Book Review: Innocence Revisited: a tale in parts.
Author: Dr Cathy Kezelman.
This book is written by Dr Cathy Kezelman, a trained medical practitioner, the mother of 4 children, chairperson of Adults Surviving Child Abuse and director of the Mental Health Coordinating Council. It is Cathy’s invaluable account of rising to the challenge of addressing emerging memories of child sexual and organized sadistic abuse triggered by the death of her beloved niece in a car accident.
Cathy writes beautifully – which helps in recounting a story of such agony and cruelty. As Mark Tedeschi, QC, Senior Crown Prosecutor, NSW says ofthe book “it does happen … in every segment of our society …. from family friends and family members”.
Cathy is skilled at portraying the complex reactions to trauma as a child struggles to know and feel, at the same time as to not, in an effort to maintain crucial attachment bonds and create the illusion of safety to endure the abuse. Her account is easy to read despite the horrific abuse. She describes the emergence of ever more overwhelming material yet it is not a sensationalized account. Cathy responsibly and gently touches
on often ignored or denied issues such as the re-enactment of abuse (eg. with her doll) as well as the ultimate victimization in setting up a child to victimize. The final chapter includes important material about the nature and complexities of memory and related issues to healing from severe abuse, torture and overwhelming trauma.
The courage, sensitivity, responsible consideration of issues and willingness to put her story out there is to be commended. It is an important account that will benefit therapists and related professionals such as legal and policy makers. It will also aid clients when at a point in their healing where the accounts of others may be beneficial.
Psychologists, psychiatrists, counsellors and related mental health professionals still do not receive adequate under-graduate training in identifying or responding to psychological trauma. Typically, inexperience in identifying trauma reactions leads to misdiagnoses or a belief that dissociative disorders are rare or confabulated. Therapists may also feel deskilled or succumb to concern about being professionally ostracized in the face of recognizing the reality of a person’s suffering and the causes.
Cathy was fortunate to find a therapist with an open heart and mind who did not merely medicate or pathologize her but who appreciated that her psyche and body would let her story unfold given a chance. She had faith in the process of healing. Like most trauma therapists, she no doubt found herself on a steep learning curve and would do some things differently now. I mention this because I imagine that both
therapists inexperienced with complex dissociative reactions, as well as clients beginning, or contemplating their journey in therapy may be concerned or confused by some of what Cathy outlines.
While every client’s path, and every therapist’s style and approach, is unique, principles of effective, compassionate therapy for dissociative disorders have evolved over a couple of decades from experience worldwide. The International Society for the Study of Trauma and Dissociation provides ethical guidelines based on this. Different from Cathy’s early experience in therapy the ISSTD recommends no more than two, ninety-minute sessions a week. Weekly sessions are typically enough. On occasion, where some clients may benefit from brief hospitalization, specialized units such as the Trauma and Dissociation Unit at Belmont Private Hospital in Qld can avoid compounding problems due to medical and nursing staff being unfamiliar with trauma dynamics and dissociative responses.
Principles of healing from trauma (such as outlined by Briere and Scott; Ross and Halpem) underpin effective strategies for helping clients navigate boundaries, ground flashbacks, place the locus on control with him/herself, and safely pace work around abuse dynamics as well as process deep emotion. Clients do the challenging work of therapy best when supported to manage a career or job, cope with a family and engage
in a social life and be a contributing member of society. Healing is not faster or better by focusing time and energy primarily on therapy. Being consumed by it actually makes it harder. Decompensation is more likely. Perceived lack of choice and control is disempowering and re-enacts the trauma.
Powerful feelings are brought up in the therapist. Even the most experienced and competent can easily find that without case consultations and ongoing professional development to address the vicarious traumatization and counter-transference, as well as enhance effective therapeutic strategies, it can impinge on therapy and therapist self-care. Without this, it is easy to respond to what the client may intensely but erroneously believe he or she needs in the midst of often excruciating distress and complex defense mechanisms.
Cathy’s book is a rare, well-crafted, one. She elucidates the terrible impact of child abuse and the long term consequences that we as individuals in society, not just therapists and academics, have a responsibility to address. It is also an account of hope and inspiration; the power of truth.
The Delphi Centre
Professional Development Training and Counselling Services
Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms,
evaluation, and treatment. Thousand Oaks, CA: Sage Publications.
Ross, C. & Halpern, N. (2009). Trauma Model Therapy: A Treatment Approach for
Trauma, Dissociation and Complex Comorbidity. Manitou Communications: TX, USA.