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Section 9
Conflicts in Treatment of Child Sexual Abuse: Transference and Splitting

CEU Question 9 | CEU Test | Table of Contents | Child Abuse
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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On the last track we discussed and demonstrated the use of "leaning into"; responding with empathy; taking a one-down position, as well as, a quiet tone and eye contact to assist in building rapport with a client in a potentially volatile session.

On this track, we will discuss two barriers to treatment; transference and splitting. At the end of this track we will look at the steps to Expanding Self Trust and the use of Thought Stopping in altering transference and splitting situations.

As you know, transference is the projection of formerly learned interactions, feelings, attitudes and reactions onto current relationships. Janette, age 18 who had been sexually abused had many negative interactions, such as rejection, abuse and maltreatment, from people that she trusted. Thus, she expected others to treat her the same way.

Janette had a history of being sexually molested by her biological father for 10 years from the time she was 3 until she was 13, when her parents divorced. Janette came to me to explore why she always seemed to find and date boys who would took advantage of her. She made extra spending money by working at a fast food restaurant. Janette's transference was illustrated in the fact that her extra money quickly disappeared to boys like Carl, who manipulated her into buying meals, clothes and so on for them. She had just ended a relationship, in which she frequently found herself involved in her boyfriend Carl's financial and emotional problems.

Transference occurred once again when she decided to end the relationship with Carl when she found out about his buying and using cocaine. Soon afterward, she started telling me about a new love interest, Brad, who had many of the same issues as Carl. Within weeks she announced, "I have decided to drop out of school and marry Brad. My step-father and my mother don't want me to even date Brad."

As we continued therapy, she began to perceive me as being judgmental, and critical like her step-father and mother. Janette stated, "Why are you asking me about my marrying Brad? You are judging me! I love him and that is enough!" Clearly Janette was transferring her negative feelings to me as her therapist. After several sessions, Janette began to see the distortion in her perception and how she had clearly transferred feelings and perceptions she had internalized about her parents to me. I accomplished this by use of such techniques as "Thought Stopping" and "Expanding Self Trust" described at the end of this track.

When considering your Janette, are there issues or feelings she has transferred onto you?

As you know, in addition to transference, splitting and projection is another barrier to treatment. Many clients, like Janette, will often perceive the therapist in dramatically contradictory roles. Clients like Janette, who are involved in splitting and projection, may see the therapist as both the person who wants to help her and the person who does not care about her.

Let's look at Janette's perceptions of my role as her therapist. Janette stated, "You are the only person who understands my problems and listens to me." Then in another session, she stated, "You are an uncaring, sarcastic bitch who doesn't really know how to help me!" Janette would constantly test my reactions to her many abrasive comments. She would then sit, waiting for a negative response from me. By not reacting as Janette's projection of me to do, Janette learned that my interest in helping her would not diminish.

As you know, by treating me aggressively, Janette was using me to project her negative internalized experiences, therefore relieving her own inner tension. At the same time, it gave us an opportunity to discuss where her distortions were coming from.

John W. Jones wrote in Effective Group Therapy With Survivors Of Sexual Abuse "Splitting and projections, and primitive idealizations and devaluations, are all adaptive defenses to long term traumatic survival, and will often be acted out in group." Often the process looks like members of the group attempting to divide the group or collude with one another, making passive aggressive comments, or withdrawing.

Jones feels it is up to the therapists to name these processes and to help members to empathically work through their projections and self-loathing without shaming or devaluing the others in group. These individuals can and do trigger each other.

Technique: Expand Self Trust
I found for Janette the key was an exploration exercise used to Expand Self Trust.

At the end of one of our volatile sessions, I asked Janette to think of a time when she trusted and complete the following homework assignment.
She was to write a short paragraph about one or more of the following "trust experiences":
1. A time of trusting herself
2. A trustworthy place where she felt comfortable
and or
3. A trusting encounter between herself and another person

I asked Janette to use vivid, descriptive language in the present tense in her writings to help convey the image of these times and places.

