ask dr-robert

Dear Dr. Saltzman,

I don't know where to begin. I'm 31, and until recently, my depression, diagnosed 8 years ago, was being managed ok. But the last year has been very stressful, making me extremely anxious, and slowly my life has been unraveling. I don't know how long I would have let things go on without seeking help, but a routine physical with my doctor in February pushed me over the edge. During the pelvic exam I believe I had a flashback to a rape 10 years ago, and I became hysterical, and for the next month I was on a downward spiral, with overwhelming anxiety attacks and crying spells daily. My husband and I finally talked to my doctor about the incident; he has me taking tranquilizers to stop the anxiety attacks and help me sleep, added Zoloft to the Wellbutrin I've taken for the past 5 years, and I'm now seeing a counselor. I'll also be evaluated by a psychiatrist in a month. The last couple weeks have been exhausting, but I'm starting to feel better. My family is very supportive, especially my Mom and my husband. My friend, a family therapist, suggested that we find a therapist specializing in sexual assault to come to terms with the rape.

OK, now here's the problem. As open as I've been with my family, there are things from my childhood that I've told almost no one, and I'm feeling really guilty, especially now that I'm in counseling, trying to get to "the root" of my problems. But now I'm thinking the root of my problems might be something that I'll never be able to deal with.

I have a blurred memory of being in bed with my father, both of us wearing little or nothing. All I really remember is my father pushing my hands down under the covers to below his waist. I kept pulling them out of under the blanket, but he kept pushing them back down, saying that it was cold and he wanted me to stay warm. I don't remember touching him, or anything else. Not sure how old I was, somewhere between 6 and 9 I guess. I don't remember if my mother or brothers were home.

My other memory is much clearer. I must have been around 10 or 11, and my dad called me into a spare bedroom and shut the door. He was wearing only a robe and we both sat on the bed. He opened his robe and exposed himself. He started explaining "the birds and the bees" and stroking himself til he was erect. He explained that when men ejaculated, that semen spurted out; some men could even hit the ceiling when they ejaculated. Then he asked me if I wanted to touch it. I said no. He encouraged me a couple more times, but I refused. He said that was OK, and I left the room. I remember feeling really embarrassed the whole time.

These aren't things that I suddenly remembered. I've always known. I've told two people about this: a counselor 8 years ago, and my husband. The counselor said it really wasn't that bad. I was relieved, but I think she may have said that because I was practically hysterical when I told her, and she was saying what I wanted to hear. My husband says that he thinks my dad made a really dumb mistake explaining sex to me, and that he probably felt really stupid after and regretted it, and that's all it is. Could this be true? Can a person do something like this once, realize it was stupid, and never do it again? In the earlier memory, maybe it was really cold in the house, and he wanted me to stay warm? I'm so pathetic. If a friend told me this, I'd think, your dad's a child molester. But I just can't bring myself to believe he'd do something to intentionally hurt me.

I love my father very much. At the same time, if this has contributed to all the problems I've been having, I'm really going to be angry, especially since he's known I've had depression for years. He's never been affectionate with any of us kids, 2 brothers and me, always kind of distant, but he's that way with everyone. Over the years I've thought of just going up to him when he's alone in his garage and saying,"Dad, remember when we had that sex talk?" Or smack him on the forehead and say, "What the hell do you think you were doing?" What if he doesn't remember? What if my mother finds out?

The last couple months have been really hard. I've barely left our house, and I've only been to my parent's home once. When we left, I couldn't hug my father goodbye. I usually do, even though he really never hugs back. For years I've been able to bury this, but now, after years of infertility, my husband and I are close to adopting a child, and now I start thinking, why did Dad do that? Oh my God, what about my niece, who is 19 now? Should I have said something a long time ago? Why didn't I?

Every time in the last month my mother says,"You'll get through this; your Dad and I love you," I feel horrible, like I'm deceiving her. My whole family thinks this is about rape (which was horrible and I have had a hard time dealing with it). What if it's really about child abuse, and here I've kept a secret for all these years.

