portrait

Eyes Wide Open:

Facing and Learning to Manage the Chaos of the Borderline Personality

by

Therese Keeling, M.D.

Karen Lovett, M. Div.

Richard Derle Underwood, D.Min.

and Christy Webster*

(*Christy Webster is the ficticious pseudonym for the client in this case study.)

 

Introduction

Borderline personality disorder, childhood sexual abuse, post traumatic stress disorder, major depression, suicidal ideation; all are terms that attempt to describe the most difficult kind of wounding a person can experience. It is almost impossible to describe the depth of brokenness or the process of recovery a person goes through in response to early boundary violations and lack of a trusting connection with early caregivers. However, this presentation will offer a summary of just such a lifetime struggle as well as some reflection on the principles that enabled a very courageous young woman to manage her woundedness.

The presentation will include an outline of the things that CW has come to know are true along with some thoughts about how she has slowly found some hope and healing. Since the early part of her therapeutic journey involved preverbal work, we will include samples of her drawings. As you will see, these drawings gave voice for the first time to the trauma and awesome sense of betrayal that she experienced. The shame was so pervasive that images were all that could be managed in the early part of the recovery. Finally, poems written by CW are interspersed to illustrate the power of the externalized written word in the healing process.

The work with CW occurred in a Pastoral Counseling Center over a three-year period and is ongoing. This center is located in an old farmhouse. Three professionals have worked together to provide the supportive holding environment for CW's process. Each of these professionals will provide some reflection on the process. Karen Lovett, pastoral counselor, formed the initial therapeutic relationship in which she worked intensely with CW for about eighteen months. Rick Underwood, pastoral counselor, joined the team providing the primary therapeutic relationship for the next two years. Therese Keeling, psychiatrist, offered the medical interventions which would prove to be very effective. This team continues to work closely in providing the therapeutic friendships that undergird CW's work.

CW is a young professional women in her late twenties. She had made several attempts at therapy with minimal results. On two occasions, she was hospitalized for suicidal ideation. She had rejected organized religion since her abuse occurred in the context of a "religious family." She is currently functioning at the highest level she has experienced. She is ready to tell some of her story.

Figure 1: My Name is Incest

 
Figure 1.

 

"Christy's" Story


These are the things that I know to be true.

  • Two dream images showing my father spreading apart my toddler legs and another showing him laying on top of me at the age of seven.

  • My father's interest and curiosity about personal body functions.

  • The uncanny and not-quite-able-to-be-placed recognition of my body's reaction to my first sexual experience. My uncontrolled and out-of-proportion sobbing during this same experience.

  • My drawings, which depict knowledge I have but don't know I have. Drawings that impart knowledge of invasion, shame, and suffering.

  • My intense hatred of my father for as long as I can remember.

  • My negative and unable-to-bear reaction to words that have very bad meanings all connected to sex; the anger that is evoked in relation to the subject of sex.

  • My inability to look at me.

  • My inability to acknowledge body parts.

  • My desire to die dating back to my teenage years.

  • The amount of red blood flowing from my body after reading a story about a girl who was sexually abused.

  • The compulsion I have to cut, destroy, hit, burn, to drive recklessly.

  • Calls received by my father from former students saying they remembered what he did.

  • The secretiveness of my parents.

  • My mother's hatred and dismissal of me.

  • My inability to speak beginning at the age of thirteen and lasting for six years--a need not to be heard.

  • My father's interest in me doing sit-ups to have a thin stomach.

  • My father's out-of-place concern about my sexual activity when he had been called about my suicide attempt.

  • My reactions to my father--climbing across the car seats in order to get out on the side farthest from him and raising a knife to him as a weapon as a third grader.

  • My grandma's request to my parents to let me come live with her when I was eight. My parents refused.

  • Scraping my fingernails down my face at the age of five.

  • Feeling bad, dirty, ashamed, different, wrong at the heart of me; unable to trust.

  • My addiction to food and to people.

  • My parents' concern for appearances only-to "rescue" the sick daughter for appearance sake. Only when someone else outside the family was able to see inside the family did the family act.

  • My search for help in secret all these years-my latching onto adults beginning in elementary school.

  • My asexuality.

  • My gut-level sense that it happened--that this is my truth and not believing would be to befriend the chaos that comes from leading a double life--that sexual abuse is the reason I kept trying to find help for what I knew wasn't the way it was supposed to be.

