Regression: A Universal Experience

REGRESSION: A Universal Experience

Averil Marie Doyle

PRAEGER

REGRESSION

REGRESSION A Universal Experience

Averil Marie Doyle

Library of Congress Cataloging-in-Publication Data Doyle, Averil Marie. Regression : a universal experience / Averil Marie Doyle. p. cm. Includes bibliographical references and index. ISBN 0-275-97919-9 (alk. paper) 1. Regression (Psychology)—Therapeutic use. 2. Reincarnation therapy. RC489.R43 D695 2003 616.89⬘14—dc21 2002030728 British Library Cataloguing in Publication Data is available. Copyright 䉷 2003 by Averil Marie Doyle All rights reserved. No portion of this book may be reproduced, by any process or technique, without the express written consent of the publisher. Library of Congress Catalog Card Number: 2002030728 ISBN: 0-275-97919-9 First published in 2003 Praeger Publishers, 88 Post Road West, Westport, CT 06881 An imprint of Greenwood Publishing Group, Inc. www.praeger.com Printed in the United States of America

The paper used in this book complies with the Permanent Paper Standard issued by the National Information Standards Organization (Z39.48-1984). 10 9 8 7 6 5 4 3 2 1

I. Title.

To the Spirit of Research and Inquiry

Contents

Preface Acknowledgments Introduction to Regression: A Universal Experience

ix xiii xv

1.

Infantile Awareness: Implications for Sexuality

1

2.

Inside the Developing Child

9

3.

The Lasting Impact of Highly Charged Sexualized Events

19

4.

Developmental Blurring

27

5.

Case Study of Severe Regression

39

6.

Case Study of Moderate Regression

57

7.

Cases of Mild Regression

73

8.

Regression Therapy: Applied to a Case of Encopresis and Touch Phobia

87

Treatment Approach

97

9.

Bibliography

107

Index

113

Preface

This book is about the learning process and its infinite plasticity. Regression, the universal psychic phenomenon of going back instead of forward, is an example of how the human learning process can be stretched to accommodate various combinations of information even before the mind is fully formed. Infants, children, and adults under extreme stress are minimally able to perceive, sort, and store bits and pieces of overwhelming experience for later use, and that process is often incomplete. Regression provides a necessary avenue for the individual to go back or return to the psychic point where traumatic learning first occurred, to fully integrate its meaning and express the body’s reaction to it. This allows the learner to reorganize the bits and pieces into an integrated whole, which can be used as a reference point for further learning. Regression is not a breakdown of the learning process, but a natural, adjunctive, cerebral capacity designed to aid the learner in integrating challenging experience. Body memories are an integral part of regression. Infantile tension states, movements, sensations, smells, and touch combine to create patterns of somatic associations that act as cues to assist us in remembering what our bodies have experienced in the past. Often these memories are inaccurate because we are also remembering similar unrelated events that have occurred subsequent to the discrete original occurrence. The raw material is thus mixed with the residue of subsequent learning. When memories are spontaneously activated, a regressive chain of sensations, feelings, and associations are galvanized, resulting in behaviors that do not fit the current situation. The regression bearer is responding to a past incident that is only somewhat similar to the current one. For some, to go back is to temporarily lose awareness of the present and become immersed in the past. For others, regression provides a

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simultaneous experiencing of past and present. Either way, the resulting behaviors interfere with responding solely to the present. Regression makes conscious control feel impossible. But is that really so? Or is the universal experience of regression evidence of a state of higher consciousness that we must stretch to understand and utilize? The clinical examples presented in this work are generally sexual in nature. Sensual and erotic sensations are more memorable than nonsexualized ones because sexuality is still an overcharged topic of exploration. While many regressed clients do not present with sexual issues, nor does their sexuality necessarily become a focal point in the course of their treatment, it is rare for clients not to present sexual concerns during the course of therapy. Childhood sexual issues are broadly defined in the context of this discussion. They include touching patterns, spanking, abuse, toilet training, body image, role taking, gender restrictions, and/or related topics that have been eroticized in the course of psychosexual development. In the cases presented for exploration, we see how children’s attitudes toward their genitals and body waste can become significant components of the regressive process. Regression therapy, like the term regression itself, is narrowly defined. Within the context of this discussion, it simply means treating regressed people. Clients who present in a regressed state or with regressive tendencies are accepted and treated in the developmental state in which they enter therapy. The goal of treatment is to facilitate progression to the age-appropriate developmental state. The symbolism of acceptance is a powerful confrontation of regression itself. As clients give in to their awareness of regressive impulses, they feel the relief of letting go of the adult persona and, symbolically, allowing an infant or child self to emerge. This does not permanently define them. It is often a nonverbal statement of inner emotion. For those clients who have been traumatized, who seek to return to the past for reparative purposes, regression offers an opportunity to relive a traumatic event that has impeded their development. When an adult becomes childlike and engages in childish behavior, those around him/her find it disturbing. Likewise, when a child or adolescent exhibits regressive behavior, the immediate impulse of caregivers is to arrest the backward movement and pull the individual forward to age-appropriate behavior. It is not always immediately necessary, or advisable, to do this until the regressed feelings and behaviors are acknowledged and confronted by the regressed person. It is only

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then that the regression bearer can integrate the experience and resume forward movement. In severe cases, cautionary measures are necessary to protect the regression bearer from harming self or others. A certain amount of discomfort and psychic pain is unfortunately inherent in the reparative and growth process. Hospitalization and medication are safeguards that can be utilized to hold and protect the severely regressed. But if hospital personnel are unable to commit time and needed focused attention to accomplish integration, progress will not be made. Regressive symptoms may subside only to reemerge and demand further treatment. Therapists trained in working with regressed clients can often treat them in outpatient settings. Indeed, mild regressive states yield to increased self-knowledge on the part of the regression bearer. Staged reenactments of traumatic incidents should be scrupulously avoided. They are not necessary to the natural process of regression and function as dangerous intrusions that could impede progress. To regress is to go backward, to return to the psychic locality where a particular image or memory was first formed in the brain. Sometimes regression is an interpsychic effort to trace unexplained or repetitive body movements or sensorimotor reactions back through the process of sensation and emotion to the original perception that gave rise to them. It is as if the body needs to express a physical as well as emotional response to a past event before total integration can occur. We engage in regression in dream states, in moments of hallucinatory madness, in defense of pain, or even intentionally in pursuit of self-exploration (Freud, 1953, pp. 571–588).

Acknowledgments

I gratefully acknowledge the following people who have helped me in the preparation of this work. Jeri Ragan for calm, consistent support in preparing the manuscript. Debbie Carvalko, Acquisitions Editor, for friendly encouragement. Michael Mulhearn for humorous and tireless editing skills. Tamar and Nickolas Kusmick for their poetic and practical support. Readers: Richard Abloff, Ph.D. Linda Day, Ph.D. Michael Mulhearn, Ph.D. CM. Robert Wehrman, J.D. who gave precious time on short notice.

Introduction to Regression: A Universal Experience

Regression is a strange and disquieting experience. It is like reliving the past, through the perceptions and feelings of oneself as a child. All of us have had experiences from infancy through adolescence that we have been unable to integrate. At a preconscious level, the memory of those experiences still actively affects our thoughts and behaviors. During times of stress, or simply when similar incidents occur, these experiences may be reactivated, releasing emotionally charged memory fragments that affect our current perceptions and behaviors. Distortion and overreaction characterize the responses of the regressed person, who becomes childlike in a flood of confused feelings and sensations. Emotional memories overpower rationality. Joseph LeDoux, a neuroscientist at New York University, focuses on the pivotal role of the amygdala in the brain. The amygdala gauges the emotional significance of an event. In this cluster of interconnected structures above the brain stem, emotions linked to memorable events are scanned and utilized to recall similar earlier knowledge and experience that may be relevant to the incoming experience. This almond-shaped emotional center of the brain works faster than the neocortex, the thinking part of the brain. Serving as an alarm system, it releases a series of feeling clusters that rapidly affect our behavior without mediation by rational thought processes (LeDoux, 1992, pp. 69–79). These regressive sensations are often linked to physical touch, sensuality, and eroticism. To feel warmth and closeness is a memorable infantile experience; it promotes a sense of well-being. It also promotes a memorable aura of sensations that form the basis for other incidents of touch. As infants, we associate closeness, warmth, and touch with being cared for or loved. Touch and closeness can also be associated with fear and abuse. This occurs when infants are mishandled by their care-

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givers or when infants misperceive the connection between caregivers and sensations of pain and pleasure they might experience in the presence of caregivers. Warmth and closeness can thus be linked or associated with fear, abuse, and pain. Infantile sensations of genital pleasure and pain create memory traces long before cognitive memories are formed. Other very fine sensate memory links are formed between the neural pathways evoking pleasure and pain. Depending on the nature of the relationship between parent and child, the associations grow, linking sensations of touch, sensuality, and eroticism to the warmth and closeness of caregivers or parents. Most caregivers have moments of indifference, impatience, and anger, which are communicated in various ways to the learning infant. Often the young child senses powerful negative feelings, perceived as hatred, coming from the parent, even though the parent may not actually be consciously feeling hatred toward the child. Another associative link may be added to the memory chain—the link between love and hate. The dependent infant learns to love, hate, and fear the powerful parent, who gives both pleasure and pain. Mixed, overcharged associations result within the infant learner. In order to understand the process of mislearning and how it contributes to regressive tendencies, consider the internal framework of the child during a common chastisement occurrence. It feels abrupt and startling to an infant, child, or even an adolescent when his/her sense of self and others is disrupted by a tense, overreactive, or abusive parent. During this type of incident, all sensations are amplified; sounds, touch, smells, and visualizations are all more acute. The neocortex, the thinking part of the brain, does not respond rapidly enough to mediate the emotional clusters generated by the amygdala. These sensations are, therefore, indelibly imprinted upon the memory of the developing child. Each separate sensation is powerful enough to later serve as a recall cue when activated by similar sensations, such as a sound, touch, or smell that are reminiscent of those present in the original abusive learning context. If an infant or child’s genitals or buttocks are roughly handled, which is often the case in diapering or spanking, erotic sensations can also be experienced along with the pain, particularly when the spanking stops but the throbbing persists. Another associative link in the memory chain is thus forged. Genital sensations of both pleasure and pain are associated with punishment. Complex and unpredictable associations occur. Later stages of psychosexual development are affected because

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the child continues to reassociate these various sensate links in different combinations. Highly charged, overgeneralized positive and negative reactions are transferred later in life to close figures in intimate touching relationships. Overreactions to sensuality and eroticism are established. Generalization is central to the learning process. It allows the young child to extend his or her knowledge base from one situation to another. Since generalization promotes the same generalized response to new but different stimuli, there is considerable margin for error. The learning child will have the same response to new stimuli that do not properly belong in a given response category. When a child loves a parent and the parent inflicts pain on the child, that child may learn to love and accept pain. The child’s response of love, thus, spreads from the original stimulus, the parent, to include the pain inflicted by the parent. Since the child is totally dominated by the parent in early phases of development and must submit to parental control, themes of dominance and submission are also linked to eroticism, punishment, and assault. Thereafter, each time the child feels erotic genital sensations, multitudinous memories are associated with them. This occurs at conscious, preconscious, and unconscious levels of awareness concurrently. Sadism, masochism, and other sexual perversions are possible outcomes of such confused linking. The sexual pathology involved in both masochism and sadism has been traced to infancy and early childhood (Doyle, 1992, pp. 79–90). Initial experiences with eroticism are memorable events. In masochism, sexual arousal and satisfaction are derived from being beaten and made to suffer. Spankings by parents, as well as continual and prolonged genital exposure, which may go along with spanking or even diapering in the presence of parents and caregivers, form enduring association patterns. The same is true for sexual sadism, a condition wherein the suffering and humiliation of the victim promote and sustain sexual arousal and satisfaction. A sense of completely controlling the victim is a significant component of sadism. This parallels the child’s past experiences of being completely controlled physically during spanking and other early childhood assault experiences. What constitutes assault? When is it sufficiently severe to promote mislearning, psychosexual disturbance, and regressive tendencies? Within the context of this discussion, assault encompasses most, if not all, physical punishment. Rough diapering, striking, shaking, or shoving a child of any age constitutes assault. Based on the descriptions and reactions recounted by children, adolescents, and regressed adult clients, emotional coercion or intimidation is also often perceived as assault.

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Raised voices, cursing, and aggressive gestures are assaultive in nature. Assaultive acts can range from mild to severe. Assault is always encoded upon the memory of the victim. Repetitive assault reinforces the negative impact upon the child and compounds the injury. A child, particularly an adolescent, may appear impervious or unaffected by assault. This is generally a defensive pose. Authentic indifference to assault is extremely rare. The child simply responds within. Concealing pain may be more damaging to the child than crying out. Even though crying or wincing may not visibly occur, at some level within the child the acute experience of humiliation, pain, suffering, shame, and anguish is felt and remembered. Associations with parental assault experience affect subsequent psychosexual development and drastically alter the ability of the child to relate to others. Memory traces have been formed that later shape the sexualization style of the damaged child in very subtle but lasting ways. Complete memories of assaultive incidents may never reach the conscious level, but the feelings they evoke of fear, mistrust, and hatred occur repeatedly throughout the lifetime of that individual, as repetitious shadows of those past experiences. All infants experience various forms of assault. All parents have assaulted their children emotionally, physically, or both. Often, it is not intentional. These assaults are easily rationalized. Inflicting pain and suffering on infants, children, and adolescents is an approved and institutionalized practice. Christian ethics provides a basis for corporal punishment in the home as well as in educational settings. It is only recently, in the 1990s, that state laws have been passed and enforced, protecting children from physical punishment from their parents, caregivers, and educators. Regardless of whether the assault is made in hot or cold blood, is done out of disciplinary motives, or is purely the result of uncontrolled frustration on the part of the parent, teacher, or caregiver, the result remains the same. Aberrant learning occurs as well as the potential for psychosexual disturbance. In infants, there is a memory trace arising from sexualized abuse that lingers throughout the life span, even if specific recall of the incidents does not take place. Young children, however, may actually recall specific incidents that swirl to the surface of consciousness in situations when they sense the recurrence of a similar incident. In such instances, the accuracy of the memory cannot be depended upon (Goodman & Loftus, 1988, pp. 115–121). Infants, children, and adolescents may also develop overgeneralized fear, anger, and mistrust responses that characterize

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their attitudes toward authority figures as well as close associates and family members. Clinically, children, adolescents, and regressed adults experience overwhelming fear and anxiety when they recall and seek to express feelings about childhood punishments they received or witnessed. Philip Greven’s (1992) historical analysis and meticulous research regarding the institutionalized use of corporal punishment in child rearing sheds light on how entrenched and socially acceptable it is to perpetrate assault on children and ignore or minimize the impact it has on their psychosexual development. As the child experiences pain and suffering, he/she learns about inflicting pain and suffering on self and others. The experience is often erotic due to the engorgement and throbbing sensations in the buttocks and genital areas during and after a spanking or beating. This type of learning will not fade with time. Through these eroticized memory traces, the child consolidates a connection between assaultive experiences and sexual pleasure. Outcomes thus include the probability that the child will absorb and incorporate abusive and uncontrolled erotic behaviors modeled by the parent and later practice the same in his/her own future sexual and personal relationships. Normal genital arousal can thereby be infused with the desire to feel pain or inflict pain on others. In some cases, when the damaged child matures, his/her sexual encounters must contain elements of the aberrant learning context for arousal to occur. The child may also become a criminal perpetrator and victimize others outside of personal relationships (Doyle, 1992). An infant or very young child is unable to absorb and integrate the sensations, cognition, and emotions of a real or perceived assault incident because his or her cognitive ability to do so has not reached the necessary stage of development. Infants, children, and many adolescents have only rudimentary skills to cope with powerful emotional and physical stimuli. Instead of being felt, sorted, and understood, emotional reactions are pooled within the child’s memory system as fragmentary particles awaiting the remainder of an integration process that may or may not occur. Until this process is complete, the child’s perceptual screen is distorted. Regression can be defined as a recurrent impulse to return to this unfinished process. It occurs when the child, adolescent, or adult experiences similar situations that activate components of the original experience. Regressive tendencies in adults are not always rooted in actual punishment and abuse. Infantile and childlike reactions to simple disap-

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proval, coercion, and control are infinitely more significant to the young learner than parents or caregivers realize. Perceptually, an angry or disapproving adult is like a powerful monster to an infant. Simple tasks like toilet training, bathing, and dressing can be terrorizing experiences for a child if the parent or caregiver is tense and angry. Genital sensations, accompanied by a sense of being controlled or confined, are monumental and memorable occurrences to a child. Repetitive recurrence of genital sensations is part of toilet training. For many children, toilet training is emotionally overcharged and, as a result, sexualized mislearning occurs. Anxiety associations formed by negative toilet training experiences are similar, sometimes identical, to anxiety felt in traumatic, life-threatening events, such as rape, accidental injury, or any incident that evokes a reaction too intense for the child to process because of undeveloped integration skills and abilities. Genital sensations experienced during toileting present a significant learning challenge with which the child has to contend to develop normally. Harsh toilet training links genital arousal to abuse. These abusive memories are difficult to assimilate. If the developing child has a tendency to overgeneralize, regression will occur in later years in response to a broader spectrum of sexual arousal (see Chapter 5). The regressing individual undergoes a sometimes gradual, sometimes swift, loss of maturity and is often reduced to the level of developmental competence present when the original incidents of abuse or trauma occurred. The result is an adult body responding with disturbed, childlike feelings. There are many levels of regression. Nonpathological regression is thought to be a common experience. Frequently, people in the general population have regressive episodes that provide a discharge of anxiety without their ever recognizing that this has occurred (Meerloo, 1962, pp. 77–86). This type of regression has a beneficial effect. Indeed, induced regression is widely used by psychoanalytic clinicians to facilitate progression from one stage to another when development has been interrupted by insufficient ego integration (Van Sweden, 1995, 30–37). Regression also occurs as a defense against sexual self-knowledge and further maturation. Frequently, children and adolescents seek a nonsexual or asexual identity because this seems less threatening to them than moving forward to a more sexualized identity. This type of regressive tendency occurs at both conscious and preconscious levels, and is not necessarily pathological. It sometimes provides the regressed child with time to become habituated to the idea of being sexual without

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actually engaging in sexualized behaviors. Often the child progresses to the next psychosexual stage with less vulnerability to further episodes of regression. Sexualized regression is not benign. There is little doubt that regression caused by erotic assault experiences, whether actual or perceived as such by the regression bearer, has significant and deleterious effect on psychosexual development. Sexual arousal, as it relates to physiological process, may be totally or partially affected. Sexual dysfunctions are characterized by disturbances in the sexual response cycle. These disorders can affect the desire to have sexual activity or the subjective sense of pleasure accompanying physiological changes. Vasocongestion of the genitals may not occur. Regressed males often do not have or maintain erections sufficient for penetration and thrusting. Females do not experience vaginal swelling, expansion, and lubrication. Regression bearers also commonly experience orgasmic disorders. For females, there is often an absence of peaking in sexual pleasure. There are no contractions of the perineal muscles and no release of sexual tension. Males frequently do not ejaculate or, if they do, there is an absence of the sensation of ejaculatory inevitability. The general sense of relaxation and well-being is also absent. Unintegrated memory fragments, cued by the general context of sexual encounter, distract the regression bearer and prevent normal sexual response. Resolution is not easily accomplished due to increased anxiety that is generally felt by the regression bearer as the memory traces are activated. The closer one gets to recalling a traumatic sexualized incident, the more pronounced the anxiety becomes. Sexual behaviors are less controllable. Many sexually disturbed people link their sexual perversions with early incidents of physical punishment. Corporal punishment seems to promote cognitive overgeneralization due to the rapid influx of emotions and sensations during the actual abuse incidents. The ability to discriminate is not fully present in infants, children, and adolescents. Indeed, many mature adults never learn to discriminate competently. They confuse and categorize dissimilar or even widely different circumstances and events, clustering them together in a single category. This is overgeneralization, which is a significant factor in the regressive experience. Overgeneralization often occurs when strong emotion is linked to a particular event. This can happen whether or not the stimulus is actually significantly related to the event. Thus, all stimuli in the immediate

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environment may be associated with the same strong emotion. The linking of those associations to the traumatizing event is durable. Thereafter, each time the memory of the event is recalled, the feelings and associations linked to that event are also recalled; each separate memory link can become a cue that recalls the entire event. After a certain number of recalls, the memory of that event and the associations, relevant or otherwise, are permanently stored in the brain. Very often the regressed person recalls the event with its attendant emotions due to an irrelevant or tangential cue. For example (see Chapter 5), as a small girl, Clarisse had been raped in the presence of a cat, and for years to come, experienced a range of feelings, similar to those felt during the actual rape, each time she saw a cat. The cat was associated with eroticized pain and fear. Those links to the incident might be sufficient to evoke erotic genital sensations similar to those felt during the trauma, along with the pain and fear. Thus, cat-pain-fear all became cues in later life, linking the adult woman to memories of the rape that had occurred in childhood. Similarly, during sexual encounter, the same woman, when cued by erotic and sensual genital sensations, felt transported back in time so completely that she believed herself to be a child again, reliving the incident of rape. At this point, there was little or no discrimination between past and present. Figures from the past merged with figures in the present. Current perceptions were distorted. Regression had occurred. Many unintended teachings are set in motion when rough handling, discipline, or corporal punishment is utilized in child rearing. Unfortunately, parents and caregivers are often unaware of the deleterious impact their behavior has upon the developing child. Fortunately, regression, the symptom or outcome of traumatic learning, also furnishes an opportunity for remediation. By returning symbolically to the original learning context, trauma symptoms are made accessible to remediation. Emotions, cognitions, and somatic memories can be integrated. Conversely, regression also furnishes a repetitive context wherein the original mislearning can be compounded. Clinical caution is advised. An awareness of the learning process is mandatory in the treatment of regressed individuals (see Chapter 9).

1

Infantile Awareness Implications for Sexuality

The mysterious process of learning creates many dilemmas. Infants gather and record lasting impressions and information about themselves and their caregivers before birth and thereafter. This includes information regarding touch, love, sensuality, and eroticism. Much is learned that is not specifically recalled. Much is learned that is not intentionally and specifically taught. But all infantile learning, regardless of how fragmentary, affects future learning. In early stages of development, the child’s learning process is primitive and primarily subcortical. An infant learns the distinctive smell of its parent. He or she learns to distinguish parents or primary caregivers from others in the immediate environment. Familiarization and communication also occur through touch, voice tone, facial movements, and eye contact. These discreet social interactions will never be specifically recalled, but as these early social exchanges accumulate, the infant is forming response patterns that will endure. Infantile sensate awareness constitutes learning. Response patterns and associations thus formed may weaken and fade in later stages of development, but they can be reactivated, sometimes in fragmentary form, when cued by related incidents and perceptions. This is a form of memory revival (Eysenek & Keane, 1990, p. 557). Current intimate touch, for example, reminds the learner of earlier intimate touch. Symbolic and imaginal information held in memory storage centers can be cued and recalled involuntarily when a similar stimulus experienced in the past is represented. This occurs most frequently when features of recall and recognition in the current environment are similar to environmental features of the learning context. Infantile memories of warmth and intimacy experiences, that is, holding and being held,

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touching and being touched, may be recognized and recalled in subsequent intimate and sexual encounters (Doyle, 1992, pp. 42–45). There are other significant factors that contribute to infantile awareness of sexuality. Parental behavior, combined with the rudimentary personality of the infant, determine which early experiences and associations will be learned and remembered by the child. Perhaps only fragments of an actual touching, visual, or olfactory experience will be perceived and stored for future retrieval. Fragmentary recall of touch may be inaccurate and misunderstood due to the immature perceptual system of the infant. Memory traces are general rather than specific (Eliot, 1999). Distortion over time is common. Much controversy exists regarding learning and memory of childhood sexual experiences (Goodman & Loftus, 1988, pp. 115–121). However, inaccuracy of such memories does not alter their impact on subsequent sexual learning and behavior. It is what a child believes about an incident, rather than the actual incident, that affects later behavior. Emotional and physiological excitability varies in newborns. Some infants are intensely reactive and expressive. Others are less responsive, more quiet and easygoing. Regardless of the temperament of either infant or parent, intense and lasting attachment styles are usually formed by the child. Feelings generated within these relationships become prototypes for all intense and intimate relationships to follow. Infant love, or awareness of the all-powerful caregiver, translates into a feeling of awe in later stages of development. Angry, inexperienced caregivers transmit and imprint their negative feelings onto the developing child, who, in turn, imprints his/her impressions of parental anger and frustration on his/her memory traces. Infants often feel fear and aggression, not just through mirroring what parents may demonstrate, but through their own emotional response to arousal or physiological changes that they become aware of in their own bodies. These tension states form the basis for more specific genital responses that will come later. The infant’s awareness is general and reflective of parental attitudes and behaviors as he or she perceives them. Infants, for example, cannot accurately perceive the difference between genital sensations generated from within themselves and those caused by caregivers in the immediate environment. Infants thus associate genital sensations with caregivers and often attribute their own arousal sensations to particular caregivers; this is true whether or not they have been sexually touched or stimulated by the caregiver. Moreover, physical arousal, genital or otherwise, felt with one emotion may

