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I have a patient who was abused as a child. She is replete with painful experiences from a family that delighted in hurting her with those games that children play on one another, so she needs a complete therapeutic approach to ridding her of the problems that really reinforce themselves with her everyday.

For example, although she is bright, she works as a secretary and her job is not all that guaranteed either. When she reaches to answer the phone, she may spill a cup of coffee, so she gets terribly anxious because they frustrated her like that as a kid. She will be financed by me, a friend of the family, but she needs a complete catharsis in order to function socially and occupationally.

Do you have a program for her? If so, let me know or direct me to those who do, please.


Dear RK--

When children are abused in the way you describe, often the sense of self that should form during childhood, by means of positive interactions with caregivers and siblings, gradually filling in and becoming firm and enduring, fails to gel into a complete and unbroken unity. Then, when frustration and setbacks occur, the compromised sense of self--a sense of self filled with empty spaces like a swiss cheese--fails to maintain a workable coherence, leaving the person incapable of managing in certain challenging circumstances. Usually the worse the abuse, the earlier it occurred, and the longer it lasted, the larger and more numerous are these gaps or lacunae in the sense of self, and the more pronounced is the struggle with ordinary life.

In my experience, an approach to therapy called "self psychology," a treatment pioneered by Dr. Heinz Kohut in the 1970s, provides a useful and effective framework for healing these kinds of problems. I suggest that you find a referral to a competent self psychologist for your patient, and that you be prepared for a fairly long course of therapy. For example, if this were my patient, I would be thinking in terms of at least a year of weekly meetings--perhaps more. The good news is that these types of problems are usually very amenable to treatment as long as the therapist is well trained and capable.

Be well.

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