Within the next month I'll be sitting across from a therapist trying to talk about my "problems" and the rape, and I'm terrified I'll say something wrong. I've heard of therapists making child molestation cases where there is none, or convincing someone that something happened when it didn't. I know something happened, but I don't want someone putting visions of sex acts that didn't really happen in my head, or am I just totally in denial? Is my Dad a child molester? Or am I making something out of nothing? What if I tell a therapist and this person wants to me to prosecute him, can he or she expose him, if I don't want to? I cannot do anything that will result in the breakup of my family. I would rather die first. Can a person get over abuse without confronting, or exposing, or prosecuting the abuser? I'm so confused. I guess I desperately want you to tell me it's not a big deal. A friend was molested by her Uncle, and I totally backed her in prosecuting, and now her family is split in two. I know by no fault of her own, but I can't let something like that happen to my family. I know I'm babbling and I'm so sorry this email is so long, but I don't know what to do. Can you help me?

Sincerely,

(name withheld)

Minnesota, USA



Dear (name withheld),

Thank you for your letter which raises several important questions. In your own interest as well as for others who read this ask the psychologist page, I will try to do my best in addressing them.

To begin with, I am afraid that I cannot gratify your hope that I will tell you that this is no big deal. Judging from you have written, it certainly is a big deal which requires careful and expert handling. You certainly need the help of a therapist--someone experienced in childhood sexual abuse--to help with your anxiety, to help you to stop feeling guilty about things which are not your responsibility, and to help you to answer some of the questions you have asked me in your letter, such as if or how to confront your father with your memories.

Naturally, without knowing you personally, I cannot be confident in coming to any definite conclusions, but based on the facts you have given me, I am sorry to say I think it likely that you were sexually abused by your father, very possibly beyond what you remember.

Although I have never seen any research about this, I, along with other therapists in my acquaintance, have noticed that often women victimized by rape as adults also have had a history of child sexual abuse, so the fact of your having been raped at the age of 21, in my opinion, already is suggestive. Of course, many women who were not abused as children experience sexual attacks as adults, but in my own clinical work, when hearing about rape I always begin to wonder about early sexual abuse. If other therapists would like to comment on this, I would be pleased to publish their opinions here.

Your memory of being in bed with your father, and his insisting that you keep your hands under the covers should not, in my opinion, be explained away by imagining that he was trying to protect you from the cold as he said. It seems clear enough to me that he wanted you to touch him in an inappropriate way, and whether you really did nor not is not the point--the point is that you felt coerced, which already is a form of abuse.

Your other recollection, the one about the "birds and bees" lesson, is frank and obvious sexual abuse. It is inexcusable for a father to masturbate in front of his child, to expose his erect penis to her, and to invite her to touch it. If you had touched it, I imagine that further abuse would have ensued, and I think in your heart you suspect that too. Your husband's opinion is incorrect, but he can be forgiven for expressing it since I imagine that he only meant to set your mind at ease. In other words, his attitude was naive, but defensible. The same cannot be said of the counselor who tried to make light of your memory. Any mental health worker on hearing that kind of recollection has a positive and compelling obligation to explore it further, and fear that exploring it would upset the patient is no excuse for finessing it. In my opinion, if your "counselor" was a licensed professional (quotation marks because anyone can be a counselor), she was guilty of malpractice when she failed you in this regard.

The amount of psychiatric medication your doctor has prescribed without the expert advice of a psychiatrist or psychologist is, in my opinion, also indefensible. As I have written elsewhere, no one, in my view, should be taking these medications without also being in an ongoing psychotherapeutic relationship, and I wish medical doctors, most of whom have no training in psychology, would stop prescribing them without first referring the patient to a psychologist or psychiatrist. Of course, I should not be surprised that some medical doctors hand this stuff out like candy--many of them do the same with the other medications at their disposal too. In other words, too many medical doctors have no real interest in searching for the underlying causes of disease; they only care to treat the symptoms. When I have confronted some of them on this issue, they tell me that they must prescribe something because patients would be disappointed to leave the office without a prescription. In other words, if they failed to gratify the patient with a bottle of pills, the patient might require more time for a real explanation, or more time for a real investigation, or--god forbid--might not come back at all, costing the doctor a source of revenue. How cowardly! If you are a medical professional, have the courage to take your profession seriously. It is not your needs which must be met, but those of the patient. Your needs must be met when you are the patient--when you are paying the bill.

In this situation, your anxiety, and the hysteria during the pelvic exam, are not diseases requiring treatment with medication. Those manifestations are symptoms of deeper problems which must be addressed seriously, not simply masked by drugs. When symptoms are masked, leaving the cause of the symptoms untouched, the disease will simply find a new way of expressing itself, and often the new way will be worse than the old. In other words, treating symptoms alone is always a mistake. Now, a psychologist might also want you to take medication for anxiety, but the idea would be to treat the anxiety temporarily while investigating your life, not simply to use drugs to paper over your discomfort. That is why I say--and here I repeat--psychiatric medications should not be used at all unless the patient also has access to regular psychological counseling.

