An Interpersonal Psychoanalytic Approach to Treating Adult Survivors of Childhood Sexual Abuse

Interpersonal Psychoanalysis is ideally suited to understanding and facilitating change in adult survivors of sexual abuse. From its inception with Harry Stack Sullivan, interpersonal psychoanalytic theory has emphasized the crucial impact of interactions and relationships on character and self-development. With its focus on anxiety and dissociation (e.g., the “not-me”), Sullivan's theory can be viewed as a theory of trauma. Contemporary interpersonal writers have further developed our understanding of the impact of dissociative processes. Sexual abuse is relationally based in its occurrence and the ways in which survivors process it. Interpersonal psychoanalysis, with its emphasis on the two-person collaborative model, allows the adult survivor to analyze and process the abuse memories and their aftereffects in a here-and-now relationship in which the subjectivity of each participant affects the other.

The interest in childhood sexual abuse and its effects emerged as a result of the confluence of several developments. The feminist movement heightened awareness of the victimization of women. This included focusing attention on how childhood sexual abuse and its aftereffects impacted on the development of the feminine self. At the same time, many Vietnam veterans were found to be experiencing surprisingly enduring and disruptive aftereffects of the war that were understood as posttraumatic stress. Also, some clinical thinkers “rediscovered” the importance of Freud's “seduction theory” and questioned its abandonment a hundred years ago (Herman, 1981; Masson, 1984; Miller, 1984). What began to come to awareness from practice and research was an appreciation of the similar symptoms of all trauma survivors. This resulted in a body of work known as trauma theory. Our practice with adult survivors of sexual abuse is informed by this theory. This paradigm, however, does not