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be almost indistinguishable from that which occurs with another emotion. The differences in brain pathways and hormone levels experienced in physiological states accompanying different emotions are subtle. This is true for adults as well as children. Broad, overgeneralized learning patterns are the norm for infants and young children. Since infantile awareness levels and learning patterns vary, depending on the rudimentary personality characteristics of the developing child, highly emotional children may tend to personalize environmental events and believe those events are either caused by their parents or themselves and/or directed at them, when they are not. Early experience with assaultive sounds and sensations, be they direct spanking, loud noise, or rough touch, generate unpredictable emotional responses within the infant that often are generalized capriciously. Memories of episodic events contain many components. These include emotions and sensations subjectively experienced, the people involved, as well as much extraneous stimulus present at the time the memorable event occurs. This is all stored in various parts of the brain for later retrieval (Anderson & Conway, 1993, pp. 1178–1196; Eliot, 1999). Trauma expert Bessell van der Kolk, in his general discussion of “The Processing of Experience,” alludes to the complex process in which babies are immersed as they gain an understanding of their own body signals (van der Kolk, 2001). The task is to derive meaning and context from sensations and emotions in a continuous process of filtering, interpreting, transforming, and making meaning out of incoming sensory input. Babies are dependent on their caregivers to relieve their distress, to soothe them, and to regulate them, because they cannot accomplish these tasks alone (van der Kolk, 2001, p. 6). Indeed, infants are dependent upon parents and caregivers to form representations of inner psychic states (Bollar, 1979, pp. 97–107). Many parents would be surprised at what they are or are not teaching. Infants’ ability to separate reality from fantasy or hallucination is dependent upon their early interactions with their parents. Infants are random learners and they respond to memorable stimuli in unpredictable ways. In child rearing, a father may erroneously believe he is teaching his infant son to respect him when he sternly demands acknowledgment that he has spoken. The intended message is “Pay attention to what I say.” The child, however, may learn that stern male voices are unpleasant. The father is associated with the unpleasantness of the stern voice and the fear generated by it. Ironically, the infant does not know or understand that the father wants to be acknowledged and respected. He has learned only that the father is

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unpleasant and intimidating. This is hardly the lesson intended by the misguided father. Likewise, parents who sternly interrupt infants and children who are masturbating may be communicating negative associations with genital sensations in general. This may interfere with psychosexual development. Simple incidents such as these may cause sexual dysfunction and/or sexual identity problems in later years. Much is taught that is not learned. Much is learned that is not intentionally taught. This is particularly true as it relates to sexuality. Normally, infants learn about pleasure and pain in a very global way. Pleasure and pain are general feelings, which can be experienced at both physical and emotional levels. Often pain is a combined experience, encompassing both unpleasant emotion and unpleasant bodily hurt. Sometimes pleasure is experienced as the absence of pain. This is particularly true for children who have had repeated pain experiences. Usually, however, pleasure is experienced as an agreeable physical sensation or an agreeable emotion. Pleasure can also be a combination experience. It can give rise to a feeling of joy, satisfaction, delight, or relief. Infants associate happiness with sensual and erotic genital gratification unless those sensations are associated with pain and punishment. Extreme pain produces anguish. Extreme pleasure produces ecstasy. Undifferentiated infant awareness often results in similar external responses for pain and/or pleasure. Since infants cannot speak, caregivers do not generally know when genital sensations are part of the child’s learning experience. Little is known about the associations children link with early genital sensations, but when there is pleasure or pain involved, genital associations are committed to long-term memory along with the emotions to which they are linked. This is substantiated by the phenomenon of flashbulb memory (Pillemer, 1990, pp. 92–96). An event associated with pleasure or pain creates a vivid memory tract that may be more resistant to forgetting than events that are less charged with emotion. The intense arousal of pleasure or pain short-circuits the ordinary pattern of remembering. The limbic system and brain stem blend bodily sensations and emotions without the ordinary controls higher levels of the brain usually supply. Pleasure and pain are memorable events. When linked to genital sensations, they become even more memorable. Frequently, parents misinterpret infant cries and responses. The internal awareness of the child cannot be known with certainty by the parents. At any given moment assumptions about mothers’ instinctive knowledge regarding what their child is experiencing are frequently

Infantile Awareness

5

unfounded. One cannot infer with any degree of certainty what the child is feeling since the child has had many learning experiences to which parents and caregivers are not privy. Much of what a parent surmises about what his or her infant is feeling is based on projection of the parent’s own experience onto the child. In reality, an infant does not feel and respond as an adult feels and responds. Infants cannot discriminate in a refined manner. This is particularly true when intense sensual or erotic sensations are involved. Children do not think, feel, or process their feelings in the same way adults do. Piaget discovered many years ago that the infant mind is not a tiny replication of the adult mind. And although children may be capable of more sophisticated thought processes than Piaget believed possible (Halford, 1993), it is clear that the child’s mind goes through predictable stages of development before reaching maturity. Infantile awareness is rudimentary. Thus, an infant experiencing pleasure or pain cannot fully perceive the subtle nuances that accompany those emotions and physical sensations. Emotions and bodily sensations are experienced as perceptual waves. The infant’s awareness may be a global one of good feeling (pleasure) or bad feeling (pain). An attending parent’s response may be much stronger and more focused than that of the child to most shared experiences. The adult has a greater and more complex knowledge base from which to draw a response than does the child. Moreover, the child may also confuse his/her own response with that of the parent. If the parent simulates great pleasure or joy at a relatively simple occurrence such as defecation or urination, the child may associate the raised eyebrows, rounded eyes, wide smile, and high-pitched voice with the act of elimination, or the child may simply become confused at the parent’s reaction compared to his/her own internal response of simple somatic relief. Moreover, the child’s feeling may not be specifically attached to the act of elimination. It may simply be associated with the parent, or even some other object or event that has caught the child’s attention at the moment. Inferential knowledge regarding causation and how events and sensory experiences are related differ markedly between adults and children (Graesser, Langston, & Baggett, 1993, pp. 411–436). More harmful simulations of feelings, such as obvious or exaggerated parental disgust at the infant’s bodily excretions, may cause anxiety in the infant. Obviously, the production of bodily waste, such as urine, feces, mucus, and saliva, occur regularly as a part of the child’s normal functioning. If the parent communicates dislike of these bodily emissions, the infant may not know what the parent dislikes. Is it him or

6

Infantile Awareness

her? Is it the diaper? Is it the feces or urine? Most parents and caregivers do not realize the impact of their visible reactions upon the learning child. Such communications to the child about his/her genitals, feces, urine, and other bodily waste have lasting effects. Preconscious memories of these events and parental reactions are likely to be recalled throughout the life span (Nelsen, 1992). Early associations linked to defecation and urination resist forgetting since these bodily functions are repeated and practiced events. Memory traces are, thus, deepened and reinforced. Infants can learn to feel conflict and anxiety regarding their own genital functions. Sensations of genital pleasure may normally be associated with release of bodily waste. If the parent communicates disgust or dislike when the child urinates or defecates, the child may later associate those negative feelings with sensual and/or erotic sensations, not just with bodily wastes. There is a strong possibility that this will occur. Memory is built on associations. As these associations connect, the brain actually changes. Memory in children thus encapsulates the world around them in a unique manner (Greenfield, 1997, p. 145). Most parents do not choose to teach their children to feel disgust toward their genitals and/or bodily waste, but many do so unintentionally. The infant’s own earlier association of pleasure with his body products and genitalia will conflict with his perception of the parent’s negative response. Given the infant’s strong attachment to and dependency on his/ her parent, internal conflict or tension occurs. Similar repeated incidents will consolidate the conflict and etch it indelibly in the child’s memory. Fragmentary memories of parental responses will be stored in a neurological tangle of unintegrated reactions, which later give rise to regressive incidents when genital sensations occur within a context of emotional intensity. A regressive incident is a complex associational response wherein an older child or adult is overwhelmed by the memories of past feelings and behaves the way he or she did as an infant or child in the original learning context. Ironically, regressive incidents offer an opportunity for new learning to occur. Parents and caregivers can promote integration and nullify the effects of unintentional learning. This requires reeducation and therapeutic intervention (Van Sweden, 1995). In summary, parents and caregivers often exaggerate their emotional responses with children in a preconscious and misguided effort to teach their children social attitudes. It may seem harmless for mothers to speak in unnatural, high-pitched, sugary voices to their babies, simulating happiness. The

Infantile Awareness

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intended impact is for the infant to learn to simulate happy sounds, thus assuring the mother that all is well with her child. Interchanges such as this, however, are confusing to the child who is being encouraged to express a feeling that may not be felt within. In some cases, internal infantile dissonance results. More serious conflict occurs when genital associations are part of these early learning experiences. Exaggerated negative sounds during diaper changing may not teach a child to avoid contact with feces and urine, which is often the general message intended, but may teach a child to experience tension in relation to his/ her genitalia and/or bodily waste. Although there is a possibility that no appreciable damage to the developing learner will occur, there is a stronger possibility that negative associations with bodily processes will be encoded and stored in the memory. The child may also be confused by the sounds and gestures emitted by the caregiver. Since producing bodily waste is a repetitive and consistent function, the negative reactions will be remembered, reassociated, and reinforced. An array of learning and memory processes are involved in producing this type of infantile mislearning. Learning categories may include imprinting and aversion, as well as classical conditioning. Recognition and recall may be cued by an event, sound, sight, odor, or erotic and/or sensual sensation. Infants are general learners who respond more favorably to moderate, rather than exaggerated and intense stimuli. When intense stimuli occur, some infants effectively tune it out by attending to something else. Others are imprinted by the emotion, physical sensations, and the persona of the stimulus bearer. This early learning is indelible and forms the basis for maladaptive social and sexual responses. Potentially positive and significant experiences involving touch, love, intimacy, and sexuality are often contaminated because of chance associations and mislearning generated in this manner.

2

Inside the Developing Child

Unique variations of learning and remembering develop within each child. A combination of genetic programming and environmental events determine what each learner will incorporate into his or her knowledge base and the style and manner in which he/she will recall that knowledge. Psychosexual development is a process heavily dependent upon environmental learning. The growing child must learn how to learn, that is, a young learner does not automatically distinguish between central or main factors and lesser, insignificant factors in a learning situation. Nor does an ability to discriminate occur automatically in the developmental process. The ability to separate general from specific, or essential from nonessential, is a learned skill that must be specifically taught. Significant factors that must be learned in order to survive vary. Many children learn to avoid punishment or obtain approval by adjusting to the behavioral quirks of their caregivers. Discrimination thus learned may not generalize successfully in later relationships. Physiological maturation places additional constraints on the process of learning. Increased ability to think and learn occurs with progression from infancy through childhood and adolescence (Squire, 1987, 1989; Canfield & Ceci, 1992; Eliot, 1999). The developing child forms a primary attitude toward learning. If the learning attitude is welcoming, learning becomes a satisfying and somewhat joyous experience. When the attitude toward learning is conflicted, feelings of anxiety and self-doubt prevail and the child has ongoing difficulty with subsequent learning. In such cases, avoidance of learning may develop. This is particularly true when learning is linked to physical punishment, which is still quite common in child rearing and education.

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Inside the Developing Child

The practice of whipping, swatting, or beating the child’s buttocks results in a combination learning experience that links genital sensations with pain and punishment. A learned association between erotic genital sensations and the persona of the spanker or punisher also occurs. Sadomasochistic tendencies may be developed within this learning context. The associations thus formed may also result in an adult fetish; that is, spanking must be present for genital arousal to occur during a sexual encounter. Bernard, a young medical student attending one of my Sexual Attitude Restructuring Seminars, described how his mother would spank him very hard on his bare buttocks with a brush when he was a preschool child. It would sting but the pain was also oddly pleasurable. She ended the experience by kissing him and telling him to be a good boy. He offered this memory as an explanation for why he wanted his wife to spank him as a prelude to sexual intercourse. His associations did not reach fetish proportions, since he could also enjoy sexual intercourse without spanking. But he did prefer to be spanked because it ignited a stronger arousal response. Spanking and whipping are common child-rearing practices, which constitute aversive teaching. Aversive teaching has lasting effects. Caregivers often seek to protect young learners from danger by scaring them. This approach to child rearing and education actually inhibits appropriate learning. Aversive teaching is widespread and has been historically accepted and even promoted in many cultures. The symbolism of punishment has long been associated with biblical interpretations of God’s wrath at Adam and Eve for their disobedience in seeking carnal knowledge. Many parents and educators inadvertently use this aversive and somewhat negative interpretation of divine teaching as a model. Unfortunately, this institutionalizes the use of pain or punishment as a teaching mechanism. Based on this model, in a general but consistent manner, our culture inadvertently associates the seeking of new experience or knowledge with guilt and punishment. This is particularly true when it relates to sexuality. As children seek knowledge about their own bodies, particularly the genital sensations they are capable of experiencing, they often encounter parental disapproval. Young learners usually absorb, but do not integrate, punishment experiences. They are incapable of the refined discrimination necessary to understand the meaning of disapproval and punishment as well as the motivation behind it. A loose network of fragmented cognitive, affective, and sensate associations occurs within the child’s learning system. The specific point being taught is rarely, if ever, learned. Instead,

Inside the Developing Child

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an aura of discomfort, permeated by anxiety, is linked to the learning context. There are obvious problems in generalizing about the internal awareness of children who have been affected by aversive teaching or corporal punishment. There is a large body of clinical and historical evidence that relates corporal punishment to problems in psychosexual development (Greven, 1992). Clinical material, based on self-report, that is, parental admissions and memories of instances when they engaged in physical disciplinary action with their children, are not fully reliable. Moreover, the specifics of cause and effect cannot be readily established. What can be established, however, is that many adults and children believe that they have experienced corporal punishment and/ or punitive sexual events at the hands of their parents and/or caregivers. Many also believe that their attitudes and associations regarding learning and sexuality have been severely affected by punishment experiences. Studies that focus on early learning suggest that earliest memories are usually of emotionally charged, negative events (Usher & Neisser, 1993). Memorable sexual events experienced in childhood are not treated with the same thoroughness and dexterity as memorable nonsexual events. A child who has sustained bruises from an accident usually receives more empathetic attention and comfort than a child whose psychological and physical bruises have resulted from aversive teaching by a parent or caregiver. Minor sexual events are readily integrated if treated soon after their occurrence. This often does not occur because parents and educators alike are products of the same sexually repressive environment and consequently do not deal with sexual issues directly. Many parents and educators approach sexual self-knowledge with ambivalence. Predictably, they become fearful and overreactive when signs of sexual awareness occur in their children. Summarizing, we approach sensual and erotic experiences with an aura of cultural confusion. Sex negativism remains the norm in our society. It is therefore predictable that confused learning regarding sexuality will continue to be transmitted to future generations. Misperceptions and ambivalent feelings regarding sensuality and eroticism are transferred to children who assimilate the confused attitudes and behaviors of their parents toward these and associated emotionally charged experiences. Psychosexual development is impaired by this process. Various levels of pathology result in the growing child’s ability to learn.

12

Inside the Developing Child

Discipline itself is an emotionally charged experience that can disrupt a parent/child relationship indefinitely. Disciplinary acts frequently cause mislearning as well. Parents and children rarely agree on the need and severity of punitive measures. Adult clients often report that as children they were punished when they had no idea what they had done wrong. For example, it is common for a curious young child to seek knowledge by exploring the texture, smell, and taste of his/her own feces. It is also common for concerned parents to overreact to this form of exploration, fearing germs and infection, or just socially inappropriate behavior. Unintentional abuse may follow as the agitated parent seeks to train the child not to touch fecal matter. Consider the impact on the young child when a parent swoops down unexpectedly with assaultive and loud sounds, excited gestures, and rough handling, or some other form of disapproval when the child is curiously exploring his/her own body or bodily wastes. In such incidents, the child is startled, helpless, and, of course, confused. From the perspective of the child, resistance is impossible and the events that follow are a frightening ordeal. The parent has complete control over the child’s body. The child must submit and endure. Rough childhood genital cleansing experiences often cause psychosexual disorders. Therefore, memorable experiences with sexual overtones occur due to the proximity of the genital area to the urethra and the anus. Clusters of sensations, some painful, some erotic, are indelibly imprinted upon the child’s learning system. The developing child does not have the capacity to understand the motivation or behavior of the parent. Even in situations where the parent may have given a previous warning prohibiting such exploratory behavior or activity, the child must fully understand the warning, agree with it, comply or be assaulted in some manner by the parent. If the child does not understand or agree with the parental point of view, he/ she cannot effectively argue the point or persuade the parent to allow the prohibited behavior or excuse the misconduct. The child has no recourse but to accept the punishment, submit, and, at least in the presence of the parent, discontinue the forbidden behavior or be punished repeatedly. Curiosity and learning are inhibited. What further impact does this type of incident have upon the young child? Does learning occur, and, if so, what kind of learning? We can assume that assaultive learning or learning associated with assault occurs. The child has learned that unpredictable assault can occur. The child may also learn that exploratory behavior or knowledge seeking

Inside the Developing Child

13

may be followed by assault, and that parental figures can be assaultive. This type of association relates to a function of the primitive explicit memory system available to young children. In her discussion, “With Mind in Mind,” Susan Greenfield (1997) constructs a good case for correlation, if not cause and effect, of this type of lasting early association. Reviewing the experience from the perceptual perspective of the child, we discern that, initially, the child is startled and then resentful, angry, and confused. If the assault is associated with the parent, the child may thereafter mistrust, fear, and hate the parent. The child may be sufficiently shocked to suspend any ability he/she might have developed to process interpersonal experience at that point in development. Overcharged negative associations with genitals and bodily waste may also occur. In the first year of life, the thought process is extremely primitive, since there are no symbols or verbal representation; thinking is made up of visual fragments or pictures. Moreover, there are no mechanisms of defense in place to protect the child’s psyche from emotional distress. Tension states may become unbearable, causing lasting damage to the child’s ability to learn. Internal functions such as perception, memory, emotion, thought, and motor capacity are all affected by intense occurrences in the environment. Attempts to educate or train a child in the assaultive manner described above have unintended results. The developing child experiences a disruption in his/her ability to integrate new learning. At best, incidental learning occurs. Inside the developing child, mysterious and unpredictable associations are formed. Connections are simplistic and categorical. Some, all, or none of the events may be recalled as they actually occurred. Distorted encoding and storage of memory fragments occur. The emotional component is overwhelming. Cognition is impaired. The child cannot reason or conceptualize sufficiently to comprehend the intended message. Obviously, mislearning occurs. Sexual mislearning is particularly problematical, since it carries the added charge of genital sensations. Physical abuse involving spanking or striking the buttocks or upper thighs may sexualize discipline and punishment even when deliberate sexual molestation is unintended. Clients report that as children they experienced sensual and erotic sensations during spankings, and later learned to associate the relief they felt when the spanking was over with orgasmic relief. Moreover, since so much concentrated attention was focused on their buttocks and lower extrem-

14

Inside the Developing Child

ities during spankings, it approximated the intense focus in the same general area of their bodies that occurs during later adult sexual encounters. The up-and-down movement of pelvic thrusting that occurs during intercourse is reminiscent of the up-and-down movement of an arm or hand delivering strokes during a beating. These primitive associations occur frequently in the stories and dreams of sexually disturbed children and adolescents. A study of these associations generates the following questions: How does sexual pelvic thrusting, which an adolescent or adult experiences many years after childhood spanking incidents, become linked to the up-and-down motion of spanking? What do they have in common that would form the association and fix it so permanently in the storage area of the learning system? The area in the brain referred to as the association cortex is responsible for the coordination of senses and movement. One sensory system is linked to another in a complex manner. Extreme problems with sorting and association occur even in the undamaged brain (Greenfield, 1997, pp. 121– 146). Note the following similarities: intense erotic sensations, genital engorgement, and rhythmic, repeated movements that occur when one is prone or restrained from full body movement. Initial sexual experiences are exciting and often fear inducing; so are spankings, beatings, and other forms of assault made upon lower body parts. Somatic memories are formed even if there are no cognitions or verbalizations to help sort and integrate these memories. In therapeutic settings, small children and adolescents frequently draw, model in clay, create sand sculptures, or paint fragmentary scenes depicting beatings or spankings of children and animals in an effort to express feelings that have collected around unintegrated memories of beatings they have experienced or witnessed. These experiences are memorable because of the high level of emotion and bodily sensations associated with being spanked. There is also a high level of emotion and bodily sensation that accompanies sexual encounter. It is clear that sexually disturbed children and adults learn, link, and remember these occurrences. Another associative factor is the presence of a familiar person, which approximates the intimacy previously experienced in a parent-child relationship. Intense feelings experienced in the present cue similar past feelings. Thus, when a sexual encounter occurs or is imagined, the current arousal reactivates memories of similar unintegrated arousal incidents. This does not always occur within conscious awareness. It is likely that the disturbed child who has experienced assaultive learning will

Inside the Developing Child

15

later, as an adult, seek to replicate parts of the earlier experience he/she had as a child in an effort to integrate fragmentary learning. This type of recall may have the effect of initially increasing sexual arousal, but, later, with the onset of anxiety, may also inhibit the sexual arousal response. Either way, the likelihood of sexual dysfunction or deviation for this child has been increased. The basis for regressive tendencies is also formed in this manner. The unintegrated experience is recalled repeatedly until it is absorbed (Doyle, 1992, pp. 91–107). During sexual intercourse, the disturbed adolescent or adult relives fragments of the early childhood assault experience. This is because the memory links formed in childhood between genital sensations, sexual arousal, spanking, and punishment are closely associated and cue one another. The overgeneralization of these early experiences will not dissipate until new learning occurs with sufficient intensity and repetition to interfere with or balance out the initial erotic assault experiences. The intensity of new learning must approximate the intensity of the initial mislearning. To contain sexualized regressive tendencies, the disturbed adolescent or adult must also learn to discriminate between past and present, pleasure and pain, as well as submission and dominance. The ability to discriminate both consciously and preconsciously is essential to integrate assaultive early childhood experience. Only then will regressive states cease to be cued in adult sexual encounter. Children are not generally encouraged to talk about their reactions to spankings, any more than they are encouraged to talk about their masturbatory experiences. But they do have strong, confused reactions to these occurrences. Because there is little opportunity to sort through and integrate these intense emotional and erotic experiences, the child’s mind is overwhelmed. The fragmentary responses are relegated to a storage area for sensate memory traces. When erotic or sensual sensations are felt in later years, these earlier associations are activated and affect perceptions of current sexual sensations. Social and sexual development is impaired. The child’s mind also associates genital sensations with toileting. If early toileting experiences are traumatic, due to punitive toilet training or improper management of common toilet-related fears, the child’s level of anxiety and/or genital excitement regarding urination and defecation is substantially elevated. Encopretic children frequently have stored up anger and resentment toward parents (see the case of Niomi in Chapter 8). Significantly, these children also have not been afforded the opportunity to talk about their anger or other feelings they might have accumulated as a result of their toileting failures.

16

Inside the Developing Child

From infancy, an accumulation of knowledge drawn from new experience is formed. With each new experience the child constructs an internal representation of what is seen and felt in the external world as well as what is felt within his/her own body. The internal representation or memories of traumatic events are fragmentary because the process of internal representation of external events is disrupted by the force of the learning context. Sexual mislearning often occurs with assaultive teaching due to the child’s inability to construct an internal representation of what has occurred. Moreover, if a child experiences a memorable event at a particular age—for example, age two—the characteristics of a two-year-old thought are associated with the traumatic event. When the memories return, or during a regressive state, the grown adolescent or adult will think the way he/she thought at the age of two when the memorable event occurred. This is a component of regression. The regression bearer may even take on the attitude and demeanor of a two-year-old. For example, egocentrism is one of the features of early thought. This means that the child cannot put him/ herself in the place of another person such as the parent or caregiver. In cases where the child is playing with fecal matter—that is, smearing it on self and/or the walls—and the parent responds with alarm and/or anger that takes the form of loud voice tones, quick movements, and/ or vigorous scrubbing to cleanse the child, the normal learning process will be interrupted. Distorted, fragmented mind pictures will be formed. Startled, the child may experience terror and fear, both associated with the physical pain and discomfort of the forced cleaning of genitals, hands, face, and other body parts. The child does not understand the parent’s point of view. In fact, from the internal perspective of the child, the parent’s point of view is irrelevant due to the influx of other stimuli in the learning context. For this child, in later personal relationships, the point of view of the relationship mate during certain situations may also become irrelevant. If the damaged child regresses in later years and/or recalls that incident, it will be recalled with the mind of a twoyear-old, or a two-year-old in crisis. The regression bearer, regardless of his/her current chronological age, still will not understand the point of view of others, and will be completely self-absorbed. Focused new learning must occur to alleviate childlike egocentrism. Until the incident is discussed, along with appropriate and sufficient feeling, plus appropriate emotional and sensorimotor expression, the disturbed adolescent or adult will continue to see the incident as he/she first did—as a two-year-old from the egocentric point of view charac-

Inside the Developing Child

17

teristic of that stage of cognitive development. This is not conscious self-centeredness, although it may be experienced as such by relationship mates. In a very real sense, development has been suspended. Developmental incidents, such as fecal smearing, self-stimulation, or sex play with others, are representative of the child’s search for knowledge and experience. When these exploratory activities are interrupted and meet with punishment or parental disapproval, the child is more hesitant to explore and learn. Without remediation, the interrupted behavior takes on more significance than it normally would have had without interruption and punishment. Ironically, when a parent seeks to extinguish a behavior through punishment, it renders the targeted behavior memorable and ensures that it will resurface in some form for years to come.

