CASE STUDY:
Braduta and the burned hands trauma (first part)
Presentation: Camelia Stavarache is President of the Integrative Psychotherapy Association, Integrative Psychotherapy Trainer and Supervisor, Clinical Hypnosis, Erisksonian and Psychosomatoanalisys Psychotherapist.
Summary: “Braduta and the burned hands trauma” case study describes the intrapsychic dynamics, shame and self-justification mechanisms, in a life scenario dominated by a cumulative trauma and a disorganized attachment. These defense mechanisms help the individual protect himself against the breaking up of a relationship. From a life-scenario perspective, shame derives from believing the “Something is wrong with me” scenario, as a result of messages, decisions, conclusions generated by impossibile requests, as well as from defensive control or defensive hopes.
CASE STUDY:
Braduta and the burned hands trauma
Richard Erskine says that these defense mechanisms help the individual protect himself against the breaking up of a relationship. From a life-scenario perspective, shame derives from believing the “Something is wrong with me” scenario, as a result of messages, decisions, conclusions generated by impossibile requests, as well as from defensive control or defensive hopes. Also, shame implies a low self-esteem due to its confluence with criticisms, defensive inversion of sadness and fear, with denying the anger. Moreover, shame can also be an archaic fixation or an introjection. Self-justification, which is a replica of shame, is actually denying the need of relating. Integrative psychotherapy is contact oriented, focusing on investigation methods, syntonisation and involvement.
The patient, whom I will refer to as Braduta, started psychotherapy in February, last year. Braduta was a final-year student of a humanistic faculty. She doesn’t talk much, has a hidden aggressiveness, she is afraid of loneliness and considers herself neither pretty, nor ugly.
She has been depressive since she was 5. Her parents had a volcanic relationship: the father was pseudo-present, while the mother was aggressive. Because the girl was her dad’s favorite, her mother beat her black and blue each time she had a bad day.
THE HISTORY OF HER TRAUMAS:
– at 5, her mother put the girl’s hands of a hot iron, because she suspected the girl to have stolen some money from the house; numerous beatings and other physical ill-treatments.
– at 8, her parents divorced and the father broke the parental relationship with her.
– at 18, she began her sexual life with a “good-for-nothing”. They broke up as friends, but afterwards she was sequestrated and forced to practice prostitution for 3 weeks, before she managed to escape. For the following 6 year, she couldn’t have a relationship with a man. After those years, she had a boyfriend for 3 months and another one for 11 months. Both men were aggressive. Now, she is oscillating, having sporadical sexual relationships with the latter. Se feels depressed and non-assertive. Solving her relating traumas became the objective of the therapy.
Braduta is the second of two daughters. Her sister is 7 years her senior and took part in raising her after the parents’ divorce. Her older sister has always been her mom’s favorite and protected. “No matter what my sisters did, she was right. When she made a mistake, we were both punished, while if I made a little mistake, I was suffering the punishment alone. I remember one time when my sister stole the only pair of nylon tights I had and I couldn’t go out any more. I was 18 years old then. I just couldn’t take it any longer and I showed my anger telling my mother that my sister was stupid. My mom slapped me in the face so hard that I started bleeding.”
The two sisters were often left home alone, with the responsibility of keeping the house clean, preparing their own food or doing their homework.
The every day life post-trauma reaction model is, as follows: she doesn’t express her initial anger, according to the “something is wrong with me” scenario. This particular scenario has been built on the confrontation with a potential losing of the relationship. In this case, the child can feel constrained to take the confluent defensive decision of accepting as her identity the labels put by the ones she depends on.
When confronted with impossibile tasks and requests, children often draw conclusions like “There is something wrong with me”. Through this conclusion, they can defend themselves against the discomfort produced by their unfulfilled contact needs, maintaining a false-appearance relationship in this way.
The belief in the “Something is wrong with me” scenario can appear as a defensive reaction, as well. This reaction is meant to ensure both the control and the hope of a continuous interpersonal relationship, in full contact. When family relations are dysfunctional, “ a child longing for contact-in-relationship can come to imagine that the adult who takes care of him has problems because of him.”
