fact.  Do we comfort each others' experiences of frustration? Do we accept that there are some things that may never be perfect but know that we can keep trying anyway? Do we have enough good stuff in the bank to get us through? Gottman calls this the ability to "dialogue with perpetual problems".  Ultimately, it's the quality of the dialogue, not the seeming seriousness of the problem itself, that will predict the success of the relationship.

6.  Although this may be somewhat true when couples meet at a young age, because the younger they start, the more quickly they will change and might simply become so different they are no longer compatible, for most couples who claim they just "grew apart", this is an excuse that tends to gloss over the deeper issues that can cause serious trouble in a love relationship. 

So if fighting, avoidance, differences, growing apart, and "honesty" aren't the real problems, and huge differences like children, sex and money don't necessarily predict disaster - why is there so much divorce? And what is the solution?  Gottman refers to the "Four Horsemen of the Apocalypse" as being:  1. Criticism 2. Defensiveness 3. Contempt and 4. Stonewalling, and says these 4 patterns are the most reliable predictors of divorce/separation or of a long but miserable relationship. When these four horsemen take over a relationship, the end is near, even if the couple physically stay together.  But with help (professional help is usually necessary for this) you can learn to consistently "build in the antidotes.¹"

Here are some "antidotes" I have found effective:
*for Criticism: try complaining without suggesting that your partner is somehow defective
*for Defensiveness: try accepting responsibility for a part of the problem
*for Contempt: learn to create a marital culture of praise and pride to replace the contempt, and
*for Stonewalling: provide self soothing, stay emotionally connected and give the listener nonverbal cues of your attention.

7. Attraction is more related to what's in the emotional bank account than to physical appearance.  When loss of attraction or change in physical appearance is used as an excuse for divorce or constant criticisms,  it is more indicative that the person doing the criticising is having self esteem or identity issues.  Although these problems may require individual or couples treatment,  it is not physical changes that are at the heart of the deterioration of a marriage.

8. Sexual compatibility, not frequency, is the key to couple sexual satisfaction.  Difficulties (again, not irresolvable) arise when there is a difference in the amount of sex desired by each member of the couple.  Many satisfied couples have little or even no sex because this is all each of them desires.  Gottman found that it is the nature of the friendship, more than the frequency of sexual relations, that gets people through in the long run. When frequent sex is desired by both partners, and sex is part of the overall fondness and affectional system, it can be a wonderful asset.  When one is wanting more sex than the other, it is likely to cause stress in both partners.  However, more often than not, the development of sexual problems is a symptom rather than a cause of relationship difficulties. Because sexual intimacy requires each partner to be vulnerable to the other, when the relationship is experienced as emotionally unsafe by one or both partners, sexual disturbances will likely arise.

9.  I have worked with many couples who were dealing with changes in one partner's body size.  I have seen some couples break up when there was no perceptible physical change and other couples thrive through considerable physical changes. When there is a wealth of positive regard in the relationship, physical attraction tends to follow that regard.  It is unfortunately common for someone with an eating problem to project their body image insecurities onto a partner.  This can be true for certain same sex couples too- one partner "absorbs" the bad body feelings and the other projects them.  When this is the case it is important for each member of the couple or family to work separately on his or her eating problem and put a special effort into being loving and respectful of the partner's food and body boundaries.  It is not easy to go against the cultural dictate of thinness for everyone, but a family can work together to develop a culture of love and respect for differences that will ultimately solve way more problems than the temporary (for usually it is no more than that) weight gain or loss of one or more of its members.

10. There are many ways for couples to share power and responsibility that do not necessarily correspond to absolute equality in all areas.  What is more important is that each partner have equal influence on the other.  Weiss'² coined the term: "positive sentiment override" (PSO) to describe this ability.  He coined the term "negative sentiment override" (NSO) for the opposite. What this means is that when partners feel trusting  of one another, they tend to hear each other's suggestions and complaints non-defensively. There doesn't have to be agreement on the issue, just willingness to talk about the differences. Statements judged neutral or negative by observers can be interpreted positively by a partner with a couples history of respectful conflict (PSO) just as statements judged neutral or positive by observers can be interpreted as negative by a partner with a  couples history disrespectful conflict (NSO) as in the following examples.