3

The Lasting Impact of Highly Charged Sexualized Events

A memorable sexual event acts as a magnet for all subsequent sexualized events regardless of how dissimilar discreet aspects of those following events might be. As long as there is a sexualized sensate component—be it tactile, visual, audiokinetic, or olfactory—that sensate component is sufficient to form a connection or link to the original sexualized event. Moreover, fragmentary sights, sounds, movements, or smells occurring within a sexualized context are sufficient to activate the memory of an anxiety response that then floods the senses of the person involved with similar anxious feelings. For example, a small child who has felt the pressure of being sexually penetrated orally, anally, or vaginally will have formed and stored an image of that occurrence complete with associated sensations. Recurrence of any of those associated sensations are sufficient to provoke an anxiety response. In many of these cases there are also lasting negative effects from nonsexualized punitive attitudes surrounding the learning context in general. Aversive teaching by a parent, caregiver, or educator produces aversive learning in the child; this means that the child does not enjoy learning and instead seeks to avoid new information and experience. The absence of new learning allows the aversive learning to dominate the child’s memory and knowledge base, resulting in maladaptive behavior that does not always surface immediately but does have a deleterious effect on subsequent development. At five years old, Arthur (see Chapter 6) was slow to internalize his gender identity as a male, a developmental task usually completed by three or three and a half (Parsons, 1983). Arthur did not identify himself as either a boy or a girl. He stood up to urinate, although he frequently felt the impulse to sit on the toilet, as his mother did. He seldom gave in to the impulse,

20

The Lasting Impact of Highly Charged Sexualized Events

remembering how upset both his parents had been when they observed him sitting on the toilet to urinate rather than standing. In an effort to teach him to “do it right,” his parents took turns demonstrating. Arthur was forced to watch while first his mother sat and got up, then his father put up the toilet seat and stood. His mother then put the seat down and sat. The process went on for a prolonged period of time. The incident felt punitive. It was difficult for Arthur to integrate. It was also clearly linked to gender identity formation. A screen memory was formed that impeded new learning relative to gender identification. Arthur eventually identified himself as a male, but he never forgot the traumatic incident. A child who has experienced sexualized trauma may appear to have recovered or emerged unscathed from the event. Sexualized trauma may seem to recede into the past but its effect on sexual identity and/ or sexual behavior resurfaces as the child attempts to move forward from one psychosexual stage to another. Due to the highly charged nature of a sexualized learning context, and the limited cognitive abilities of the young learner, there is a great deal of uncertainty within the child regarding the source of the knowledge that is encoded at the time of the sexualized traumatic learning event. In some cases, being unclear about the source of knowledge may produce delusions and hallucinations (Johnson, Hashtroudi, & Lindsay, 1993, pp. 3–28). In Case History I, Severe Regression (Chapter 5), a woman who was anally raped as a child is unable to distinguish between reality and imagined events. Her knowledge, beliefs, and assumptions regarding what had happened to her were a combination of dreams, imaginings, and real experience. Recall of traumatic sexualized events seems to come at various levels of awareness for differing aspects of a given memory. Clients often report remembering an odor or a genital sensation and little else about a sexualized traumatic event, except for a pervasive feeling of dread. Inability to put together a clear picture of the event and identify its source results in pressured preoccupation with cues that repeatedly reactivate the event. In general, trauma teaches the learner about pain and discomfort. This forms discrete pieces of knowledge that are stored in the memory for later retrieval. All other emotions and physical sensations associated with the traumatic event also become a permanent part of the memory. During infancy and childhood, traumatic events can be so devastating they actually interrupt the normal process of learning or alter it indefinitely.

The Lasting Impact of Highly Charged Sexualized Events

21

In learning to learn, the child must engage with new experience. It is commonplace for children to acquire undesirable responses as a result of trauma, which may fade away or be replaced with more adaptive responses. In nonsexualized instances, this type of mislearning is more readily noticed and corrected successfully by parents or teachers. In most cases attending adults fail to understand or tend to minimize the extent of sexualized trauma and its impact on the child. It is very difficult to ascertain what the learner actually perceives during trauma. We know it is an aversive experience. When mislearning occurs, it usually remains uncorrected. Multisensory experience stemming from intense, forced participation in physical events, such as a spanking, harsh toileting practices, or sexual molestation, has varying effects on different learners. The total impact on memory depends in part on prior learning, the temperament of the child, and the context of the event. There are, however, some repetitive thematic associations that emerge with childhood trauma. The sexualized traumatic theme includes a pervasive fear of its recurrence. In addition to learning that brutal violation of self can occur, the damaged child also learns to inhibit his/her previous openness to new experience in general and/or new experiences in the specific area wherein the trauma occurred. This compounds the situation, making integration and developmental progression even more problematic. This has obvious implications for treatment, that is, introducing new learning that interferes with the pathological effects of sexualized trauma. Related new experience, if presented and integrated, would interfere with the memory of the sexualized trauma and cause it to decay naturally. But the damaged learner becomes more cautious about allowing new experiences for fear of additional pain and/or punishment. The memory of the highly charged event thus becomes more resistant to forgetting (Bower & Mann, 1992, pp. 1310–1320). The child also formulates lasting associations with feelings of dominance and submission. The juxtaposition of power and helplessness or dominance and submission assume central importance for the child who relives or regresses when cued by fragmented memories of the sexualized trauma. This occurs repeatedly. Dominance and submission feelings figure largely in later adult sexual arousal and response. The child’s early experiences of normal dependency are likewise contaminated with intense reactions to being dominated and forced to submit to the will of the punishing or sexually assaultive person. A polarization of dominance and submission themes associated with sexuality often occurs.

22

The Lasting Impact of Highly Charged Sexualized Events

Sexualized sensations or experiences involving feelings of dependence, dominance, submission, and helplessness take on exaggerated importance due to the highly charged nature of the early assaultive learning context. In normal adult sexual encounter, positions of dominance and submission are interchangeable and both usually furnish arousal and satisfaction for the sexualizing person. Role rigidity can sometimes make it difficult for some females to enjoy the on-top or active position during intercourse. Males generally feel more powerful in the on-top or superior position, but enjoy the contrast of passivity in the supine position. These preferences fall within the range of normal behavior. If, however, there are unintegrated sexualized assault experiences in early development, positions of dominance and/or submission may take on fetish proportions. The adolescent or young adult so affected cannot feel arousal or sexual satisfaction without the presence of exaggerated master-slave components accompanying sexual encounter. Bondage, the stylized use of leather whips and chains as well as other restraints, is often incorporated into the sexual play of individuals who have been sexually traumatized as children. Complex associations with dependency also impinge on the ability to maintain intimate relationships. Earlier mistrust of parental figures, who have taken the role of assaultive punishers, later affect the learner’s ability to give and receive sexual pleasure from another person in an intimate relationship. This may occur whether or not the childhood assault was sexualized. The assaulted child both fears and craves emotional and physical closeness. Developmental arrest or regression occurs. Conversely, the ability to exist or flourish alone is also affected. There is an unfulfilled need for nurturance and/or protection that interferes with the task of separation from parental figures. As an adolescent or adult, the regression bearer seeks to erase memories of the damage in the parent-child bond in order to proceed to autonomy and maturity. This can result in repeated reenactments of sexualized master-slave encounters wherein the regression bearer seeks to detoxify and integrate memories of assault. The self is perceived as childlike, even though the person is now actually an adult. The ability to bond is incomplete or takes on a component of cruelty. From the child’s perspective, pain can be visited upon him/her unexpectedly at any time. Moreover, the child cannot trust his/her own ability to evade, escape, or effectively deflect the assault. This perception of self as small and weak prevails over time, even though the actual size

The Lasting Impact of Highly Charged Sexualized Events

23

and strength of the regression bearer is that of an adult. Feelings of helplessness and low self-esteem result. The ability to tolerate relationship intimacy is compromised, since, to the damaged child, relationship intimacy carries the risk of being subjected to pain. Although intimate relationships may be formed, they inevitably take a different course than they would have had the assaultive experience not occurred. If corporal punishment or assault is an ongoing experience for the child, emotional learning, which comprises conditioning and imitation, will permanently link anxiety associations with the punitive learning context in the child’s memory. Negative feelings of basic mistrust will be linked with shame and self-doubt, blurring the first two developmental phases the child must complete (Ericson, 1982, pp. 25–53). Conditioning is the most effective form of learning during the first year of life. It is automatic and does not involve reasoning and judgment. Later, imitation is carried out through the child’s observation of other people’s reactions. Practice and repetition fix early emotional reactions and behaviors within the child’s memory. Retrieval of the experience, with its attendant associations, occurs each time similar situations occur. The associations are thus strengthened with each repetition. The child will learn to respond as the parent has responded or as the child believes the parent has responded. The assaultive behavior of the parent will function as a model for the child’s own behavior. The child does not often retaliate in later years with assaults upon the parent, although this is not entirely uncommon. Many adults describe, with pleasure and satisfaction, how they finally turned the tables on their assaultive parents by striking them back, or physically or sexually abusing them in a retaliatory manner. More often, these adult children, once damaged, perpetuate assault patterns by damaging their own children, or children and adults with whom they relate intimately, acting out their earlier experiences as a perpetrator rather than a victim (Doyle, 1992, pp. 39–52). In those cases in which some form of direct retaliation or confrontation occurs with the assaultive caregiver, more successful integration of the incident is likely. The compulsion to relive the incident in current relationships also seems to be lessened. Summarizing the lasting nature of sexualized assaultive learning, infants and young children do not have the ability to discriminate effectively among the multisensory stimuli of highly charged events. They may link all input present in the assaultive learning context with the negative feelings experienced at the point of trauma. This includes the learning process itself. Anxiety and confusion become fixed associations

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The Lasting Impact of Highly Charged Sexualized Events

with learning. Thus, learning itself, or the process of acquiring new information insofar as the child is aware of it, may be negatively linked with pain and discomfort and/or elevated levels of tension and anxiety. Children are dependent upon the process of adaptive learning for development and survival. If pain, discomfort, and anxiety are associated with learning, their ability to learn comfortably and develop normally is severely impaired. Highly charged sexualized events are difficult for children to sort through and process. Fragmentary components of traumatic, multisensory experiences are linked together capriciously. As a whole, they generate an aura of sexualized anxiety or sensory barrage that can be reexperienced when even slightly similar situations occur. An older child, adolescent, or adult intuitively sensing the emergence of a painful memory will seek to avoid it at the preconscious level. Memory content can thus be distorted or disguised when it reaches the surface of consciousness. For example, one may feel that he/she is being abused in the present by a spouse when, in fact, the abuse occurred in the past and was perpetrated by a parent or sibling. In many cases, regression occurs. It may take the form of an uneasy, preconscious awareness that something dreadful is about to occur. It may temporarily reduce the cognitive, affective, and/or motor abilities for those of a younger age. In its most severe form, it blurs the distinctions between past and present, infant and child, child and adolescent, adolescent and adult, resulting in a confused blend of thoughts, feelings, and behaviors that characterize severe regressive episodes. Fragmentary responses may be reactivated again and again, causing regressive episodes long after the child has been assaulted (see case histories in Chapters 6, 7, and 8). Regressive awareness of early assault continues into adulthood. As sexualizing adults, regression bearers are constrained by their childlike sexual states and reexperience exaggerated feelings of dependence, dominance, and submission sexually, with the awareness and responsibility level of children. In some cases, highly charged sexualized events, experienced in childhood, give rise to psychosexual disorders and sexual crimes result (Doyle, 1992, pp. 91–107). For others, the impact impairs general adult sexual functioning. Most common are the cases in which intimate sexualized relationships become a source of anxiety and pain rather than pleasure, peace, and comfort (Doyle, 1995, pp. 109–121). Sexual addiction frequently occurs in regressed individuals who have experienced a highly charged sexual event in childhood.

The Lasting Impact of Highly Charged Sexualized Events

25

In treating these cases, it is necessary to isolate the sensate components present in the original sexualized events. Then the sensate component, be it tactile, visual, audiokinetic, or olfactory, can be associated with new, acceptable experiences that eventually balance or replace original, damaging ones. Thereafter, the regression bearer is less focused on returning to the original sexualized learning context to integrate memory fragments. The released energy can be spent on forward movement. Regression gives way to progression.

4

Developmental Blurring

Developmental blurring is a phenomenon akin to regression, though it is not as severe. Both psychological states are products of the learners’ perceptual screen and learning style. Both are greatly affected by the emotions and sensations experienced in past learning contexts. Developmental blurring is more common than regression and can occur with or without trauma. The essential difference is that regression is more likely to progress to a pathological condition. Developmental blurring inhibits progression and often contains clinical features of malignant regression. Inclusive of these are difficulty with trusting relationships and erotic symptoms (Van Sweden, 1995, pp. 69–70). When a young learner is faced with a developmental task similar to one previously experienced, memories of that earlier phase are cued, as are the original feelings associated with that stage. There is a subtle blurring of time and place. As the new or current experience cues memory traces previously generated by the old or past experience, the learner is challenged to maintain contact with current external reality rather than react to earlier accumulated knowledge and behavioral responses. Certain maturational experiences are repetitive, as are the cluster of anxious and excited feelings that they generate. The developmental task of separating from the parent or caregiver in order to form an individualized sexual identity is a prime example. There are two parts to this process. The first part involves separation. To complete this task, the child must establish an independent reaction to touch, sensual and erotic sensations, body image, gender awareness, and sexual orientation. This is a very subjective experience, strongly affected by the learning context in which these sexual identity components are first presented.

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Developmental Blurring

The child must have his/her own distinct reactions, quite separate from those of parents or other caregivers. If the child has difficulty separating from parents, difficulty will also be experienced in sexual identity formation. Learning to be sexual is a task that cannot be accomplished successfully until the child is secure enough to separate from the protection and control of caregivers. As long as the child is anxious about the separation portion of sexual identity formation, he/ she cannot progress through each of the separate components of sexual identity formation. Sally, a single mother of two, was emotionally and financially dependent on her parents. Her husband had abandoned her and she was forced to assume responsibilities for which she was not developmentally prepared. An obvious option was to find another male protector and provider, but Sally was conflicted about prolonging her dependency. To seek another male would mean honing her feminine skills and subordinating other parts of herself to that stereotype. Developing more autonomy requires a sustained effort at developing new skills requisite to independence. This dilemma activated a developmental blurring effect that was extremely uncomfortable. Sally’s ability to sort through and integrate her feelings and cognitions was dependent upon how well she had completed previous developmental challenges in early childhood and adolescence (see Chapter 7). Feeling clusters will resemble those that have occurred in earlier phases of development when gender restrictions were experienced or when there was a memorable reaction to a genital sensation. When the predominant feelings and events of an earlier stage are replicated or even approximated in a later stage of development, the child or adolescent may reexperience fragmentary recall of events and sensations that occurred in that earlier stage. It is as if both stages were being experienced simultaneously. This may result in uneven regressed behavior (Doyle, 1992, pp. 65–78). When early developmental tasks have been completed successfully in a balanced manner, attendant feelings of success, pride, and confidence will be reexperienced when subsequent developmental tasks are presented for mastery. Likewise, when imbalance in earlier task completion occurs, the reemergence of anxiety, dread, and feelings of failure ensue. Early developmental imbalance thus augments and swells anxiety reactions occurring in conjunction with a similar current developmental task. There is a phenomenological blurring of the two stages, even though they are not consecutive and overlapping. In psychosexual development, gender identity tasks emerge with intensity at about eighteen months to three years, and again during early

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adolescence. In both stages there is a dramatic preoccupation with gender-role prescriptions and expectations as the learner becomes acutely aware of his/her gender identity. In both stages, the child must clarify and practice behaviors appropriate for his/her assigned gender. Stereotypes are utilized to furnish guidelines for speech, tone of voice, and mannerisms. The young child makes assumptions regarding gender based on very generalized cues such as hair length, dress, and task division or occupation. Obvious visual signs of masculinity and femininity are very important. Parents serve as models for sexual identity formation. Children may consciously model themselves after parents or pick up their sexual identity characteristics through incidental learning. Increased masturbation occurs in both stages (eighteen months–three years and twelve years–eighteen years), and there is an intense preoccupation with body parts and ideal body image. There is a high need for information regarding all aspects of sexuality. If parents and teachers do not furnish adequate information, children and adolescents fill in the blanks with imaginings or turn to peers for knowledge and guidance. There is a prevalence of dirty jokes that revolve around bathroom habits in early childhood and sexual encounters and orientation in adolescence. Sexual misinformation and confusion are common in both stages. If toilet training was problematical, genitals may have become negatively associated with excretory processes. If spankings or corporal punishment were utilized as a corrective measure, dominance-submission themes are likely to have emerged as an element in eroticism. The basis for sadomasochism, fetishism, exhibitionism, and pedophilia is formed as a result of mislearning during these two pivotal stages in psychosexual development. Urination and defecation are extremely significant psychosexual events to infants and young children. Toileting offers an opportunity for the child to gain a sense of mastery over his/her own body functions. Feelings of fullness and relief are usually accompanied by pleasant sensual and/or erotic sensations. It is through excretory functions and toileting experiences that children form enduring attitudes and associations with genital awareness and sexual arousal as well as with body image. Parental attitudes or the learner’s perception thereof are a major influence during this process. Children who are allowed to toilet train themselves with minimal input from caregivers are less likely to form negative attitudes toward their bodily processes. This makes it more likely that later, in early adolescence, these children will be un-

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Developmental Blurring

hampered by overcharged negative memories and associations surrounding their genitalia and bodily excretions. Developmental blurring is also less likely. Sexual identity formation is less problematical. If we focus on general development in both stages, partial separation from parental control is a primary task. Separation often involves an aura of antagonism, or rebellion, on the part of the child. Parental acceptance or nonacceptance of the child’s need for separateness and autonomy determines the feelings and attitudes the developing learner will formulate toward autonomy as well as toward the concurrent psychosexual task of gender identity formation. In developmental blurring, the tasks, as well as the stages, seem to merge. When separation from parental control is blocked, sexual acting out may occur as the child uses acts of masturbation, exhibitionism, or promiscuity as statements of independence. When an adolescent approaches the task of separating from parental control and pursuing activities directed toward establishing an autonomous sexual identity, previous feelings of vulnerability, experienced between the ages of eighteen months and three years, may surface. It is during this earlier period that the young child first develops the motor skills and ability to willfully crawl or run away from the attending parent and experience physical autonomy. If the child had difficulty either accepting his/her assigned gender identity, and its attendant role restrictions, or the other task of pseudoseparation from caregivers during the earlier stage, feeling clusters, including somatic sensations, regarding those issues will be cued and reexperienced in pubescence and adolescence. This complicates the challenge of learning specific sexual behaviors, such as body movement during sexual encounter. The ability to emit sounds during sexual activity is compromised. Adolescent males and females at this stage are often concerned with not knowing what to do and how to physically do it during a sexual encounter. From their perspective, the actual experiences of sensual and erotic sensations are often secondary to mastering the mechanics of coital activity. Not being embarrassed by appearing sexually inept is more immediately important than actually enjoying the encounter. Gender-specific developmental tasks involve conforming to mainstream heterosexual stereotypes. Males are expected to be more sexually knowledgeable and aggressive than females. A female must learn an elaborate system of stop-and-go signals to guide or control her male counterpart. This can be confusing and distasteful for any young learner, regardless of whether there are complicating factors like sexual

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orientation or genital abnormalities. Because there is less guidance provided for children of homosexual orientation, the entire process of separation and sexual identity formation is prolonged, as it presents more complexities. This is also true for children with genital abnormalities. Hormonal changes increase genital awareness and present what feels like urgent decisions regarding sexual behavior. Children deviating from the heterosexual norm experience a higher incidence of developmental blurring and regression. Most children experience alternating periods of clinging to and distancing themselves from parental figures throughout their development. These reactions are most extreme during eighteen to twenty-four months and fourteen to sixteen years of age. Intense struggles or overcompliance with parental control ensues. As described above, developmental tasks are similar: the child must separate from the parent and explore the environment through his/her own perceptual screen. Emotional reactions intensify because of the concurrent task of gender identity formation. Anxiety is heightened due to increased genital awareness. This is both exciting and frightening. The younger child crawls or runs away to explore, returning to the parent for reassurance and comfort. The adolescent approximates the same behaviors with a great deal more at risk. From the adolescent perspective, this separation will be the final one. After this, the adult world will claim him or her. Childlike behavior will no longer be allowed. Returning to the parental figure is less of an option. The adolescent must make his/her own way without obviously returning to the parent for succorance, support, or clarification. This is a formidable task. The adolescent must see the world through his or her own eyes, which will differ markedly from the parental worldview. This is particularly true where sexual behavior and attitudes are concerned. Parental sexual practices and needs are often very different from those of adolescents. Moreover, the adolescent must learn to make decisions without significant parental guidance and evaluate the outcomes based on his/her own personal value system without benefit of parental interpretation. In sexual matters, the developing child and/or adolescent will feel more intense genital sensations than parental figures will remember feeling at that time in their own lives. Sexual interests and impulses are closer to the surface and less governed by impulse control in developing adolescents. This disparity gives rise to anxiety in parents and caregivers who often seek to repress any sign of sexuality in their adolescent children.

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Developmental Blurring

In both stages, overwhelming feelings of vulnerability and anxiety occur in relation to self and parental figures. To avoid rejecting parental control and risking disapproval, the adolescent may regress to the earlier state and exhibit childlike responses and associations more common to eighteen months or three years than to early adolescence. The childlike behavior, in turn, cues memories of earlier regressive feelings, which include earlier genital sensations. A repetitive cycle, sometimes continuing well into adulthood, is set in motion. Fragmentary memories of spankings, toileting experiences, and masturbation drain the child’s energy, impeding psychosexual development. When the child finally invests more energy in moving forward and establishes a pseudoemotional and semi-autonomous sexual identity that feels separate from parental figures, the developmental task nears completion. Anxiety surrounding masturbation and genital sensations also diminishes. Developmental blurring subsides, and regressive behaviors are less evident. Pronounced regression is more likely if the parental figures have projected their own anxiety and mistrust of the child’s ability to accomplish the task of separation or the establishment of a functional sexual identity. Oftentimes, parents overreact to signs that their children are sexually active, doubting their own ability to manage that developmental occurrence. If the parents are overprotective, the child must fight harder to achieve separation, struggling against both his/her own and parental anxiety. Parental management of these stages is a pivotal factor in determining the extent of developmental blurring or regression that will occur. Poor management of developmental blurring can result in gender dysphoria, a condition that ranges from simple role rebellion regarding gender expectations to a delusional determination to remain nonsexual behaviorally. This is a futile effort to avoid maturation because separation from parental figures, which is greatly feared, will follow. Inevitably, hormonal messengers chemically ignite sexual desire: the sex hormones—androgens and estrogens—circulate throughout the biological system, creating sensations and emotions that alarm and confuse the child. Genital emissions and discharges cue memories of bodily waste associated with toilet training. A blurring effect is set in motion due to the similarity of feeling clusters experienced in both stages. Smells, textures, and tactile reactions to urine and feces, as well as stinging and genital burning sensations, are memorable events contributing to gender dysphoric conditions.

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Since the basis for developmental blurring normally occurs before the ages of two and four years old, if the attachment to parental figures is loosened gradually during that period the intense emotional as well as physical reactions will not create as severe a developmental crisis. The child can absorb and integrate awareness of erotic sensations as long as those feelings are not linked to parental disapproval. Memories of prior genital sensations normally resurface during pubescence and adolescence, when they will again be paired with learning gender-based restrictions and other societal controls. The child experiences consistent pressure to conform to appropriate gender-role behavior and controlled sexual expression. For a small number of children, gender prescriptions for urination—that is, utilizing the standing or sitting position depending on whether one is male or female—can create profound sexual identity issues. This occurs more often when the child has negative associations with bodily wastes as well. There are other significant differences in the rules for boys and girls. As adolescents, boys are encouraged to engage in more sexual experimentation than girls. Many young males resent being pushed into sexual behaviors they do not understand and, therefore, fear. Dominance and submission themes present pressures that give rise to sadomasochistic fantasies, dreams, and behaviors (Milburn & Conrad, 1996, pp. 238–251). Performance anxiety resulting in erectile and/or ejaculatory dysfunction is often based in gender dysphoric developmental blurring. Simple psychosocial messages, intended to control public masturbation, provoke overreaction in many sexually disturbed children. Adolescents usually feel apprehensive about masturbating. If, as younger children, they were reprimanded for exploring their own genitals, any current reactions of sexual shame, self-doubt, or anger will be augmented by memories of those past incidents and feeling clusters. The child cannot discriminate. Any overt sign of sexuality met with disapproval may result in broader associations in later stages of development. As sexual identity formation continues, the likelihood of developmental blurring also increases. This takes a circular course and affects the child’s ability to tolerate erotic feelings. The pubescent child reexperiences earlier anxiety that occurred around the age of three, when sexual identity formation was the developmental task. Genital activity again becomes a focal point but is overcharged and exaggerated by the developmental blurring. Erotic and sensual sensations, normally generated at this age, cue anxieties and associations formed around genital sensations in the earlier stages of development. If feelings of guilt

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Developmental Blurring

were also associated with masturbation and early group sexual expression, such as playing “doctor,” guilt feelings are likely to recur with greater intensity associated with sexual experimentation in pubescence. Thus sexual associations of any kind generate an anxiety response within the child. Homosexuality is also a childhood issue. Many children sense their differences from heterosexual counterparts before pubescence. Since they do not understand these differences, anxiety and guilt reactions ensue. Many parents believe that sexual orientation is simply a choice and seek to eradicate early signs of gender ambivalence in their children. The scientific community is still engaged in an ongoing controversy over the matter (Hamer, Hu, Magnuson, & Pattalucci, 1993, pp. 321– 327). A biological basis for sexual orientation does not exclude the significance of cultural and social influences on psychosexual development. Initial gender identity formation, a sense of awareness of one’s own sex and what is expected of males and females, are preschool experiences. It can be a very pressured experience for a gender-ambivalent child. Sexual identity formation in homosexual children is more complex due to discrimination by the heterosexual mainstream. Unfortunately, it is rare for any child to receive clear messages regarding sexuality in general, let alone sexual orientation in particular. Very little is articulated or expressly communicated. Instead, sexual attitudes and expectations modeled by parents are generally only sensed by developing children. Pressured ambiguity of this sort promotes developmental blurring. Guidelines restricting sexual identity formation present overwhelming confusion to the sensitive child. Many prepubescent children seek to delay their own sexual identity formation by becoming asexual or prolonging homosocial activities. Homosexual activity may appear to be a simpler alternative than attempting to follow the maze of genderbased restrictions designed to shape and control heterosexual expressions. Although homosexuality is not considered a pathological condition, whether it is chosen or biochemically determined, avoidant regressive behavior can be the pathological end point of developmental blurring. Homosexual children are at greater risk of avoidant regressive behavior than their more numerous heterosexual counterparts. Punitive mismanagement of masturbatory activity commonly results in fetishistic behavior, which affects sexual response throughout the life cycle. For example, very young children sometimes utilize objects of comfort linked to parental approval during masturbatory activities. If a parent approves of bath taking, the child secretly masturbates in the