During the musico-theraphy exercise, in “Fighting the dragon inside the labyrinth” Braduta identified the dragon as being her own mother, and the difficulty of getting out of the labyrinth as a mother dependency. I symbolically translated that she needs to live that period of small child in fusion with the mother, the young pupil days, to talk about a 8 year old secrets with the emotionally missing mother. Living, she will learn the daughter’s part, while the mother – the mother’s part.
AREAS OF CONTACT INTERRUPTION AND TRAUMA TYPOLOGY
Braduta was on the point of giving up therapy. She noticed that she had a problem with “abandonment” (she gets out of relationships, gives up all kinds of activities). The only exceptions were school and job. It turned out that she wanted a long term relationship, but that she was adopting an adventurer’s behavior. She used the scheme learned from her mother: “my personal value is zero”. On an unconscious level, we worked on the metaphor “I’m dressed for sports, but I want everybody to believe that I’m wearing an evening dress.”
The interaction with this patient was, and still is, an attentive and sensitive investigation, defined by continuous encouragement, affection and empathy, stimulation of self expression, auto-valuing everything that has to do with her, support in finding a personal rhythm and patience, giving her the time she needs to understand what happens inside her. My mirror-anchoring, using patience and respect, helped her “feel her”, “think about herself” and express her experience, attributing a great value to this experience.
The contact during the session would be preceded by a pre-contact during which we commented on current social events. This pre-contact would last somewhere between 5 and 10 minutes, having the purpose of re-opening more easily the contact with me and get ready for the session. The contact is very good at the moment, as she has the availability for it. The post-contact is something we are still working on, as Braduta is aware of the fact that after the sessions she has the tendency of closing the contact even with herself. She defines the process as follows: most of the times she leaves all relieved after our sessions but afterwards, she feels the need to close herself in order to protect her vulnerability, either in relation with her, or with others. She also wrote a poem about a worm and a child calling for the mother without being heard. I interpreted it as a regression, as the problem is related to the mother.
During one session, she expressed herself using the language and posture of a child, so I imagined she was 5 or 6 years old. I tuned myself corporally and sensorially with that child and I started the session using the language and the tone of voice I would have used with a child of that age. This behavior brought to surface a spontaneous memory: her sister stole some money from the house and the mother had accused Braduta. As she was petrified with fear, she couldn’t deny it and the mother put her palm on the hot iron so that she “will never put her hands on things that isn’t supposed to”.
Braduta also lived the experience of an imaginary dialogue between two chairs: “the mother” was on one chair, “she, at the age of 5” on the other chair. During the dialogue with the chairs, she succinctly described the process of unconscious introjection in this way: “Mom, I love you so much, that I would bear the shame in your place”.
After that, I asked her to write the qualities and the faults that had been suggested by the mother or by others, on red cards. On yellow cards, what comes from her. Then, I described the image of a house with walls eaten by termites and with normal walls, and I asked her what she would do. She answered that she would demolish THE AFFECTED WALLS and then, would build something else instead. I gave her the task of ripping off the cards and even to burn them (she actually asked “Can I burn them?”). She felt as though things were settling. She had the insight of a baby bird that finds itself inside an egg and makes two-three holes, getting ready to come out. This traumatic episode can be considered an indicator of her feeling of fear, a feeling that is extremely present when relating to others. The conclusions of the relating with others scenario are obvious: the desire of making herself less visible and of being ignored maintained her belief that she was not OK. Even more, looking from a physiological perspective, her voice was “blocked” by the trauma and she was left with the voice of a 6 year old girl, from whom nobody could expect wisdom or intelligence.
Her child voice is actually a somatization of the implicit memory. The therapy allowed her to integrate the trauma and the fixation on herself. While my words of validating the experience allowed her to give the value and the understanding back to herself. During a different session, I used the relaxation with a story: “After losing his flowers, how does a tree or a flower know to make other flowers just as beautiful?” (C. Stavarache, 2004)