A Shift for Victim
by Tim Baumgartner, Ph.D. Houston, TX
A 24-year old client who had been in therapy almost continually since her mid-teens presented a long history of sexual abuse and incest. Five years previously, she had been hospitalized for major depression and suicidal concerns.
At that time she reported abusive treatment by her psychiatrist. Complaints involved isolation when she refused medication, verbal insults, and suggestions of memories that she did not have. She reported that the psychiatrist subsequently lost his license.
Prior to seeing me, she was in therapy with another psychiatrist for five years. The client reported feelings of resentment and distress toward this psychiatrist. She reported that he insisted that she had engaged in specific sexual acts with her father. These acts were not consistent with her recollections. Therapy had included confrontation of the father.
The client was now married and had not been troubled by suicidal depression or drug abuse over the last three years. However, her history combined with her reported abuse by family, boyfriends, employers and treatment providers contributed to her depression, post-traumatic stress, and “victim” self-image.
Treatment began with the setting of clear boundaries and focusing on the client’s rights and expectations . Her abuse history was gradually disclosed, accompanied by expressions of fear and anger. The client agreed to the use of trance to shift her focus from the perspective of victim to one of curiosity and empowerment. She responded well to conversational inductions. The therapeutic focus was on learning and development as opposed to remediation. As she learned to express her feelings of anger and frustration, she began to express the need to “get away somewhere.” Her fantasy was to take an island vacation, but she believed that she required psychiatric inpatient services to stabilize her thinking.
In our discussion, she expressed that the dollar price of the short hospital stay would be about the same as the desired vacation, however, she was concerned about her husband’s “emotional price tag” that would result if she took a vacation. In therapy, I suggested that some people “prepay” vacations so they can enjoy the entire experience knowing that there would be no legitimate bill waiting on their return. She was challenged to determine all “hidden” costs and experience them affectively and interpersonally, as soon as possible, so she could begin anticipating her trip.
The client accepted this suggestion, and shifted her focus from anticipation of hospitalization to planning for the trip. She took the vacation while her husband stayed home. Upon her return, she reported that she had successfully set boundaries with her husband and did not assume any emotional debt for her trip.
The metaphor of the vacation was used to reinforce her inner strength and independent action. The client reported successful goal planning, boundary setting, calculated risk taking, initiation of interpersonal relationships, and a feeling of inner courage and empowerment. Over the following months, she remained in therapy and reported that the vacation provided a “turning point” for her. The client enrolled in college and performed well. While the change from “victim” to responsibility was rapid, and occasional slips into the former role occurred, the resources for change were integrated within her.
Otani, A. & Koska, M., (1992). “The dialogue technique of hypnotic induction.” American Journal of Clinical Hypnosis, 35, 1, 20-28.
Phillips, M., (1993). “Turning symptoms into allies: utilization approaches with post- traumatic symptoms.” American Journal of Clinical Hypnosis, 35, 3, (179-189).
Rosen, S., (1982). My Voice Will Go With You. New York: W.W. Norton
by Gene Davita, M.D.
Baumgartner focused on presenting issues in the past as well as present boundary violations and abuse from numerous sources including professionals. Establishing a therapeutic relationship with clear expectations, respect for the rights of the patient and opportunity for her to express her emotions was paramount. This established a fluid, process focused therapy in which change could be promoted.
The patient seemed adept at trance since conversational induction worked well. She was able to move from the victim position to one of empowerment rapidly. More traditional therapeutic approaches that encourage hours of exploring victimization experiences can further crystallize that role. Such a shift in the therapeutic paradigm for a patient allows responsibility, self-assertion and creativity that universalizes to all areas of living.
The patient’s concerns with the cost of hospitalization presented Baumgartner with an opportunity to employ an Ericksonian approach and the patient’s fears then could become a useful part of therapy. The vacation metaphor allowed the patient to experience “getting away” and to create an experience that furthered her responsibility, assertion and individuation . This created even more encouragement for further growth and development in living by using the skills developed while turning a dream into a reality. She was further empowered by beginning to create a life of self hood rather than perpetuating the life of a victim.
Baumgartner’s work with this patient, who presented with a multitude of serious problems, demonstrates therapeutic elegance in his work with one aspect of her problems. The assistance of movement from being reactive in her life to being the source of creating her life was important. This resolution can serve as a springboard for future therapeutic advancement.