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bathtub to alleviate anxiety, hoping to magically stave off parental disapproval regarding masturbation by engaging in the prohibited behavior in an approved location. A childhood habit is formed that is reinforced in adolescence. This bathtub setting becomes eroticized. Thereafter, the child prefers or must be in the bathtub to feel erotic sensations or experience orgasm. Although this may not constitute a full-fledged paraphilia, with all of the criteria points listed in the diagnostic manual of mental disorders, it makes it difficult for normal sexual expression to develop later in life. Acceptance of sensual and erotic sensations is necessary for normal psychosexual development. Parental approval or disapproval of genital sensations and expression affect the level of anxiety the child will experience with each subsequent stage of sexual development. Developmental blurring may be a manageable, passing phenomenon or it may contribute to more serious regressive tendencies in the developing child or adolescent. The ability to give and receive touch is a significant factor in psychosexual development. Parent-child touching patterns are a prime example of indelible conditioning. Early learning pertaining to body contact and touch becomes the basis of an enduring psychosexual attitude toward physical closeness and genital contact. Commencing with birth, the infant experiences the world through touch. Gender assignment influences the way an infant is handled. Boys are generally handled more roughly than are girls. Girls receive more tenderness and cuddling and are conditioned to expect it. This gender-based treatment forms the basis for stereotypical attitudes toward touch and sexual encounter that cause problems in later heterosexual encounters, particularly for inexperienced adolescents. If infants of both sexes received similar forms of touching, men and women might develop more compatible lovemaking styles later in life. Males might be less genitally aggressive and females less hesitant in their sexual touching patterns. Anxiety arising from dominance-submission themes would also be less prevalent. Human touch symbolizes contact with others, both physically and emotionally. Development is dependent upon it. Touch also bridges the preverbal communication gap between child and parent. To remain untouched, for many children, is to be unacknowledged, isolated, and abandoned. Gentle touch signifies tenderness and caring. Rough touch signifies harshness and threat. Initial experiences with genital touch promote infantile attitudes toward eroticism, which endure throughout

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Developmental Blurring

childhood, adolescence, and adulthood. How one feels about being touched or touching others significantly affects the ability to engage in sexual behavior. Touch is even more significant in sexual identity formation when there are genital abnormalities. In those cases where there is ambiguity in gender assignment, the parents often unconsciously express their reaction to the infant’s genital abnormality through avoidance of touch or through tenseness in their own bodies while touching the child. This causes anxiety in the infant about being touched or touching others. Such anxiety, particularly when linked with genital sensations, may result in touch phobias and/or sexual dysfunction in adulthood. How much can we actually remember about how we were touched as infants? Memory is dependent upon maturation. Because the brain size of newborn infants is only one-fourth the size it will be at maturity, there is a limited capacity to formally remember whether early touch was rough or gentle, but recent theorists believe that emotionally powerful events alter the shape of the developing brain. Touch is a memorable experience, particularly eroticized touch. This means that mature memory storage need not be present to establish learning based on collected experience (McEwen, 1995, pp. 117–136). Dread of touch and genital contact builds from one successive stage to another. Developmental blurring based on earlier touching experiences complicates subsequent psychosexual phases of growth. This is due to the powerful and repetitive symbolism of touch. If the infant does not develop a sense of trust and comfort with touch, he or she will carry this deficiency into childhood and adolescence. In normal psychosexual development, genital touch is accepted without tension and without excessive seeking of erotic and sensual sensation. Ideally, infants and children should accept genital sensations in the same way they accept vision or hearing, without a sense of intensity or focus. When the young learner experiences anxiety and tension in association with touch, whether sexualized or not, a link in the chain of aberrant learning about sexuality is formed. Sexual identity formation is affected. In subsequent stages of development, when the frequency and intensity of intimate touch accelerates, developmental blurring will occur. Regressive behavior will follow. Earlier anxieties about touch experienced in previous stages will reemerge, augmenting current anxieties regarding current sexualized touch. Other negative events or perceptions relative to sexual and erotic sensations are also more readily subject to recall at these times. The sensitive nature of memory traces

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provokes cross-cuing, which means that fragmentary associations with sexual events cue one another, sometimes capriciously. For the child experiencing developmental blurring, the full appearance of secondary sexual characteristics can be agonizing. For a female, a new distribution of fat alters the shape of her body and more readily identifies her as a sexual object. Menses begins and she is biologically ready to reproduce. Her male counterpart is filling out, his voice is changing, and a noticeable hairy cover is emerging on his face and other parts of his body. Both genders are now biologically prepared for sexual activity and reproduction, but social restrictions on sexual expression create ongoing conflict, which continually reactivates sexual anxiety experienced in earlier development. Erotic and sensual sensations may continue to be enjoyable, but when tinged with anxiety they are felt as an undesirable presence—something that must be overcontrolled, concealed, or even eradicated. This cannot be done. Physiology is the determining factor. There is no way to suppress or completely sublimate the reality of sexual desire. In vulnerable adolescence, the blurring effect creates a complex web of sexual awareness that is partially childlike, partially mature. The physiological arousal is mature. The emotional and psychological reactions are those of a confused child. As developmental blurring continues, the disturbed adolescent becomes preoccupied with erotic sensations and generally receives little or no positive and practical guidelines for sexual expression. What might be experienced as natural, pleasant, and exciting has become unbearably intense. Developmental blurring takes on pathological proportions and regression occurs. Psychosexual development is suspended. The developmental task of separation from parents must be completed before sexual identity formation can be stabilized. Progression depends upon the adolescent’s acceptance of his/her own unique perceptions of sensual and erotic experience.

5

Case Study of Severe Regression

This material, though presented from the subjective experience of the regression bearer, actually represents a compilation of self-report, spousal reactions, and clinical interview. It offers insight regarding the internal experience of the regression bearer, Clarisse, and her husband, Lee (pseudonyms are utilized in all case study material). Client behaviors resulting from specific components of the original traumatic event are linked to the activating cues evoking recollection of memory fragments from an erotically stressful experience that occurred over thirty years previously. Regression transcends diagnostic categories and is not limited to post traumatic stress reaction. This case study, as well as those that follow, illustrates a consistent component of regression phenomena. Forbidden topics or socially unacceptable subject matter such as erotic sensation, sexual encounter, and the sights and smells associated with acts of defecation and urination often serve as focal points for memorable sexual events. Other sensitive gender-restrictive social and political issues, such as dominant sexual behavior and prescribed female submissiveness, may evoke regressive reactions that are equally memorable. Regression often results from denial or lack of integration of highly charged sexual events. These unintegrated incidents impede normal sexual identity formation. Regression may occur at several levels of consciousness, sometimes concurrently. Integration is defined as the process whereby experience is acknowledged, understood, accepted, and assimilated into the existing knowledge base. When assimilation is impeded, symptoms include persistent reliving of the traumatic event; feelings of fear, helplessness, and rage; along with anxious attempts to avoid recalling what actually happened. Disturbances of cognition and memory are common, as are somatic sensations. The regression bearer is often

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Case Study of Severe Regression

diagnosed as suffering from post traumatic stress disorder. Within this context, regressive episodes are combination approach-avoidance attempts to resolve the painful event and bring it to successful resolution. This case history presents the emotional reactions of Clarisse, a severely regressed thirty-six-year-old female, recalling an anal rape incident that occurred when she was a little girl. Her pet cat was also involved in the incident. Memories of that experience interfered significantly with her ability to function socially and sexually as an adult. Clarisse was at home in her bedroom, involved in a sexual encounter with her husband, when a severe regressive incident occurred. An intimate touching incident had cued sensate memory traces, provoking the regressive state. This is how she described her feelings and thoughts. Regressed to the time when her cat had been strangled, she lay there, unable to tell past from present, or past assailant from loving spouse. It was as if the furry, lifeless body of her pet were there on the pillow beside her, where her uncle had placed it just before her anus felt the ripping sensation of his penis forcing its way into her body. Now, mercifully numb, Clarisse felt nothing: no pain, no pleasure, just a strange, suspended sensation like a numbing of consciousness. Lee, her husband, had started by rubbing her back, then kissing her shoulder as he caressed her buttocks and thighs. His touch was gentle, but as soon as she felt his hand approaching her genitals, regressive sensations overwhelmed her. She felt transported back in time to a much younger age. Her body felt small, her conscious awareness diminished. Her knowledge base contracted. It was as if she could neither participate nor defend herself. She had no power; she felt like a child. At the same time, her adult mind was also working. She questioned what she felt. How could she be a child with diminished strength? She was thirty-six years old, with a firm, strong body, hardened by workouts and consistent exercise. Her sense of self was now totally unrealistic. Her perception of her husband had become blurred, and then indistinct from recollections of her Uncle Samuel who had killed her cat and raped her when she was eight years old. The regression bearer was simultaneously experiencing two states of awareness: that of an adult woman recognizing that she was regressing and that of the little girl reliving fragments of the past childhood incident with an awareness of herself as an adult. She felt swept back in time by an irresistible force that reduced her to a previous level of development, reliving an unassimilated past trauma in a pressured, repetitive cycle, complete with sexualized pain and pleasure.

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I asked Clarisse how conscious she was of the regressive change and what had caused it. She was certain that she had reacted to “the way he smelled” and the sensations of lubrication within her vagina. She reported a slight ongoing awareness of past and present sensations and thoughts, concurrently, as her psychological state shifted from functional maturity to nonfunctional, childlike immobility. For this woman, regression was like a movie in slow motion, with a particular segment repeated incessantly. Finally, the memory cue and accompanying sensations that evoked the regressive episode faded and receded into the past, allowing reality to reclaim the present. Her awareness of current behaviors gradually emerged as if from a fog. Her husband was recognizable for who he was and she no longer felt like a mute, terrified little girl. She was fearful; she dreaded its recurrence. She knew she would regress again when cued by similar sexual stimuli—not always predictably, but generally in association with direct sexual contact. Regression occurs because memories of past incidents have not been integrated, understood, and accepted into the psyche. Broad, overgeneralized associations, similar to schizophrenic looseness, occur. Gross distortions of perception are possible. In this case, the sensory modalities affected were olfactory (smell) and tactile (touch). Olfactory cues are directly connected to the limbic system and can stimulate strong emotional responses, thus evoking vivid memories. Newer associations or additional sexualized trauma can compound the condition. Each time a negative sexual encounter occurs, it becomes more difficult for the regression bearer to approach memories of the original incident and achieve resolution. In this case, feelings of desperation accumulated within the woman until they became intolerable. As a result, the episodes of regression occurred more frequently. Even though she eventually tried to cope by totally avoiding sexual encounter, the regressive reaction had been overgeneralized. Less specific sexual stimuli than actual direct sexual touch and smell sparked a regressive response. It was becoming increasingly more difficult for her to maintain contact with reality. Her sense of self was severely compromised. She felt guilt and humiliation because she had no control over her current behavior. Her greatest fear was that she would not come back from her regressive episodes, but would be imprisoned in the terror of the past, reliving the experience of anal rape over and over again, lying next to the dead body of her pet, engulfed by pain and rage, with no one to help her. She said

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Case Study of Severe Regression

she could not remain in the present and assume her adult identity without resolution of this terrible incident. Clarisse asked me repeatedly how it could be resolved. She seemed to ignore my responses. She would not comply with suggestions of hospitalization or medication. I found myself in a clinical dilemma. Patients’ rights allow, even mandate, that she make her own decisions regarding the acceptance of hospitalization and medication. Moreover, she had been released for the hospital and referred to me after a particularly intense regressive episode. The intricacies of managed care had long ago eroded the medical model. Outpatient treatment was the only practical choice. Undeniably, Clarisse needed treatment. She had lived with the recurrent memory for nearly thirty years. The incident had affected her subsequent development in all areas: socially, sexually, and intellectually. Her moral development had also been affected. The idea that anyone could have done this to her, particularly someone in her family whom she had known and trusted, compromised her own sense of right and wrong. It offered the option that she herself could become a homicidal sexual predator. She abhorred this thought, but sometimes she felt it would be much better to be a sexual predator than a sexual victim. This idea seemed to fascinate her. She talked about inflicting similar sexual pain on another person in order to obtain some relief from her own painful memories. This frightened her. She felt conflicted, so much so that she wanted to remain small, so she could not harm anyone. During these moments, the tug of the past seemed to make regression more desirable to her than the reality of the present. She also reported having impulses to regress to the time of the original trauma, so she could fix herself permanently in the role of victim and avoid the fate of becoming homicidal. This defensive maneuver emerged most frequently when she felt sexual arousal. Her own genital responses frightened her. The sensation of vaginal lubrication was almost unbearable. When eroticism engulfed her, the sensations seemed to reduce her to a self-described “state where there was no control, no right, no wrong, only stinging pain with flashes of exquisite pleasure.” It was clear that she wanted revenge. She sensed that there would be tremendous relief in taking power, in defending herself and symbolically killing her assailant, as he had killed her beloved pet. She felt murderous impulses, accompanied by regressive awareness of present reality mingled with recall of the past. Thoughts of killing her husband often crept into her mind. She said he was not always loving. Sometimes he was indifferent; occasionally

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he would drink too much. At times, it seemed to her that he, too, lost his current identity, having only a fragile grasp on the different roles he seemed to assume with her. Lee acknowledged during his individual therapy sessions that he tried to “calm her down” by assuming different identities. For example, sometimes he acted like a parent, sometimes like a friend or lover. His lack of consistency confused her further, so much so that I suggested he remain silent and still without seeking to intervene during those times. Clarisse was hypervigilant, noticing even the smallest details of her environment. Her sensory awareness was heightened. She was acutely aware of odors, as she had been when the rape incident had occurred. Regressive episodes could be cued by similar odors occurring in the present. Her husband’s smells were disturbing to her. He smelled of sweat, alcohol, stale cigarette smoke, all of which reminded her of the traumatic past. As she spoke, there was an element of hysterical exaggeration in her verbalizations. She described his “unbrushed” teeth as reeking from particles of “decaying food.” She presented a disgusting picture of her spouse, which was obviously affected by memories of her uncle’s smells. Her husband’s smells enveloped her, acting as cues that sent her spinning back to those moments when her uncle Samuel ejaculated within her with such force that it caused an emission of her own, of blood and feces. From her descriptions, she could not tell his smells from her own, so thoroughly had he claimed her body, her mind, and her senses. “Christ,” he had screamed, pulling away and pushing her from him. He was very angry. She did not know what she had done wrong. She did not understand. He had opened her bowels. Her insides flowed out. She could not halt their flow. She felt it was shameful and wrong and that it was her fault. This was a significant issue for her. She recalled how upset her mother had been upon discovering her alone in her room without her underwear. Her mother acted as if it were she who had done something wrong. Blood, feces, and semen were on the sheets. Her uncle was gone. There was no one there to explain. She got the impression that there was only herself to blame, and she could not speak. There were no words to describe it. “No one to listen or care”: she repeated that phrase several times in many different sessions. These memory traces were sealed inside her mind, linked to her sense of genital arousal, touch, and smell. She said that these unspeakable memories formed the gateway to her regression. She imagined there were many variations of her internal self. She imagined that the memories were alive within her. She described them as sensitive and vigilant

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entities, waiting for an opportunity to erupt. She also felt that the terrible incident had to be acknowledged and avenged so that traces of the occurrence could finally dissolve and she could rest and forget. Her imagery was psychotic. In her mind, the charged memory took on a life form of its own, vivid and pulsating within her. In her perception, it was sometimes mercifully quiescent, sometimes barely discernible, always waiting to emerge with raging urgency. She lived in fear of this happening. Her anxiety mounted, and this prompted more frequent episodes. There were also times that she described the feelings as if they had taken the shape of her cat, the beloved animal that her uncle had killed at the time of the rape. I asked her if the raging feelings within could be her own sexual arousal. She said that was how it felt to her much of the time. As her condition worsened, due to overgeneralization, the memory traces could be activated with the slightest provocation—when she saw a man approach a woman with disrespect, or in a threatening manner, even when no touch at all had occurred. For example, while viewing a movie with her husband, she had a strong shame reaction, accompanied by murderous urges. The male actor in the movie was flirting with another woman in the presence of his wife. Shame and rage swept over her, as if she were the woman in the movie—the wife, the other woman, all other women whom she believed had been mistreated and/or used by men. This broadened to identification with all women, all girls, all female infants who had been raped, beaten, or exploited in some way by a man or by men. At times, she seemed to have no ego boundaries or individual integrity. She identified with all female victims. It was terrifying for her. She sobbed convulsively as she described her feelings. Indirect and therefore incomplete abreaction occurred. Perhaps it was the strong sense of outrage that activated the link between the movie scene and her own past experience. During this regressive interlude, she could not separate herself from what she felt was the historic injustice of sexual crimes committed by men against women. She personalized each injustice as if it had happened to her. She also seemed to depersonalize her husband. He became the enemy. As she described her murderous impulses, it was clear they were directed primarily toward him. Her thoughts were disordered. Events seemed to swirl around in her mind. She felt she would go permanently crazy unless she avenged herself and other female victims of men. Her sense of time and her place in it were disoriented. When the sensory cues receded, she felt

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relief, and almost sane. Her therapy sessions were extremely trying for both of us. Usually at the close of our sessions she would feel relaxed. By contrast, I was often exhausted after meeting with her. Externally, Clarisse appeared quite calm, even while she was hallucinating. Even her husband did not know about the original traumatic event. She hid it from him and others. No one knew of her sexual secret or the anguish it caused. She said she could look into the eyes of others and smile, while internally she had an image of strangling those same people. Sometimes she would close her fingers, very gently, gradually tightening her fists, reassured by their strength and the power she felt in her hands. She often said that it comforted her to know that her hands were strong, “strong enough to kill.” This occurred simultaneously with conscious awareness of current reality. She said repeatedly that she knew she was very confused. Her self-perception varied. She did not believe herself to be insane. But she often felt out of control, and feared she would become permanently so unless she avenged herself. Although she knew she regressed to the past and relived the traumatic incident repeatedly, she did not know how confused her sense of time had become, nor did she realize the extent to which her husband and other men were becoming synonymous with memories of her uncle Samuel. Her tendency toward overgeneralization worked well as a psychological defense. Sometimes it softened the focus and temporarily relieved the intensity of anxiety she experienced when memory traces were activated. It was both a preconscious and a conscious defensive maneuver on her part, designed to protect herself from psychological pain. Instead of feeling the full strength of her sense of violation and rage, she would focus on the fantasy of getting even with Uncle Samuel for what he had done to her and her cat. Until Clarisse married, she had completely avoided full sexual encounter. Her hymen was intact and she had never had intercourse. It was a conscious decision on her part to avoid penetration of any kind because she did not want to remember and relive the anal rape incident. Staying in the present usually felt safer than returning to the past, but she did experience flashbacks and hallucinations. It was common for her to report intrusive, unwanted thoughts. For example, she hoped that someday she would go back in time and kill her uncle Samuel. She did not know how to accomplish her goal because each time she went back, she believed she became a child again, losing the strength and maturity she needed to kill Uncle Samuel.

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Clarisse was very concerned about her capricious thought patterns. At times, they seemed orderly and rational. She knew, for instance, that as a child she could not kill her uncle. She would not be strong enough. But she also believed that she could go back in time to the rape incident as it occurred, as if it were suspended in time, and find her uncle there. In reality, her uncle was dead. She had been informed of his death when she was twenty years old, twelve years after the crime and sixteen years before she entered therapy with me. It had registered at the time, and she was glad he was dead. She remembered writing in her journal, “I have survived Uncle Samuel.” For the past three years since she had married, she had been engaging in sex on a regular basis. Her regression experiences had also increased in frequency. During sexual encounter she often felt that Uncle Samuel was alive and she was a child again. The stimulus of sexual encounter with her husband cued sensory memories of the unintegrated rape incident. More recently, in the past eighteen months, the regressive experience had changed in other ways. She described it as “continually merging with the present.” She was never quite free of it. Even when she felt rooted in the present and had a sense of herself as an adult, she would see Uncle Samuel in her husband or in other men. She would feel his touch, and homicidal urges within her would return. Her tenuous grasp on reality seemed to be loosening. She felt she had to do something to save herself. She became quite desperate. In these moments, her fingers moved nervously, as if she were squeezing something or strangling someone. This fantasy reduced her anxiety. And then, suddenly, the tension would remit. Her mind would become quiet. She would feel a sense of peace, which allowed her to relax. I was acutely aware of these transformations when they happened in session. (See Figure 5.1.) Clarisse continued to like cats and always wanted them around, but she didn’t want one of her own. She had no pets. She had never had another one after her uncle Samuel had strangled the one she had. This was another issue that caused her anguish in the present. She didn’t know what had happened to the cat’s body. She wondered if her mother had thrown it away, along with her underwear and the blood-stained sheets. Everything had disappeared without a word. She repeated, several times, “If only Mother and I had talked about it.” But they never had; it was as if it had never happened. But the cat was dead, her own body was torn, and she had the memories. The fragmentary pictures in her mind, the smells, the stinging pain—they were all real to her. She

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Figure 5.1 Clarisse: associational blur; inability to discriminate between predatory and nonpredatory men.

internally validated the incident. Never once in therapy did she ask for me to validate that it had really happened. She was sure it had occurred. (See Figure 5.2.) When I asked Clarisse why she hadn’t told Lee, her husband, or someone else—a friend, a stranger, a minister, anyone—just to share the burden, she replied that she could not because she trusted no one. Her uncle and her mother had both betrayed her. No one had helped her

Figure 5.2 Cat sketches done by Clarisse (one session).

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when she was little. How could she believe that anyone would ever help her? Her statements spilled out, one after another. She was a grown woman who had to take care of herself. She believed she would. She said she felt strong. Usually at this point in our discussion, when she reaffirmed her strength, she had one of her recurring intrusive thoughts about returning to the past. She would switch topics and “try to figure out a way to get back there and kill Uncle Samuel; then everything would be better. Then maybe she could forget what had happened and get on with her life.” Throughout the course of her therapy, I also saw her husband on a regular basis. Lee was her major source of support; he was the only one with whom she talked, other than myself. Without him she would have been totally isolated. Despite my efforts, neither one of them would consider participating in a support group because of the sexual nature of their problem. Although she was technically the sexually dysfunctional person, both of them required treatment. They were equally involved in the ongoing sexually stressful situation. It was necessary to treat them as a system. Her behavior provoked an anger response in her husband. Lee did not understand how she could change so rapidly from a sexually responsive, smiling woman to a childlike, nonsexual being who shrank from his touch. He validated her description of the regressive events. From his perspective, they swept over her inexplicably. Although she continued smiling, he could feel her “slipping away.” Something in her eyes and her body posture shifted. It was as if she were hearing sounds he could not hear and seeing images he could not see. To him it felt “eerie”. The first few times it happened, he did not respond overtly. He just waited for it to pass. Lee hoped that it was transitional, that she would be all right if he just waited. This was followed by futile attempts to distract her from what she was feeling. This seemed to confuse her more. Nothing helped. He felt helpless. He also felt that verbally expressing his fear or questioning her was not an option. He was limited by his own ability to express emotions. He saw himself as fragile, and felt intimidated by explicit conversation about their sexual behavior. He said, “I feel like I’m on the edge of madness myself.” Both husband and wife had to overcome feelings of mistrust and suspicion in order to reach treatment goals. They needed to talk about their feelings as well as the events that were interfering with their sexual relationship. It was difficult for them both to describe the details

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of their sexual interactions. She needed to describe the traumatic event in detail to accomplish abreaction and integration. He wanted to exchange information about what type of sexual touch was possible between them. Their joint therapy also involved breathing and relaxation experiences that they did together, sometimes in session and more often at home. Lee said that his life experience had not prepared him to deal with “intense emotion or any kind of extraordinary psychological phenomena.” Their inability to communicate reminded him of his childhood. He recounted how there had been an unspoken rule in his father’s house that feelings were not expressed. Anger was not acknowledged, just acted out with either tenseness or icy silence. He spoke about how often he had seen his father angry and silent. As a prepubescent, he remembered being immobilized by a recurrent fantasy that his father would explode. Lee also learned to contain his own anger, believing it to be too destructive to express. It had been a childlike fear, which he maintained well into adolescence and adulthood. His family of origin was completely controlled by his father’s rule governing the nonexpression of feelings. He described family conversations as consisting of mundane comments about daily life or superficial gossip regarding neighbors or friends. For him, it had been a relief to get away from what he termed as the “suffocating silence of his father’s house.” After graduating from college, he never went back except for short, prescribed holiday visits that couldn’t end quickly enough for him. As an adult, Lee had deliberately sought personal relationships that differed markedly from those he had experienced as a child in his parental home. He recalled how he felt when he first met Clarisse. She was very expressive, which he felt enabled him to feel and express more of his own emotions. Lee became visibly emotional in describing the onset of their relationship. It had been a relief to fall in love and marry a woman whom he believed to be emotionally expressive. His self-image changed. He felt that he could express love and passion. As time passed, however, he realized how dependent this was on her mood. She had the power to repress his emotional expressiveness by withdrawing or regressing. When she withdrew her feelings or stopped expressing them, he felt unable to feel his own emotions. He felt emotionally oppressed again, as he had felt as a child. His current anger response was swelled by this association. His perception of his wife’s regressive episodes was affected by his growing resentment. He felt helpless when she withdrew. He said that her appearance changed, as did the sound of her voice. When