  • My adverse reaction to a tampon--shaking just holding it and feeling sick to my stomach.

  • Having to go to the basement and use jars or the drain to go to the bathroom when they wouldn't get out of the bathroom or when they were listening to the sounds that come from the bathroom.

  • My reaction to my first gynecological exam and the doctor's subsequent question: "Have you been sexually abused?"

  • Migraines that began in the fourth grade and came five times a week.

  • My father's laughter when I slammed down onto the bar of my bike.

  • My long-standing habit of always being fully clothed to go to sleep.

  • My father's treatment from a place specializing in physical and sexual abuse.

  • My father's weekly habit of going to confession.

  • My father's obsession of checking wastebaskets to look for evidence of taking care of the blood.


All of these things have lead to a life filled with chaos that is experienced with emotional intensity and physical destruction. Chaos is the hallmark of the borderline and is defined by the dictionary as a place of total confusion or disorder and as a vast abyss. It is characterized by a myriad of behaviors, thoughts, and feelings all raging through the body.

I am going to waste--absolutely waste--however long my life is!! The damage is who I am, and so my goal is to do everything I can to be damaged. I am cutting myself to pieces. Did I tell you that I knew the smell instantly-the smell that comes with sexual activity- the smell that opened and retrieved a file in my mind? Get in my car, turn off the heat, turn off the seatbelt, listen to loud music, drive faster and faster; so tired, eyes closing. CRASH!! I don't want to have a body. I need to damage it in some way so it can't be felt again. You're gonna have to let me hit me. I don't know what else to do. Hold the pieces of me together.


These chaotic scenes demand action. Action for me has come in the form of management. To manage means to carry on. Managing the illness requires delicately balancing a temperamental scale of emotions. It encompasses the adventure and sometimes the trauma of learning what needs to be done to survive and to actually live a little. Trauma is defined by the dictionary as a physical wound or an emotional shock that creates lasting damage to the psychological development of a person. A synonym for trauma is sexual abuse perpetrated by the child's father. I am that child. Indelibly written on my "hard drive" are the words "I am bad", "Shame is my name", and "I need to be punished". Recovery comes slowly in the day-to-day management of the demons. Each day builds upon the other so that when the chaos looms threateningly, the little victories stand up to defend themselves.

The Transition from Delightful to Defenseless
Laughter and Jokes
Sparkle in the eye
The ease of friendship
Good feelings and sharing
She is a delightful child

Silence and stillness
Invisible hiding
Hardships of honesty
Bad feelings and sharing
She is a defenseless child hovering in the wings ready to fill in

Sex, Body Parts, Body Functions, Bodies
The delightful child has been kidnapped
She can no longer play out her role as intended
The defenseless child steps out of the shadows to take her place
The stage becomes dark and silent


Connecting with other people is the cornerstone from which all other management techniques extend. Connecting with others can be exercising with a friend early in the morning, having lunch with another friend, saying hello to people I meet on the street, and talking in a therapeutic environment. Connecting with people gets me out in the real world and there is a rush of adrenaline that occurs with each contact. Although hard to do at first, the rewards are obvious to me.

Managing the illness also requires basic interventions such as exercising, taking medicine as prescribed, drawing and writing, self-talk, and eating healthily. When I first began therapy, I acted on impulse, and my behavior was a picture of exactly what I was feeling. I have learned to write down obsessive thoughts and ideas as well as negative thoughts that flow through my head. In so doing, the thoughts and ideas are out of me and on the paper. I can return to them if I need to, but until I do, I can let them go. All of the chaotic thoughts are thus contained--but not inside of me.

figure 2

Figure 2.


Self-soothing seems to have a sexual stigma. Self-soothing for me involves none of that. It simply involves finding lullabies or stories read on tape for me to listen to. I have a special bear and blanket that I have with me at all times for comfort and as a reminder of my connection to others. I concentrate on taking long, deep breaths in and out. I have notes written to me from important people that I can take with me in a pocket. Self-soothing also involves the controlling of my thoughts by getting them written down and put outside of my head.

Finding purposeful behavior has become extremely important in finding a way to spend previously used-up energy that is now available. Having a goal or a vision directs my behavior and makes good use of my time. Idleness is an enemy to be reckoned with.

