Article about Trauma

TRANSFORMING TRAUMA INTO SOMETHING BETTER: MY WORK WITH EX- OFFENDERS

By Patricia O. Hunter, Psy.D.

People don’t ordinarily associate the institution of prison with psychoanalysis. Nor do they usually think of psychoanalysis as an approach that would be suited to persons raised in poverty, with great material deprivation. The theme of this conference seemed ready-made for my presenting the work I have been doing with ex-offenders from the inner city, many of them with African American and Hispanic cultural backgrounds. I was initially trained as a radical behaviorist. Social change engineered by altering environmental contingencies was seen by radical behaviorists as the best way to empower people. Individual psychotherapy was seen as impractical and elitist. Attempting to integrate my psychoanalytic ideas into settings where people have been deprived of such input in any systematic way, gave me an opportunity to blend the youthful idealism of my behavioral years with some of the psychodynamic realities I came to embrace while developing a private practice in middle age.

I have facilitated what I call a ‘woman’s group’ at a nonprofit agency for people who have been sent to the agency in lieu of prison. It is not what most mental health professionals would consider a typical psychotherapy group. The patients who make up the group vary from week to week, from month to month. They are women involved in a prison diversion program that they must complete in order to eventually remain outside the penal system. My group is just one of many activities they are asked to attend. Attendance is encouraged but not mandatory.

I compete with classes on computers, workshops about job skills, parent training, drug monitoring and other components of a day treatment program that has a concrete and critical impact on the quality of life of these women. Some women come to group every week. Others come only once. Most clients in the program are sentenced to six or twelve month periods at the agency. Some return to visit the group after they have graduated from the program.

I have had an interest in the criminal justice system for many years. The struggles this population experiences in attempting to function outside of a punitive, traumatizing way of life has always stimulated my curiosity and concern. The Fortune Society in New York City is an agency dedicated to helping ex-offenders start over again. I volunteered there several years ago, by suggesting that I facilitate an open-ended, psychotherapy group for women there who had been exposed to traumatic events in their lives. I was welcomed warmly and treated with great respect (Arroyo 2001; Chico 2002). I can’t say enough good things about the fortune Society. It’s innovative without being inconsistent, caring without being overly sentimental. I have kept attendance records, demographic data, and my own notes about the group process, each time I’ve led the group. It has met and still meets every Monday morning except holidays. I’m pleased to have the opportunity to think about, write about and now talk about this work with you.

The winter has been so cold as those of you from the Northeast know. To be presenting some of my experiences related to it, in such lush surroundings, makes me think of the title of the paper: transforming trauma into something better. I associate trauma with the winter, with a frozenness of the spirit, of the heart. I associate something better with a contrasting scenario, a warmer, greener, livelier more fertile atmosphere. I wanted to leave the second part of the title open-ended on purpose. Not because I didn’t know or couldn’t speculate about what something better might be, but because part of the point of the work for me was the actual process of specifically ‘not knowing’ where I, or the group, was going.

Stern (2003) describes a fitting context for psychotherapy, as “one that allows the meaning of the others speech, conduct, or our own experience, to unfurl”. In contrast, he says “a poorly suited context does not enable in this way…it forces understanding down paths that lead only to familiar destinations (p.844).” I wanted my understanding and the members of the group experience, to be unfamiliar and different, to be creative and new. I didn’t want an agenda for the group, or even for this talk, as much as I wanted to provide a fitting context where meaning was free to emerge on its own terms.

