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The Therapist's Voice & AWarrior PrevailsJudith Ruskay Rabinor & Shari BotwinPublished online: 10 Nov 2010.

To cite this article: Judith Ruskay Rabinor & Shari Botwin (2001) The Therapist's Voice& A Warrior Prevails, Eating Disorders: The Journal of Treatment & Prevention, 9:2,177-183, DOI: 10.1080/10640260127720

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Eating Disorders, 9:177–183, 2001Copyright ©2001 Brunner-Routledge1064-0266/01 $12.00 + .00

Contributions to The Therapist’s Voice should be sent to Judith Ruskay Rabinor, 36Biarritz St., Lido Beach, NY 11561.

Address correspondence to Shari Botwin L.C.S.W., 1930 E. Marlton Pike, Building T-12,Cherry Hill, NJ 08003. E-mail: WarriorPrevails@aol.com

The Therapist’s Voice

JUDITH RUSKAY RABINOR, Editor

Becoming a psychotherapist has been compared to learning a craftor becoming a fine artist. It is not surprising that one of the mostimportant opportunities for growth is in one’s own personal treat-ment. Subtle learnings, almost impossible to define, take place inthe process of internalization. This paper offers several clinical vi-gnettes that attest to the fact that who has been the therapist’s thera-pist makes all the difference.

A Warrior Prevails

SHARI BOTWINPrivate Practice, Cherry Hill, New Jersey

I knew from the moment I walked in the door that Dorothy would be thewoman who would help me save my life. My drive to search for someonewho would guide me through my journey towards safety, freedom, andhealing started as far back as I can remember. I am a survivor. Who I amshapes everything I do, including how I work as a therapist. “Never give upon your quest to be heard,” resonates inside me now and always has. This ismy voice and I held on to these words knowing someday that I would befree from the abuse I suffered.

My healing began long before the abuse stopped. I had the ability froma young age to take in and hold on to positive thoughts and feelings. Theonly image I could draw up as a child was a fantasy I created by watchingmoms on television. Although no one in my life filled this role, knowing itexisted provided me with hope. I held on to the words “caring” and “love” Iheard on the television and was able to imagine that someone would feel

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The Therapist’s Voice178

these things for me.My search for love and acceptance helped me survive. In my early

twenties, I realized I had the power to make my dream of being free fromthe abuse a reality. Then, I found myself a therapist: Dorothy Saynisch, Ph.D.While it took me almost three years to begin talking about the abuse, Irecognized her ability to convey sensitivity, compassion, and acceptancefrom the onset.

Psychoanalyst Bertram Karon comments that as patients internalize thetherapist they then replace the internalization of the abuser (Karon, 1998).Furthermore, Karon asserts that as a patient internalizes the therapist as amodel for the ego, she can use the relationship as a model of human rela-tionships. Clearly, that was my own experience. This paper is on the inter-nalization of the therapist as an aid to healing. By internalizing the therapeu-tic alliance, change occurs in the way one thinks, feels, and functions inrelationships. I discuss many components related to the importance of thetherapist as an internal object related to my own work and then bring it intomy work with my patients. I work primarily with women and teens in recov-ery from eating disorders, abuse, trauma, and loss.

Before I broke my own silence, I spent countless hours trying to under-stand so many years of confusion, pain, and shame. When I spoke aboutwhat I was feeling, Dorothy sat with tears in her eyes, and her energy wasfocused all on me. I left the sessions feeling, hearing, and sensing her re-sponse to what I said as well as to things I censured or blocked. I broughther with me everywhere. Sometimes I imagined her standing behind my leftshoulder looking at me and telling me it was going to be okay. This was myfirst real experience of being heard, accepted, and cared for by an adult/authority figure.

For years I buried so much shame and pain. Having someone to walkwith me through the horrors of my past was vital to my recovery. Before Ibroke my silence, I digested and internalized Dorothy’s presence on manylevels. I spoke to her in my journals and revealed many fragmented piecesfrom my past. I asked myself important questions regarding the impact ofthe abuse. At times I heard her voice coming through in my writing. Threeyears into therapy, I trusted myself and the process enough to grab hold ofDorothy’s hand, as I asked her to walk beside me and be a witness to mypainful past.

One of the most important aspects of our work was the creation of thetherapeutic pause. Therapeutic pauses were moments when we would sittogether through the feelings. For example, Dorothy would tell me “I admireyou, you have so much courage and it will be okay.” It was at these timesthat we could step back and appreciate the meaning of the work we weredoing together.

Throughout my years of abuse I was constantly running from feelings toprotect myself from dealing with something that seemed insurmountable.Only when I was alone could I grieve and acknowledge the abuse. As Dor-

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othy and I sat together with the feelings, I began to believe that I could beloved and understood, and I did not have to be alone anymore. One of themost intriguing parts in this process is how different I experience my feel-ings in a safe and contained environment.

