Child Abuse and Treatment Examined

The subject of what appears to be the wilful hurting of the helpless and the relatively innocent is full of contradictions and complexities. It is always difficult for any adult observer to know exactly what has happened to a child. Legal authorities, obliged to investigate charges of sexual and physical abuse, are familiar with this difficulty; and so are psychological workers who hear traumatic stories from their patients or who begin to feel that such stories are there for their patients to tell. This difficulty in establishing fact about childhood is especially true from my vantage point as a psychiatrist who sees adults. Fantasies of having been seduced are universally present. Conscious memories are unreliable and historical truth is not easy to ascertain. Even for those who see the purportedly abused child at or shortly after the alleged trauma, establishing what happened and ‘who did it?’ can be almost impossible, and the attempt to mediate between the purported abuser's version and the child's (particularly if legal considerations are involved) is frequently damaging to the child, especially if, as is so often the case, the abuser is a parent. There is a formidable universal psychological resistance to the idea of a bad - a depriving or abusing - parent. Unconscious identifications with parents form the cornerstone of our identities and our self-esteem.

So the problem of disassociating fantasy from memory remains formidable, for therapist and patient alike. The possibility of adult and parental seduction and torment should neither be assumed nor denied. The therapist must be able to suspend disbelief. Pathological doubting is often a consequence of child abuse. In most cases repetition of the past in the course of the treatment (usually in relation to the therapist) will make the probability if not the certainty of the traumata clear. (Sometimes the therapist feels no doubt about the reality of the abuse, for example if the parents - sometimes as grandparent