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she spoke it was as if she were speaking to someone else. Because of his own lack of ego-integrity, he felt as if he himself were vanishing. It had become very difficult for them to sexualize. Although they slept in the same bed with their bodies often touching, they were physically inhibited and emotionally estranged. They both feared that intimate touch would result in an uncontrollable outburst on her part. Because they did not talk about it, there was no validation for what was really happening, although he gradually learned to express himself in session. Lee described an inability to do so when his wife was regressing. He wanted to say, “Don’t leave me. Come back. Take me with you. Let me help you.” He felt all those things, but he could not speak. Instead, he lay there silent and immobilized. A critical incident occurred in which her regressive behavior overwhelmed them both. They were in bed, engaged in a sexual encounter. Lee was trying to arouse her, and she was having difficulty responding to his touch. At first they were cuddling and it felt so comfortable they almost fell asleep. She was soft and warm next to him and he started to explore her body. His hand moved down from her head, where he had been stroking her hair, to her throat and shoulder, but before he could go any further, she seemed to leap from where she had been lying beside him to an astride position on top of him. He was confused. Initially, he thought it was sexual fervor, so he did not resist. Later, when she was bearing down on him, and her hands were grasping his throat and squeezing the air from his mouth, Lee realized what was happening. She was trying to strangle him! His vision was blurred. He saw sparks and then he seemed to lose consciousness. The next thing he remembered, he was lying on the floor, with her beside him. She was crying and holding her head. A large bruise was forming over her left eye. Had he hit her? He could not remember. He did remember her trying to kill him. He was stunned, but he could no longer deny that something was seriously wrong. Lee called an ambulance and had her taken to a hospital. He felt he had to do something. He knew it would happen again. The days following that incident were blurred and indistinct for both of them. She was in a psychiatric unit for several days, sleeping most of the time, until she finally decided that she did not belong there. Her husband agreed with her. The other patients looked like zombies to them, overmedicated zombies shuffling around with little awareness of their environment. These patients seemed unable to tell staff from visitors or other patients. In strong contrast, his wife appeared quite nor-

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mal; she was amazed and remorseful when he described to her what had happened, what she had done. She remembered nothing beyond going to bed together, being very frightened, and waking up in the hospital. She refused both psychological assessment and medication, saying she wanted to go home and figure out what had happened and what they should do about it. Her husband agreed, because he “loved her” and because he “could not bear to see her in what seemed like a very terrible place.” They left the hospital against medical advice. Predictably, they were tempted to continue denying the significance of the incident and minimize the imminent danger they both felt. They wanted to forget about it, but when they returned home together and saw their bedroom, the broken lamp, and other signs of their sexualized skirmish, they were afraid and decided to call me. Neither one of them had previously experienced therapy. The brief sessions they had in the hospital had made little or no impression on them. They were still in crisis when they came in for their first session in my office. They sat there, side by side on the couch, looking me over, wondering what kind of person I was and if I could help them. Her eyes looked tired and she blinked frequently, holding her eyes closed at times, as if she wanted to go to sleep. He stared at me for a while and then moved forward, resting his head on his hands, somewhat doubled over so I could see only the top of his head. I said, “Tell me what’s troubling you.” My voice was low and perhaps they sensed that I, too, was tired, and understood how they felt. Lee said, “She tried to kill me.” I looked at her and she nodded her head yes. I then asked her, “Can you talk about it?” He responded for her. “She can’t remember.” I continued to address her, “Nothing comes back?” “We were in bed,” she said, “I got scared and the next thing I knew I was in the hospital. He will have to tell you. I cannot.” She looked at me and seemed to sink into the furry pillows behind her on the couch. I felt she was receding from our presence. It was more than dissociation. There was a change in her body posture. She curled up like a child and appeared to retreat into a private world of her own. Later, I realized that Clarisse had experienced a light, self-induced, regressive episode, right there in my office. At the time, although I sensed the change in her demeanor, I barely had an inkling of her regressive tendencies and how rapidly they could occur. Throughout that initial session, which lasted only an hour, her husband did most of the talking with only collaborative nods from her. This was not very infor-

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mative since, of course, he had a very limited knowledge of her internal state, but it allowed me to establish rapport and to see her through his eyes. I asked them to sign a release form so I could obtain her hospital records. Lee described her attempt to strangle him and everything he remembered about its aftermath. His voice quavered toward the end of the session when he asked me what they should do. Should they sleep together? Could they have sex? Or would it provoke another incident? I didn’t want to decide for them and establish an unrealistic aura of omniscience. I asked them to talk about what they thought would be best. She said she did not want to be alone, but she did not want to have sex or “anything like it.” He preferred to sleep together but agreed that sexual contact would be too risky. We all knew that our agreement was a token precaution and that the situation was far from stable. I explained that I might refer them to one of my colleagues since my caseload was quite heavy at the time. We could discuss it later, perhaps in our next session. They left my office feeling relieved and hopeful. I was aware that this would be a very complex case, and was not at all sure that I wanted the challenge at that time. I was already carrying several regression cases. This type of case is very demanding in terms of time and energy. I considered referring them to a training associate, maintaining only supervisory status. Before that decision was made, I received a telephone call from Lee. He was quite agitated. His wife had crawled under the bed in their room. She would not come out, saying that was where she wanted to sleep. He asked me to come to their home and “see for myself.” Clearly, it was time to establish limits. I suggested that he give her a phone, get on an extension, and we would decide together what to do. He did so. They rejected my suggestion that they return to the hospital where she would be safer if this was the precursor to another dangerous episode. They also refused to consider medication. At that point, I felt as if I were dealing with two headstrong children. I essentially gave Clarisse permission to sleep under the bed, and we agreed that Lee would sleep on the floor beside the bed so they could hold hands through the night. The resolution of this mini-crisis was entirely their own. I served as a parental figure to whom they turned for approval and reassurance. This incident also resolved the question of whether I would be therapist in charge or merely supervisor of the case. Perhaps I was manipulated into that position but I didn’t want to add the stressor of changing therapists to the significant issues they were facing. I added them to my

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caseload with misgivings. During the first phase of our work, we usually met in conjoint sessions. That seemed to be the best way to proceed, since, at the outset of therapy, Clarisse felt safer when he was present and Lee also needed therapy, because he tended to regress with her, pretending everything was all right. He had to learn more effective ways to cope with his feelings and her behaviors. I knew that her problem predated their marriage, and that he was heavily contributing to her unstable behaviors by not addressing them openly. Eventually they both responded to individual therapy as well. But since their sexual relationship was inextricably involved in the dynamics of her regression, meeting together was both expedient and clinically sound. We met in my counseling office. At first I did not consider the use of the playroom, which is often employed in regression therapy to induce childhood associations. In this case there was no need to induce the aura of childhood. In fact, to do so was contraindicated. Clarisse was already regressed. Severely regressed individuals should be allowed to feel and act out their regressive tendencies in the presence of an experienced therapist, who symbolizes a competent and a caring parent. This functions as an aid to integration. In this case, inducing stronger regressive tendencies could serve no useful purpose; it could, in fact, impede integration by increasing her anxiety and promoting another homicidal gesture. Permissive acceptance of the client’s existing level of regression was the best option. It would ultimately encourage progression. This client did express interest in seeing the playroom, which had been mentioned in our discussions of how her therapy might progress and what needed to be done to “cure” her. I showed her the playroom and we did have three sessions there at her request. Each time we met there she made a little bed in one of the large beanbags, selected a stuffed cat, curled up on the beanbag covered up with a baby blanket, and simply laid there for twenty to thirty minutes in silence. I sat quietly by in one of the small chairs. These experiences were nurturing and transferential in nature. Clarisse had mentioned repeatedly that she wished her mother had been more responsive and caring at the time of the original trauma. Symbolically, this occurred in the playroom sessions where her childlike behaviors were accepted. I also started almost immediately gathering material for a transition room, in which I planned to layer in more integrated reactions to the feelings and events we talked about in session. A transition room is a place where we could symbolically explore past events that contributed significantly to the

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unintegrated material that evoked regressive disturbance. The therapeutic task in this case was to reorder those events in a more acceptable and detoxified manner to facilitate resolution of the rape incident that precipitated her regressive episodes. In regression therapy, a transition room is generally utilized after a series of sessions in the playroom have occurred. The playroom series allows each client to remember what it is like to be a child, without the responsibilities of being an adult. They are not required to engage in adult conversation about painful and unpleasant topics. They can draw pictures or do clay modeling instead. Sand trays are useful in cases like this, since evidence created actually disappears along with the memory enacted. To sit on a small chair, surrounded by toys and childhood mementos evokes an aura of make-believe, and allows the acting out of childlike wishes and fears. Children experiencing post traumatic stress reactions play out aspects of the traumatic theme repeatedly. This is also true of regressed adults. Clarisse drew paper-and-pencil sketches of her internal regressions. They suggest the associational confusion she felt regarding the rape incident and the murder of her cat. Sessions in the playroom allow the expression of emotions connected to remembered incidents. When heavily charged incidents occur in childhood, children are rarely able to understand them. Remembering them as adults, in the therapeutic setting of the playroom, facilitates the release of overcharged feelings that occurred with the original incidents. Later, the client is moved to a transition room where integration with current reality is accomplished through the use of conversations about the impact of the incidents on subsequent development. The transition room usually contains memorabilia from the person’s past, such as pictures, cards, clothing, or a favored toy or two taken from the playroom experience or brought from home. This imparts an air of continuity to the entire experience. Sometimes the client is asked to bring items from home to furnish the small transition room, which measures about ten-by-ten feet. There is a bulletin board to fasten developmental charts of the client’s childhood, which are usually done by the client as homework assignments. The room is not used for other clients. It symbolizes the encapsulation of time and the healing process. It becomes a very protected environment wherein strong feelings can be expressed, accepted, and integrated. The transition room becomes the place where all subsequent sessions are held until the time is right to resume meeting in the therapist’s office, where the sessions first began.

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Severe regression described above requires immediate containment of the destructive behaviors. Hospitalization, medication, and structured programs are frequently utilized to facilitate containment. This did not occur in the case of Clarisse and Lee: the couple declined further hospitalization and/or medication. They were seen twice a week on an outpatient basis until the reeducation process was completed. After eighteen months, sessions were tapered to once a week for four months, when termination occurred due to relocation of the client couple. At that time, Clarisse, the regression bearer, was able to engage in sexual encounter with her spouse without confusing him with her uncle. She accepted her own arousal response, without negative reactions to her vaginal lubrication. She had a stronger sense of herself as an adult. The anger she felt toward her uncle for raping her and killing her cat recurred intermittently but she chose not to focus on it, since she had accepted and integrated what had happened to her. Further discussion of this case appears in the treatment section of this book. The description presented above focuses on the subjective experience of the regression bearer and her spouse. In moderate cases, such as the one outlined in Chapter 6, both the playroom and transition area were utilized in treating the regressed client and his spouse. Discrimination exercises in the form of play therapy are utilized to limit overgeneralization and to contain the regressive tendency.

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Case Study of Moderate Regression

As with the case of severe regression detailed in Chapter 5, the following material is presented from within the perceptual framework of the regression bearer. This allows the reader to understand the phenomenon of regression more directly than through the use of traditional case history presentation. This case history describes a moderate level of regression. Arthur, the regression bearer, is a spiritually oriented adult male, a psychiatrist who experienced two significant and separate career-altering incidents involving managed health care systems. He felt that his professional integrity was threatened and his economic status was undermined in both instances. He reported feeling disempowered and emasculated. He lost interest in sexual activity and intimate contact. His previous belief in God was shaken. He no longer prayed, and appeared to be distancing himself from personal relationships. His reaction included a blurring of place and time. The two incidents, chronologically eleven years apart, seemed to merge. There was disorientation regarding time and place, as well as between the identities of his male work associates during both those separate time periods. The persona of his wife assumed symbolic meaning in that her behaviors were perceived by Arthur to be identical or similar to those of previous significant female figures in his life. At the time of our first therapy session, the regression bearer was in crisis. Normally, he functioned quite well under stress. The suburban hospital he had founded kept him busy. Alternating between administrative and clinical tasks, he had grown accustomed to a flurry of activity and pressured demands. For well over seven years, his small hospital had been eminently successful, making a great deal of money. He had exceeded his personal financial goals and felt that he was building something for the community. He dreamed of a freestanding psychiatric hos-

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pital, which he hoped could serve as a national model, maybe even a chain of mental health facilities, delivering personalized patient care for psychiatric illness. He had created a homelike atmosphere in his hospital, where patients could relax and welcome the healing process. There was a chapel or prayer room on every floor. Community ministers called on patients regularly. Hospital furnishings and color schemes were cozy, tasteful, and definitely noninstitutional. He had been a happy man. He loved his home and his large family— five adopted children, for whom he provided very generously. He indulged his wife’s love of shopping and appreciated her talent for interior decorating. During the week in which the regressive episode occurred, their home was featured in the annual Home and Garden Show, a benefit affair to fund the restoration of historical sites in the community where they lived. Arthur had just been nominated as an elder in his church. Everything in his life was going well until history seemed to repeat itself. An unintegrated event from the past was reactivated. There were a series of incidents that reminded Arthur of an earlier professional crisis in his life. Once again, the specter of managed health care threatened his livelihood. He felt a sense of dread and confusion. It was like being transported back in time. At first he didn’t consciously realize what was happening. The new male partner he had brought in a year or so ago seemed to share his own need for autonomy. They had been able to make joint decisions regarding administration and patient care without seriously curbing one another’s sense of independence. When Western Health, a national health-care conglomerate, acquired the outstanding debts on the hospital site and facility, a new agreement was formed between my client, his new partner, and Western Health. My client was optimistic. Here was an opportunity to expand, which excited him and exceeded his wildest dreams. There were, however, numerous reorganization meetings that he chose not to attend. Instead, he became more involved in church and community activities. This fit with an established pattern of avoidance in his coping system. Instead of participating in what to him was an unpleasant experience, he allowed his new partner to represent their combined interests and report back to him about the significant changes that were recommended by the negotiators for Western Health. Many of the new ideas were good as well as cost effective. They required a little more paperwork, which seemed reasonable at the beginning. It would have been acceptable if it had stopped there, but it had not, and my client experienced a growing feeling of dread and self-doubt.

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It was becoming clear to him that the doctor/patient relationship he had sought to protect was being altered by the new guidelines imposed by Western Health. Even therapeutic intervention and treatment planning were being restricted and, in some cases, completely altered by the emphasis on cost efficiency. There was also pressure to eliminate the homelike atmosphere that was more costly to maintain than the austere and somewhat dreary institutional atmosphere more common in hospital settings. He was informed that germs, bacteria, and associated human waste more readily adhered to “homey” furnishings and were more difficult to control. My client’s feelings surfaced in what felt like a flood of emotion. He was alarmed and incredulous. The whole reason he had founded his own hospital was to ensure that the patient care he provided was distinctively superior to the norm in health care. He had wanted to free himself from the restrictions of paperwork that in the past had eroded the quality of his work. Above all, he did not want administrators who knew nothing about medicine, therapy, or treatment to influence decisions regarding patient care. Everything he had worked for was being undermined. As his anxiety increased, intense feelings of regret and mistrust surfaced. He was dismayed when he discovered that his new partner had compromised his position and had actually agreed to adopt Western Health’s policy and procedure codes in return for substantial market shares the health-care conglomerate controlled. He blamed his associate for his own lack of participation in the lengthy process that had ensued. He felt betrayed. Although he knew these changes would lead to more immediate profit, he also knew that his share would predictably taper off as the health-care conglomerate reorganized the operating procedures of the hospital and skimmed off its share of the profits by increasing administrative costs. All his personal goals were being compromised. His mind raced. He feared he would lose his autonomy and his income would eventually be reduced. He would be nothing more than a paid employee, controlled by hospital administrators. His power would be taken from him and he would be completely emasculated. This series of changes was similar, but not identical, to what had happened in the past. He was overwhelmed by a flood of broad associations. He became disoriented as to time, place, and person. His sensations blurred. He felt dizzy. Closing his eyes, he sought relief from a rush of feeling that seemed to engulf him. When he opened his eyes, it was as if he were

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younger by almost two decades. Sitting across from him was an old friend who had also turned into an enemy. He was reliving the past. The man he thought he saw had taken his position at City Hospital, where he had been director of psychiatric services before managed care had changed that professional setting. He was in the throes of a regressive episode. The two incidents overlapped in his perception. He could not tell past from present. This is how he described coming out of it. He heard his name spoken loudly, repeated insistently, and finally shrieked. The piercing sounds brought him back to current reality. He opened his eyes to see his wife sitting across from him in their family room. She said, “You’re fading out again. Let’s go. It’s time for our appointment with Dr. Doyle.” He didn’t want to come see me. He hated talking to a therapist. Being in the patient role further eroded his identity. He didn’t feel comfortable with women, particularly therapists. He later said I seemed to stare right through him. I apparently reminded him of other females in his life around whom he had felt uneasy. The visual hallucination faded, but a post-regressive state remained. He assumed a childlike demeanor. He felt lost, and unable to remain rooted in the present. He was desperate. He knew he needed help, and he had nowhere else to go. His wife liked me and felt I was helping. I was less threatening than a male would have been. So he got up and allowed himself to be led like a child into my counseling office. He was regressed. His psychological state had shifted. Functional maturity had faded away. In its place was a childlike lethargy that blurred distinctions in place and time. His regressive states were often activated by feelings of betrayal by males whom he had hoped would be protectors rather than rivals. He felt that his current partner had betrayed him. He felt mistrust for men in general. It was a sickening feeling, like being engulfed by a deep and unbearable sadness. He felt overwhelmed, as he had felt in the past when the similar, but separate, incident of betrayal in his work setting had occurred. His memory seemed to be without boundaries in space or time. Fragmentary memories from his store of unintegrated, preconscious feelings regarding the first incident were blurring his contact with current reality. Nineteen years before, when he directed psychiatric services at City Hospital, a man he thought was his friend had also betrayed him. The circumstances were somewhat similar to what was occurring now. The

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hospital they both worked for was being absorbed into a health-service conglomerate, a holding company that would gradually take over and control everything from physician salary levels to patient care. He felt that changes had occurred rapidly until there was no place for him, no place for any doctor with self-respect or professional integrity. Now it was happening again, only this time they were taking his own hospital. He had much more to lose this time. He was older, too tired to fight, but he had to, because he feared that he and his family would be annihilated. Clearly, he was not in any condition to resist in a competent manner. He could hardly tell past from present. The impact of the first incident had never been fully absorbed. His intense feelings of outrage and disbelief that his friend had betrayed him remained pooled somewhere deep inside. He had never talked about it with anyone. He was too ashamed and frightened, ashamed because he had cared so much about his friend who obviously had cared less for him. And frightened that he had not been strong enough to hold firm and maintain his professional and spiritual integrity. He was angry at God, and was losing his belief in a higher power. There were other associational responses. He also felt foolish now because he had trusted his friend in financial matters, instead of taking care of his own business affairs. He had allowed his associate to meet with the new administrators without him. As in the past, he was avoiding fiscal and administrative responsibility. My client rigidly defended himself from the knowledge of his own lack of business experience by pretending the problem wasn’t there or that others could and should handle it. He was an unusually effective psychiatrist, very competent in delivering direct service in therapy. He excelled in medication and diagnostics as well. He enjoyed patient contact. Administrative tasks, however, generally bored him, so he avoided them, allowing others to organize and eventually control this significant area of his practice. Avoidance was a significant factor in why he had trusted his male associate in the past, as well as his male partner in the current situation. In those moments when he felt more grounded in the present, he wondered how he could have been so negligent. He would often shake his head in confusion. He felt he was living both experiences simultaneously. He certainly could not clearly distinguish between the earlier unintegrated incident and the current one. He felt as if there were something sealed inside his mind, something he had to release in order to make the confusion disappear. He wasn’t always aware of the pressure surrounding those unresolved issues from the past. But the pressure

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became more obvious when he felt betrayed. The pent-up feelings clouded his mind. He became suspicious of everyone. He felt that he could trust no one—not even his wife. He had uneasy feelings that she had betrayed him sexually as well. He began to think of her as evil. He knew she was irritated by his passivity. Her attitude of overprotectiveness often made him feel emasculated and childlike. He feared that she would take over and try to control the negotiations herself, even though she had no relevant experience. He thought in stereotypes: she was a good mother and a good homemaker. She had been very helpful in the interior design and decoration of the hospital. But she was hardly a businesswoman. Even though he appreciated it when she took over their personal finances, she was not up to this challenge, in his view. He feared she would be like putty in the hands of his current partner and the Western Health negotiators. He felt a sense of desperation. He would say over and over again that he had “to pull himself together” if he was to save the hospital. One of his stated goals in therapy was to stay rooted in the present and fight for what was his. Spousal perceptions of the regression bearer were conflicted. She believed that she was “the competent one.” Arthur’s wife, Melanie, was very angry. She felt that her husband was behaving irresponsibly. She knew he was usually competent, at least when he was working with patients, but, from her perspective, he had never been much of a businessman. Melanie took credit for the financial success of the hospital. It was also she who usually made the decisions regarding the investment of their savings. She had bettered their financial position and had the foresight to engage the services of a financial planner with whom she worked closely. At the beginning, her husband Arthur had attended the financial planning meetings, but he was usually bored and preoccupied with other concerns. Gradually, he stopped going to the meetings altogether, allowing Melanie and their financial advisor to decide everything. Arthur’s avoidance protected him from confronting his anxiety regarding financial matters. Rigid defense mechanisms are characteristic of regression bearers. Their overdefensiveness serves as a barrier to integration of accumulated feelings. Ironically, only by confronting the painful truths are they able to integrate their feelings and quiet their anxiety. In this case study of moderate regression, my client fooled himself into thinking he was “in charge” because he sat at his desk and signed checks that his wife laid out for him to “approve.” He had never been one for details. That weakness had never consciously bothered him until

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the situation at City Hospital arose when his friend and associate had established himself as the prime mover with the buy-out administrators. By focusing on the details my client ignored, his friend had impressed everyone, including my client couple, with his ability to absorb and recapitulate numerical minutiae. Since the friend was so adept at it, Arthur, my client, allowed him to speak for both of them. Arthur repeatedly reported boredom and disinterest when it came to nonclinical matters. At the same time, his anxiety mounted and he avoided spiritual exploration and prayer, sensing that it would be painful to confront his own issues. Blurring of time, place, and person are common in regressive episodes. For Arthur, a relationship with God was a necessary component of stability. Without this spirituality, he was decidedly less stable psychologically. The similarities between the two situations were striking. In both cases, my client had given in to avoidance and rationalization. Both then and now he felt as if a trusted male friend had taken his power and rendered him helpless. He couldn’t bear the thoughts he was having about himself and his own incompetence and lack of virility. So, consciously, he regressed to the past incident because at least it was a predicament from which he had emerged intact. He tried to remember how he had survived the past incident so he could make it happen again. He hoped he could then save himself, his hospital, and his family. He said his mind felt “loose.” He was overgeneralizing. Fragments of both time frames flowed together. This was most noticeable in connection with his wife, whom he almost demonized. Arthur also experienced recurring intrusive thoughts. Unwarranted sexualized fears plagued him. He suspected that Melanie was intimately involved with his current partner as he had previously suspected that she was having a romantic and sexual affair with the friend of the past who had betrayed him. His regressive associations often involved a dominant woman—a woman in power, a woman whom he loved and admired as well as feared and hated. There were other fragmentary memory traces of feeling that cued regressive reactions. My client was experiencing general mistrust. It was an old feeling; one that was associated with a great deal of pain, humiliation, and childlike dependence. The pervasive feeling of mistrust had its roots in his childhood, preceding the incident at City Hospital with managed care and the health-care conglomerate. His earliest memories of mistrust were associated with his parents, particularly his mother. A powerful ambivalence between love and hate characterized

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his feelings toward his mother. When he was quite small, further back than he could really remember, she had handled him roughly. She had shaken and pushed him, threatening him in a loud and abrasive tone of voice. He could not remember actually being beaten by either parent, but their anger and repressiveness were memorable. He loved his parents, partially because of his dependence on them. Also, they could be very kind and loving, but the unpredictability of their responses had resulted in a confused and desperate mistrust. He never knew what would provoke wrath either toward him or each other. There were a lot of arguments. They often shouted at each other. At those times, if he made a sound or even a movement, they displaced their rage toward him. He hated them when that occurred. It was unfair, but it made the quiet times, the peaceful times, sweeter. Arthur treasured those moments when his parents smiled or spoke softly to him. But he could never trust that such times would last. His mother’s gentle touch could harden into a painful, pinching grasp. Her soft hand stroking his hair could stiffen and shove, sending him spinning into a wall or a piece of furniture. Like other regression bearers, Arthur developed a basic mistrust of himself and his own senses. He believed, erroneously, that he had caused his mother’s capricious behavior. At the same time, he mistrusted both his parents because they had so little control over their feelings and behaviors and so often made him the target of their anguished frustration. All of his subsequent relationships were affected by early experience with his parents. He adjusted himself in order to survive. He had a soft and somewhat childlike demeanor. He worked hard to ingratiate himself and was very cautious not to unnecessarily displease his friends and associates. Although he was extremely successful, he avoided responsibility not directly related to clinical expertise. Whenever it came to negotiations or compromise, he felt threatened and inadequate. He reverted to childlike silence, a posture he had assumed repeatedly with his parents to avoid their wrath. As an adult male, however, his silent withdrawal was often mistaken by others for silent wisdom. It fit the male stereotype. Arthur was prone to regression in the presence of women. He regressed most noticeably in the presence of assertive or dominant women. He said he felt like a little boy, trying to please an anxious mother. These feelings overcame him even when the woman he was actually with was neither anxious nor difficult to please. His perceptions and behaviors were clearly rooted in the past. His wife,

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Melanie, was not appreciably similar to his mother, but when he was regressed, he did not experience her realistically. Thus, his behaviors with her, in the present, were frequently inappropriate. One clinical task was to separate past from present, narrow the overgeneralized feelings, and teach the regression bearer to discriminate between current and past events and people. Therapeutic intervention was conducted at several levels. The client couple spent many sessions exploring their past experience while he was employed at City Hospital. They remembered disruptive arguments in which Melanie had faulted Arthur for incompetence with details. She recalled an incident wherein they had both confronted his friend with his duplicity. My client had become so upset that the two men had almost traded blows. It was at that point that Melanie had intervened and salvaged their relationship. The regression bearer reported that he emerged from that event with a strong feeling of mistrust for both his wife and his friend. These feelings were associative in nature. They were a replication of unintegrated feelings he had felt as a child when his parents disagreed. Constructing a time line on newsprint, in session, aided the discrimination process. The client couple listed past events and figures in one time period and current ones in another. There were times when Arthur suspected that his wife was currently having an affair with his friend and that together they were both plotting against him. There were also times, however, when he realized how unlikely it was that this was the case. My client was disturbed about the blurring of similar incidents in the present and past. Arthur knew his thoughts were clouded and sometimes felt his efforts to discriminate were futile. The current incident with Western Health had revived and amplified existing fears regarding his sexual identity. The aging process was affecting his erectile firmness and his ejaculations were much weaker and less pleasurable. He felt emasculated and insecure. He suspected that his wife was now relating sexually to his current partner. He seemed to equate the financial threat of losing his hospital with the sexual threat of losing his woman. My client was experiencing the major components of moderate regression, anxiety, overgeneralization, lack of discriminative ability, and engulfment by unexpressed feelings from the past. He was not particularly dangerous to himself or others, but he was certainly rendered nonfunctional by these symptoms. He was unable to work effectively. He was also unable to sexualize or relate intimately with his wife. His symptoms were becoming more intense and less manageable at the time he entered therapy.