During our next session, I asked her if she could adapt any of the elements of her "trust experiences" to her current situation. Janette had written about a trusting encounter with a friend. So, I dialogued with Janette about the specifics that she had learned in that "trust experience". She stated, "I learned that when I am starting new friendships, trust is a gradual thing. I mean I started with small stuff. You know things you don't really care if others know. As time went on I was able to share things that were really important to me, because it never got around."

As she increasingly became aware of behaviors and interactions that contributed to her trust, she then had new options she could translate to new situations. This exercise created positive momentum as Janette began to adapt the skills she used in her "trusting experience" to her current relationships.

Consider your Janette. Is he or she a black and white thinker? Would group therapy or the individual exercise of "Expanding Self Trust" benefit your Janette?

Technique: Thought Stopping
Now let's look at how I used Thought Stopping to refocus Janette's transference thoughts. As you may know with any distorted thinking process, Thought Stopping can be used to help your Janette realize and correct her thoughts.

According to Cruz in "Adult Survivors of Childhood Emotional, Physical and Sexual Abuse", Thought Stopping via use of a rubber band is an effective technique.

This is how it worked with Janette. I instructed Janette that when she first realized she was reacting to me as one of her parents, she needed to think the word "STOP" to interrupt the dysfunctional thought.

Next, I then had her substitute a positive or working coping statement and think it over and over again. An example she gave was, "You are not one of my parents. You listen and don't judge. What did you really mean by …?"

When the negative thoughts persisted, I suggested she might try wearing a rubber band around her wrist and gently pulling it, at the same time, she was thinking stop and her positive or coping statement. Janette stated, "It was hard at first. Negative thoughts about your judging me would creep into our sessions. But you know, once we added the snap of that rubber band and I kept reminding myself, you are not my parents. It really began to sink in. I guess you haven't changed, but my reaction to you has. It seemed to take weeks but my negative thoughts about you aren't happening as often."

Consider your Janette. How might practicing the Thought Stopping exercise benefit your Janette?

On this track, we discussed two barriers to treatment; transference and 'splitting and projection'. We also looked at the steps to Expanding Self Trust and the use of Thought Stopping in altering transference situations.

On the next track we will look at aggression and the desire to please, two more barriers to treating childhood sexual trauma and the use of Corrective Statements.

Peer-Reviewed Journal Article References:
Ferrajão, P. C., & Elklit, A. (2020). World assumptions and posttraumatic stress in a treatment-seeking sample of survivors of childhood sexual abuse: A longitudinal study. Psychology of Violence, 10(5), 501–508. 

Jones, T. M., Bottoms, B. L., & Stevenson, M. C. (2020). Child victim empathy mediates the influence of jurors’ sexual abuse experiences on child sexual abuse case judgments: Meta-analyses. Psychology, Public Policy, and Law. Advance online publication.

Karlsson, M. E., Zielinski, M. J., & Bridges, A. J. (2020). Replicating outcomes of Survivors Healing from Abuse: Recovery through Exposure (SHARE): A brief exposure-based group treatment for incarcerated survivors of sexual violence. Psychological Trauma: Theory, Research, Practice, and Policy, 12(3), 300–305.

Keller, S. M., Zoellner, L. A., & Feeny, N. C. (2010). Understanding factors associated with early therapeutic alliance in PTSD treatment: Adherence, childhood sexual abuse history, and social support. Journal of Consulting and Clinical Psychology, 78(6), 974–979.

Pogge, D. L., & Stone, K. (1990). Conflicts and issues in the treatment of child sexual abuse. Professional Psychology: Research and Practice, 21(5), 354–361.

Online Continuing Education QUESTION 9
What is the term used to describe a client's projecting two dramatically different perceptions of the therapist? To select and enter your answer go to CEU Test.

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