I have worked with a woman in individual therapy whose psychosocial history reads very much like the histories of the women in the group. In fact, she worked with ex-offenders in her own career for several years. Born in NYC to transplanted Puerto Rican parents, Isabel was one of 8 children born to a frequently depressed, occasionally hospitalized (for depression) mother, and a father who was subject to extreme mood swings. Isabel was very attached to her father as a child, but saw that he could be brutal towards her mother and her brothers. Isabel had been sent on occasion to Puerto Rico by herself to stay with relatives, or sent to a foundling home in the city with her siblings, when her mother was hospitalized. Her adored older sister had become a heroin addict by the time Isabel was seven, and her older brother, who had sexually abused her for many years, came back from Viet Nam a heroin addict as well. Isabel had been used as a human shield when her brother needed help buying and dealing drugs, and as a lookout for her older sister when her sister wanted to retreat into the bathroom to use heroin at home or in public places. Isabel had used drugs herself, before joining Narcotics Anonymous, where she had been clean and sober for three years before coming to twice a week analytic therapy with me. Before joining NA. she had also initiated sex with a variety of men, in other words prostitution, in order to acquire money for her drugs. Isabel had struggled for many years with feeling frozen and enacting behaviors that can plague someone who has not had a chance to process and understand her traumatic experiences in any other way. The sexual abuse she was subjected to at the hands of her older brother did not end until killed by the police during a drug raid when Isabel was 13. That same week her older sister died in the hospital from an infection in her leg stemming from an unsanitary heroin injection.

Michael Balint wrote On Punishing Offenders in 1951, about “how the offender can be helped to have a true catharsis, can acquire a social superego and learn a wholesome discipline.” Robert Lindner wrote Rebel Without a Cause: The Story of a Criminal Psychopath in 1971, where he talks about the use of psychoanalysis in his lengthy analysis of a middle aged man in prison. Helena Deutsch believed criminal behavior to be related to varieties of pathological mourning states. She believed “every unresolved grief is given full expression in the subsequent behavior and character development of the person who cannot grieve.” (Frankiel,1994).

More recent writers have explored the terrain encompassing the relationship between traumatic experiences and subsequent offending (Baer & Maschi, 2003); Renn,2002; Chamberlain, 2002; Katz, 2002. Bradley and Follingstad (2003) led a group with incarcerated women who have experienced interpersonal violence using Linehan’s 1993 Dialectical Behavior Therapy while Pollock & Belshaw (1998) used Ryle’s 1993 object relations-based cognitive analytic therapy with a male who had sexually abused boys, and a female who had shot and killed her husband. Guenter (2001) explored the central conflicts of juvenile sexual offenders, suggesting that “coping with chronic feelings of defeat, inferiority, and humiliation, along with accumulated rage” often became organized as sexually deviant behavior (p.254).

Stone & Kibel (1990) explored the difficulties inherent with working with borderline and narcissistic patients in a group therapy setting and Transformation Cycles: The Symbolization of a Frozen Constellation (Freedman, Berzofsky, DeMichele & Haferty (2002) described psychoanalytic group therapy with specific attention paid to traumatic themes in the patients’ backgrounds Although I imagine they exist, this was the only article I could find in the literature where trauma was being worked with explicitly in a psychoanalytically-informed group setting.

I wish I had something halfway intelligent to say about how I first began to approach the group I was facilitating, but I really was writing my own script as I went along. Billow in Relational Group Therapy (2002) states that “Groups amplify emotional reactions”(p.54). Bion (1961) referred to this combustible process of emotional contagion as valency, describing a rapid formation of group uniformity of thought, feelings, and interpersonal behavior. I realized during the course of writing this paper that I feared the aggressiveness I imagined these women might display towards me if provoked during the group, and I feared my own aggressive potential as well. Billow’s (2003) statement that: “Symbolically, all therapy is an act of aggression, interfering, challenging, undermining patients’ beliefs, values, and relationships, and perhaps their sense of themselves” (p.48) captures what I was contemplating in a more formulated way. At the same time that I feared potential problems, however, I also longed to create a group where the members could feel safe enough to let go of their needs to dominate and control others; and where any absence and loss of meaning from their own usual way of doing things could leave enough mental space to open up new channels for them, new ways of interpreting and experiencing feelings. In breaking down existing meaning for them as well as myself, confronting what was unknown and confusing, I raised my own anxieties, my own fears of persecution and my own potential for depression ( Bion, 1965). I also raised the hopeful possibility that I, with the groups’ help, could help all of us to outgrow frozen postures of despair, by risking getting to know each other in entirely new ways. I must confess that I was also afraid of feeling invaded by posttraumatic feelings related to my having been exposed to difficult experiences during my childhood, that I was still in the process of symbolizing. I was afraid of feeling out of control and at risk of switching into particular self states (Bromberg, 1998) I had developed, ‘falling into holes’ (of unremitting despair), as I used to say in my own analysis. Given the state of my internal affairs, I came to understand how my being willing to show up for the group on a consistent and caring basis came to feel like a major breakthrough for me, an unusually vital opportunity for me to affectively expand. Outwardly, I sometimes felt like I was intruding into an alien culture, and the truth was that I was. Most of the staff at the agency where I led the group had had some exposure to the culture of prison. Many were familiar with drug abuse. Everyone it seemed but me had ‘done some time’ and been in recovery in ways I had only imagined, and I felt green, and naïve, next to them. The truth was that I had been a psychologist in private practice for over 16 years at that time, and my adult life had been relatively comfortable compared to prison or life on the street (where most of this population had been prior to prison). I had worked at a clinic where I had treated sexually abused children, but that had been in an affluent suburb outside of New York City, and in a very protected and supportive setting. This place was a whole new world. And it took me awhile to see past the cultural camouflage. It took awhile for my eyes to adjust. I frequently felt like I was walking into a darkened movie theatre on a sunny day, with the movie already showing, and I was standing still in the back and waiting, wanting to go ahead but fearing the possibility of tripping and being hurt, and/or of making a real fool of myself.

