Psychotherapy: Theory, Research, Practice, Training
© 1994 by the American Psychological Association Volume 31(3), Fall 1994, p 383–390
ATTACHMENT TO THE ABUSER: INTEGRATING OBJECT-RELATIONS AND TRAUMA THEORIES IN TREATMENT OF ABUSE SURVIVORS
BLIZARD, RUTH A.1,3; BLUHM, ANN M.2
3Correspondence regarding this article should be addressed to Ruth A. Blizard, P.O. Box 129, Vestal, NY 13851-0129.
Attachment to the abuser
often occurs when the primary caretaker of an abuse survivor was abusive.
Attachment and object-relations theories help to explain this attachment
and can inform the treatment of survivors. These theories are integrated
with current knowledge of posttraumatic stress disorder and dissociation
to explain the defenses used by survivors to maintain attachment to
the abuser and to clarify patterns of attachment in survivors' adult
relationships. This integration of theories informs the pacing of treatment
and offers insight into transference and counter transference issues.
One of the greatest conundrums for therapists treating abuse survivors is the problem of understanding the attachment of the victim to the abuser. The riddle may take the form of various questions, such as, 1) Why does a child cling to the abusing parent and protect him or her by hiding the abuse? 2) Why do battered men and women keep returning to their abusive spouses? 3) Why do abuse survivors repeatedly become involved in relationships with persons who resemble their abuser? 4) Why do persons with multiple personality cling so tenaciously to internalized abuser personalities? 5) Why do patients often choose to leave therapy when a well-meaning therapist tries to help them leave an abusive relationship?
The recent literature on posttraumatic stress disorder (PTSD) and dissociation offers much to explain the defenses survivors use to avoid the trauma, and offers some hypotheses to explain reexperiencing and reenactments of trauma (Eth & Pynoos, 1985; Putnam, 1989; Spiegel, 1984; Terr, 1991; van der Kolk et al., 1991), but contains little to explain attachment to the abuser. The literature on trauma and dissociation contributes greatly to understanding how, over time, defenses against chronic trauma become an integral part of the personality structure (Fine, 1990; Herman & van der Kolk, 1987; Landecker, 1992; Rieker & Carmen, 1986), and clarifies some aspects of how these defenses affect relationships in trauma survivors (Fine, 1990; Gunderson & Sabo, 1993; Kluft, 1991; Landecker, 1992), but does little to explain the specific patterns of attachment in individual survivors.
For example, both Marie and Stacey (not then-real names) were sexually abused by their fathers and severely physically abused by both parents. Marie married a rather distant and passive man who was nevertheless relatively stable and caring. Stacey married an abusive, drug-addicted man, and after leaving him, became involved in a succession of abusive relationships. These widely diverging outcomes from two apparently similar histories cannot be explained by the trauma and dissociation literature, but can be accounted for by concepts derived from object relations and attachment theory.
An excellent article by Young & Gerson (1991), integrates object-relations and attachment theory with knowledge about the effects of chronic trauma on children in order to make sense of the continuing attachment of battered women to their abusive spouses. They describe how an intermittently abusive relationship with a caretaker can actually cause an infant to become more attached to the caretaker. The child learns early on to endure pain in order to maintain the attachment. This becomes the child'S “working model” of the environment and the important people in it, and also of the self as object and agent (Bowlby, 1984). Later, as the child matures, this model becomes the template for adult marital relationships.
This article will integrate concepts from object-relations and attachment theories with trauma and dissociation theories in order better to understand the general case of attachment to the abuser. This combined perspective will be applied to understanding: 1) patterns of attachment in the abuse survivor'S relationships, 2) the defenses used to preserve the self and the object, 3) the need to work in therapy with internalized object relations as well as with the trauma, and 4) how patterns of attachment to the abuser are manifested in the transference and countertransference.
In the first half of this century, Fairbairn (1952) broke with the earlier psychoanalysts by positing that the primary motivator in humans was not biological drive, but a relationship or attachment to another human being. The notion was essentially that, for infants, the primary ‘drive’ was not hunger, sex, or aggression, as Freud would have it, but attachment to the primary care-giver.