PSO Example:

Partner 1: Will you shut up and let me finish?

Partner 2: Sorry, go ahead.

Though partner 2 may not be very happy about this comment, he still recognises that his partner felt hurt by his interruption and gives her the benefit of the doubt.

NSO Example:

Partner 1: Will you shut up and let me finish?

Partner 2: To hell with you, I’m not getting a chance to finish either. You’re such a bitch, you remind me of your mother.

Here partner 2 assumes negative intent and feels he must defend himself.

In summary, this does not mean that a couple in trouble can just start being loving and affectionate during their arguments.  It takes work and often professional intervention to get out of negative cycles.  Repeating affirmations that have no meaningful basis is not the solution either.  Genuine positive regard, if not already deeply embedded in the marriage, can only emerge once the relationship is made emotionally safe for both partners.
************************************************************************

*   * This article does not apply to couples struggling with physical or sexual abuse. Much stronger interventions are required in those cases to first and foremost keep all parties physically safe.  For resources on this topic, please see: http://www.womensrefuge.org.nz

Link to:  Couples therapy

Notes:

1. Gottman, John M.  The Marriage Clinic, NY:  WW Norton & Company; 1999, page 193.
2. Weiss, R. L. (1980) Strategic behavioral marital therapy: Toward a model for assessment and intervention. In J.P. Vincent (Ed.), Advances in family intervention, assessment and theory (Vol. 1, pp. 229-271). Greenwich, CT; JAI Press.

Learning to Comfort and Self-Soothe

In human infants and children, the ability to comfort oneself is learned through extensive experiences of healthy "bonding" with one's caregiver/s from early on. Healthy bonding requires long periods of holding, cuddling, mutual gazing and adoration between child and caregiver/s, and that the child is kept safe and protected from abusive or violent experiences, especially in the family. Early emotional neglect, childhood abuse and/or the unavailability of reliable soothing in early childhood, which can be due to many causes, such as illness in the caregivers, can have dire consequences when the child grows into adulthood.

We now know that such safety and bonding are necessary for the infant's optimal brain development, which results in the child's ultimate ability to learn how to comfort him/herself. A child that grows up unsafe, and/or without this "bonding and holding" will be vulnerable to experiencing repeated unnecessary alerts set off by the "survival" (hind) brain throughout their lifespan; signals that survival is threatened even when it isn't. These signals shut down optimal functioning of the "human" (thinking) brain, leading to difficulties in word retrieval, interpersonal skills, and concentration when such skills may be most needed. When an adult can't naturally self-soothe, s/he may become dependent on tension-reducing activities that can appear self-destructive, but in actuality are desperate attempts to calm the body down, some by forcing a flood of endorphins. Such tension-reducing activities include smoking, drinking, self-harm, compulsive gambling, overeating, purging, self-starvation, and sexually risky behaviour. Compare this to people who grow up safe with loving and supportive caregivers, who are able to self-soothe with little effort as adults because the learning is deeply embodied from infancy.

The combination of repeatedly experiencing anxiety in situations that aren't actually dangerous, with a compromised ability to calm oneself when such anxiety does occur, also makes it more difficult to fall asleep at night or to get a full regenerative experience from sleep. Having difficulty soothing oneself can also mean having difficulty taking in comfort from others, even those who are trying to be kind and supportive. This can cause problems in one's most intimate relationships.

All of these difficulties fall under the psychological category of "poor affect regulation," which understandably often results in a tendency toward the kind of harmful attempts at tension reduction described above. Standard forms of “talk therapy” that do not address the physiological shutdown caused by an overactive survival response are unlikely to be effective, because the client will spend a lot of time feeling unsafe. When feeling unsafe, the talking (‘human”) brain is not working adequately enough to integrate verbal interventions. Therapeutic approaches that focus on analysing one's thought patterns are called “top down” therapy – because they address the “higher” brain functions while ignoring the lower brain functions, such as survival reactions.