When I first started the group, I realize in retrospect, I often avoided asking anybody detailed questions. I would sort of skirt around the point I was trying to make, trying not to push anybody’s buttons. I very much wanted to be liked, since I was a volunteer and I wanted to continue running the group there. In my asking fairly circumspect questions, I realize now, ironically, that I was doing a good job of preventing any feelings remotely related to trauma to emerge. In my efforts to not aggress against anybody else, I was also protecting myself from being overwhelmed, and I think that was important for me to do at first. It reminded me of when I taught undergraduates psychology in graduate school. I wanted to be liked then too and saw to it that I was. But over the years I sometimes would wonder what would have happened if I had had higher standards for the students, and whether the colleague I knew who was a much tougher grader than I, had done the students more good in the long run. It felt the same with the group. I felt a little bit guilty, initially, that I wasn’t asking more of the women emotionally, and more of myself. I wondered if I could do a better job of standing up to the tough strident tone of some of the women’s defenses. I wanted to quit avoiding conflict at all costs. I just wasn’t sure how without activating my own unresolved issues. As time went on, and I continued to feel appreciated as well as welcomed by the staff there, I began to relax, and pay more attention to specific feelings that would emerge for me during group. I began to feel more hopeful about the possibility of holding onto myself and my inner experience, in a way Fonagy (2003) has described with the term ‘mentalization.’ I came a little closer to the goal of approaching the group ‘without memory or desire’ (Bion, 1962).

Isabel, initially didn’t want to ‘waste time’ talking about things she ‘couldn’t change anyway.’ She was a woman of action, who wanted concrete advice, directives, almost orders from me in the beginning. She would recount her latest tale of anger and frustration, at family members, bosses, and the occasional male date, and want to be told what to do about it. I was seen as the expert problem-solver, a magician with answers (hopefully), not merely another limited human being with blind spots of my own. Finding a way to help Isabel to voice her wishes in this regard, (that she wanted me to ‘fix’ it) and then my trying and much of the time failing to meet her explicit expectations, was a large part of our work in the beginning. I would sometimes have to be willing to tolerate a palpable sense of gloom and despair hanging over the room, as the time to end the session was upon us and she was still, if not even more depressed, than still as depressed as she had been when she walked in. Even though there was a lot of talking going on, I would find myself feeling almost nothing in the way of emotion, and it took awhile for me to learn to work my way out of what I later came to understand as an enactment (Black, 2003; Stern,2003) on both of our parts. I had to learn to interrupt Isabel, and to be willing to ‘go first,’ and share my feelings of boredom, or numbness, or lethargy. I had to quit waiting for things to happen, to risk being disliked and hurting Isabel’s feelings, and to not collude with keeping everything seemingly comfortable and on an even keel. To even more of the extreme than usual with Isabel and the women in the groups, I had to come to terms with the idea that sometimes I would be seen as a ‘bad object’, if only because, to quote Bion (1962,p.84) “All objects that are needed are bad objects because they tantalize.” To Isabel, the group and myself, we all represented bad objects to one another, because we all on some level needed each other. I had to learn to accept my ‘bad object’ status to them, as well as their ‘bad object’ status to me, if we were to get passes a superficial understanding of where we lived emotionally. Davies & Frawley (1993) put my dilemma into words with these lines: “Uncomfortable with their own aggression and … any identification with their own abusers, clinicians may defuse patients’ aggressive transference reactions. This preserves the therapist as a good object, keeping the relationship with patients primarily loving and ‘nice’ may represent survivor/therapist attempts to compensate patients and themselves for the wonderful childhood neither ever had”(p.64). I didn’t want to force myself or the women into behaving in overly compliant patterns, all the while missing the opportunity to work our way out of stuck places where our feelings appeared ‘nice’ but remained frozen underneath the surface. I began to take more risks, and to allow myself and the women more opportunities to disagree.