Going to church has become a search for what is out there. Raised in a "perfect" and image-driven Catholic family, I sought refuge there as a teenager and was turned away twice with no place to go for the night and no time available for me. My life turned away from any kind of religion. In the past three years, I have again sought a place in a different kind of church. I am drawn to the church, yet the light is dim and I have been unable to find my way. How can a God who embodies love itself put children into homes with families who assault them? How can any person who claims to be a voice for God and Jesus abandon a teenager with no place to go? Who is Jesus? What is/was his purpose? Where were they?? For the moment I recognize that something draws me back to church most weeks. Belonging to a church requires an acceptance of Jesus as my savior. So I don't belong to a church. I just keep waiting to understand-waiting to believe.

Little by little I am able to extend my world and my experiences. While anything involving sex remains far out of my world, I am venturing out and discovering the world I should have known as a young girl. I don't know if I will ever include anything having to do with sex in my management of my illness. I think I am making progress simply in learning about it from a good male role model. Discovering the idea of management as opposed to recovery has loosened the tethered strings holding me to the ground. I am experiencing freedom at last.

Some of the books that I found helpful are as follows:

  • Survivor Prayers: Talking with God about Childhood Sexual Abuse by Catherine J. Foote
  • Waking Up, Alive: The descent, the suicide attempt, and the return to life by Richard A. Heckler
  • When Food Is Love: Exploring the Relationship Between Eating and Intimacy by Geneen Roth
  • Getting Through The Day: Strategies For Adults Hurt As Children by Nancy J. Napier
  • Daybreak: Meditations For Women Survivors of Sexual Abuse by Maureen Brady.

 

Making Sense of the Reflection:
Some Theoretical Understanding


Since there were many dimensions of CW's complex life story, it was difficult, at least in the early stages, to gain a clear differential diagnosis. Therefore, from the start it has been important to keep focusing the diagnostic lens. Overall, we have proceeded with the assumption that the early trauma experienced by CW set the frame work for what later became a coping style that is best characterized by the borderline character disorder. Cohen and Sherwood and Chessick articulate a variety of theoretical understandings that helped in making sense of the chaos and confusion and offered some direction in the therapeutic process.

The therapeutic task with CW was complicated by many factors. We mention a few in order to set the context for our reflection. In order to psychologically and spiritually survive CW learned as a small child to keep secrets hidden from herself that included unacceptable thoughts and feelings. Therefore, she had a very difficult time offering herself in an integrated, focused fashion. Another hallmark of her suffering was the fact that she had not established a trusting relationship with her mother in the first year of life. Without this constant connection, it was impossible for CW to trust that mother would be there emotionally for her when she moved away. She, in essence, did not have a home base from which she could test her wings. Many problems resulted from this lack of object constancy. First, she was not able to pursue and develop her individual identity. Second, an interpersonal pattern of clinging dependency replaced the object constancy as a form of security in which CW 's identity must be built around some other who could offer some definition. Therefore, there was no capacity for mature relationships, no ability to tolerate being alone and no sense of sameness across time.

Important relationships were tenuous at best and abandonment was the inevitable expectation. Getting her own needs met was out of the question. CW could not image getting her own needs met in relationship without losing the other person. The rage and independent strivings would destroy a relationship. Because of these dynamics, being alone for CW meant a complete loss of self. The resulting old brain/hard drive programming made it very difficult for CW to enter and stay in a therapeutic relationship. Desperate for some relief from her suffering and isolation, she came to therapy eager to find someone who would take care of her but assuming at the same time that the therapist would eventually grow tired of her, betray her, or throw her out of the office. Given CW's perpetual concern with abandonment, inability to modulate effect, and intolerance of separateness, forming a therapeutic alliance was a challenge to say the least.

The task for the therapist, given the multiplicity of problems, is to provide a constant object presence. This constant object presence gives CW an opportunity to initially develop the internal belief that the therapist will provide that holding environment where some healing can occur. In order for the early damage to be repaired, it is helpful if the therapist presents him or her self as a constant, reliable, trusting person who can be approached, clung to, pushed away, and left and returned to. Further, the therapist must find ways to deal with his or her own countertransference in order to allow the attachment to unfold over time. Learning to stand still meant accepting CW's discomfort and not demanding that she feel better. It meant drawing on supportive colleagues and trusting in a higher connection in order to deal with the therapist's own sense of powerlessness and helplessness. In the early phase of therapy, the process involved occasional emphatic reflections of CW's perception and emotional state with a persistent curiosity and interest in her as a person. Also, it was important to demonstrate understanding and appreciation for CW's suffering and difficulties.