As I recovered, I took what I internalized from Dorothy as a model tofoster connection and healing with my patients. I find this happening in mygroups, too, and take notice of how group members internalize each other’svoices to create change. Something remarkable began happening once Istarted finding words to express my experience. Patients I had been workingwith for a year or more also began breaking the silence and creating a pathfor something different. The following vignettes illustrate how this happenedin individual and group sessions.

VIGNETTE #1

Staci is a 23-year-old recovering anorexic with lifelong major depression. Forthe first several months of her therapy, it felt as though she was not in theroom. She was just bringing her body to session, a body without a voice. Attimes it felt impossible to connect. There were two of us in the room, yet sheworked so hard to keep her feelings separate. She would not allow herself tomake space for contact. Sometimes she would drift in and out, silently look-ing around the room.

One day I asked her where she went during those times. I said, “I hopeyou are going somewhere peaceful and relaxing.” She just smiled. I said, “Iwas wondering if I could come with you.” We continued to struggle; yet achange began to occur. Connecting to me allowed her to begin talking aboutthe past and not be alone. She began expressing her feelings about her Dad,who abandoned her, and her stepmother, who physically and mentally abusedher.

As she started to let herself feel sadness, her symptoms began to dimin-ish. Once they dissipated, she left therapy, although we both knew her workwas not done. A year later she came back after a break-up with a boyfriend.After only two sessions, she left again.

Six months later she called me again, but this time she seemed different.She was more connected to me and let me hear how emotional she was.After one session, Staci came in and said “I did something huge.” She andher sister had decided to find their paternal father and they had called himtogether. They berated him and confronted him about the abuse and aban-donment from 15 years earlier. She acknowledged the impact her past hadon her and grieved for her childhood. She sobbed and said, “I just want tocare about myself.” She looked at me with pain all over her face and said, “Ifeel like screaming out ‘Someone please help me!’”

Her quest to be free from depression and destructive patterns continues.However, by allowing herself to be in the room with me, she opens up the

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The Therapist’s Voice180

opportunity to work through and understand the meaning and impact of herpast.

VIGNETTE #2

Samantha, age 13 also struggled for several months to let herself connect andfeel safe in therapy. Like many 13-year-olds, she would not let herself expe-rience her innermost feelings, Mostly she shrugged her shoulders and said,“I don’t know.” Sometimes nothing worked. We tried everything, includingshooting scrunchies to each other and chewing gum balls, anything to es-tablish a connection! At one point I asked, “Do you feel like you know whatyou want to say, but can’t get the words out?” She nodded and her eyes filledup with tears. She had expected me to be rejecting, harsh, and mean. I foundmyself repeating to Samantha what Dorothy had told me many times. “It’snot about you.”

Samantha had felt responsible for her father’s rage and her mother’sanxiety. There was little room for her to express her feelings at home. And,when she did she felt ignored and belittled. I found myself repeating toSamantha what Dorothy had told me many times. I kept telling her that it isokay to say what you feel, even if others cannot hear it. She never responded,but she looked at me differently. I noticed the sadness in her eyes.

One day, she showed up with two friends. She never told me why, butit seemed to me that she needed them to be her voice. The next week shebrought them into therapy. We were talking about what kinds of thingsbother them when one of her friends said to Samantha, “It bothers me thatyou keep calling yourself fat and ugly.” I said with surprise, “I didn’t knowyou felt that way.” Her friend jumped in, “Your supposed to tell her thatstuff; she’s your counselor.” We smiled and chuckled.

A few weeks later, I felt like I was sitting in the movie, “Awakening”(Marshall, 1990). From the minute she had entered the room, Samantha hadbegun talking incessantly, describing a moment when her father had reachedout to her. As she described the experience her joy was contained, but hereyes sparkled. She told me that she was making new friends at her beachhouse, and she said, “I told them I was depressed.” We celebrated her cour-age to take a risk and the choice she had made to no longer suffer in silenceand alone. Dorothy’s voice resonated with me as I heard her telling me “It’sokay to be sad,” and “You don’t have to be alone anymore.”

VIGNETTE #3

A recurring theme in one of my current therapy groups (comprised of fivewomen age 29–46) is “It wasn’t my fault.” The following example demon-strate how members grow as they see their own dynamics reflected in others

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and are able to internalize new strengths and coping styles.For months Merry, age 29, played the role of mom/caretaker in the

group. She had lost her mother when she was nine years old. Being thegroup’s “mom” helped her stay connected to her own mother while at thesame time live out her own feelings of grief.

As the group progressed, Merry became aware of how much she ad-mired another member, Jackie, who was able to speak up easily. Merry toldher, “I admire you so much for opening up to us and telling us what hasbeen happening with your husband.” Jackie had become a model for Merry.A few weeks later Merry finally opened up in group. She shared some verypainful feelings regarding the loss of her mom. She realized, “there musthave been a part of me that thought it was my fault.”

