PTSD Patient

Friday, September 30, 2011


I have been talking to my therapist about confronting the perpetrator who abused me when I was a child. There is a strong feeling inside of me that I need to be free from this person. I've heard that the only way for a survivor to complete their healing process is to face the victimizer and hold them accountable. My therapist is urging me to take this slowly, but I want to get better now. I know you are a therapist. So you must have worked with victims of sex abuse. This has really become an obsession with me. How can I do it safely? Will it really help?


I don't like the term “patient” because it seems to imply that an individual is sick. (Constant Readers, PTSD stands for post-traumatic stress disorder.) In my work with people who have been abused, I see them as the healthy ones, despite the fact that they are often in pain. The perpetrators are the ones who are sick. I feel a little weird about giving you a different name since “patient” is a term you chose for yourself. I hope I am not taking away your power by using a term that is more consistent with my own beliefs. If you want to send me further e-mail, I will be happy to discuss this with you.

But that isn't the main reason why you got in touch. Sorry. It's so easy to get side-tracked by terminology. Just ask John Money.

Very few of my traumatized clients decided to confront the person or people who abused them. I'm glad you asked about safety because this is a legitimate cause for concern. A person who can disregard the taboo on violating a child or teenager will usually be desperate to keep their predatory behavior a secret. They are willing to lie, bully, threaten, and even become violent to make a former victim keep silent. In some cases, perpetrators have split families up into bitterly warring camps because they do such a good job of pretending to be innocent and smearing their victims as “crazy.” Some of them have even threatened to sue a victim who makes allegations of abuse.

You may be at a disadvantage in such a situation because you have a conscience, and your abuser has none. You will be thinking rationally and he or she will be reacting like a trapped wolverine. If they lose their temper (which is pretty much guaranteed), they may be able to trigger emotions that leave you vulnerable and slow-moving. While you re-live agonizing memories, the perpetrator can maneuver for even more control. This is not a recipe for empowerment or healing.

Of course, abuse survivors grow up to have many different talents. It may be that your own skills will allow you to face this person and walk off having said your piece, feeling vindicated. Just be very careful to think it out, get help, and be extra clear about your goals. Sometimes having a third party present is a good idea, but only if they can be trusted to keep you safe. I sometimes advise people to do the confrontation in a public place, but strangers may hesitate to get involved in an emotional situation. You would definitely want to make sure that a supportive person knew when and where the talk was going to take place, and be prepared to contact police if you did not return at a pre-arranged tie.

Let me give you an example drawn from the victim of another sort of crime. Would you want to confront someone who had broken into your home, held you at gunpoint, and stolen valuables? What would make that a safe thing to do? This is the standard of security you want to preserve. Think like a psychopath. If you can't do that, stay away. Learning how to keep safe is one of the first victories for an abuse survivor. Being hurt might predispose you to think of yourself as throwaway goods. It might even impair your ability to tell who you can and can't trust. Defining, believing in, and protecting your emotional and physical safety is a huge triumph over the past.

You may be motivated to do this so you can prevent others from being harmed. If an abuser continues to have access to potential victims who are minors or seniors, your therapist can file a report for you with government agencies charged with protecting children or the elderly. This can lead to an investigation and perhaps even formal charges being filed. If nothing else, it serves notice that the days of secret-keeping are gone for good. If you were an adult when you were harmed, you may want to talk to law-enforcement personnel or an attorney. Some victims have been able to win a written apology or reparations in the form of payment for services like your therapy.

Remember that a confrontation does not have to take place in person. You can communicate your feelings with a letter, e-mail, or phone call. (Just be aware that if this event ever comes up in a court of law, your communications will not be private; they will become evidence.) Decide whether you want or need a response from him or her. If you don't, a letter may be your safest bet. You can keep a document on hand and revise it till you feel happy with what it says. It's harder to rewind a conversation and start over. Think twice before giving this person any clues about where you live or how to get in touch with you. This is someone who doesn't have your best interests at heart. One of my friends received a series of obscene phone calls after telling off an incestuous family member. When contacted by police, he said, “If she didn't want to get together with me, why did she come see me?” See what I mean when I compare rational thought with the twisted, weird world of a perpetrator?

Not all abusers become punitive or engage in denial. The adult who hurt you may collapse and weep and even beg for forgiveness. This may be as difficult to deal with as being assaulted once more. Remember that as an adult, they had many more choices and resources than you did as a dependent. Even if their life was hard, even if they had been abused themselves, there is no excuse. Be wary of getting drawn into taking care of somebody who pretends to be weak when it suits their purpose.

Like you, I have often heard that abuse survivors can't heal unless they confront their attackers. I've also heard that it's important for survivors to forgive the people who hurt them. But I haven't found either “rule” to be true at all. Healing means different things to different people, of course, but in general survivors are looking for a feeling that they are in control of their own lives. They don't want to be troubled by flashbacks. They want to be able to react to the present moment instead of living in the past. Feeling good about their own bodies, being able to have close relationships, not putting up with future abuse, having an accurate self-image, abstaining from self-harm, ameliorating depression—all of these things might be on a survivor's wish list. If a memory of abuse can derail your close relationships, distort your relationship to your own body, rob you of your spirituality, or make you live in fear, you still have some work to do.

Pain is a shared experience, an inevitable part of being human. You know what your own portion of suffering is like. There is no way to quantify it and say it is less or more than others' agony. It may sound great to get rid of all triggers or flashbacks. A therapist can help you learn how to ground and clear terrifying memories. There are medications and cognitive behavioral techniques to reduce flashbacks or anxiety. But you can't rush your healing—sometimes these things just get better as time passes, and good memories crowd out the old garbage.

Trauma can create an open heart that has the power to heal others. I don't advise my clients to forgive the people who hurt them, especially if there's been no apology or atonement. But I do think it's important to be able to feel compassion for others, to display empathy and concern for the rights of disempowered beings. When one has received violent treatment, it can be very tempting to take a cold, furious path that leads to being a violent person yourself. Knowing that you have not become a perpetrator is probably more healing than being able to chew them out.