27.1 Inclusion and a positive self-evaluation
A common denominator amongst the
participants in this study seems to be that they express the need for
inclusion, respect, recognition, solidarity in order to be able to talk about
their life stories concerning shame and sexual abuse. These are factors which
seem to be present at the Incest Centre. Linda argues that it’s difficult to change anything
just by talking about one’s problems. She says that the important factor in
helping others is helping others to have new and positive experiences, because
helping others with shame involves finding possibilities and solutions.
Linda_1: A
long time ago, we used to talk to the users of the centre about all their
problems, about abuse and everything. This didn’t help. (.) Nothing changed. Well something changed,
but it took a long time in a way. (.) They
umm felt that it was difficult to find words and things and they felt umm they
didn’t dare to do anything, so we changed our way of working with them and
that’s when we created what we call mind-mapping. I’m trained as a family
therapist and I’ve changed myself in the process of gaining competence. We’ve
created a model using what I felt was important. What really matters in life?
It really doesn’t help just to talk, and I’ve gone to therapy for many years
and found that it doesn’t help just to sit there and talk about how you feel
today. That only makes you stationary and very isolated – just you and your
therapist. It’s hard to change anything that way. It started with umm a
complete change in my own life, something I could relate my self-confidence to.
What’s important in life is experience. That’s why I call it holistic
experience therapy…The first thing we do is to make a mind-map. We make a note
of how one relates to one’s own body (
) and we draw a map showing the
connections umm (.) the specific problems
one has and how they are experienced. Then we start to map out in which
situations you feel this or that. There’s a great difference in different
situations. In some situations one doesn’t feel shame at all about one’s body,
while in others one does. Then we draw on the blackboard or on a piece of
paper. There are a lot of situations that they talk about. Then we grade the
seriousness of the situations on the map. We rank shame in the different
situations. After that we start talking about exercises where they are to think
about the different situations we just placed on the map and try to express
what they feel. If there are situations with no feelings of shame, we try to
build on that small fragment and transfer the experience of not feeling shame
to other situations where the shame is greater. We focus on solutions and not
problems. A solution oriented therapy. This means that it is the victims who
use our centre who are the experts on their own lives. It is only the person
seeking help that can say umm what will work and what will not work. My role is
like yours ((Nods her head towards Kaare)), a researcher, who is interested in finding out as much as possible
about the person. (.) We sit together
and create a map and use different techniques to get the person to open up. Try
to get them to dare to look at themselves and relate to problems as problems we
can try to solve together.
Linda calls the help she gives at
the Centre for holistic experience therapy, which seems to be a self-made
approach based on her own experiences being in therapy and the need for an
alternative form for approach which includes what she felt was missing in traditional
psychiatric therapy. Her approach seems in my opinion to have much in common
with existential orientated therapy and gestalt therapy which focuses on the
whole human being. She describes techniques which include listening,
acceptance, recognition, tolerance, confirmation and support. She starts by
mapping the past, present and future together with the person asking for help,
trying to keep her focus on the whole person and not only the problems that
stem from being sexually abused. This mind mapping, as she calls it, includes
both past experiences in order to perceive one present situation, resources
that can be used to build a new identity and wishes one has for the future. Her
starting point is where the person is and uses the time necessary to find the
person, implying that it is she who must move from one position to another in
order to find the person seeking help. The focus is on help to self helping,
giving the person help to find solutions and helping them chose for themselves
the way to carry out these solutions which aims at giving the person a better
life than before. Working this way tries to reduce: putting people in
predefined categories; analyzing symptoms; and being patient-orientated.
Skårderud and Ekern (1990) argue
that people who do not co-operate in traditional forms for therapy which uses
analytic techniques which the patient is not in control of and where the
patient does not perceive the meaning of the predefined categories one is
placed in, as difficult patients. The difficult patient seems to be a well-known
character in therapeutic circles. They underline the need to analyze not only
the content of the symptoms but also the meaning of symptoms in a wider
relational context. Feeling shame is a source of difficulty for many people who
seek therapy and appears to be relevant in a range of personal problems
(Gilbert 1998; Harder 1995; Tantam 1998).
Linda explains that she was supposed
to be admitted to a home for the elderly and disabled when she was in her early
20’s when psychiatric treatment had, in her opinion, no more to offer. She protested
to the idea of being placed in a home for the elderly and disabled and ran away
from the hospital. Traditional thinking within psychiatry seems often to have focused
on the negative aspects of life. Linda argues that this type of thinking destroys
people more than it helps them. She describes the Incest Centre in Vestfold as
her salvation.
Linda: I was supposed to be admitted to a home for the elderly and disabled
when I was discharged from the psychiatric clinic where I had been for several
years. I went there and saw the room I was going to live in. God all-mighty, I
didn’t have time for that. ((Laughs)) I
ran away. I’ve kept away from psychiatry for years. Being a psychiatric patient
for as many years as I have been does something to you, you’re not
self-confident anymore. Everything is focused on the negative aspects of life.
My psychologist even went out to buy cigarettes for me. Everyone there had
power over me. I got what I needed without having to do anything in return.
This destroys you. You’re destroyed as a person…This place here has been my
salvation. (.) I’d probably be sitting
in a wheelchair without the Incest Centre.
