Sunday, November 25, 2012

Dissertation on shame. Chapter 27.1 Inclusion and a positive self-evaluation

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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