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As I listened to Arthur describe his reaction to managed health care and its impact upon his life, I became aware that his churning anger, which was formidable in itself, covered deeper feelings of sadness and humiliation. This was also representative of similar feelings he had experienced as a child and adolescent. In the current situation, he had been economically defeated and in a sense emasculated by an impersonal and uncaring health-care conglomerate. As he talked about his past experiences and current fears, he would consistently select a male adversary to embody the enemy. As our meetings progressed, I was struck with a change in his language and demeanor. Curse words, such as prick, shit, motherfucker, and asshole, liberally sprinkled his expressions. This stood in sharp contrast to the soft-spoken, gentlemanly speech pattern he had used at the outset of therapy. This negative sexual imagery increased as he talked about his fears that his wife had sexualized with his rivals. For the most part, I listened without comment, except to encourage him to go deeper into his feelings of sadness and humiliation. He cried and shouted out in a childlike manner. Other behavioral characteristics included repetitive physical movements, which seemed to be cued by unintegrated feelings from the past. It was at this juncture that he began to punctuate his verbalizations with angry, pointing gestures, using his right index finger like a rod, almost as if he were striking or spanking the air. There were other changes. His tone of voice was higher, and, at times, there were tears in his eyes. He appeared more childlike. He was continuing to regress. It was at this point that we moved our sessions to the playroom to encourage a more balanced regressive state, wherein I could provide positive symbolic support and acceptance for his regressed condition. Melanie continued to attend most of these sessions. This would promote integration. In this case clinical strategy involved accepting the client’s regression as it emerged. No effort was made to push Arthur back in time. There was no search for earlier trauma. The playroom setting provided a gentle confrontation. Arthur understood that he was behaving like a child, because he had the feelings of a child. As he sorted through his feelings, thoughts, and behaviors, he was able to marshal his adult strengths and face the current crisis in his life. The spousal perceptions of the regression bearer were as follows: Melanie did not like the changes she saw in her husband. It made her anxious. She wanted him to conform to the adult male stereotype. She feared he would regress permanently and need perennial care. That did

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not occur. Each time Arthur regressed emotionally in session, more balance between affect and cognition occurred, facilitating integration of past events. The regression bearer was becoming more articulate and grounded in the present. He could, eventually, describe past erotic feelings and reactions he had felt toward his mother and how he both loved and feared her. He also, at my request, began to list differences between his mother and his wife, Melanie. He remembered that his mother had died when he was nineteen years old. He reported a feeling of heightened sexual arousal at that time. He was embarrassed to admit these feelings but gradually realized that his sexual feelings were the result of developmental arrest rather than serious pathology. Like most mental heath professionals, he overdiagnosed himself. At the same time, he was learning to discriminate between significant female figures in his life and clarify the actual chronology in which their shared experiences occurred. The following discrimination exercise was utilized to treat confusion regarding time and place: I asked him to construct a developmental chart listing significant incidents on a yearly basis that occurred throughout his childhood. At first, his attempts at chronology were difficult and scattered. He collected old photographs and other memorabilia, recalling his birthdays and other holiday events. This was related to the subject matter of his fragmentary memories. The pictures were of holiday family gatherings, with the exceptions of his school pictures, which were usually group scenes that included his teachers, all of whom were women. While looking at a class picture of his third-grade teacher, he became angry and started to cry. I asked him to draw a picture about his reaction. Figure 6.1 is what he drew: a small sketch of himself as a young boy, seated at his desk, with his teacher standing over him with a ruler in her hand. He pictured the ruler so large that it bore more of a resemblance to a baseball bat than a ruler. It must have seemed very large indeed when he was a child under assault by his teacher. I asked him to talk about his picture. “Miss Pugh hit us with a ruler whenever she had a bad day,” he said. It was apparently quite common in the school he attended for the teachers to use corporal punishment as a disciplinary measure. I asked him how he felt about being punished that way. He reported having “no feelings,” saying it was not unusual and he was used to being spanked “pretty hard”; his parents never “spared the rod.” This contrasted with earlier statements that he did not remember being beaten. At that point in session he made the same gesture

Figure 6.1 Distorted recollection. The oversized ruler indicates childlike perception. The tears represent internal as well as external anguish.

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with his right index finger that he had made in earlier sessions. Arthur seemed to associate that motion with being hit. These discussions and the feelings expressed during them facilitated integration. Repetitive physical movements often emerge in therapy as clients’ feelings cue somatic memories associated with traumatic events. When asked about the gesture, he had no explanation, other than some vague recall of his mother shaking her finger at him when he was “naughty.” I remained silent and he reported having a dream about a woman shaking a stick at him and then pushing it up into his body through his anus. He did not identify it at that time as a recurring dream. He reported feeling “excited” upon awakening. I asked him to talk more about the excitement. He flushed and said it was definitely sexual, but he didn’t want to talk about it further. In later sessions, he reported dreaming of his mother giving him enemas. He felt that she had been aroused by this process. He admitted that he, too, was aroused by the enema experience. Regressed people frequently have sexualized dream images and fragmentary recollections, such as the ones described above, during the exploration phase of therapy. As the therapist listens without comment or interpretation, clients generally feel free to fully explore and express feelings regarding memorable events. This promotes integration. If the images are still overcharged and cannot be integrated, they will return to be reprocessed once detoxification occurs and integration is complete. It is seldom necessary for the therapist to pick out an incident like this and direct the client back to it for further exploration. In this case of moderate regression, many of the therapy sessions involved the client couple. As the regression bearer explored childhood associations with his mother and his abusive teacher, Miss Pugh, it was helpful for him to see his wife as an accepting female figure in his current life, separate from the threatening female figures of his past. This aided the discrimination process, which we later consolidated by talking about the differences between his wife, Melanie, and the other two female figures associated with Arthur’s regressive episodes. Regression bearers usually have overgeneralized feeling responses that serve as cues to regressive or childlike behavioral tendencies. Betrayal and mistrust were predominant in Arthur’s case. In Arthur’s case, a blend of feelings—fear, hatred, mistrust—mingled with sexual arousal, cued his regressive response in relationship to significant female figures in his life.

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As treatment continued, my client also clarified the differences between his two male colleagues—the one associated with the incident in the past and the current one with whom he was now involved. The strong similarities in these professional situations had overwhelmed him and contributed to his broad associational responses. Fear and hatred of managed care were now the predominant current feelings that cued his regressive tendencies. There was an element of sexual imagery in these cues as well. They seemed to be evoked by male competitiveness and self-doubt regarding his own masculinity. My client’s sexual functioning improved as his power of discrimination grew stronger. He retained a tendency toward mild regression in times of stress. By termination of therapy, Arthur had gradually adjusted to his altered position in the health-care system, but remained bitter about the loss of his autonomy and previous earning power. His confidence level was never fully restored to its precrisis level. The most obvious change in Arthur’s life was that he no longer prayed. He had withdrawn from all church activities and refused to talk to his wife or members of his congregation about his loss of faith. In therapy, he expressed anger toward God. In one of our sessions, when I attempted to guide him in an exploration of his previous belief system, he accused me of hypocrisy, saying, “Do you even believe in God? I don’t see much evidence of your divine connection.” There was silence for a moment. Perhaps I felt defensive. My spirituality continues to undergo changes, and I believe my success, clinically, is very dependent upon it. My response was simple. “Yes, I believe in God, and hope that it is evident in my work.” He stared at me for a moment and then started to cry. I felt like crying too; my eyes filled a bit, but cleared when he started to talk. “How can you believe in God when you see so much evidence of pain and wrongdoing?” he asked. I told him that it was easier for me to see suffering because I also saw recovery and growth. He then asked me a question about sexuality and spirituality. “How can you reconcile our sensual and erotic nature with our spiritual selves?” That question was easier to respond to. Our senses are God-given, as is our spirituality. When I told him that, he laughed and leaned back in his chair. I hadn’t given him very much in response to his questions, but I had disclosed my true feelings and he was grateful for that. Much controversy exists regarding self-disclosure by clinicians in therapeutic settings. It is best to proceed judiciously and withhold unnecessary information. With Arthur, it was clear at this point that he was asking for my support. I knew he had to reconnect with his spirituality and integrate it with his sexual

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self in order to overcome his regressive tendencies. We continued to talk about it in therapy. Arthur joined an adult discussion group sponsored by his church on sexuality and the church. I have conflicted feelings about that endeavor. It was a very broad topic, which might encourage generalization. However, there is little doubt that it would be helpful for Arthur to reconcile his conceptual conflict between God and sex. At this juncture, Arthur was functioning at an adult level of acceptance regarding what managed care had done to his professional status. He was now ready to explore how his regressive reaction had impacted the rest of his life. Melanie reported that their sexual relationship had improved, and that she experienced him as more sexually assertive. Arthur’s view of himself had undergone a significant change. He felt freer to adopt stereotypically male behavior during sexual encounter. He seemed less awestruck by female power. Arthur’s male sexual identity had been strengthened in the process of therapy. He explicitly and humorously thanked me for that, saying, “You made a man out of me.”

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Cases of Mild Regression

Mild regressive states are quite common and more recognizable as simple defense mechanisms designed to protect the regression bearer from truth. They occur frequently in the general population, that is, that segment of population that does not seek therapy or even reeducation in the form of support groups or published forms of self-help. Mild regressive states disrupt relationships, diminish productivity, and drain the regression bearer of energy and time. The underlying feeling in mild regressive experiences is often displaced rage, or unexpressed anger, usually accompanied by a confused litany of grievances that fail to address the specific unintegrated issue provoking regression. As with any defense mechanism, self-knowledge is instinctively avoided in an effort to prevent the psychological pain and discomfort that comes with encountering truth. Mild regression is also characterized by a conflicted attitude toward parents, family members, and early childhood caregivers as well as other figures from the past. There are some similarities to reactive attachment disorders. The regression bearer is not fully grounded in the present. In many cases, there is an outraged sense of not having been loved enough, which develops into a firm belief that one has been neglected and abused. Feelings of deprivation result, which also impede selfawareness and diminish self-esteem. Exaggerated emotional responses occur, which remain unmediated by cognitive awareness. For example, a mildly regressed adult person might have a childlike temper tantrum without realizing how juvenile he/she might appear to others. Sally was prone to episodes of mild regression. She disliked her menstrual flow. She hated Tampons or sanitary napkins of any kind. While shopping in the local supermarket, she frequently dislodged containers of these items, causing them to fall to the floor. When purchasing them

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for her own use, she habitually threw them in her cart with noticeable force. Store personnel came to expect this behavior from her. Had she known this, it would have mortified her. Even mild regression bearers suffer from reality contact. Sally drew a picture of herself having a temper tantrum in a grocery store (see Figure 7.1). Mild regressive states engender intense feelings, which are readily displaced and redirected toward controversial social issues or minor irritants in everyday life. This temporarily relieves the anxiety caused by the unintegrated psychic matter. Issues that promote mild regressive states in adults are rarely addressed directly. It would be difficult to do so, since the feelings evoked by them are experienced as undifferentiated global surges of emotion that cloud cognitive processes. Moreover, when overcharged, sexualized issues are encountered, discrimination is less likely to occur. The regressed individual is cognitively limited to rough categorization processes similar to those experienced in early childhood development when mislearning or lack of integration was developmentally normal. Gender issues are often associated with mild regressive states. More often than not, the same-sex parent has been invested with exaggerated significance. This occurs because same-sex parents are presumptive role models. Parental attitudes and behaviors are often misperceived and/or misunderstood by children attempting to form their own sexual identities.

Figure 7.1 Developmental blurring in a case of mild regression.

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Memory fragments, loose associations, unexpressed feelings, and misperceptions may engulf the regression bearer, who responds with a suspicious, accusatory attitude in his/her own close relationships. The regressed person, overwhelmed with anxiety, may develop a dislike or even hatred of his/her own gender. Thus, one, or the other, or both parents become targets of abuse and/or sexual symbols. A blaming, hostile attitude actually masks a desperate yearning to be loved and valued, ideally as a small child is loved. It is an externalizing process to alleviate rage and anxiety. Marked two-dimensional behavior similar to that found in a parentchild relationship problem surfaces in current relationships. Patterns of interactions typically include impaired communications, overprotection of self and others, and inadequate impulse control. There is a definite lack of self-discipline. The essential feature of this regressive level is overdependence on socially prescribed roles and expectations to resolve normal daily interactions. Mildly regressed adults with sexual identity issues take on attitudes and behaviors that characterize pubescence and adolescence. Low tolerance for stress may result in avoidance of responsibility. There are gaps in psychosexual development. Sally was unable to experience orgasm during sexual encounter. She could, however, stimulate herself to orgasm. When she sexualized with her husband, Newton, she was extremely passive, relying on him to provide her with arousal and resolution. Sexual mutuality is implicit in mature sexual exchange. By contrast, adolescent sexual encounter is generally characterized by self-absorption in males and passivity in females. Sally’s childlike egocentrism prevented adult sexual exchange and made it unlikely that she could sustain a successful sexual relationship. The regressed person will not have completed the development tasks of childhood and/or adolescence in a balanced manner. Therefore, autonomous, proactive social behavior does not occur. Thus, the ability to relate is heavily dependent on stylized rituals frequently found in parent-child relationships. The causes and contributors to developmental arrest are apparent in the case of Sally and her mother, Anne. Sally’s case illustrates the impact of regressive tendencies on feminine identity formation. Although neither mother nor daughter in this family identified herself as a feminist or felt they were dealing with gender issues, many of their reactions and feelings were directly related to unexpressed reactions to women’s position in life. This occurred at both preconscious and conscious levels. Unrecognized, unexpressed, and un-

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integrated feelings regarding feminine roles they felt forced to assume affected their behaviors in mutual interactions. In the case that follows Sally’s—involving Kenneth and his father, Mike—ethnicity, symbolized by their different skin colors, was an unarticulated, overcharged concept with sexual overtones. The difference in their skin color gave rise to strong anxiety feelings that were not addressed directly and clearly. In Kenneth, the son, these unexpressed feelings surfaced in sexualized dominance-submission themes. This distressed him, and he blamed his father for his own confused sexual response. Contrasts and similarities in these two cases of mild regression are illustrated in the text that follows. In both cases the regressive states resulted from an inability of the regression bearer to sort through and understand the intense combination of sexualized thoughts and feelings, accumulated in infancy and childhood, regarding gender-based social and sexual restrictions. Mild regressive reactions like these, occur in many people. It is not unusual for adults to feel and act as they did in childhood during stressful situations. In the two cases presented in this chapter, sexualized associational responses produced dysfunctional regressive behavior, which persisted over time. Let’s look at Sally’s regressive state from her own internal perspective. Sally was very angry with her mother. She blamed her mother for everything that went wrong in her own life. No matter what her mother did for her, Sally felt resentful. She could not understand why her mother expected gratitude. When Sally’s husband, Newton, divorced her and left the state, her mother, Anne, assumed financial responsibility for household expenses while Sally went back to school to finish her bachelor’s degree in art. Without her mother’s help, Sally would have had to go on welfare or work two jobs to take care of her two small children, Priscilla, age two, and Patrick, age five. Going on welfare would not have bothered Sally as much as it would have bothered her mother. Sally’s mother had always been generous to the point of fostering dependency. She did not want to see her daughter and grandchildren sink to a lower social level. So Anne provided housing, utilities, groceries, clothing, and even medical care. Sally lived in her own house on an allowance. Like an overindulged adolescent, Sally asked for, even demanded, more and more of her mother, becoming very angry in the process. She was angry at Newton, her ex-husband, for abandoning her and the children. She was angry at her mother’s assumption that she

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could not make it on her own. She was angry at her children for being there and taking so much of her time and energy. Most of all, she was angry at herself. There was an underlying sexualized issue. Although Sally was angry at her own dependency, it made her feel more feminine to be dependent. Sally felt sexual arousal in her dependent state. She couldn’t admit this—not consciously. The arousal feelings she sometimes felt frightened and disgusted her. Whenever awareness of the sexual issue came to the surface, Sally repressed it. If she took responsibility for herself, life would be a lot harder. She would have to grow up, provide for herself, get her own laundry done, get the children to school on time, put the trash out, and do everything male protectors usually do. Sally didn’t want to work that hard. She had been raised to expect someone to take care of her—first her parents and then her husband. She had become a perpetual child. At a preconscious level, Sally knew she would have to grow up someday and assume responsibility for herself, but she wanted to avoid that as long as possible, hoping that she would be rescued and allowed to enjoy dependency without guilt. Conflicting emotions regarding autonomy versus dependency created a constant inner turmoil. The underlying sexualization of the dependency issue intensified her reactions and behaviors. Anne was Sally’s primary female role model. Sally felt she could not measure up to her mother’s unspoken expectations. As a little girl, Sally’s mother, Anne, had taken good care of her, meeting all her needs and making her feel important. Sally had never been spanked. But, as a little girl, she had fantasized about being spanked and associated being hit on her buttocks with sexual excitement. This, seemingly, is a common, almost universal theme in children’s dreams (Freud, 1950, pp. 172–201). In reality, punishment had taken the form of silent withdrawal of affection and material benefits. Sally learned to associate love with material benefits and hate with withdrawal of material support, common misassociations that occur in developing children. Another major difficulty for the adult Sally revolved around consistent messages she received from the surrounding culture about what being a woman meant. Females were less valuable than males. Unlike the male, she was only half a person, entitled to only marginal respect. She would never be strong enough, smart enough, or successful enough to overcome the fact that she was not a man. This enraged her, but secretly pleased her because it allowed her the option of remaining childlike and being cared for.

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Another, less subtle message told her she would be prized and loved as a sexual object if she behaved with feminine grace and kept herself perpetually young and attractive. Sally felt that her only viable choices were to be dependent on either her father or her husband. After Newton had left her, her father had said, “My advice to you, honey, is to make yourself as attractive as possible, and train your children to be quiet, respectful, and obedient. You have to work fast because the older you get, the harder it will be to find a man to take care of you.” This message was extremely damaging to Sally’s sense of worth. Sally’s mother was more sensitive, but her message was essentially the same. Find a man, marry him, let him take care of you, but also learn how to take care of yourself because you might get tired of your man or he might abandon you. Either way, men are important and necessary. A woman is less than a man. This is the essence of what Sally extracted from parental teachings about her role as a woman. It was not a message that motivated her to be an adult woman. Sally wanted to be taken care of, but she didn’t know how to reciprocate. She felt entitled to unconditional love, as a child often does. She believed her parents had both failed her by not preparing her more realistically for life. Different parents might have steered her toward a more practical career. She was intelligent enough to have gone to medical school and become a physician. But her parents felt that would be inappropriate since Sally was destined to marry and have children. Her degree in art relegated her to a low-paying job. Sally blamed both her parents for her lot in life, but she was angrier at her mother. Perhaps this was because her mother was a woman, and, as such, functioned as a culturally approved target of abuse. Deep down, Sally believed that women were equal or superior to men. But that wasn’t borne out in the way she was treated. Particularly after her divorce, everywhere she turned she encountered discrimination against her because she was a woman. Credit was hard for her to establish in her own name; she had previously depended on her husband’s employment history to obtain credit. When Sally wanted to go out on her own, she discovered that no one wanted to lease a house to a single woman because she “wouldn’t keep the property up.” Indeed, Sally was capable but inexperienced in performing mechanical tasks. It wasn’t because she was unable to learn; she simply hadn’t been taught how to use tools or even how to operate a lawn mower. She blamed her mother for that. Why hadn’t her mother prepared her for life, taken better care of her, done something to protect her from the misfortune that had befallen her?

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As time went on, Sally’s resentment became more pronounced. Her mother still had a man to take care of her. Sally had trouble keeping boyfriends. Her mother had a job she enjoyed and had managed to maintain a size-ten figure, while Sally herself constantly battled a weight problem. And so it went. Everything her mother, Anne, achieved gave Sally another reason to hate her. Sally’s perceptual screen was seriously distorted. Her self-loathing caused her to loathe her mother and discount women in general. She had grown to hate herself for being a woman. She didn’t want a penis and she didn’t really want to be a man. But she couldn’t accept the second-rate status assigned to her for being female. It felt unfair. She had not chosen her gender. She didn’t accept it. As her anger increased it became unbearable, so Sally projected it outward as hatred toward her mother. Her mother exemplified womankind, and Sally hated her for it because she hated herself. The overgeneralization and lack of discriminative ability in Sally’s thought process are prime components of the regressive state. The regressed person distorts objects and events in a broad circle around the offensive stimulus or painful issue. Anne, the mother, had also grappled with the status assigned to women. She, too, resented the myth of male superiority, but she had absorbed the myth and had passed it on to her daughter unintentionally. There were other instances in which Anne unwittingly damaged her daughter through the acculturation process. Her exaggerated deference to males was a prime example. Anne felt that self-abasement was encouraged in women by the subordinate position assigned to them. She cringed at the male attitude of superiority and the exploitative manner in which males were taught to approach interactions with women. It had the effect of making her doubt and devalue herself and other women. Much of this teaching and learning occurred at a preconscious level; it contributed significantly to the pool of unintegrated cognition and affect accumulating within Anne as a developing child. It became more evident in her reactions as she grew older. It also formed the basis for her regressive tendencies. Anne, the mother, had successfully learned to play the game of being a woman supporting her male. Sally was more resistant to the process. She didn’t defer to men. She knew how to flirt and catch a man’s attention, but she didn’t want to clean up after him, or cook for him, or do whatever it took just to meet his expectations. Acting submissive or less intelligent didn’t come easily to Sally. The men she was attracted to, however, liked deference in women because it made them feel more

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important. It enraged Sally that her mother, Anne, did it so automatically. She didn’t even seem to know she was doing it; she just automatically sensed what a man wanted her to be and projected that image. It seemed deceitful to Sally, and perhaps it was. But Anne had learned to be that way when she was a little girl to please her own father, and it had worked for her. Moreover, she had pleased her husbands—all three of them. Anne had divorced three times and had ended all three of her marriages to go on to another man that suited her better at each successive stage of her life. By contrast, Sally, her daughter, couldn’t keep any man interested in her long enough to consolidate the relationship. She envied her mother’s apparent success, and felt shame at her own failure in relating to men. Sally didn’t want to be a woman if it meant subjecting herself to some man. But she wanted to be loved. She also dreaded loneliness. Her marriage had failed because she refused to accept the roles of wife and mother. These roles required a degree of flexibility and maturity that Sally had not achieved. The powerful feelings of anger about being unloved kept her in a state of constant emotional upheaval. She wanted to be a child so she behaved like one. She was regressed. It was an effort to avoid assumption of female maturity. Her regressive states varied in duration and intensity. She didn’t want to be genitally sexual, because to her that meant she had to be a mature woman and take responsibility for meeting male sexual needs whether or not she derived any pleasure for herself in the process. Sally thought that it was unfair that men achieved more rapid orgasm. Therefore, she masturbated instead, utilizing elaborate fantasies of servitude to males to enhance her erotic responses. Sally refused to comply with female role behaviors. She hated her mother and all other women who complied with those role requirements because their compliance increased the pressure on her to do the same thing. Conscious role rebellion augmented the more significant preconscious regressive tendencies of which Sally was completely unaware. Sally did not realize she was being childlike and unreasonable. She felt betrayed by her mother. Her mother’s role-bound behaviors made her own rebellion more difficult. Sally wanted her mother to abandon her own identity and become more like she herself was becoming. She believed her expectations of her mother were justified. Her anger distorted her cognition. Although, developmentally, she was capable of more clarity and reason in her thought processes, the feelings she had as an adult woman were closer to those she had experienced as a child. So, when she felt the helplessness of dependency, she was

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flooded with childlike sensations and perceptions. Overgeneralization occurred. Sally felt helpless and desperate. She wanted her mother to fix everything, which was not possible. This gave rise to bitter disappointment and externalization, which perpetuated the regressive cycle: (a) Sally feels like a child; (b) Sally acts like a child; (c) Sally is treated like a child, which causes Sally to feel like a child. This ongoing cycle generated a strong need for a mother figure in her life. Having a mother is more significant to a little girl than it is to a grown woman. When she was regressed, Sally felt that her mother was the most important person in her life. These were links in a circular chain of associations that bound Sally to childish perceptions and behaviors. As with moderate and severe regressive states, more refined thought processes involving discriminative sorting were needed to promote age-appropriate behavior. Could this occur without focused therapeutic intervention? Perhaps, in time, Sally might, on her own, become more aware of her childlike reactions and alter them in order to obtain more adult satisfaction in her relationships and life experiences. Rewards might be gratifying enough to consolidate the new behaviors. The acquisition of more discriminating thought processes depends on reinforcement and understanding of the new behaviors. Without insight and increased self-awareness, however, Sally’s behavior would not change. She would continue to be vulnerable to mild regressive states. A large segment of the general population is vulnerable to mild regressive states. The blurring of developmental stages, as illustrated in Sally’s tendency to experience herself as a child and an adult simultaneously, is common in all cases of regression from mild to severe. Developmental blurring becomes more intense when eroticized. That occurs when heightened genital sensations are present; the associations are all the more memorable. Gender identity formation is a highly charged process, due to the intensity of emotional and physical sensations associated with sexual behavior. Overgeneralization of associated sensual and erotic cognition promotes confused linking, as in the case of Kenneth and Mike, detailed below. Kenneth was a small male. Unlike his father, who was a large-boned, towering man, Kenneth had narrow shoulders and hips. His feet were size seven, the same shoe size his mother wore. Kenneth’s skin was also lighter than his father’s. For as long as he could remember, he had envied his father’s black skin. It served as a symbol of arrogance and

