An important and often neglected part of reconstructing the past is remembering the good times along with the bad. We often would see that patients were unable to remember anything good about their childhoods, anything truly worthy about their parents until they were able to give voice to the bad. Frequently they would first come into treatment idealizing a family of origin that certainly was far from ideal. Their mothers, fathers, siblings were all perfect-they were the sick ones, they were the problem. As they remembered the reality of their experience, their family would become the "family from hell." This seemed to be a painful but necessary corrective to the total self-blame with which they entered treatment. They needed to see that they had been victimized by a sick system, that they had once been helpless and innocent children whose trust had been betrayed. Armed with this insight, they were much better equipped to take responsibility for the destructive actions they had taken as adults, and only then were they able to make changes in the present. And then, as they became able to put their narrative into perspective, the family came into better focus as well.
In many cases they were gradually able to describe their perpetrator not as an evil Satan, but as a wounded, hurt, and angry person who sometimes lost control and sometimes could be loving and funny. This change often indicated a real maturing of perspective as the childhood terror gave way to a more realistic appraisal. Sometimes families are truly sadistic, even psychopathic, but far more often the situation is distinctly more complex. We found that as survivors became more compassionate about their own suffering they were able to begin the process of struggling to understand how their own families had passed on a legacy of pain and trauma. When multi¬ generational family histories were available, we were usually able to trace the traumatic affect back to some understandable, "socially acceptable" life tragedy such as war, immigration, early death of a parent, concentration camp experience, disease, or disaster, some overwhelming experience that had produced a significant distortion in the intergenerational transmission of healthy attachment relationships.
This is part of the reason why any confrontation with the family of origin should be delayed until late in the therapeutic process, when the survivor is well along in outpatient treatment and the process of recovery. If family members are confronted prematurely, pointless and unnecessary rifts in the family can end up harming the already tenuous attachment relationships that survivors often cling to in the early stages of recovery. We learned to carefully weigh the benefit of confrontation against the risk. During the stage when the patients had managed to mobilize rage against the perpetrators, they often became flushed with a sense of personal power, and pushed for a premature confrontation. We discovered that it was important to try and prevent this from happening. Too often when actually in the situation and confronting the perpetrator, his or her continued denial would puncture their recently achieved sense of empowerment, plunging them into even deeper despair.
Sometimes, confrontation is unavoidable. This is likely to be the case when the confrontation occurs before hospitalization or when some present danger exists in not confronting the situation, for example, where the patient or other children are still being abused. In such a case, patients often needed more support, including sound legal advice, in order to proceed. Current involvement in violent relationships interferes with therapeutic work that is focused on the past. In these circumstances, reconstructive work may have to be delayed until the immediate crisis is past and dealt with adequately.
Family-of-origin work can be extremely helpful if the family is able to provide support and validation of the patient's experience. In many of our cases, family members had long known or suspected the origins of the psychiatric dysfunction. When they were able to talk about it, share experiences, express anger, remorse, guilt, and grief, the benefits for the patients were often enormous. The patients' symptoms would often be relieved, and recovery accelerated much more rapidly than when the families were not positively involved.
We saw that families could move on, even with the perpetrator still connected, if there was honesty and true remorse. Forgiveness could not be unilateral. The patient who had been hurt by a family member could not be expected to forgive the perpetrator until the person admitted to guilt, experienced remorse, and asked for forgiveness. Such a process can take many years, but we frequently underestimated the power of family loyalty and attachment. When a family accomplishes this process they change, mature; become more humble and more human. We saw many sad occasions, how¬ ever, when this proud sense of loyalty and the profound need for human attachment was perverted in the service of maintaining secrecy and destroy¬ ing the perceived "squealer." When this happened, the survivor was isolated, targeted for abuse, lied to, and betrayed repeatedly. These cases were often the most potentially lethal and difficult to manage. There are few social stimuli as powerful as the age-old method of shunning. Over time we became impressed by the awesome power of a family united against the betrayal of secrets and the magnitude of the tragedies that ensued.
We never recommended suing family members as a constructive solution to any problems. Too often, the goals and methods of the legal system are contradictory to the goals and methods of recovery. Although some survivors say that they felt they could not rest until they had received some kind of justice, our concern was always that the civil system does not necessarily lead to justice for the survivor. It can and often does, however, perpetuate the abuse. Legal cases drag on for many years, and throughout that time the survivor cannot move on and put the past in the past. In too many instances a legal case is simply another way of staying attached to the abuser and of reenacting the abuse. Again, legal action may be unavoidable if a danger to others remains. If this is the case, the survivor will need a great deal of support and will have to be far enough along in recovery to withstand the rigors of an adversarial system. Too often in such legal confrontations the perpetrator's continued denial can arouse murderous impulses, grave self¬doubts and an undermining of important therapeutic work .
During critical stages of recovery involving the family-of-choice is vital. Sometimes patients came to us with an admission complaint of child abuse and only later did we discover that the patient was currently involved in an abusive relationship. It is not possible to recover from past abuse as long as a person is being abused in the present. Our rule of safety required, then, a focus on stopping the abuse in the present. Sometimes children were being abused or were in danger of being abused or neglected which meant we had to call the appropriate agencies and report the abuse. Whenever possible, we urged the patients to report themselves or other perpetrators in the family. We saw this as an essential part of recovery as they simultaneously learned how to self-protect and protect their own children. Other times, it became clear that the patient would have to leave the abusive situations and we needed to help them make a liaison with shelters for battered women and domestic violence agencies. We learned how frightening a step this is. Trauma-bonding means that our patients were dependent upon those abusive relationships, just as they had been dependent on their abusive family members, and getting out of those relationships, left them feeling terribly abandoned. Often they needed a great deal of time and encouragement to establish an adequate support system before they left and after, to help prevent failure.
Other survivors had managed to make relatively healthy relationships. But often, by the time they had deteriorated to the point that hospitalization was required, their family members had become exhausted, frightened, threatened, bewildered, and angry. Living with someone who is emotionally disturbed is usually extremely stressful. These families needed as much help understanding what was happening to their loved one as the patients did. As they became educated about trauma we could help direct them toward more helpful forms of interactions with each other. Frequently, opening up the door to talking about childhood trauma provided a way for the other family members to begin talking about their own traumatic experiences and how those experiences had affected their families. If a spouse, child, friend, or any significant other was willing to be involved, learn, and provide support, improvement was quicker and more efficient. Holding family sessions, even for relatively young children, can be enormously reassuring for the kids. We learned that the children had been living with a more-or-less dysfunctional parent for varying lengths of time and had suffered the consequence of this to the dismay of the parents. Teaching children something about what was happening, conveying an understanding of what they and the family had been going through was something we could do in service of prevention. Children inevitably blame themselves, just as our patients had done when they were children, and removing the burden of blame from them can be healing for the children as well as the parents.
except from Bloom (20130 Creating Sanctuary Toward the Evolution of Sane Societies