You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
This book centers on the impact that working with survivors of childhood sexual abuse has on psychotherapists. The authors believe that this type of work can have such a negative impact that the therapist's values, ideology, and entire personality are at times compromised. As a result of this “vicarious traumatization,” they argue, countertransference responses become less accessible to consciousness, leading in many cases to an impasse in the treatment. Pearlman and
Sakvitne prefer to call their patients clients, on the assumption that they can avoid the asymmetry that the word patient seems to connote to them. I would argue, however, that any therapeutic intervention is by definition asymmetrical, though this implies no hostile design on the therapist's part. If the patient is prone to view the nature of the therapeutic relation as by nature humiliating, that in my view will not be avoided by a psychological trick. Even were the trick to work, the meaning of the patient's idiosyncratic understanding of the relationship would remain unexplored. Such an approach can foster a manic defense based on the unconscious fantasy that there is no difference between adults and children, thereby reenacting in the transference-counter-transference relationship the belief that there are no adults who know right from wrong.
The authors describe with commendable honesty their personal experiences in working with severely traumatized patients. They discuss the anxiety, pain, guilt, and hopelessness to which the therapist is inevitably exposed. The wealth of clinical material allows the reader to identify with the therapeutic interactions that take place, especially the loneliness and isolation to which we are exposed when trying to help, and shows how this dynamic becomes a traumatic experience for the therapist. The authors describe how the practitioner involved exclusively in the treatment of these patients can develop a countertransference that is not specific to a particular i