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superiority to Kenneth. His own light tan color embarrassed him. On occasion, he would catch a glimpse of himself in a mirror or reflected in a storefront window, and he seemed to look almost yellow. This puzzled him because his mother also had very black skin—smooth as satin and very soft. He never saw blemishes on either of his parent’s faces. His own face was marked with bumps and crevices, a skin disorder that Kenneth associated with Caucasians. This also embarrassed Kenneth. He wanted to be big and black. His ideal male stereotype was unobtainable for him. Kenneth became so anxious that, by the time he was seventeen, he felt as if he were not his father’s biological son, although, as far as he knew, his father never doubted it. His parents both loved him and treated him with kindness. In spite of this, Kenneth continued to have disturbing dreams and fantasies associated with the difference in their skin colors. Glimpses of his own golden tan body, contrasted with his father’s black hands, figured in his dreams and promoted regressive tendencies. When Kenneth awakened from these dreams he felt like a very young child. Dreams have long been connected to organically determined sensations. Moreover, the impact of sexual arousal on dream content is a common experience known to mental health professionals as a result of listening to client dreams, as well as their own dream experiences (Freud, 1954, pp. 68–71). The following dream content occurred repeatedly during Kenneth’s pubescence and adolescence: His father would be changing his diapers. He tied the diapers on with some kind of a knot right above his naval. No safety pins were used: the diapers were just held in place by the knot made of the twisted white fabric, like a rope. Perhaps his father pulled the diaper too tightly sometimes, causing discomfort, even pain in Kenneth’s genitals. He seemed to imagine or recall his mother loosening the twisted knot to relieve the small welts that appeared on the folds of his lower body from being bound so tightly by the diapers. These dreams or sensory memories formed a chain of memory fragments, or sensation traces— visual, tactile, and finally, olfactory—that were linked with the odors of excrement. He apparently had unintegrated memories from infancy and childhood about defecation and feces: the linking of these sensations apparently occurred when Kenneth had bowel movements and experienced the relief that came from eliminating the waste from his system. Relief was a strong sensation; it was also mildly erotic. His feces was black. He was fascinated with his power to produce this rich, dark sub-

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stance from his light-colored body. The color, the size, and shape of his feces consoled him. It compensated for the light golden tan of his skin, with its bumps and crevices. Kenneth’s excrement was associated with his parent’s skin color, genital relief, and a sense of power. These were peculiar, unwanted associations, not entirely unpredictable, since they are consistent with the nature of incidental learning, particularly as it relates to the presence of strong physical sensations. Kenneth’s association of love and nurturance with the black skin of his parents, the strong pleasant sensations of relief that accompanied the bowel movement, its dark color, along with the pungent smells of excrement—all these were repeated over and over again throughout Kenneth’s infancy and childhood. They were, in combination, a memorable genital experience. Singly or in combination, each of these memory traces served as cues for regressive states. By seventeen, he had strong genital urges that he relieved by masturbating, sometimes several times a night, wiping up the milky ejaculate in the twisted folds of the white sheets with which he bound his genitals in much the same way as he dreamed his father had twisted his diapers when he was an infant. All of this embarrassed Kenneth, and whenever he thought about it he blamed his father. He felt that he was sexually disturbed because he masturbated so often. He also blamed his father for his habit of arousing himself by twisting the folds of his sheets around his genitals and buttocks. There were times when he believed his father to be a homosexual pedophile who had sexually molested him when he was an infant—too young to remember. Kenneth was never able to clarify whether his father actually molested him. Even in the dream states, nothing more occurred other than the tight diapering. Kenneth’s fears may have been the product of infantile associations and inappropriate linking. Kenneth’s disturbed dreams induced hatred toward his father, Mike. Kenneth never told anyone about his confused thoughts and feelings. He would have felt disloyal at some level; he also loved and respected his father and, in those moments, he did not want to believe that he had sexually molested him, even if he was “small, puny, and light skinned.” Combined feelings of love and hatred toward parental figures such as these are quite common in the general population. They are more disturbing to the regression bearer because the importance of parental figures is magnified. Kenneth projected his feelings about his own body size and skin color onto his father and felt that he was hated. He felt his father hated him. This was a false belief. Kenneth hated himself. He despised his small

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size and light skin, which made him feel less masculine than his father. He felt somewhat effeminate. There were times when he had dreams of being a woman in love with his father. The unintegrated erotic feelings associated with being diapered by his father were activated and overgeneralized, surfacing in this dream content. Feeling inferior to his father promoted an acute awareness of dominance-submission themes. Kenneth was sexually aroused by being dominated. He had fantasies of being bound and led around by a large black man who resembled his father. Kenneth did not act out these fantasies, although, from time to time, he would procure erotica through the mail, computer Web sites, or at an adult bookstore and utilize the material for masturbation purposes. Kenneth felt guilty and anxious about this. He continued to hate his father and to blame him for his own feelings of inadequacy and selfdisgust. An erotic mixture of dream fragments, primitive images, and conscious fantasy characterized Kenneth’s attitudes and feelings toward his father. When Kenneth married, which he did when he was twenty-six, he was still a virgin. The woman he married, an attractive AfricanAmerican with light brown skin and hair, was not a virgin. She had considerably more sexual experience than Kenneth and taught him to enjoy heterosexual marital sex. Kenneth began to accumulate other associations with sexual arousal. After several years, more of his fantasies and dreams were of sexualizing with women. Although he was attracted to very black women, he had never approached or dated one. At any rate, his sexual behavior, despite his rich imagination and dream life, remained well within conventional normal limits for his entire lifetime. On one occasion, he was out of town on a business trip and chose to visit an adult book and video store. There was a notice in one of the booths advertising, “Professional Black Submissive.” Kenneth was flooded with strong feelings of arousal and an intense desire to pursue an encounter with a black submissive. He dialed the number and was disappointed when he heard a woman’s voice. He hung up and went back to his hotel room, called his wife, and had telephone sex with her. Calling her felt like a desperate, fearful act, but it strengthened his growing heterosexual arousal response. By reassociating the orgasm, which he had through telephone sex, with his wife, Kenneth was essentially balancing out his regressive sexual associations with his father. He did this instinctively, without benefit of ongoing professional therapeutic intervention. During times of stress and high arousal, these same regressive tendencies reemerged, but Kenneth would find the

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power to combat them because he was highly motivated to do so. He continued to blame his father for his sexual confusion. The strong combination of love and hate for his paternal parent furnished Kenneth with the strength to resist severe regression, sexual fantasies, and sexual behaviors. At a preconscious level, Kenneth was homophobic. He associated erotic genital sensations with the way his father had diapered him. Later, as he incorporated the twisted sheets into his own masturbation practices in pubescence, it was difficult for him to discriminate between the various components of erotic sensations he experienced during selfstimulation. As he matured, however, and broadened his sexual experience, his erotic associations were no longer limited to those he had known in infancy, early childhood, and adolescence. He accomplished this with very little professional guidance. As an adult, Kenneth was able to make choices about his sexual arousal response. This process occurred over time. In order to free himself from the chain of associations that had affected his development, Kenneth had to integrate the pool of memory traces, image fragments, and sensate associations formed when he was an infant and small child. Obviously, it would have been much easier had the highly charged events and associations been acknowledged and absorbed earlier in his development. His sexual identity formation would have been less difficult had he been able to detoxify the associations he had with his natural body processes. Feces, urine, semen, and other bodily emissions necessary to life are often looked upon with disgust and chagrin. Since these same fluids are often associated with genital sensations in infancy, they become highly significant issues to the growing child and developing adolescent. Generally not talked about or, at best, alluded to in some indirect, overgeneralized manner, these bodily functions and fluids continue to serve as inappropriate cues, causing confusion, embarrassment, discomfort, mislearning, and finally, regressive reactions in a significant segment of the population. In summary, light forms of regression are universal experiences. All children accumulate unintegrated feelings and intense fragmentary reactions to experiences that render them vulnerable to regressive episodes throughout their life span. Severe and moderate regressive states generally require therapeutic intervention by a trained professional. Mild regression yields to informed self-reeducation by motivated individuals.

8

Regression Therapy Applied to a Case of Encopresis and Touch Phobia

Regression therapy is a highly intensified relearning experience. The goals are clearly specified and the learning context is constructed to symbolically approximate the course of normal development with its various stages and tasks. Therapeutically induced regression is designed to remove developmental blocks and correct mislearning. Regression is utilized in the service of clarifying and treating the presenting problem. General regression to the pre-oedipal or mother-infant state is not encouraged. In this case of encopresis and touch phobia, goals are very specific and focus on toilet retraining and reactivating the child’s acceptance of touch as it existed prior to the onset of the regressive behavior. Disruptive aspects of the regression bearer’s current functioning are targeted for exploration and clarification. The feelings generated by this process are integrated to produce new learning. The client is allowed to regress to the age level where mislearning occurred, then repeats the previously unsuccessful learning process in a more successful manner. This usually involves gaining understanding of and insight into the problem behaviors. Overcharged cognitive information and emotional associations are detoxified. In most cases, the client is already in a semiregressed condition at the onset of therapy. Unresolved sexual issues are common in regressed children and adults. Early detection of problem areas involving sexuality is unusual, since children are inaccurately viewed as nonsexual. General factors affecting psychosexual development include reactions to touch, awareness of gender identity, role conformity or rebellion, masturbation, and anxiety reaction to toilet training experiences. The therapist must gather information regarding the availability of appropriate gender-role modeling during early childhood. Methods of punishment utilized by

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caregivers also affect psychosexual development. Cognitive and affective reactions to these should be explored. The clinician should give special attention to tone of voice and nonverbal client reactions during therapy sessions. Overreactions or tendencies on the part of the client to overgeneralize should be carefully noted and treated specifically with discrimination exercises as part of the targeting procedure. In developmental terms, if a child or adolescent is exhibiting consistent self-doubt and inadequate age-level behavior, his/her ability to learn may have been compromised. Two clinical issues emerge at this point. The regressed behavior has to be replaced with age-appropriate behavior and whatever damage has been done to the process of learning must be addressed. In order to accomplish these two goals, new learning must be presented at the regressed level of development. If, for example, the age of eighteen months to two years is identified as the critical developmental period, therapeutic experiences are then designed to layer in feelings of excitement and satisfaction in autonomous learning. This would increase intellectual curiosity and confidence as well as minimize existing self-doubt and feelings of inadequacy. Specified behaviors, appropriate cognition, and affective states are identified and provided in a therapeutic intervention. In this treatment approach, regression is not induced through hypnosis. Conscious awareness of the entire process is encouraged. In severe to moderate cases, the client often presents in an obviously regressed state. The first step is to identify the approximate developmental stage in which the client is blocked. A safe and suggestive environment, such as a nursery or playroom, is provided. This environment encourages fuller recall of the targeted developmental phase. As childlike feelings and behaviors emerge, they are managed through acceptance and discussion. Then well-planned symbolic learning experiences are generated. There is a consistent review of the client’s perception of ongoing therapy as well as recollected incidents that may have interfered with normal development. The incidents or recollections may be actual or imaginary. Therapeutic focus is on the material generated by the client. The accuracy of recall is not fundamental to restructuring. For example, if a client reports falling into the toilet bowl during a toileting experience, client reactions to the incident are fully explored. This may or may not include whether the incident actually occurred. The fact that the client presents this information indicates a need to talk about associations connected to the experience in question. The goals and nature of the therapeutic intervention are explicated frequently in the context

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of discussions that may occur in the playroom, the transition room, or the regular counseling setting, as the case may be. This is necessitated by the fact that regressed clients have difficulty with place and time and may lose their orientation during therapeutic interventions. Integration of fragmentary experiences from infancy or early childhood is accomplished through the use of existing adolescent or adult cognitive functioning, which was developmentally unavailable during the critical development phase. Existing cognitive abilities in the client are strengthened by this process. Previous damage to the learning process is addressed. The primary goal of sorting through memory fragments, detoxifying them, and preparing them for integration is accomplished, mutually, by therapist and client. During the process of integration, fresh linking occurs. A new chain of association is formed. There is a fusion or bond constructed between the developmental learning states, which previously had existed separately or had only a weak or overgeneralized connection prior to the therapeutic learning experience. In the example of the child of eighteen months to two years old experiencing self-doubt and inadequacy feelings (see Chapter 4), during therapy fresh linking occurred between the child state and the adolescent state, allowing satisfaction and selfconfidence in autonomous learning to replace self-doubt, inadequacy, and dependency feelings. The process of linking is facilitated through both verbal and nonverbal interventions. Touch is an invaluable aid in regression therapy with young children, as well as older clients. Touch may elicit regressive feelings during a verbal interchange with an adolescent or adult client. This occurs because touch is a primary conduit for learning during infancy and early childhood. David Lefell, M.D. (2000), professor of dermatology and surgery and associate dean of clinical affairs at the Yale School of Medicine, states that touch not only plays a formative role in social interaction, it is essential to the learning process itself. Cuddling, rocking, and holding stimulate and forge the infant’s ability to connect and feel secure in the presence of others. Hugging and patting promote optimal social and sexual development throughout life (2000). Abuse and neglect in the touching experience create blocks to healthy associations with touching and being touched. The regression bearer learns new associations to touch during therapy. Clinicians must scrupulously avoid direct touching and hugging of the client. Therapeutic interventions include holding and touching stuffed animals and dolls. Touch should, therefore, be used judiciously

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by the therapist. Clarifying client reactions to touch in the therapy session can be accomplished by talking about the client’s attitudes and feelings about being touched and touching others. This is an integrative process that dispels inappropriate sexual connotations that may have been previously associated with touch. Touch can thus be utilized to bring the regressed sexual feelings and associations forward to the current age level of the client. The touch can be symbolic or actual; that is, the therapist may stroke a pillow or toy animal during session and encourage the client to do the same. An example of the therapeutic use of symbolic touch follows. When Niomi was five, her parents brought her to counseling, reporting that she was encopretic and had violent temper tantrums. She was also touch-phobic, in that she would not allow anyone to touch her. She would become violent, bite, scream, and run away if she were approached for a kiss, hug, or even a light hand touch. Niomi’s toilet training had been a harrowing experience for the whole family. She had been forced to sit on the toilet for hours at a time in hopes that she would learn to “do it like a big girl,” instead of soiling her panties. A power struggle ensued. Niomi would hold her bowels stubbornly until she was allowed to get off the toilet, and later soil her panties. The attending pediatrician found no physical reason for this problem, although her stools hardened because she held them too long. When he referred the family to me, he felt the parents had been too strict and tense with Niomi. He prescribed a mild stool softener so that her bowel movements would not be so painful, but felt that the basic problem resided in parental attitudes, which he hoped I would correct. Her parents were also extremely upset because Niomi would touch her genitals while sitting on the toilet. She would also sing little songs to herself made up of nursery rhymes. Her parents described her as “infantile,” “babyish,” and “bratty.” It was obvious that they were very angry with their daughter and blamed her for their own feelings of failure. They were particularly overreactive to Niomi’s genital play, which is common in early childhood. As I listened to their description of Niomi’s infancy and earlier childhood, it became clear that she had accumulated many negative feelings and associations with touch, genital sensations, and toileting. For Niomi, having a bowel movement was often painful. It hurt physically so she avoided it as long as she possibly could. She also had committed herself to a power struggle with her parents regarding control over her toileting habits. Parental reactions to her soiling included rough handling; such

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as slamming her down forcefully on the toilet, as well as shaming her verbally by labeling her as “babyish” or “bratty.” As a result, Niomi became fearful of toileting. She cloaked this with belligerence. She had tantrums, usually after she had soiled her undergarments. She would smear her feces on her toys and on the walls. On several occasions she urinated on her father’s shoes and her mother’s purse. Her tantrums, touch phobia, and soiling made it difficult to find a day care center willing to take her. By the time she got to my office, her parents were desperate, and Niomi was regressing rather than progressing developmentally. I asked the parents to accommodate her regressive behavior and assume a more accepting and gentle attitude toward their daughter’s behaviors. I assured them that in time Niomi would train herself. I reframed their attitude by acknowledging their concern for their daughter and expressing my concern for them. It was clear that they had not asked for, nor received, adequate support in dealing with this difficult phase of parenting. As much as possible, I detoxified their anxiety and reinforced their decision to seek help. I made it clear that normal psychosexual development included genital play, and that it would diminish with time and proper management. My sessions with Niomi took place in the playroom. Immediately upon entering the room for the first time, Niomi went to a beanbag, hollowed out a place for her body, and sat on it as if she were going to the toilet. She glared at me. I pulled up a little chair about two feet away, picked up a small bear, and stroked it while asking her if she wanted to play. She shook her head no. I started to sing a nursery rhyme, while stroking the bear. For a while she listened and then sang with me. She introduced her own little song and I sang with her. We repeated this process for several sessions. I moved my chair closer each time. During the fourth session, she removed her panties and had a bowel movement in the beanbag. I expressed interest, gave her some tissue, and together we carried her feces to the bathroom down the hall and deposited it in the toilet. She did not flush it, and neither did I. I allowed Niomi to control the therapy process. There were several other times when she had bowel movements in the beanbag during our sessions. We always cleaned it up together in a very calm and accepting manner. I described what was happening to the parents and asked them to adopt the same calm and accepting manner at home, should Niomi repeat the process with them. By this time, I had met several times with

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them, both together and individually, to discuss their feelings about Niomi and their parenting. They were both most concerned about Niomi’s continued masturbation habits. She would touch her genitals and sing softly to herself. This continued even after they had discontinued restrictive toilet training. I asked them to be patient and withhold judgment or punishment. As I predicted, Niomi stimulated herself in session. I commented that other kinds of touch also felt good and might not attract negative attention from others. Niomi smiled and said nothing. I showed her how to touch a toy bear on his head and back. At this point I introduced a baby hairbrush into our play. I brushed the bear’s hair while we sang (see Figure 8.1, a drawing by Niomi). Niomi no longer restricted herself to the seated position on the beanbag. This happened less and less as she started using the toilet in my office or at home. Self-stimulation in

Figure 8.1 This is a drawing made by Niomi illustrating symbolic touch in the playroom.

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front of others diminished. One day while I was brushing the bear and singing with her, she got up, took the brush from my hand, and started to brush my hair. It was the first touch that occurred between us. I allowed her to touch me and sat very still while she brushed my hair and shoulders. That day she took the brush home. I usually do not permit the removal of toys from the playroom, but it seemed appropriate, so I said nothing. Several weeks later, her parents reported that Niomi initiated hair brushing with them. The tension level in the home had been reduced considerably with the suspension of parental control over Niomi’s toileting. Niomi took charge of her own toilet training and developed the habit of closing the door while she was using the bathroom. Her masturbation became less of a concern since she did it while she was alone rather than in the presence of her parents. Her touch phobia also diminished after the hairbrushing experience in the playroom. Niomi was able to initiate touch and receive it without apparent anxiety. What had happened? Niomi had regressed because she was unable to move forward developmentally. The harshness of her toilet training had traumatized her. She was very angry with her parents’ efforts to control her. The therapeutic intervention was a simple one. I allowed Niomi to regress and retrain herself. I made little or no effort to structure her play. She seemed to take control of the therapy from the very beginning when she fashioned a toilet out of one of the playroom beanbags. Her autonomy was encouraged. I believe she truly enjoyed the new learning experiences. I introduced therapeutic touch by stroking the bear and utilizing the baby brush to desensitize her to touch. This also served to distract her from open masturbation. I reinforced her progress with attention, interest, and encouragement. I allowed her to take the lead to encourage her to initiate learning at her own pace. This was a very significant aspect of the therapeutic regression. Niomi had to reclaim her right to learn again. She had to take the initiative and succeed at her own pace, both in toileting and in touch. This was a relatively simple treatment plan, but it did correct the mislearning she had experienced during her initial toilet training. The affective experience of satisfaction and pride in learning was made available to this child in the therapeutic setting. The regressed child was motivated to sort through accumulated negative feelings and associations with touch and self-stimulation. This was an important component in correcting maladaptive psychosexual development, which

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had been caused by inappropriate toilet training and ambivalent parental attitudes toward bodily wastes and genital touching that normally occurs in conjunction with these processes. Layering in a new experience in the playroom constituted interference with imbalanced or maladaptive earlier learning. Engaging in desirable behavior and/or affect weakens the undesirable behavior and/or affect. Defiant and angry feelings regarding sensual and erotic sensations were minimized and balanced out with feelings of acceptance. The child was allowed to repeatedly engage in the desirable behavior autonomously until it was established securely as a new response. Every session included focused play that facilitated new learning in the area targeted for change. This was effective because it was built on an earlier stage of development and integrated fragments of affect from the regressed state. Learning new behaviors became a source of satisfaction and pride. The accumulation of negative emotions was reduced. The treatment guidelines utilized in Niomi’s case are widely applicable in working with developmentally regressed children and adults of any age. Treatment goals must be specified. Targeted behaviors must receive consistent focus. The entire process may span several sessions. This includes planning and review as well as enactment of the actual regression experience. In some cases, a series of regressive experiences are planned that repeat the same process with the same targeted behavior. Throughout the sessions, there is a fluidity between regressed and ageappropriate states; this flow is directed by the therapist. The goal is to make the two states more compatible and integrated. Fragmentary feelings and sensations are accepted, discussed, and integrated through the use of puppets, clay modeling, drawings, and other growth-inducing enactments of the developmental tasks for the targeted phase. In our example of the touch-phobic, encopretic child, satisfaction in autonomous learning promoted discipline and self-control. Another goal of this process is to promote a developing pride in accomplishment. The learner, thus, anticipates the challenge of learning with excitement and joy rather than anxiety and dread. Current functioning is enriched and adjusted to appropriate age levels. A combination of motor, affective, and cognitive tasks is generally needed to challenge and motivate the regression bearer to move forward in his/her development and accept the new learning. The learner’s internal satisfaction regarding his/her own growth is a significant component of the new experience. Integration occurs through interacting

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with the therapist, who serves as a surrogate parent and/or a reflective playmate. Therapeutic movement is intrapsychic, although it clearly involves an interpersonal component. The infant or young child is less hampered by ego defenses than an older child, adolescent, or adult. Acceptance of the regressed state opens a client of any age to new learning without unmanageable interference from cognitive dissonance. Integration of fragmentary earlier learning and subsequent resolution of confusion is accomplished as the regressed state is accepted and supported by the therapist. The regressed person naturally moves forward to more mature levels of cognition and affect as anxiety about the current level of functioning dissipates. The therapist’s role is to accept the regression bearer in his/her presenting state, regardless of developmental deficits, to provide understanding, support, and targeted, structured experiences that promote integration of fragmentary reactions to trauma or mislearning experienced in earlier stages of development (Doyle, 1992, pp. 111–130). Often clinicians are anxious about integrating touch into therapeutic interventions. This is understandable. Damage to the client as well as the threats of malpractice due to inappropriate therapist touch are commonplace. Metaphoric touch or cradling is utilized in psychoanalytic settings where purposeful regression to dependence in the presence of the analyst is encouraged. A state of lesser integration is sought to promote progression or movement to a later developmental stage (Van Sweden, 1995, pp. 197–203). Talking directly and openly with the client and the client’s family about the significance of touch and the client’s need to form positive associations with touching experiences must be included in treatment strategy. Avoidance of sexual or sexually suggestive touch is essential to the relearning or therapeutic process. As therapy progresses, it is sometimes helpful to recommend massage experiences such as acupressure, Rolfing, shiatsu, or Swedish massage as a consolidating experience. Again, the therapist in charge should not directly touch or massage a client of any age. The deep currents of transference and countertransference create sexualized associations that may block therapeutic progress. Although touch offers an irreplaceable form of physical and emotional nourishment that promotes new learning, it also opens the client to additional trauma and mislearning. Symbolic touch, as illustrated in Niomi’s case, is the preferred touch experience for regressed clients.