There are a number of psychotherapeutic approaches that work from the “bottom up.” These are especially effective for those suffering from the effects of "poor affect regulation." Many of the techniques have been integrated into PSI (PsychoSomatic Integration) Therapy, and are taught to counsellors, psychotherapists and psychologists to help them learn to address these kinds of problems more effectively with their clients.

Click here to find out about distance learning programmes and here to find out about general training and supervision options.

Overcoming Powerlessness

"We who lived in concentration camps can remember the men who walked through the huts
comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms -- to choose one's attitude in any given set of circumstances."-- Victor Frankl

When you feel powerless, you feel afraid to express your needs because you fear (often rightly) that what little you have will be taken from you. You may have learned powerlessness if you were kept in powerless positions repeatedly and/or over long periods of time (possibly during childhood) by those who used external forces (money, physical strength, legal status, and/or military force) to control you. You may have been abused as a child, a partner or spouse, an employee, a soldier, or you may have been the victim of racial or ethnic attacks. Such prolonged abuse can cause you to become afraid to feel even your own needs, i.e., to admit to yourself that you need something. You become immobilized. And in certain critical ways you stop growing, you cease to thrive.


Distinguishing Externally Imposed Powerlessness from Learned Powerlessness


When powerlessness is "learned", it becomes self-perpetuating, even if the external forces are no longer there. An abused child may grow up to feel permanently powerless as an adult, even though his/her parents no longer have physical or economic power over him/her. One may then enter into a situation that repeats childhood experiences (e.g., living with or marrying an abusive partner), and therefore keeping oneself in externally imposed danger. Or one may keep oneself down through self-abuse, compulsive behaviors, and/or depression...because the powerlessness has become internalized.

This is different from the externally imposed powerlessness of racial, class, and gender oppression, which may be enforced through economic, legal, physical, or military, might. The secretary who is being sexually harassed, the single mother who cannot get a promotion due to sex discrimination, the homeless family that cannot afford housing: these are victims that require collective power and direct action to overcome their powerlessness. Collective power may take the form of a union, or a "network" of friends, supporters and professional helpers. Direct action might involve a lawsuit, going to the media, or organizing a strike or protest. Collective power and direct action together make an even more powerful combination.
Even more insidious than this is when--as is often the case--externally imposed powerlessness is combined with learned powerlessness. When this is the case, the above methods are not possible because the person is emotionally incapable of asserting her/his rights.

Overcoming Learned Powerlessness

The first step to overcoming learned powerlessness is to learn to feel entitled to your personal rights. You have the right to live a life free from physical, emotional, sexual, and financial mistreatment. You have the right to be treated with respect, to earn a livable income, to be informed of matters that affect you, and to express yourself freely (without harming others). Most importantly, you have the right to ask for what you need (even though you may be turned down) and to fight for what you need and want (even if you are turned down!). This list of "legitimate entitlements" is easier to read than to experience. Most people who have learned powerlessness barely feel entitled to speak, let alone to speak freely. Often professional therapy is necessary to overcome the ingrained patterns. Never the less, to overcome learned powerlessness, you must gradually, haltingly, but persistently lay claim to each and every human right, one after the other.

Click here to find out about distance learning programs for therapists and here to find out about general training and supervision options.

Improving Body Image

"If we place pornography and the tyranny of slenderness alongside one another we have the two most significant obsessions of our culture, and both of them focused upon a woman's body." -Kim Chernin

Body image involves our perception, imagination, emotions, and physical sensations of and about our bodies. It s not static- but ever changing; sensitive to changes in mood, environment, and physical experience. It is not based on fact. It is psychological in nature, and much more influenced by self-esteem than by actual physical attractiveness as judged by others. It is not inborn, but learned. This learning occurs in the family and among peers, but these only reinforce what is learned and expected culturally.

In this culture, we women are starving ourselves, starving our children and loved ones, gorging ourselves, gorging our children and loved ones, alternating between starving and gorging, purging, obsessing, and all the while hating, pounding and wanting to remove that which makes us female: our bodies, our curves, our pear-shaped selves.