I was both surprised and delighted. For years I had been asking her ifshe felt she was at fault, but she would disagree. Evidently, she had tuckedaway that notion and brought it to her awareness when she was ready andfelt safe enough. As she began talking about these feelings, she sobbed andlet herself feel the anger, grief, and despair she had buried for over 20 years.“Nobody ever told me it wasn’t my fault.” The group was silent. “I just neededsomeone to tell me that it was going to be okay.” The group took a thera-peutic pause as we acknowledged and sat with her through the feelings.Then, all of us began to cry as Suzy, another group member, said, “Youneeded to hear that then and now.”

Suzy was obviously touched by this interaction. The next week shecame in and said to Merry “I was thinking about what you said last weekabout your mom.” She went on to tell us about one of her fourth gradestudents whose mom was dying of cancer. “I saw the weight of the world onthis little girl’s shoulder. I recalled your story and I told my student, “It’s okayto be a kid, too, even though your mom is sick. It really isn’t your fault.” Thegroup froze; they were moved by her story. One group member began to cryand another, whose mom also died of cancer, cried and said, “I wish some-one had said that to me.” Merry beamed. And for weeks to follow Merrycarried their words with her as she continued to explore and understand theimpact her mom’s death had had on her life.

Suzy began to look more closely at her own life. For several monthsSuzy had repeatedly asked me, “Do you think I am being abused?” AgainDorothy’s words came to mind—words about the importance of findingways to claim and honor your experience without letting defenses cloudyour insight. Much of our work in individual therapy focused on helpingSuzy find ways to trust herself and know her truth without protecting herhusband from her feelings.

In group, she shared that she had been writing down what happenseach time her husband abused her. “I write down what happens every timeI am feeling abused. One time I decided to show him what I wrote after heberated me for collecting evidence against him.” Very calmly Suzy had shown

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him what she had just written. Suzy went on to tell us that her husbandreacted with shock and despair. “I feel this is awful, I didn’t know it was thisbad.”

When another member asked her how writing helped, Suzy responded,“When I doubt I am being abused, I look back at what I have written.” Thegroup used Suzy’s experience to look at their own relationships.

This marked a turning point in the group. The flood gates had beenopened. Jackie stopped idealizing her marriage. For months, Jackie had de-scribed her husband, Steve “as the greatest guy I could ever ask for.” Nowher story began to change. Further into treatment she began bringing otherfeelings she was having in the relationship to group.

Initially, group members were shocked at how distraught and unhappyshe was. Then, Merry took the plunge and joined Jackie and Suzy in ex-pressing the pain and frustration she was feeling in her marriage. The threeof them joined forces in finding ways to overcome the shame and to em-power each other to make changes without shrinking from it. Members alsowitnessed Rachel’s pain after being in an emotionally and mentally abusivemarriage for 12 years. Teri shared her experience of being sexually abusedas a child and validated members on feeling less than, unworthy, andundeserving.

Members supported each other in fighting back. Jackie told Merry, “If Icould do it all over I would never have had a baby before working on mymarriage and making changes with Steve.” Merry tuned into her words andwas able to understand her urge to start a family as a way to avoid dealingwith the abuse in her marriage.

At different points, each of them sobbed. For instance, one week Merrycame in with tears running down her face saying, “I f’kin hate him.” Othermembers responded, “You deserve so much better,” and “That is not okay.”At times each have expressed the urge to give up. During these momentsmembers validate each other and help each other turn the shame into action.

After three months Jackie was able to stand up to her husband. Mem-bers responded with surprise and admiration when she told us, “I told Stevehe mentally abuses me.” Within weeks Merry began couples therapy withher husband. And, Suzy began asserting herself and setting limits with herhusband. Members became a witness to each other’s pain, struggle andgrowth.

DISCUSSION

My own personal experience has been my most important guide for work-ing with patients. Years of painstaking work which still continues now, al-lowed me to take in and digest Dorothy’s words and filter out the feelingsassociated with the abuse. Installing Dorothy’s voice in my mind, body, andheart allowed me to believe I could feel loved, accepted, cared for, and

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understood. As I took these feelings in I made space to pass these feelingson to my patients.

Over time I found new ways to hold on to these feelings. Some sessionsI left Dorothy’s office dancing down the street singing, “I love Dorothy andshe loves me.” At the end of one session we created an image of having asign on a bridge saying, “My therapist loves me.”

One year as Dorothy was leaving for vacation she wrote down a sayingshe had said to her daughter. It ended with “Good night, sleep tight, see youin the morning light. I love you.” I continue to hold on to this piece of paperand it has become one of many treasures I store in my heart from Dorothy.

I describe the process of healing as a ripple effect. First I change. Then,my patients created a path for something different and they brought mealong. Finally group members journeyed together. No one went alone. Asthe process continued, we prevailed, individually and together, as we mas-tered the ability to take in new gifts and create healing experiences.

REFERENCES

Karon, B. P. (1998). Internalizing the tolerant, kind, confused, and stubborn thera-pist and insight. Psychotherapy in Private Practice, 17(4), 9–16.

Marshall, P. (1990). Awakening (film). Columbia Tristar.

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