There were at least three phases in the process of providing constancy: adaption; differentiation; and reparation. Each of these stages centers around one important aspect of what it means to have a stable, constant, trusting, healing attachment. These are not goals to be achieved but rather predictable things that happen eventually in the process of the evolving therapeutic relationship. In the preconstancy phase the primary task is "standing still" and naturally allowing the attachment to occur as discussed earlier. As the later stages of constancy become noticeable it is important to become more active in the process. As we move to the reparation stage the therapeutic work becomes more like the work with normal neurotic problems. It is not surprising that a specialized approach be needed in the first place because there was so little coherence or integrity to CW's experience of self and others. The object constancy is a principal organizing force in the development of personality. As CW resolved some of that early deficit in the current therapeutic relationship, interventions and techniques from major schools of psychotherapy could be utilized. While having to essentially throw out many of those interventions early in the process, at the end of the reparation phase many of those same techniques could be reclaimed and utilized to good effect.

In conclusion of this section, we would like to mention a few special problems. In regards to the transference reactions that emerge early on, it is extremely helpful to remember that we are dealing with the symbiotic reactions normally experienced with a six month to one-year-old. Complicating the work is the tremendous rage that must be worked through as the client comes to grips with the limitations of life as given them in the early years. Suicidal gestures and/or threats came up very often during the early phase work. Raising questions about the consequences of self destructive behavior while taking the threats seriously and trying to turn the threats into externalization of feelings was an on going part of the process. The profound grief that was blocked from conscious memory was gut wrenching for both the therapist and CW as she grieved the failure of her own caregivers. As this loss and rage was (and is) worked through in a caring relationship, CW began to feel better. However, the chaotic coping style doesn't die quietly. It is very difficult to give up a style that has been so familiar for so many years. Cognitive work with the automatic negative thoughts becomes a part of the therapists work. Lastly, the therapists' countertransference throughout the process presents on going challenges. Dealing with the therapists' anxiety, discouragement, helplessness, hopelessness, and anger in reaction to the above described process is key to the positive outcome of the therapy. More will be said about the management of these reactions later.

underwood-03

Figure 3.

The Early Phase:
Karen Lovett's Reflection on the Process


The early days of the therapeutic relationship with CW were tenuous, confusing, and frustrating at best. After the initial sessions, during which CW presented herself with her mask firmly in place, there were many, many sessions of just silence. Sometimes the silence was compounded by CW hiding behind the swivel chair in my office. Mind racing with theories, I was very aware of my own emotions, which at the time consisted mostly of frustration and confusion. Yet in spite of the maddening nature of our sessions there was something about her that called to me; some spark of effort on her part that kept me rescheduling her for appointments. There must also have been the spark of connection for her because she kept coming back. Believing that all behaviors have meaning, the task was, of course, to find the hidden message. What was she trying to tell me? What was her emotional age? I, of course, being highly verbal, asked her all of these questions and got zero response. The response I did get was one of a turned away head or of a blank look. I felt highly manipulated. This was a young woman who functioned in a highly demanding and stressful work environment, why could she not 'talk' to me? Slowly the realization came that she was "talking" to me, just in a preverbal manner. That, for me, was the key. She had no language for what she was feeling. About that time a colleague loaned me the book Becoming a Constant Object in Psychotherapy with the Borderline Patient, by Charles P. Cohen and Vance R. Sherwood. In their highly readable book the "preconstancy" stage was developed in such a way that awareness of what was happening with CW allowed my own feeling of ineffectiveness to give way; becoming instead a resolve to be a constant object. CW and I had to form a place of safety and "object constancy" which would allow the slow process of attachment and growth to take place.