Attachment theory was further elaborated by Bowlby (1969, 1973). Bowlby (1988) later described several distinct patterns of attachment. He theorized that in early childhood the dominant pattern of attachment becomes the property of the child and resistant to change. This pattern of attachment becomes a template which is then imposed on all relationships, distorting the child'S perceptions to fit the template, and shaping reactions to the object as if to follow the primary attachment pattern.
Later object relations theorists (Kernberg, 1984, 1985, 1986; Masterson, 1976, 1981) describe the internalized self and object representations. These are stable, internalized representations of the self, the object, and the affect linking the two, which are derived from the child'S experience of the early relationship with the primary care-giver. For example, the internalized object-relations representation might involve a self that is weak and helpless, an object that is protective, and an affect that is fearful when the object is absent, and happy but anxious when the object is present. In another case, the self may be represented as weak but able to learn, the object as supportive, and the affect linking the two as pleasant and empowering.
A third possible object-relations constellation, which was described by Fairbairn'S student, Guntrip (1989), is the schizoid dilemma. In this pattern, the self is represented as powerless and bad, and the object as dangerous. The affect is abandonment depression when the object is absent, and terror when the object is present. This is frequently seen in persons who have been abused by their primary caretaker. Although Fairbairn did describe the environment of the infant who experiences the schizoid dilemma as dangerous, none of the major object-relations theorists has explicitly discussed the direct role of childhood trauma in the development of psychopathology until a recent article by Gunderson and Sabo (1993).
Masterson (1976) further developed the idea of the abandonment depression, which results when the object is lost. Even when the object is rejecting or abusive, the child clings to avoid feeling the abandonment depression. Van der Kolk 1987) reviews several animal studies showing that not only is attachment to a care-giver necessary for healthy social development, but hi fact the infant animal clings more strongly when the care-giver is abusive. He goes on to describe other studies showing that children also cling more strongly to abusive parents. This clinging was described as “traumatic bonding” by Dutton & Painter (1981). Fraiberg (1982) observed that infants exposed to unpredictable eruptions from caretakers and prolonged experiences of helplessness were able to obliterate pain from consciousness and participate in “sadomasochistic” play with the parent. Similar findings were reported by Galenson (1986).
If the child is driven to maintain a strong attachment to the primary caregiver, and experiences an intense abandonment depression when the attachment is lost, then the child faces a special set of problems when the primary care-giver is also an abuser (Bluhm & Blizard, 1992). The child may have to go to great lengths to create defenses that will allow the preservation of the attachment to the object. Only some of these defenses can be explained as a means of avoiding the trauma. Without resorting to an understanding of the attachment to the abuser, it is difficult to explain the tenacity with which the survivor clings to an idealized image of the abuser, a degraded image of the self, or to the series of abusive relationships that ensue in the survivor'S life.
In persons with multiple personalities, there is frequently an internalized abuser personality. This personality may have several functions, some of which may serve to protect the person from memories, or allow him or her to feel more powerful by being in control of the abuse. Often, however, the internalized abuser is modeled after the primary object of attachment, particularly when the abuser was a primary care-giver.
Patterns of attachment develop early in life (Bowlby, 1969, 1973a, 1988; Mahler et al., 1975; Masterson, 1976, 1981). Object-relations theorists believe that these patterns are formed by the early mother-child relationship. Bowlby (1988) discusses ways in which later life events also influence these patterns. Westen (1989) makes a strong case for the continual development of internalized object relations throughout childhood and adolescence. The cases of Stacy and Marie will help to illustrate how the relationships not only with mother and father, but with other, later, significant caregivers shape patterns of attachment and internalized object relations.