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Regression, as psychological phenomenon, transcends diagnostic categories and can be either malignant or benign. It is common enough in clinical practice and educational settings that all professionals directly involved in the learning process should be familiar with its characteristics and management. Ideally, all parents and caregivers should be aware of the principles of learning and the enduring impact their behaviors and attitudes have on those in their care. In therapeutic settings, the clinician has a great deal of latitude regarding treatment of the regressed client. Various combinations of verbal and symbolic interventions can be interspersed with body awareness exercises. Treatment is best designed taking the temperament of both clinician and client into consideration. In treating the regression bearer, a flexible attitude toward the symbolism of the playroom is essential. Clinicians who do not have access to a playroom, or who cannot overcome the sense of “feeling silly” utilizing this type of setting, might experiment with keeping stuffed toys, pillows, and blankets readily available in the counseling office. Accommodation of the client who presents in a regressed state is implicit in the symbolism of these items. Moreover, this serves as a mirroring technique that confronts and motivates the regression bearer toward progression to an adult state. The clinical challenge is to find the best way to manage the regressed state, prevent further damage, and meet the client’s objectives. In treating regressed clients with psychosexual disorders, it is often necessary to increase the person’s awareness of his/her own body sensations. Treatment of sexual dysfunction involves teaching clients to clear their minds during sexual encounters and focus on sensations in their genital and other erogenous zones. Reducing anxiety and disas-

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sociation are integral parts of helping a regressed client perceive and appreciate sensual and erotic sensation. It also keeps the client grounded in the present and teaches discrimination between what is happening now and distracting associations from the past. Sexualized sensations arise from stimulation originating from both outside and inside the body. Internal stimuli involve tissue, muscle, and viscera. External stimuli include taste, touch, smell, sight, and sound. For instance, a sexualized reaction to defecation involves both external and internal stimulation. The smell and sight of feces served as arousal cues to Kenneth, the mildly regressed African-American whose case was detailed in Chapter 7. Sensations originating from connective tissue and muscle movement during defecation were internal sources of stimulation. Both cued Kenneth’s sexually regressive tendencies. Kenneth was able to recognize his own body sensations and consciously connect them to fantasies of his father being homosexual and sexually dominating him. He learned to understand his own response as he gained more sexual experience as an adult male. Adult experience with these erotic and sensual sensations gradually balanced out and extinguished associational responses originating in childhood. Arthur, the moderately regressed psychiatrist whose case was related in Chapter 6, was less able to track his body sensations and the associations they evoked. His difficulty with erections was connected to anxiety feelings about being less masculine than other males. He was not consciously aware of linking threatening up-and-down motions made by his abusive female teacher with the pelvic thrusting involved in sexual intercourse. He was, however, consciously aware of being dominated by females, which in his perception made him less masculine than other males. Discrimination exercises differentiating his current sexual partner from female figures in his past were paired with PBC muscle exercises. (The PBC [pubococcygeal] muscle controls the flow of urine as well as the orgasmic reflex. It is situated along the underneath side of the male penis and around the outer one third of the female vagina. Both males and females can learn to flex this muscle as an aid to genital awareness.) The physiological distraction provided by PBC flexing lessened his performance anxiety. Basic body awareness exercises are also helpful. Clients’ attention is drawn to their ability to scan their own body parts for minuscule sensations, such as the contact between buttocks and chair, then more refined sensations, such as those generated by contact between buttocks and undergarments. This method brings significant relief to regressed clients feeling undiffer-

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entiated flooding of their body parts. As regressed clients are coached to appreciate their own current ability to change positions and affect the source of sensation, they gain confidence. This allows them to experience sensuality and eroticism during sexual encounter with reduced anxiety. There is less need for distraction and/or disassociation. Regression bearers are also helped in this manner to separate present sensation from past sensation. Discrimination regarding place as well as time is, likewise, accomplished through body awareness exercises. Clients learn to ground themselves in the current external environment as well as the current external sensations occurring in their bodies. Teaching body awareness and a sense of control is not always sufficient. Clarisse (see Chapter 5), who was severely regressed, had to learn to accept and welcome genital sensations. As a result of the anal rape trauma she had experienced at the age of eight, she had learned to fear all sensations in her pelvic area, including those in her buttocks and inner thighs. She had also developed a startle response to sensations of vaginal lubrication. Clarisse experienced panic when she felt even a slight trickle of moisture in her vagina. Her response was intermittent. Her body would tense, and she would be distracted by preconscious associations with the rape. There were also times when she could feel vaginal lubrication without the startle response. After implementing body awareness and sense-of-control exercises in session, which she practiced at home, Clarisse was asked to talk about the sensations of genital arousal and describe them in detail. She said, “They are both good and bad.” This was a very general response. I then asked her what was good about them. She paused and replied, “Uh—warm, soft excitement.” She then reconsidered and said, “I don’t like it.” I accepted her response without further comment. We talked about something else less threatening, but still related to sexual arousal, this time external, or outside of her body. “How aware are you of Lee (her husband) when you are beginning to sense arousal in your vagina?” Again, Clarisse said “Uh—I always know he’s there, but it’s not always just him.” I allowed silence of about one minute and then said, “You’re thinking of someone else?” She nodded yes and said, “Uncle Samuel.” More silence, this time longer— a full two minutes passed. I said, “You don’t want to connect vaginal sensations of moisture with Uncle Samuel.” She cried softly, “No, no, no.” More silence—about two minutes passed. I said, “It’s good to feel it with Lee, but bad to associate it with Uncle Samuel.” She said nothing. “Clarisse,” I said, “look at me,” and added, “It’s good to feel vaginal

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sensations of moisture with Lee.” She said, “Uncle Samuel is dead.” I replied, “Yes, Uncle Samuel is dead. He can’t hurt you or anyone else ever again. You are free to feel good and welcome your arousal response to Lee. The moisture in your vagina is a good sign. It shows that you are ready to make love.” This calmed her. In the sessions that followed, Clarisse began to identify more positive emotions with genital sensations. It was clear, however, that her anxiety was cued intermittently by a broad spectrum of stimuli. For example, there are two cats that sun themselves on the steps outside my office building. Clarisse always noticed them and seemed to place some significance on their presence. When I asked her about her interest in the cats, she said, “I like it when they are there. I get scared when they are gone when I leave.” We talked about how understandable it was that she would have that reaction. I also consistently linked her fear reaction to the past and sought to neutralize it. “You will eventually be able to see cats and not have that fear reaction.” I planted that suggestion, and similar ones, repeatedly. I was also very careful not to block or interrupt the expression of her anxiety response. Timing was very important. It was only after she had spoken directly about her anxiety and associated memories that she could feel my empathic support and experience integration. It was at that point that she was receptive to my suggestion that she would not always be hampered by overgeneralization. I also reassociated her recovery with reclaiming her sexuality. “It will be nice when you can appreciate your arousal and the lubrication in your vagina.” Simple statements, such as these, interjected without pressure at opportune moments are essential factors in successful treatment. They provide both reassurance and direction. Severely regressed clients such as Clarisse sometimes have to be addressed as one would address a frightened child, because she was, of course, a child when the original trauma occurred and she returned to that state under duress (Doyle, 1992, pp. 111–130). I would often ask Clarisse to summarize what we had talked about as we reached the end of the session. This served to consolidate therapeutic gains we had made as well as point out areas of confusion that had to be reworked. Clarisse gradually came to see her body as a source of connection with the present. Sensations that she remembered were differentiated from those she felt in the present. She learned to recognize when current sensations in her vagina such as lubrication or contraction were likely to trigger regression. At that point, she would flex her PBC (pub-

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ococcygeal) muscle, located at the outer third of her vagina. This grounded her in the present and also gave her a sense of control and confidence. I remember when I first taught her Kegel exercises as part of her body awareness exercise program. I asked her to stop and start the flow of urine each time she urinated, explaining that this was also that muscle that controls the contractions in her vagina at the time of orgasm. “You mean it’s controllable?” she asked. As Clarisse grew more familiar with that part of her genital functioning, she became more interested in sexualizing. “I feel as if my body belongs to me,” she said. But our work was not done. The experience of anal penetration and the involuntary release of feces, which occurred during the rape, had to be explicitly detoxified. Clarisse had to talk about whatever she remembered, feel the residual sensations, and accept the reality of the traumatic assault. Finally, she had to assess its impact on her current life and make a conscious effort to minimize that impact. Clarisse was afraid to begin work on this final phase of her therapy. “What if it doesn’t work?” she said. “What if I can’t do it?” I wasn’t sure what she meant by “do it.” Was she referring to sexual intercourse or just feeling her own fear and remembering the details of the anal rape? Seeking to model specificity, I said, “What do you mean by it?” She looked at me and said, “Sex.” I remained silent. She said, “I mean intercourse, sexual intercourse.” Finally, here was a very specific focused response from her about the sexualized core of her anxiety. I proceeded: “Are you talking about anal or vaginal intercourse?” She hesitated, then said, “Vaginal. I don’t think I’ll ever have anal intercourse.” My response was simple and clear: “It’s your choice. What’s important is that you can enjoy sexual intercourse on your own terms, whether it involves vaginal or anal penetration.” She went on to talk about her shame regarding the release of feces she experienced during the rape. This seemed to be a crucial point. “It’s disgusting,” she said, and started to cry. I wanted her to feel her shame so she could integrate it, but first it had to be neutralized. “You didn’t do anything wrong. There aren’t any rules for that kind of situation.” “What do you mean?” she asked, requesting more specificity on my part. “It doesn’t matter if you got poop all over him and his penis. He deserved it.” She stared at me and then laughed. Her laughter was childlike, intense, and brittle, finally turning into sobs. I sat very still, listened, and waited. When she stopped crying, she smiled at me and said, “I got him back. I shit all over him.” She felt empowered; it made her happy to reframe the anal rape incident in this manner. It freed her from the total victim position she had been in for so long.

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I believe that this powerful session provided release from the little girl’s fear that she had been to blame for what her uncle had done to her. Clarisse had to relive the incident in order to integrate it. It would not have been sufficient for Clarisse to rely on verbalization alone; she had to feel the sensation and emotion as well. In subsequent sessions, she talked about other aspects of the anal rape: the smells, the pain, her mother, the cat, Uncle Samuel. She cried and verbalized her anger that no one had helped her. There was a repetitive quality in her consolidation and summary. I let her restate her concerns over and over again. I modeled calmness, specificity, and acceptance of feelings, both emotional and physical. Throughout her therapy, I cited points of progress as they occurred; for example, “You’re talking about your genitals specifically now; that’s good. Your fear is diminishing. Soon, you will enjoy sensual and erotic sensations without fear.” Those statements and others like them were suggestive and optimistic. She needed that reassurance. Clarisse also needed frequent reminders of what our therapeutic goals were. She had to become more aware of her own body. She had to welcome and enjoy sensual and erotic sensations in her genitals. She had to separate present sexual encounters from the past anal rape. She had to gain confidence in her ability to control her own body and what happened to it. She had to separate her husband from her uncle Samuel. Did she accomplish these goals? For the most part, yes, she did. There would be times when she would be fearful again, but she would be aware of what was happening and would be able to stabilize herself. Clarisse was no longer vulnerable to severe episodes of regression because she had sorted through and integrated the fragmentary components of the trauma. She then progressed psychosexually from being a little girl to being a grown woman who could reclaim her sexuality. Developmental growth resumed (see Chapter 5). Her husband, Lee, who was present during many of the sessions, learned to appreciate and understand the changes Clarisse made in accepting sensual and erotic touch. He was able to transfer some of what she accomplished to his own perceptions of sensual and erotic sensations. Their intimate relationship benefited immeasurably from the bonding experience of joint therapy sessions. Increasing body awareness involves discrimination exercises. Sexual dysfunction dissipates as the client’s anxiety relative to erotic and sensual sensations diminishes. Sexualized regressive tendencies are neutralized as the regression bearer learns to accept and even welcome previously dreaded genital sensations.

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The intensity of the bond between the therapist and the client varies with the temperament of both parties. Transferential currents are inherent in therapy, but do not necessarily reach dimensions sought in traditional psychoanalytical approaches. Regressed clients do not have to be returned to a state of dependence to achieve integration. Actually, it is a moot point as to whether regression was induced or already existed in Clarisse (see Chapter 5) and Arthur (see Chapter 6) at the outset of therapy. The therapeutic challenge was to establish enough of a relationship to support and facilitate integration. In both cases, the clients were accepted and allowed to express their regressive tendencies as they already existed. Clarisse was behaving like a frightened child when she crawled under the bed to sleep after coming home from the hospital. I accepted her choice and made no effort to regress her further. Arthur’s functional maturity had faded into childlike lethargy when he first started therapy. I accepted him as he presented himself and allowed him to tell me about similar incidents in his life that he thought were significant to his current confusion. In both cases, their spouses were usually present. Spousal presence served as a reminder of current time and place, as well as a natural dilution of the transference. This contrasts sharply with the traditional psychoanalytic setting where the relationship between analyst and analysand is the focal point and is not shared with other family members. Historically, the interactive dynamic between doctor and patient is clearly specified as a parent-child dyad. This is clearly so when induced regression is the treatment modality. Sigmund Freud (1856–1939), and one of his followers, Sandor Ferenzci (1873–1933), are compared relative to their participation style in the therapeutic process. Ferenzci is viewed as the more active participant, utilizing touch—occasional touch on the shoulder or hair—while Freud is described as taking a more “reflective” position (Van Sweden, 1995, pp. 34–48). Past trauma relived in the presence of the analyst is a necessary component in the healing process. This occurs within the context of a transferential relationship. In the case of Niomi, the regressed child with encopresis and touch phobia (Chapter 8), interaction and reflection are combined to facilitate integration and new learning. Touch was symbolic and suggestive. Singing and stroking the stuffed animal modeled nurturance and suggested nonverbally to Niomi that she was being stroked or nurtured and that she could also touch and/or become a nurturer. The negative impact of parental attitudes toward toilet training and masturbation were targeted and successfully integrated, allowing developmental progression.

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The therapeutic setting should be simple and free of unnecessary clutter. When the playroom is utilized, toys and furniture should be judiciously selected to fit the needs of the particular client. Age and history should also be considered. For example, a Barbie doll might be appropriate for a middle-aged regressed client. A Brittany Spears doll would be better for a younger client. Model airplanes and toy cars should coincide with those available during the era of trauma. Comfortable bean bags, along with blankets and pillows, are often useful for playroom sessions with all ages. Transition rooms (see Chapter 6) are totally personalized through the joint efforts of the client and therapist. Arthur, the moderately regressed client, selected sports equipment and a toy church to symbolize his fragmented feelings. A baseball bat belonging to one of his adopted sons seemed to function as a symbol of masculinity as well as a reminder of the ruler his teacher used to punish him. The toy church, which he had made himself for one of his other children, symbolized concerns regarding his suspended spirituality. It is clear that with Arthur and other regressed clients, the playroom setting served as a silent, gentle, but clear confrontation of the regressed state under treatment. Conversations regarding the feelings attendant with child and/or adolescent states were commonplace during sessions, assisting in discrimination. Objections to utilizing regression as a treatment modality sometimes revolve around the concept of decompensation. If the regression bearer is allowed to return psychologically to the uncertain agony of past trauma, isn’t there the danger of eternal madness? Won’t bad things happen? There is obviously merit in considering this issue. Containing regression so that further damage does not occur is a primary concern. The regressed client must be stable enough so that he/she is accessible to therapy and will not harm self or others. How dangerous is the regression bearer? There was significant danger in the case of Clarisse (Chapter 5). After all, she had tried to kill her husband. However, after leaving the hospital, they sought outpatient therapy and did respond favorably to treatment. It is possible that the regressive episode leading to hospitalization and her short internment there was akin to shock therapy. New learning occurred. The gravity of her condition could not be denied. Further decompensation did not occur. Calm acceptance and gentle guidance prevented further deterioration. Targeted verbal interventions, combined with body awareness exercises, helped her distinguish between past and present. The treatment approach suggested here is designed to restore the regressed person to an

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adult state, or in the case of a child (Niomi, Chapter 8), facilitate progression to the next developmental stage. The method employed is integrative. Fragmentary memories of sensations, feelings, and thoughts are detoxified until their power to cause regression is nullified. This is accomplished in a therapeutic setting where the regressed client can find support while encountering traumatic associations. In the interest of sparing clients the pain of reliving traumatic incidents and minimizing the risk of retraumatizing them in the course of therapy, Bessell van der Kolk endorses the eye movement desensitization process as a way to achieve integration without reliance on what he calls the tyranny of language (van der Kolk, 2001). By focusing on the patient’s ability to master eye movements and use them to calm and distract from anxiety, the client can override automatic psychological responses attendant to post-traumatic stress reaction. This seems similar to utilizing Kegel exercises to resensitize Clarisse to the feelings of vaginal lubrication during sexual arousal (Chapter 5). Somatic memory fragments cannot always be put into words. Treatment, therefore, can never be solely verbal. However, verbalizations are central to normal adult communication and, as such, useful and necessary in integration of trauma and consolidation of therapeutic gains. The clinician has a great deal of latitude in the selection of treatment modalities. An understanding of the intricacies of learning is essential, regardless of treatment approach. Regression is a multifaceted psychological phenomenon. It can be recognized and managed by clinicians, educators, and parents with various levels of competency. The severity of the symptoms and the temperament of the regression bearer determine the need for professional intervention.

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Index

Abnormalities, genital, 31, 36 Abreaction, 49 Abuse, original incidents, xx Acceptance, 95; as treatment approach, 102 Adaptive learning, 24 Adolescent, 75, 76; sexuality, 31, 33, 37; touch, 89 Amygdala, xv, xvi Arousal, 4; unintegrated incidents, 14 Asexuality, xx Assault, xvii; parental, xviii; repetitive, xviii Assaultive learning. See under Learning Assimilation, 39 Associational blurs, 47 Associational responses, 61; broad, 59, 70 Associations, 2, 15, 19, 83; childhood, 4, 6; erotic, xvi; fragmentary, 10; genital sensations, 10; overcharged, xvi; with pelvic thrusting, 14; punishment, 10; repetitive and thematic, 19 Associative factors, 14; link, 16 Aversive teaching, 10, 19 Avoidance, 6, 61, 63 Behavior, assaultive, 23 Biblical interpretations, 10

Blurring, time and place, 63 Body: awareness, 102; image, 10, 27, 29; memories, 9 Brain, xv–xvi, 36; limbic system and brain stem, 4; pathways, 2; retrieval, 3; sorting and associations, 14 Cautionary measures, 11 Childhood: genital arousal, 4; issues, 10; masturbation, 93; perceptions, 13, 15 Christian ethics, xviii Clay modeling, 54, 94 Clinical caution, xxii Conditioning, 23 Conjoint therapy, 103; sessions, 53 Consolidations, as a therapeutic method, 102 Corporal punishment, xviii, xxi, 11, 23; institutionalized use, xix Cradling, 95 Criminal perpetrator: development of, xix Cross-cuing, 37 Cues, 29, 33, 40, 69. See also under Memory Decompensation, 104 Defecation, 39 Defense mechanisms, 62, 73; in childhood, 13

114

Index

Delusions, hallucinations, 20 Dependence, 64 Depersonalization, 44 Development. See under Psychosexual Developmental: block, 87; blurring, 27–28, 30, 33, 35, 81; level, 40; progression (see under Progression); task, 27, 75, 88, 103, 105; terms, 88 Development of perpetrators, 23 Diagnostic categories, 39, 97 Diapering, xvi, 82 Discipline, 12 Discrimination, 9, 10, 15, 22, 23, 65; exercises, 56, 67, 98, 102; infantile, 5 Displacement, 74 Dissociation, 99 Distortion. See Memory, distortion Distraction, 99 Dolls, use in therapy, 89 Dominance-submission themes, 17, 21, 29, 33, 84, 76 Drawing, 54, 94 Dream formation content, 82 Dream states, 83 Early learning, negative events, 11 Ego: boundaries, 44; defenses, 95; integration, 20 Egocentrism, 75 Ego-integrity, 50 EMDR (Eye Movement Desensitization Restructuring), 105 Encoding, distorted, 13 Encopresis, 87, 94, 103 Erections, 97 Ethics, Christian, xviii Events: environmental 9; episodic, 3; memorable sexual, 11, 19 Exhibitionism, 29, 30 Experiences, repetitive maturationed, 27

Externalization, 75 Eye Movement Desensitization Restructuring. See EMDR Female role behavior, 80 Feminine identity formation, 75 Ferenzci, Sandor, 103 Fetishism, 10, 29 Flashbulb memories. See under Memories Fragmentary memories. See under Memories Freud, Sigmund, 103 Gender: awareness, 27; dysphoria, 32; identity, 19–20, 28, 81, 87; issues, 74; prescriptions, 28, 33; restrictions, 10; roles, 33; specific developmental tasks, 30 Generalization, 9, 11, 71 Genetic programming, 9 Genital: abnormalities, 31, 36; arousal, xix; memorable experiences, 83; sensations (see under Associations) Greven, Phillip, xix Hallucination, 20, 45, 60 Homicide, 42 Homosexuality, 34, 98 Hospitalization, 42, 55 Hypervigilant, 43 Hypnosis, 88 Imitation, 23 Incidents, environmental, 13 Infantile dissonance, internal, 7 Infantile learning, 1 Infant sexuality, 1 Integration, 21–22, 41, 49, 67, 69 Intervention. See Therapeutic intervention

Index

Kegel exercises, 101, 105 Knowledge, inferential, 5 Layering, new learning, 94 Learning: adaptive, 24; assaultive, 12; aversion, 7; diapering, 7; imprinting, 7; infantile, 1; primary attitude, 9; process, 9, 22; response patterns, 1; traumatic, xxii Lefell, David, 89 Love, infant-parent, xvii Male behavior, stereotypic, 66, 71 Managed care, 42; system, 57 Masochism, xvii Masturbation, 29, 30–33, 83, 87, 92, 103; childhood, 93; management of, 34 Medical model, 42 Medication, 42, 51, 55 Meerloo, J.A.M., xx Memorable genital experiences, 83 Memorable sexual events, 11, 19 Memory, 20, 36; accuracy, xviii; cue, 14–15, 22, 41, 69; distortion, 2; flashbulb, 4; fragments, 75, 105; link, xxii; revival, 1; somatic, 22; specific incidents, xviii; storage, 36; traces, xviii, 43–44, 85; unintegrated, 60 Metaphoric touch, 95 Mild regression. See under Regression Mislearning, 3, 7, 16, 20, 22, 87, 93; sexualized, body memories, 13 Modeling, as treatment approach, 102 Negative sexual imagery, 66 Neocortex, xvi New learning, 104 Original incidents of abuse or trauma, xx

115

Original learning content, xvi, xxii Overgeneralization, xv, xvii, xx, xxi, 3, 41, 44–45, 63–65, 81 Overgeneralized fear, xix; responses, 69 Pain, 4 Paraphilia, 35 Parental attitudes, negative, 103 Parental projection, 5 Parental reactions. See under Reactions Parental sexual practices, 31 PBC (pubococcygeal) muscle, use in therapy, 98, 100–101 Pedophilia, 29 Perceptions. See under Childhood Perceptual distortion, xxii Perceptual waves, 5 Perpetrators, development of, 23 Perversion. See under Sexual Piaget, Jean, 5 Playroom, 53, 54, 66, 89, 97, 104 Pleasure, 4 Posttraumatic stress reaction, 39, 40 Predator, 42 Pre-oedipal regression, 87 Primitive explicit memory, 13 Progression, x, 25, 37; developmental, 9, 21, 103, 105 Projection, parental, 5 Promiscuity, 30 Psychiatric unit, 50 Psychic states, inner, 3 Psychoanalytic approach, 103 Psychoanalytic settings, 95 Psychological assessment, 51 Psychosexual: development, 4, 9, 11, 17, 19, 32, 34, 36, 91, 93; disorders, 24, 97; disturbance, 18; stage, 20 Psychotic imagery, 44 Pubescence, 33, 34, 75, 85

116

Index

Pubococcygeal muscle. See PCB (pubococcygeal) muscle Punishment, 87; effects of, 16; physical, 9. See also under Associations Random learning, 3 Rationalization, 63 Reactions, parental, 6 Recall, fragmentary, 28; and recognition, 7 Recall and recognition, 1 Recall cue, xvi Recurring genital sensations, xx Reflective playmate, 95 Regression: beneficial, xx; component of egocentrism, 16; defense against self- knowledge, xx; defined, ix; induced, 53; levels, xx, 24; mild, 73; moderate health, 57; universal experience, x Regression bearer, spousal perceptions, 62, 66 Regression therapy, x, 88 Regressive episode, 6, 58, 60; selfinduced, 51; sensations, 15; tendencies, 19 Relationship, prototypes formed, 2 Repetitive assault, xviii Repetitive body movements, xi, 66 Repetitive maturationed experiences, 27 Responses, broad associational, 70 Role: conformity, 87; rebellion, 80, 87; taking, 10 Role model, primary, 77 Sadism, xvii Sadomasochism, 29, 33 Schizophrenia, 41 Screen memory, 20 Secondary sexual characteristics, 37 Self-abasement, 79

Self-stimulation, 92 Sensate component, 19 Sensate memory links, xvi Sensations, recurring genital, xx Sensorimotor reactions, xi Sensual and erotic sensations, 10 Severally regressed, 40 Sex hormones, 32 Sex negativism, 11 Sexual: mislearning, xx, 13; misperception, 11; orientation, 27, 34; pathology, xvii; perversion, xxi; secondary characteristics, 37 Sexual addiction, 24 Sexual dysfunction, 4, 15, 97, 102; erectile, xxi, 65 Sexual identity, 20, 29; formation, 28, 30, 36, 39, 74 Sexualized dreams, 69 Sexualized regression, xx–xxi Somatic: associations, ix; memories, 14, 22, 69; sensations, 39, 97 Spanking, xvi, xvii, 10, 14, 77 Specificity, as treatment approach, 102 Spiritual integrity, 61 Spirituality, 70 Spousal participation, 103 Spousal perceptions of regression bearer, 62, 66 Stereotype, adult male, 66, 71 Stimuli, 46; broad spectrum, 100; moderate and intense, 7 Stuffed animals, use in therapy, 89, 92, 87, 103 Suggestion, as therapeutic method, 100 Summarization, as therapeutic method, 102 Surrogate parent, 95 Symbolism, 10, 53, 76, 87–88, 97; meaning, 57; in sexual encounters, 10, 22, 36

Index

Teaching. See Aversive teaching Tension states in children, 13 Therapeutic intervention, 6 Therapeutic new learning, 16 Therapeutic reenactments, in playroom setting, 14 Therapeutic touch, 93 Therapist-client bond, 103; as surrogate parent, 95; as reflective playmate, 95 Therapy: isolating sensate components, 25; joint, 49; time line, 65 Toileting, 15, 29, 87, 88; training, 20, 103 Touch, xv, 35, 40–41, 89–90; adolescent, 89; gender discriminative, 35; phobia, 36, 87,

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103; sensual and erotic, 1, 35, 102; symbolism, 36, 95; therapeutic, 93 Touching patterns, x Transference, 103 Transition room, 53, 89,104 Traumatic learning, xxii Treatment: approach, 97, 103, 105; goals, 48, 89, 94, 102; modalities, 105 Unintegrated event, 58 Unintentional abuse, resulting in psychological disorders, 12 Urination, 39 Vaginal lubrication, 42, 99 Van der Kolk, Bessell, 3, 105 Van Sweden, R. C., xx

About the Author AVERIL MARIE DOYLE is a clinical supervisor for the American Association of Marriage and Family Therapists, the American Board of Sexology, and the American Board of Sex Educators, Counselors and Therapists. She is also author of Delusional Relationships (Praeger, 1992) and The Sexually Disturbed (Praeger, 1992).