How were we to tend to this child/infant yet maintain a therapeutic ethical stance? My impulse was to want to just hold her. This would prove to be the correct (at least with this particular person) method, however, the manner of holding was to be developed. CW had a significant input in this development of how to safely "hold" her. The relationship with her mother had been, and continues to be, one of painful coldness and abandonment. Although the family was intact, the isolation was distinct and focused on presenting a "perfect" face to the world. CW cried out for connection and nurture yet did not know how to receive it when affection and nurture was given. CW had the amazing and disarming ability to be mute and yet to bring in beautifully articulated written work. A key element was our discovery of her ability to express herself with drawing and painting. She had a history of writing poetry and that was also an avenue of communication and healing. Below is a poem chronicling the ongoing non-responsive nature of the relationship with her mother:

I call.
He answers.
Can I speak to her?
He speaks her name.
She says no
Audibly
No, she won't talk to me
When just the day before I called her at school
To tell her
Don't have him come to my house
You know what happens when he is angry
And contacts me
Yes I know, she says
No she won't talk to me
I have no choice
Again
She' s leaving me with no choice
I have to talk to him
-----------!
Not available
No buffer
A Black Hole
Wasteland
Coward - - Emotional Coward


In essence, she was teaching me her language. During the awful stage of cutting behaviors and suicidal ideation her drawings, poems and writings provided a constant window into the core person.

Theologically, CW was wounded in the pre-stage called undifferentiated faith. Fowler says of this stage, "…the seeds of trust, courage, hope and love are fused in an undifferentiated way and contend with sensed threats of abandonment, inconsistencies and deprivations in an infant's environment."

Her father's abuse and betrayal coupled with her mother's emotionally distant, disinterested style led CW to conclude that either God was a cruel hoaxster that would put a child in such an environment or that she had done something, unwittingly, to anger God and thus she was being punished. The idea of a loving God who would weep and be sad for her hurts was entirely foreign to her. It was easier to grasp hold of the idea of a God that would use people (our team) to help bring about healing.

As CW reforms a bond of trust and appropriate affection with responsive and responsible caregivers, she is beginning to heal her monster-like image of God. As she tests her boundaries and finds that they can and do hold her safely in a less hostile world, she is more open to the possibility of a God that planned a good and safe life for all children. Thus, CW continues to be drawn to faith as a part of her life and open to allow healing of this part of her person occur.

 

Medical Intervention as a Part of the Team Approach

by Therese Keeling, M.D.

CW first entered into treatment with me on 8/12/97. During our first session, her therapist, Karen Lovett, with whom she had been in therapy for 13 months, accompanied her. CW was fairly uncooperative with being interviewed. She answered very few questions. She admitted to being constantly depressed, having racing thoughts, inability to concentrate, erratic sleep and desire to be self-destructive. CW answered few other questions. She was begun on Serzone.

She returned 10/7/97 with continued depression, which had deepened. CW was a little more open and asked questions regarding ECT. She stated she would be open to this but her insurance required that she be tried on 3 classes of antidepressants before having ECT. She was begun on Wellbutrin SR 100mg bid. She was unable to handle Wellbutrin and was placed on Buspar for anxiety. She had to discontinue this as she had feelings of being spaced out. She was begun on Zyprexa. Attempts were made to increase the dosage of Zyprexa, but CW complained of twitching and sedation. She continued to experience depression and Zoloft was added.

During our next visit she was extremely nervous and refused to establish eye contact. Rick Underwood accompanied her. She had noted to Dr. Underwood increased anxiety on Zoloft and constantly focusing on food. She reported a willingness to try an increase in Zyprexa. Zoloft was discontinued and Trazodone was added at 50mg to help with sleep. Zyprexa was increased to 15 mg.

About 1 week later she was again experiencing EPS from the Zyprexa and it was backed down to 10 mg. Trazodone was increased to 100 mg. At this interview she was much more verbal and apologetic for her hostile behavior earlier. At this time CW had to take sick leave from her work because of the depression and anxiety. On 11/10 patient had to discontinue Trazodone due to insomnia and muscle twitching. ECT was revisited and insurance required a medical write up.

She underwent her first ECT Rx soon thereafter on 11/17/98 and had 7 treatments ending 12/5/98. During this time she was continued on Zyprexa. She was begun on Celexa and dosage was increased to 60 mg.

By early February 1999, CW's mood again was precipitously dropping and she was referred back to Tenbroeck for readmission and further ECT. In early March CW's mood was better, but she was fighting an urge to want to return to the hospital. By the end of March she was again quite depressed and suicidal. She was not felt to be in need of further ECT by inpatient M.D. at Tenbroeck. She was again unable to work and admitted to having stopped Celexa 1 week. CW was restarted on Celexa 60 mg and Zyprexa 10 mg and was begun on Eskaleth 450-mg bid as an adjunct to the Celexa.