Marie was sexually abused by her alcoholic father from infancy through age six. She was severely beaten by both patents. Her mother used her as a domestic slave, and demanded perfect performance under her watchful eye. She came to think of her mother as a “cold saint.” Marie'S brother Johnny, three years older, was greatly favored over her, to the point that she was even blamed for his sexual abuse of her. When Marie was between the ages of six and twelve, her Uncle Joe came to live with the family. He protected her and was her companion during those years. A younger brother, Billy, was bom when Marie was 12, and she became his caretaker. In her twenties, Marie dated a number of men, and was engaged to three that were abusive, but broke off with all of them. She then married a man who was passive and distant, but gentle and considerate. Later, when her daughter went to school, she began a career as a prison guard with the conscious intention to help people.
Stacey was sexually abused by her father from early childhood. Both parents went into rages during which they could be very violent, but her mother could literally become murderous. After several years of therapy, Stacey recalled times when her father prevented her mother from killing her. Her mother was also extremely rejecting, forcing Stacey and her younger brother to spend the entire day in the basement when they were toddlers. During this period, the children were allowed to come out of the basement when their father came home from work, and he would play with them. Stacey'S mother also favored her brother. She required her to act as domestic servant as well, but primarily while mother was away at work. In high school, Stacey used drags and engaged in a succession of brief sexual encounters. At 19, she married a man who presented himself as a protector, but was, in fact, drug-addicted and abusive. After separating from him, she became involved in a series of abusive relationships.
Marie and Stacey were both emotionally rejected by their mothers, who favored their brothers over them. But Marie'S mother was often physically present when she used her as a domestic slave, and so there was something active Marie could do to attempt to get her mother'S approval. Because she was helpless against her father'S abuse, she did not form an attachment to him. Instead, she created the idealized, ‘cold saint’, image of her mother, and viewed herself as bad and deserving of punishment in order to maintain her attachment to her.
On the other hand, because Stacey'S mother kept her physically separate much of the time, there was little opportunity for Stacey to become attached. Despite the fact that he was physically and sexually abusive, her father provided the primary social contact, and he took on the role of protector against her murderous mother. The result was that Stacey became attached to her father, and felt absolute terror if she was not attached to him or to a man who resembled him, even after she became an adult.
Marie did not marry a man who resembled her father, although she did become engaged to a succession of three men who were abusive. The reason for this was that Marie had become attached to her Uncle Joe. The man Marie married was very similar to Joe in both his kind, passive personality and in his appearance. However, she did reenact her abusive history on a number of levels in her prison work. There, she could simultaneously protect inmates, as her uncle had protected her when she was imprisoned in her family, and control abusive inmates, as she could never control her father. She could also seek the approval of the prison warden, whose role was like that of her ‘cold saint’ mother. Nevertheless, she also endured severe harrassment from her male coworkers, which was a reenactment of the abuse she suffered from her parents.
Both Stacey and Marie had to employ a number of defenses to enable them to maintain their attachment to their parents as well as to allow them to become involved in adult relationships. While these defenses were adaptive in childhood, allowing them to survive severely abusive families while preserving some ability to maintain attachment, they were quite maladaptive in adulthood. Stacey'S defenses allowed her to maintain a pattern of attachment that drew her into a succession of dangerously abusive relationships. Marie'S defenses led her into a career that proved so abusive that it led to her eventual breakdown.
The trauma, PTSD, and dissociation literature describes the defenses used by chronic trauma survivors to avoid experiencing trauma (Fine, 1990; Herman & van der Kolk, 1987; Putnam, 1989; Terr, 1991), while the object-relations literature focuses on defenses used to preserve the self, the object, and the attachment (Adler, 1985; Guntrip, 1989; Kernberg, 1984, 1985, 1986; Masterson, 1976, 1981). These defenses are highly adaptive in childhood, because they permit the child to survive in an abusive family. In adulthood, both sets of defenses become maladaptive, because they prevent the survivor from accurately perceiving the presence or absence of abuse. By permitting the adult survivor to maintain a relationship with someone who resembles the original abuser, these defenses perpetuate the cycle of abuse.