"Cosmetic surgery is the fastest growing 'medical' specialty.... Throughout the 80s, as women gained power, unprecedented numbers of them sought out and submitted to the knife...." - Naomi Wolf

The work of feminist object relations theorists such as Susie Orbach (author of Fat is a Feminist Issue, and Hunger Strike: Anorexia as a Metaphor for Our Age) and those at The Women's Therapy Centre Institute (authors of Eating Problems: a Feminist Psychoanalytic Treatment Model) has demonstrated a relationship between the development of personal boundaries and body image. Personal boundaries are the physical and emotional borders around us.. A concrete example of a physical boundary is our skin. It distinguishes between that which is inside you and that which is outside you. On a psychological level, a person with strong boundaries might be able to help out well in disasters- feeling concerned for others, but able to keep a clear sense of who they are. Someone with weak boundaries might have sex with inappropriate people, forgetting where they end and where others begin. Such a person way not feel "whole" when alone.

Our psychological boundaries develop early in life, based on how we are held and touched (or not held and touched). A person who is deprived of touch as an infant or young child, for example, may not have the sensory information s/he needs to distinguish between what is inside and what is outside her/himself. As a result, boundaries may be unclear or unformed. This could cause the person to have difficulty getting an accurate sense of his/her body shape and size. This person might also have difficulty eating, because they might have trouble sensing the physical boundaries of hunger and fullness or satiation. On the other extreme, a child who is sexually or physically abused may feel terrible pain and shame or loathing associated to his/her body. Such a person might use food or starvation to continue the physical punishments they grew familiar with in childhood.

Developing a Healthy Body Image

Here are some guidelines (Adapted from BodyLove: Learning to Like Our Looks and Ourselves, Rita Freeman, Ph.D.) that can help you work toward a positive body image:

1. Listen to your body. Eat when you are hungry.
2 .Be realistic about the size you are likely to be based on your genetic and environmental
history..
3. Exercise regularly in an enjoyable way, regardless of size.
4. Expect normal weekly and monthly changes in weight and shape
5. Work towards self acceptance and self forgiveness- be gentle with yourself.
6. Ask for support and encouragement from friends and family when life is stressful.
7. Decide how you wish to spend your energy -- pursuing the "perfect body image" or enjoying
family, friends, school and, most importantly, life.

Think of it as the three A's....

Attention -- Refers to listening for and responding to internal cues (i.e., hunger, satiety,
fatigue).

Appreciation -- Refers to appreciating the pleasures your body can provide.

Acceptance -- Refers to accepting what is -- instead of longing for what is not.

Healthy body weight is the size a person naturally returns to after a long period of both non-compulsive eating* and consistent exercise commensurate with the person' s physical health and condition. We must learn to advocate for ourselves and our children to aspire to a naturally determined size, even though that will often mean confronting misinformed family, friends, and media advertising again and again.

*Simply stated, non-compulsive eating means eating when you are hungry and stopping when you are satisfied. This involves being able to distinguish emotional hunger from physical hunger, and satiation from over fullness. Link to: Compulsive Overeating for more information. Link to: Bibliography to view sources.


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Bibliography

The Obsession: Reflections on the Tyranny of Slenderness, by Kim Chernin, Harper & Row, 1982.

BodyLove: Learning to Like Our Looks and Ourselves, Rita Freeman, Ph.D., Harper & Row, 1988

200 Ways to Love the Body You Have by Marcia Germaine Hutchinson, EdD , The Crossing Press, 1999

Fat is a Feminist Issue: A Self Help Guide for Compulsive Eaters, by Susie Orbach,

Hunger Strike: Anorexia as a Metaphor for Our Age, by Susie Orbach, Norton Books, 1986

The Beauty Myth, by Naomi Wolf, Doubleday, 1991 to buy click: The Beauty Myth

Eating Problems: a Feminist Psychoanalytic Treatment Model, by The Women's Therapy Centre Institute, Basic Books, 1994