By mid-April she was doing better and rated her mood at a 5 (1-10). CW did fairly well for about 2 months with some increase in her obsessional thinking, however, in mid-June 1999 she became more depressed and had an increase in obsessional thinking and compulsive behaviors. Her Zyprexa was increased to 15 mg again. After 1 week she noted no improvements. Given CW's problems with weight gain, continuing intractable depression and problems with decreased concentration and inattention, Ritalin was added at 10mg bid. This dosage was ultimately increased to 10-mg tid and CW had dramatic improvements in her mood and her ability to concentrate.

She currently has been able to start making friends and getting involved in activities and having interest in having a social life. She has also been able to return to her work.

 

The Middle and Late Phase:
Rick Underwood's Reflection on the Process

There have been at least three themes that have emerged in my work with CW. I will summarize these with some brief discussion. As therapist, I have had to learn to live in the tension between these extremes as CW has learned to rework early developmental deprivation that now requires her learning to live in the tension between extremes such as basic trust verse mistrust.

Collaboration verses Innovation. My work with CW has been extremely satisfying. However, without continuous collaboration with the team, my temptation would have been to replicate the secrecy of her childhood experience. As the powerful bad/mother, bad/ father transference has emerged, it has been extremely important for Karen and I to work together forming a healthy family system, parental coalition. Gradually, this open system approach enabled us all to be innovative in our work. Risking ways of relating that might be considered unconventional in this collaborative context has proven helpful. A few of these relational patterns include appropriate physical contact, some gift receiving, some appropriate social contact outside sessions, some reentry time in the center after and between intense sessions, some appropriate volunteer work for the center and some sharing of relevant parallel history. Also, the unique collaboration we enjoyed facilitated the medical intervention which has proven to be a vital part of the management.

Connection versus Boundaries. In the early phase, CW would sit across the room with sun glasses in place and never make eye contact. And yet, it was clear that she desperately wanted to connect. As the positive father transference gradually developed, we discovered ways to titrate the need for connection versus the need for distance. Throughout the process, the intensity of our work challenged me to continuously redefine myself. My own wounding history and some feelings of inadequacy as a father in my own journey, often tempted me to allow too much fusion to occur. Feedback from my family and colleagues encouraged me to set appropriate boundaries. Especially in the second year of our work, it was important for me to remain as differentiated as possible. This required moment to moment redefining myself in relation to CW, and ongoing recognition of my limitations and awareness of a healing, guiding, sustaining presence larger than either of us. Slowly, CW was able to begin giving up the bad self which included all kinds of negative beliefs about herself and others. New ways of thinking about herself began to emerge. The maladaptive coping thoughts and behaviors, which had been so fragmenting of self but necessary for survival, could be reconsidered. As CW began to define herself moment to moment, some personal power, never before felt, began to emerge. She became more conscious of her behaviors, was able to make better choices about handling emotions, and she began to form new supportive friendships. As she has grown, CW has been able to introject the good enough parent feelings. This new found trust in herself and others has allowed her to move away and to tolerate longer periods of no face to face contact. However, old patterns of thinking and behavior recorded on the hard drive of our brains are difficult to overcome. The ongoing challenge for CW during the current separation-individuation phase is to practice what she has learned and to trust her connections with self and others.

Self Soothing versus Modulating Affect. A large part of developing an integrated self involves learning to deal with feelings. Because of the early boundary violations, feelings and needs were frozen. In order to become human and feel some normality, we had to learn to live and work in the tension between the range of emotions including affection, rage, sadness, fear, anxiety, and hope on the one extreme and new ways of self soothing at the other extreme. Early in the process, living in this tension was impossible. Eventually, appropriately dealing with feelings became a form of self soothing which allowed for new integration. However, early on the gut wrenching work of externalizing the pain, grief, loss, and rage was essential. First with pictures, then carefully with words, the pain emerged. Turning the rage outward after years of turning it in on herself, was very hard to do. Finally, a breakthrough came when we were able to hear and connect with the awful rage that began to put the wounding in perspective. This drawing illustrates the agony.

underwood-04-s

Figure 4.