The purpose of PTSD and dissociative defenses is to allow the survivor to avoid pain, overwhelming memories and feelings of powerlessness. Following Braun'S 1988) BASK model, any or all aspects of Behavior, Affect, Sensation, and Knowledge may be split off from one another. This may result in psychogenic anesthesia, psychic numbing, trance states, and full or partial amnesia. It may also lead to repetitive reenactments of the trauma without knowledge of its history, purpose, or perpetrator. The trauma becomes cognitively encapsulated. While this may permit the survivor to manage it by keeping it isolated, it may also result in flashbacks, nightmares, and illusions (Ellenson, 1986). Inability to integrate traumatic experience may also contribute to very poor insight and judgment.
The purposes of object-relations defenses are to preserve the object, the self, and the attachment (Masterson, 1976, 1981). The primary defenses are idealizing and its obverse, devaluing, and splitting, which incorporates both of these. Identification with the aggressor is a more complex defense which may be employed to preserve self, object, and attachment. (Many variations of defenses may be used, but these will suffice for the purposes of this discussion.) When one or more of a child'S primary caretakers are abusive, the child is faced with a dilemma and must employ powerful defenses to maintain the attachment necessary for physical and psychic survival.
When the child idealizes the object, it is preserved as good and therefore as capable of safely being attached to. If the child idealizes the self, the self is preserved by splitting off any feelings of shame connected with memories of abuse. On the converse, by devaluing the self, the child preserves the object by displacing blame for the abuse onto the self, thus allowing the object to remain idealized. By devaluing others, the child can preserve the object as good by displacing ‘bad’ or abusiveness onto others, and can similarly preserve the self by displacing his or her own feelings of shame onto blame of others.
Object-relations theorists have favored the concept of splitting as an explanation for the separation of the idealized and devalued images of self and object (Kernberg, 1984, 1985; Masterson, 1976, 1981). (For a discussion of the lack of clarity of definition in the concept of splitting, see Pruyser, 1975). The prevalence of splitting as a defense has been understood by object-relations theorists as a developmental failure, after Mahler'S theory of separation/individuation following infantile symbiosis. Recent research on infant development cited by Stern (1985) indicates that there is no stage of symbiosis. It has been shown that even very young infants are able to discriminate self from mother.
Splitting has been considered a passive defense, namely, a failure to integrate good and bad self-and-object representations into wholes. Kernberg (1986) sees it in part as a result of a ‘constitutional excess of aggression’ which prevents the child from integrating good and bad self-representations. Masterson (1976, 1981) believes it is caused by the failure of the mother to support separation and individuation. In trauma survivors, its symptoms might be better understood by using the concept of dissociation, which is an active defense used to separate intolerable experiences of abuse from more benign experiences of the caretaker. Until recently (Gunderson & Sabo, 1993), object-relations theorists have never fully acknowledged the objective reality of abuse, at least not as a primary determinant of psychic structure. Thus they have constructed models of the developmental failure to separate and individuate in order to explain symptoms seen in ‘borderline’ patients. Memories of abuse may then be treated as fantasies created by bad self-and-object part-representations. Transference acting-out is seen as inability to perceive the therapist as a whole, rather than understood as anticipation of abuse from the therapist-as-caretaker, based on past experience of abuse from the parent.
The case of Stacey can be used to illustrate the use of dissociation to maintain separate idealized and devalued representations of self and object, and to demonstrate how these were adaptive in childhood and maladaptive later in adulthood.
Stacey initially came to therapy consciously believing that her parents were good parents, thereby idealizing the object, and believing that she was bad, thus devaluing her-self. She had dissociated all memories of abuse. As treatment progressed, it became apparent that as a child, she had dissociated her father'S sexual and physical abuse of her from his role as nurturer and protector. While this enabled her to maintain an emotional attachment to him and thus survive a dangerously abusive childhood, in adulthood, it caused her to become involved in a series of relationships with men who presented themselves as nurturant protectors but turned out to be abusive. Even after several years of therapy, it was extremely difficult for her to see these men realistically, because when she began to give up her attachment to them, she would feel in abject terror of her mother. This tenor was fear both of physical injury and of utter abandonment.
