After Severe Abuse, My Friend Won’t Stick With Therapy

Reader’s Question

I have a friend whose father was a deadbeat and an alcoholic who abandoned his family. In the father’s absence his older brother took over. This brother beat him and his sisters. I think he was also molested by this older brother.

My friend’s older brother sounds almost criminally insane. He shows no remorse. He ended up killing his own wife, stabbing her repeatedly. After the killing he calmly met with his mom for breakfast. I know my friend is still dealing with lots of anger, but it is all bottled up. I think he is a ticking time bomb waiting to explode. He ends up quitting counseling every time he starts. What can I do to encourage him to address his issues?

Our Clinical Psychologist’s Reply

If your friend grew up in an environment in which he had to experience not only abandonment but also abuse at the hands of seriously character-disordered and possibly psychopathic others, it’s understandable that he has very significant problems trusting. Because of that the “threat” of intimacy in traditional counseling can be almost overwhelming. The fact that he has gone back to counseling despite quitting many times could and possibly should be regarded as a positive sign, not only by those close to him but also by the therapist treating him. Because his trust issues are likely to be so immense, he might need to systematically desensitize himself to the pain of being in a potentially trusting, intimate therapeutic relationship. So, keep encouraging him to go back, even if he panics and bolts. Reinforce him for the effort and call to his attention the fact that he can control the pace of work, frequency of contact, and the degree of self-revealing which occurs within the therapeutic experience.