As CW allowed some light to be shone on the dark secrets, she could allow herself to experience some empathy for her plight. As she made her descent into her hell, faced some of the demonic images, revealed some closely guarded secrets, and admitted honest conclusions drawn about herself and others, she could gradually ascend and feel the warmth of the light. During this grueling phase of our work, in moments when CW modulated her anger and/or despair, I would have to find ways to soothe myself in order to anchor her as she rode out the emotional storm. As some of the grief resolved, we were able to work on other areas of development.

Confronting the darker emotions allowed CW also to gradually trust and appreciate some of the lighter emotions such as affection, gratitude, humor, and hope. This brought about new challenges. The issue of sexuality and the meaning of love was mixed with these feelings because of the early abuse. This poem written by CW describes some of the struggle.

A child
Who learns to feel
Sexual body responses
Because of inappropriate touches
Is not dangerous sexually
You see, Rick it is not my adult self
My adult body
That remembers
That would be a contradiction, don't you think?
If my body responded now
In the present
I wouldn't be remembering
So the child wants you to know
Her response - both physically and emotionally
Isn't dangerous
She now begins to understand how unsafe
She was then
How safe she is now
And she is overwhelmed with the sadness
Of the realization.
But she so very much doesn't want you
To move away
To become loud
To stop taking her hand
Or touch her hair
She wants to relearn
How it is suppose to be
She doesn't want you to be scared of her
So the adult me
Will boldly ask you
Not to go away yet
It is not me now
Who has those body memories
It is the child
Who so desperately needs to have those
Experiences to be safe
So she can heal
You said the difference will be that
With you I will heal.
That's part of it.
Please don't go away now
It will become part of her in whatever
She does
And the need for the tangible touch
Will not be so intense.


It was helpful to reflect on the meaning of love. CW was able to understand and appreciate from ancient wisdom the three dimensions of love:

* agape = valuing another's well being as much as one's own
* philia = friendship/companionship
* eros = sexual.

Slowly, she has been able, as the poem describes, to sort through her own feelings and fully grasp the reality that she can experience agape and philia without the threat of eros. A song by George Strait often played in the back of my mind and in my soul as we worked at many levels to understand and internalize the divine/human love parallel. Some of the words of the song are "let me tell you a secret about a father's love…it is a love without end, amen, amen." Maybe some day CW will be able to know more fully the meaning of this powerful connection.

underwood-05-s

Figure 5.

The Box

If the box were a person
And could be opened
the content of the box
would reveal the history
of the person

The job of the owner
of this box is to replace
and juggle the contents around
to make room for new items --
to figure out where the new
contents fit

The box rejects this attempt
to find room for new items
The box comfortably fits
what it has already accumulated
new additions are not welcome

Maybe this is what my box
would look like
I am in charge of the box
and try to rearrange items that wouldn't
fit before now
But I can't get them into the box


I have made many mistakes along the way. We still have a long way to go. The process has challenged me to continue my growth as I daily attempt to let go of ego and allow the process of living, loving, and relating to unfold.

Closing Remarks

Our process is ongoing. There is still work to be done. As mentioned earlier, we would often close our sessions by reading prayers from Survivor Prayers: Talking with God about Childhood Sexual Abuse, by Catherine J. Foote. We share one of these prayers that captures the essence of our work with CW.

There was a knife in me.
Now I bleed all over my soul.
If you get too close to me, I might bleed on you.
I sit among the people of God.
I sit among them, bleeding.
What will they do with all this pain?
Will they turn their heads from me?
Will they move away from the red splattering?
Will they cry out in disgust?
Or will they make bandages and gently cover my wounds?
Will they understand?


We hope and trust that we have heard this cry of the soul "good enough"…



Dr. Therese Keeling is a Psychiatrist with the Personal Counseling Service in Clarksville, Indiana.

Karen Lovett
is a Pastoral Counselor and Licensed Marriage and Family Therapist with the Personal Counseling Service in Clarksville, Indiana

Dr. Richard Derle Underwood is the Director of the Personal Counseling Service in Clarksville, Indiana. He is also a Pastoral Counselor and Licensed Marriage and Family Therapist.

*"Christy Webster” is the ficticious pseudonym for their client.

This article was originally presented as a paper during the Fall 1999 online conference on "Mental Illness: A Spiritual, Emotional, and Physical Perspective” hosted by the Wayne E. Oates Institute during October 1999.

Copyright © 2000, Wayne E. Oates Institute. All rights reserved.