Trauma is discussed often in graduate courses. Although trauma is in our common vernacular, I doubt many of us can identify exactly what trauma is, nor conceptualize trauma in such a way to help our patients who are suffering. Something we do not talk about is silence, specifically using silence in the therapy room with a patient. Outside the walls of therapy, the #MeToo movement has been illuminating the atrocities survivors have faced, making the private public, breaking the silence and giving a voice to the acts of violence done to them. #MeToo is a collective movement made up of individuals breaking their silence. This is not the silence to which I am referring in this post. Rather, I am talking about silence as a deliberate action of a therapist to remain silent in a session when in a room with a traumatized other.
An intriguing idea was raised in one of my classes; silence on behalf of the therapist is a re-traumatization [of a past trauma]. I passionately disagree with this, though I do not have enough space in this post to explore this in much depth. I would, however, like to start of series of posts to begin exploring silence more thoroughly as my understanding and theoretical understanding of trauma deepens and becomes more clear.
As I was piecing together words and ideas to create this post, "exile" started playing:
I think I've seen this film before
And I didn't like the ending
I'm not your problem anymore
So what am I defending now?
[...] Now I'm in exile seein' you out
Our patients come to us, asking (sometimes pleading) for answers, answers we are unable to provide. I cannot even begin to count how many times I have had patients tell me something similar to, "I felt like I was back in my mother's house," or "I can't seem to get this trauma out of my mind." They are stuck in a film from which they feel they have no agency to escape the certain ending; the certainty leaves the patient with a sense (or lack!) of personal agency to pick up the reins of one's narrative to create new possibilities. However, has she not been exiled, unable to feel like she has the will to take her story back? The severing of her reality through a penetration of another's will (and narrative) cripples and distorts time.
As therapists, it is impossible to know fully what someone else is experiencing and being committed to the impossible ideal of recognition is a losing battle. We will never have mutual recognition. I have certainly fell into trap of believing I knew what a patient was experiencing; I have eaten an apple, tasted it, so I therefore know what you are tasting. This seems obviously erroneous, but there are times when I have gotten so lost in a patient's narrative, only to believe that I might have just a small glimpse, for a mere second, into what she might be experiencing.
As psychology students, we are taught about "validation" and how to "validate" our patients' experiences. I remember receiving a grade on my very first intervention video, having received a score of 1 of 5 on empathy, needing to "use more validation." Keeping in mind my developmental level at the time, the feedback was likely given to me to pique my interest in how I relate to patients. Mission accomplished. I have not forgotten this very specific feedback. Let me illustrate using an excerpt from Slavin and Pollock (1997).
A therapist is visiting a patient who was sexually abused as a child, while she is in the hospital for a physical illness. The patient is an extraordinarily gifted psychotherapist who otherwise lives in a haunted world of globally bad feelings and no coherent sense of the trustworthiness of her own experience. The therapist finds himself taking her in, frail, thin, vulnerable, and yet at the same time compelling and sexually appealing. The therapist is unaware of his behavior until the patient becomes aware of his gaze, looks about herself frantically to find what might be in disarray, and asks, “What are you looking at? What’s wrong? Everything seems to be swirling,” she says. The therapist, suddenly conscious of what he was doing, says, “We need to look at what happened.” The patient screams in terror and says that she can’t, that she doesn’t want to talk about it. She holds her head, sobs, and vehemently insists that she cannot. She looks up, a look of horror on her face. “I had this crazy thought. I thought, ‘I need to call my therapist and talk to him about this,’ but then I thought, ‘My therapist is here!’ and it made me want to go away and die.”The therapist insists again that they talk about what happened. The patient listens as the therapist describes his experience, all of it. The therapist says she must have felt horrified at the thought of his having any sexual feelings for her. But even more horrifying, he says, was her expectation that he would not acknowledge his feelings or what had just happened. He says, “You felt you had to violate your own mind and bury part of what you saw in me in order to hold on to me as the therapist you could call.” The patient becomes calm. “The world looks clearer,” she says. They spoke at some length—the first of many such discussions—about what had happened and what she had felt.
I am aware that what I am about to say is a hot take in many contemporary circles, especially those who are married to intersubjectivity theory. The authors give an example of an enactment that happened between a victim of trauma and a therapist. The therapist was trying to validate the patient’s experience, specifically by saying things such as you must’ve been horrified. As a reader of this excerpt, what came to your mind about what the patient might be experiencing? And perhaps a more relevant question is why the therapist felt the need to explore "what happened?" I am not suggesting that we must never discuss such enactments, but I do want to bring attention to the why. For who's benefit was this discussion of what just happened?
What if the patient was not feeling horrified? What if (we will never know, of course) the patient was really feeling rage, sexual excitement, or fear? Might saying such things (e.g., you must have been horrified) leave our patients with the question of, “Am I horrified? Should I be horrified? Is my feeling of rage (or whatever else) unacceptable in your eyes that are looking at me with a gaze of desire?” Might our attempts at validating close the door to the client experiencing something else toward us, the perpetrator, and/or perhaps coloring their fantasies as perverse?
Here is the hot take. His sexual excitement was not her problem, but he made it her problem. He did not like the film he was playing in his mind and he had to defend against it [her, the signifier]. However, she was never given the opportunity to respond to say I'm not your problem anymore.
This brings me to my concluding, albeit just the beginning, remark. What about being in silence [with this woman] is so un(bare)able?
Slavin, J. H., & Pollock, L. (1997). The poisoning of desire: the destruction of agency and the recovery of psychic integrity in sexual abuse. Contemporary Psychoanalysis, 33, 273-593. https://doi.org/10.1080/00107530.1997.10747006
-cg