Identification with the aggressor is a defense used to preserve the self by taking on the power of the abuser at a time when the victim is totally powerless. Simultaneously, it can serve to preserve the object by allowing the victim to act-out an internalized image of the abuser, and thereby avoid abandonment. The example of Rosa, a person with multiple personality disorder, clearly demonstrates the need to maintain attachment in the face of severe neglect and abuse, as well as perpetuation of the cycle of abuse.
Both of Rosa'S parents, as well as her grandmother, were severely physically and sexually abusive to her, including forcing her into childhood prostitution. Her mother and grandmother were extremely rejecting and neglectful of her, singling her out from the other children. Her father, however, was very possessive of her, and could be alternately abusive and attentive. Although his primary engagement with her was through violent sexual abuse, he would at times sing to her or take her fishing.
Through the use of dissociation, Rosa created a self-representation, the ‘prostitute’ personality, who could be the recipient of the only attention available most of the time. She also formed an object representation, the ‘Devil’ personality, through which she could identify with the aggressor, simultaneously preserving herself by incorporating his power, and preserving the object by acting-out his attachment to her. Rosa'S ‘prostitute’ personality described her creation thus,
“When Rosa was little, they didn't want her around, they acted like she wasn't there, so she felt like she wasn't a person. But when they wanted her for sex, then she was somebody. So that'S when I came in. So when Rosa feels all alone and she doesn't feel like a person, I help her out. She needs physical contact, she needs to know somebody wants her.”
Rosa'S ‘Devil’ personality explained that his purposes are to protect her by being in control of pain and by caring about her more than anyone else, so that she will not need anyone else, and thus cannot be hurt by them. The Devil incorporates the power of Rosa'S father by abusing her sexually, and maintains control of pain by doing so painfully but without causing gross physical injury. He maintains the attachment by reenacting the abuse which was the primary form of relatedness between Rosa and her father. The ‘Devil's’ possessiveness reenacts the only sense of belonging Rosa felt from her father, in the face of extreme rejection from the rest of her family.
It becomes apparent from the cases of Stacey and Rosa that while the defenses may be maladaptive in adulthood because they perpetuate the cycle of abuse, they nevertheless allow the survivor to avoid being overwhelmed by memories of trauma and to maintain a fragile internal structure of self and object representations hi order to avoid abandonment depression.
In working with surviors of chronic trauma, it is necessary to move cautiously in breaking down the dissociative defenses, in order to avoid overwhelming the patient and to allow recovery and integration of traumatic memories at a manageable pace (Fine, 1991). It is likewise advisable to work cautiously in breaking down those defenses needed to preserve the self and the object. Not only might the loss of these defenses result in flooding with memories of abuse, but loss of the internal representation of the object may result in severe abandonment depression and suicidal impulses. Loss of the internal representation of the self may stir up extreme feelings of badness, worthlessness, powerlessness and hopelessness, which may also trigger self-destructive behavior.
The development of a positive relationship with the therapist allows the patient to begin to internalize the therapist as a good object, which may gradually replace the defensively distorted image of the abuser. This positive relationship with the therapist also helps the survivor to develop a more realistic and positive representation of his or her self. Development of this positive relationship requires much work with the transference and counter-transference, as the patient'S representation of the relationship with the abusive object will be projected onto the relationship with the therapist.
A too-rapid breaking down of the defenses that maintain the sense of self and object and the attachment between them can cause severe psychic disorganization, including desperate acting-out and psychotic episodes. From the beginning, an essential component of treatment must be the building-up or more adaptive defenses, both to contain traumatic memories and to increase tolerance of affect. As the representation of the therapist becomes more positive and more strongly internalized, this image can take on a self-soothing function.
Transference and
Counts-transference
In developing a therapeutic relationship with survivors of abuse, the importance of working with the transference and countertransference cannot be overemphasized (Loewenstein, 1993; Putnam, 1989). One of the easiest mistakes for therapists to make is to believe that they can cure abuse survivors with kindness. If the patient'S primary attachment has been to an abuser, any approach by the therapist toward the patient may be interpreted as an approach toward abuse. As in any other relationship, the transference to the therapist will be patterned after the relationships to the primary care-givers. In highly dissociative patients, there will likely be multiple transferences based on the multiple self-and object representations contained in the dissociated parts of the self (Loewenstein, 1993).