In a group meeting one May the subject of mothers came up, including what people were doing for their mothers on Mother’s Day, what their children might do for them, whether their mothers were alive or dead and this kind of thing. I don’t remember any one persons response as much as I remember how shocked I was, during that particular line of questioning, that nobody in the group of about eight people, had really lived with their mother while growing up during their childhood. I felt sad listening and I felt excited that I might have stumbled onto something important about these women, this population, that I hadn’t realized before, that we might be able to discuss. The room got quiet as it often does when some feeling emerges in the room that hasn’t seemed to existed there before. I got that frightened feeling I get, that I should “do” something, sum things up, say something essential that could move us along (in my fantasy of how it all works) to the next developmental level. And also that opposite feeling, that I could really blow it, really make a mistake if I said the wrong thing. I should have known right then that that feeling of having only one way to go, rather than a variety of possible paths, is a symptom of what Stern (2003) might call enactment. I also know though that enactment is defined by that very quality of feeling trapped, and can only really be understood in any conceptual way after the act: thus the word, enactment. As I was waiting to get my bearings one of the women complained of having a headache. I turned my attention to her to ask her what that was like for her, and as she was answering several other women said that they too either were having a headache, or just suffered from headaches in general. The similarities were uncanny, with people speaking of migraines, nausea, emergency rooms, days spent in bed. I found the discussion personally compelling as I had suffered from severe headaches at an earlier point in my life. As each women spoke, expressions of recognition and relief were on the others faces. Again, it seemed like a new level of intimacy (as well as its’ cousin anxiety) pervaded the room. I got that feeling I mentioned before, that I wanted to say just the right thing at that point, something essential that might capture the mood, but for that moment I remember only being filled with affection. I was touched by their humanity and their willingness to share it with one another and with me. Then somebody announced that we were out of time, which we were. I said something suggesting that this was important information we were all discovering and that I looked forward to talking more about it with them next week. Next week came, but nobody showed up for group the next week. Nobody. I asked the staff what had happened and it seemed that everybody had a legitimate excuse. But I was dumbstruck by how extremely intimate the previous group had been, at least for me, and how absent everyone was, legitimately or not, for the second. I talked about this situation and my observations later, with colleagues. Stern (2004) suggested that he and many others have had the experience that an especially intimate session was followed by one that is distant, and Frankel, 2003 made reference to Fonagy’s work on mentalization, and how impossible having such a discussion might be fore women who had spent their lives acting out, rather than feeling and integrating, their feelings. I studied Fonagy and thought back to the interruption of the discussion about Mother’s Day by the pain someone was experiencing on the physical level. Fonagy (2003) believes that for some people, experience of a particularly traumatic nature can be lived but not thought about. “When psychic reality is poorly integrated, the body takes on an excessively central role for the continuity of the sense of self” (p.405). I wondered whether in saying her head hurt right then, while the others were joining in, if the women were making a preliminary attempt at expressing an aspect of the emotional pain associated with their actual relationships with their mothers. I wondered if talking about the headaches provided a channel for their beginning to talk about their pain, while at the same time giving them some emotional distance from it. Fonagy (2003) says that “with self-harming and self-destructive patients, they are more frightened of their mental experience, their emotions and fantasies, than of the immediate physical pain of the long-term consequences of their self-destructive actions.”(p.393). I began to consider the idea that in breaking the law and going to prison these women had in a sense been self-harming and self-destructive in the way Fonagy was suggesting. I wondered if the discussion about mothers, and the discussion about headaches, created just too much stress for them at that moment. I also wondered whether the women were making a desperate attempt to protect themselves from being overwhelmed with feelings of abandonment, brought on by the discussion about Mother’s Day and then headaches, by abandoning myself and the group instead.