Linda describes a form for therapy
were everyone had power over her, and that her healing process was not
successful before she took herself back and regained power to decide for
herself the life she chose to live. In figure 4, which I have created using the
information given in the interviews, I illustrate the positive development of a
new social- self identity in seven steps The point of departure involves having a perception
of one’s self-image that is created by oneself and others, the social self
(from figure 1). One receives respect from others and respects oneself. This may
lead to a positive self-evaluation and to the possibility of feeling faith in
oneself and others and pride about becoming one’s self. The participants speak
of losing faith in themselves and others after being abused, and say that being
proud is very difficult. It takes time in the healing process to regain faith
in one’s self and others, and especially to feel pride. Receiving acceptance
and empathy from others over time helps to develop faith in both oneself and
others and pride. This gives the security that is necessary for disclosing all
of one’s emotions. The dialog with others is solution-orientated, not oriented
around all the negative aspects of one’s lived life. It’s essential to look
ahead to the future and realize that through new experiences with others a more
positive social-self identity will gradually develop, resulting in my opinion in
a reduced level of shame This leads to meetings
with others which I consider to be dialogical I-Thou relationships. Over time
one receives and feels acceptance and is able to trust oneself and others. The
positive development of the self can be attributed to the development of
dialogical I-Thou relationships, such as those that are developed at the Incest
Centre. These relationships are concerned with solutions rather than problems.
People are perceived as individuals with problems and not as problematic
individuals. Problems can be solved through social interaction with others.
This gives rise to new, positive experiences with others, influencing the
development of an enhanced social self.
I-Thou relationships which people
seeking help are met with is essential in order to create a genuine meeting
between helper and help seeker, and for finding the other where one is. This
seems easier than it really is. How can one find a sexually abused child and be
there in a genuine way? Is it possible to be where a child is? Where a victim
for sexual abuse is? My answer is yes and doing so demands: finding the child
the helper has within oneself or the experience of being disrespected; or
ill-treated; or finding ones feeling of shame and guilt and starting there.
Finding the person in need involves first finding oneself and then moving
towards the other person. Helping a child might involve sitting on the floor
together with the child, listening to the child’s story without interrupting the
flow of words even if one does not understand for the moment. Helping the
victim of sexual abuse might include giving room for emotions such as crying, anger,
rage, or silence without feeling discomfort or the need to distance oneself
when one experiences discomfort or pain together with the person asking for
help. Finding the other and having the courage to be in the moment (øyeblikket) with that person demands in
my opinion self-knowledge and practical wisdom together with the expert
knowledge that the situation requires. This expert knowledge is obtained
through education and training, and implies knowing more that the person in
need, but most important is to know what the other knows. Helping others
requires not only to know what to do in a given situation but also what not to
do, because this might result in the re-victimizing the person asking for help.
One of the seven steps in figure 4 is inclusion and a positive self-evaluation.
This places a demand not only on the helper but also on the institutional
level. This is in my opinion one of the most positive elements at the Incest
Centre, being created with a homely and caring atmosphere, with space and time
which is situated in the needs conveyed by the users.
Starting were the other is with
respect and recognition in order to create inclusion and a positive
self-evaluation, has in my opinion been taken into action in the last few years
by the Ministry of Justice and Police with the establishment of the Children’s
House (Barnehus previously called Barnas Hus) after a model from Island (Stortingsmelding number 1 2008-2009).
Here children who have experienced sexual abuse, violence or witnessed violence
in a close relationships, are given the opportunity to receive all the help they
require in one institution which acknowledges and respects the child’s requirements
as most important. The Children’s House has in my opinion much in common with
the Incest Centre in Vestfold; meeting those how ask for help on their conditions
and finding them where there are and starting there. There are now Children’s
House in Bergen, Hamar, Kristiandsand, Trondheim, Tromsø and Oslo. People with expert knowledge such as
social workers, nurses, doctors and psychologists examine and help the child
were the child is. Instead of having the child move from place to place to
receive help, the helpers all come to the same Children’s House to help the
child. This is in my opinion an important change in both movement and
direction. Police also meet children that may have been sexually abused here
for judicial examination (Dommeravhør)
in surroundings that suit the needs of the child. Police that carry out judicial
examinations of children receive now at the police academy training in judicial
examination after the principle of letting the child speak freely and tell
their own stories without interference of the police using a method called the
dialogical method (Gamst and Langballe 2004).
Even though police now receive
training in the dialogical method in their education for use in judicial
examination of children who might have experienced sexual abuse, there exists
to my knowledge no higher education in Norway which focuses primarily on
the sexual abuse of children. Østfold University/College will to my knowledge
be the first university college in Norway to offer a post-bachelor education
in the sexual abuse of children, starting in the fall of 2009. This education
will be directed towards employees at the centres against incest and sexual
abuse of children, crisis centres for battered women, the Children’s House,
police, lawyers, child care workers, social workers, health workers, doctors,
psychologists, and workers in psychiatric institutions, and others who work
with the consequences of child sexual abuse. The existential-dialogical
perspective presented in this dissertation, will be fundamental in this new education.
In my opinion this lack of expert higher education is a major fault in both the
uncovering and healing of child sexual abuse. In my opinion, we have much to learn
from the incest centres in Norway
who have collected experience on this field of social work for over 20 years.
But I also see that these centres need to take a large step forward to increase
their level of expert knowledge. This is necessary in order to know not only
what the users of the centres know but also to know more than them, even though
the first of these two is perhaps the most important in order to find those
seeking help and meet them with respect and recognition.
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