The form of the transference will depend on the pattern of the attachment to the primary caregiver. While the history may give clues to the meaning of the transference, the form of the transference may elucidate the nature of the relationships in the history. For example, if the therapist expresses interest in the patient, this may be perceived by the patient as interest in sexual intrusion. The therapist'S concern may be seen by the patient as seductive, or encouragement may be felt as a veiled threat of punishment for not complying. Patients may also idealize the therapist just as they did with the parent. Any deviation by the therapist from that idealized image may prompt the patient to switch to a transference of the negative image of the abuser onto the therapist. While this may disorient the therapist, it can provide important information about the dissociated object representations within the patient, as well as how incongruent ‘nurturant’ and abusive roles were played by the primary caretaker.
In working with abuse survivors, therapists may be especially vulnerable to countertransference reactions because of the intensity of the transference acting-out to which they are exposed. The concept of projective identification (Goldstein, 1991) may be helpful in understanding and making use of countertransference reactions. The patient may project the abuser onto the therapist and then manipulate the therapist into acting-out this role. Conversely, the patient may project devalued characteristics of the self, such as the role of victim, and then act-out the role of the abuser against the therapist. Or the patient may become seductive in a childlike manner, and project the role of a sexual abuser onto the therapist. If the therapists are not cautious, as often happens, they may find themselves acting-out the roles projected onto them, or acting-out their countertransference to the patient by becoming angry, feeling victimized, or violating therapeutic boundaries.
If therapists find themselves having unaccustomed countertransference reactions to a patient, it may be very useful to distance themselves from the interaction and view it in terms of projective identification. This often provides valuable clues to the quality of the relationship with the primary caretaker/abuser, including the affect of the abuser and the subjective experience of the patient. Therapists can then use the information to better conceptualize the nature of the attachment to the abuser, work with the patient'S transference, and control their own countertransference.
Object-relations and attachment theories have had a largely separate development from the studies of PTSD and dissociation, and though these two schools of thought have at times seemed at odds, an integration of concepts from both of them may be very helpful in understanding and treating survivors of abuse. While trauma theory may help to elucidate the etiology of much psychopathology in childhood abuse, attachment theory can aid in explaining the patterns of pathological relationships. PTSD and dissociation concepts go a long way toward explaining the defenses used by trauma survivors to avoid remembering the trauma, and object-relations theory clarifies the defenses employed to preserve the self, the object and the attachment. Because much of the behavior of abuse survivors seems contradictory or self-defeating, neither PTSD and dissociation theories nor object-relations and attachment theories are sufficient to explain it. PTSD explains avoidance of stimuli that trigger memories of trauma, and dissociation explains lack of memory, failure to learn from experience, fragmented or black-and-white perceptions of people and poor judgement. However, the drive to maintain the attachment to the object described in object-relations theory is necessary to explain the repetition of abuse, either through self-abuse perpetrated by an internalized abusive object, or via the perpetuation of abusive relationships.
In the psychotherapy of abuse survivors, both schools of thought can inform the process of treatment. In pacing the therapy, trauma theory emphasizes the importance of maintaining the dissociation or other defenses against traumatic memories until more adaptive defenses can be developed and the traumatic material can be integrated. Similarly, object-relations theory stresses that defenses that maintain the attachment to the object should be broken down gradually, while healthier self-and object representations are constructed through insight into childhood relationships and the experience of the therapeutic relationship. In analyzing the transference, PTSD concepts can help explain the tendency for patients' memories of abuse, and consequent terror or rage, to be triggered by little things the therapist does. Dissociation theory describes how the transference can change suddenly as dissociated memories of the parent are accessed. Object-relations theory helps the therapist understand the transference as replicating the pattern of the relationship with the caretaker/abuser.
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