Since I live and work in Todos Santos, Mexico, I am not totally up to date on US laws regarding the doctor-patient relationship, but it is my understanding that you have the right of absolute confidentiality. In other words, your psychologist may not tell anyone anything you say without your express written permission (subject to one exception: if the doctor believes that you personally may harm someone else physically, then he or she is compelled to report that, and only that, to the proper authorities). In other words, you should be able to say anything you like about your father without fearing that anyone else in the world would find out about it. Since no therapy can be fully workable if the patient feels that she or he must keep secrets from the therapist, I suggest that you clarify this with the therapist in your first session, and that you get it in writing if that will make you feel more comfortable. If the therapist refuses, get a new one.

Yes, you are correct in your idea that some therapists are eager to find child sexual abuse (perhaps because they have been abused, or secretly hate fathers, or men, or whatever), and so some of them like to put ideas into the therapeutic space which do not originate in the patient's experience. In fact, this is a problem in our profession which is not really acknowledged, and certainly not properly addressed. For this reason, I discourage patients from seeking out memories by means of hypnosis, or other forms of regression-therapy. If you simply remain awake and aware during all sessions, and if you take anything the therapist says with a grain of salt, this should not be a major problem. Just keep looking into your own heart, into your own understanding, into your own experience, and use the therapist as a mirror, not a source, and you should be OK. This worry is also something that you should feel free to discuss with your new therapist. If you do not feel free to discuss it--or any other concern for that matter--look for a new one.

I hope this helps, and I wish you the best in your new therapy.

Be well.



Dear Dr. Saltzman,

Thank you for your fast response to my email. . . to be honest, I was stunned to get your email, and then really nervous reading the reply on your site. My first reaction was to think, he's wrong, this cannot be right. But I guess in my heart I've always known what my father did was wrong, and I've wondered if there was more to it than what I remembered. It's interesting that you mentioned the rape/child molestation connection. The man who raped me was my fiance, 15 years older than me, who was affectionate and openly loving to his kids, everything my father was not. But he was also very controlling and as I found out too late, a rapist. So the father figure I chose ended up raping me.

I spoke to the "counselor" years ago who blew off my memories at a mental health hospital, where I spent the night after my pastor realized I might be suicidal. I assume she was licensed. The funny thing is, I've been such a mess lately that my family wants me to go back to that same hospital for awhile "til the drugs kick in and I can be less depressed." Just today I began making lists and thinking of the pros/cons of confronting my Dad vs. suicide vs. just keeping everything in and trying to cope. Although suicide at some short moments seems like a way out, the fact is I don't want to die. But I'm tired of coping.

My dad has surgery tomorrow and everyone's worried about him, my husband is upset that you think he's naive (his Dad was an abusive drunk, and mine is the Dad he never had), my 15 year old niece is right now staying at my parent's house, but with her father too, and no matter what I choose to do, my mother will ultimately pay the price. Going to talk to my pastor tomorrow, and hoping I can get in to see a good knowledgeable therapist soon. Maybe when I don't feel so awful I can think more clearly and make some decisions.

Thank you again for the amazingly fast reply, and the info. It was hard to hear, but at least now I know I'm not making something out of nothing.

(name withheld)



Dear (name withheld)--

I replied to your letter quickly because I was concerned about the tone of your letter which sounded depressed. Now you have confirmed that by mentioning suicide, so I am glad that I chose to put your letter at the head of the line.

I did not mean to insult your husband. In fact, I admire him for being supportive and gentle with you. I only meant to say that his idea that your father was just trying to give you information about sex simply does not fly. Really, anyone who was not connected personally to you and your father would know right away that your father wanted to pleasure himself at your expense. Your father has sex problems, but they do not have to be yours. Therapy can help you to drop this burden.

You should not assume that your mother will pay a price for your dealing with this matter. It may very well be that with good therapy you can come to peace of mind about this without having to confront anyone or tell anyone, apart from your therapist, what you know. In my experience, that is often the case. So please just begin therapy with the best person you can find, and take it from there.

Be well,

RS



Dear Dr. Saltzman,

Thank you again. . . your comment about it being possible to heal without confrontation gives me hope. . . .I was agonizing about revealing "the secret." I can't tell you how much I appreciate everything you've said, and again how quickly you responded to my letter.

Bless you,

(name withheld)