In groups of all sizes and with all sorts of subjects discussed, some women were openly oppositional. I always welcomed this, because it was verbalizing rather than acting out. I found Bromberg’s (1998) work on multiple self-states a great help. I would thank the woman who was saying no to whatever might have been going on at the time, and say that I really appreciated (and I did) that side of her that could stand up for herself when she held a different opinion. I also suggested that she seemed like an interesting woman and that I imagined that there may be a part of her that was staying silent and acknowledging her experience in a different way, and that I would love to know about that part of her when she had something to say. I wouldn’t interpret her refusal to speak, in other words, as the last word on the subject. I would see the side of her that was saying no as a more formulated (Stern 1997) less dissociated aspect of her personality and assume that maybe during another point in time she might be able to communicate an additional perspective. Celia was a case in point. She adamantly refused to say how she was feeling one day, as we were going around the circle ‘checking in’ with our feelings that day. “I’m not answering” she said. “I don’t like you being in my business. I don’t have to answer to any of this!” I acknowledged her response and moved on. Finally, after a heated discussion with the others about whether or not people believed that body language was a communication from the unconscious, Celia broke in and told me how nice I looked, and how much she liked the boots I was wearing. She began to involve herself in the discussion about body language, and I humorously asked her whether she had any opinions about what my appearance that day, including my boots, might have been saying. The group became joyful. I viewed Celia’s initial opposition as a possible example of the self-state that needed to say no to me, feeling sufficiently respected that she could allow another self-state a voice as well. Maybe I had proven myself secure enough to withstand her anger and she now felt sufficiently ‘held’ during the group to risk showing another feeling state. I found that if I could allow her to be herself, and withstand the inner emotional reaction that this stirred up within me, Celia, the other group members, and later on in the week, Isabel, seemed to visibly relax, acting less frozen, feeling less fearful. However we experienced the ‘bad objects’ and ‘good objects’ within ourselves, somehow our being willing to struggle through our differences as well as our similarities while we sat together seemed to have a transformative affect. Like the character played by Leonardo DiCaprio in the hit movie Catch Me If You Can, the women, including Isabel, seemed to need to know that the people who cared about them in life have the strength and fortitude to know ‘when to hold and when to fold (Bass,1996) in terms of their responses, when to let them leave the discussion and when to pursue them, without abandoning them in the process.

I treasured the chance to create an environment in my office with Isabel, and at the setting in which I conducted the group at the agency, where trust, hope, faith, and occasionally laughter and tears could break through the anguish. I liked the fact that being with one another, attempting to connect and understand one another, could soothe some of the past and present hurt, loss and despair which previously unrecognized self-states as described by Bromberg (1998) had been forced to contain. Dream work allowed us to try and understand some of the unremembered and never before discussed events that had been traumatic for the women. Palombo (1984) as cited in Blechner’s The Dream Frontier (2001) studied his own dream interpretation process with his patients. He found that when he asked patients specifically about whether they could connect an aspect of the dream with an actual experience, they did so 92% of the time. Blechner suggested that the “connection of dreams to actual experience may be seriously underreported” (p.57). I believed that this traumatic dream content, reported by the women as dream ‘drama’, fueled many of the extreme feelings they had, that had created problems for them in feeling close and trusting with others. My commenting on patterns I saw myself and the others get into during therapy and group, and get stuck in, allowed us to begin to look at ourselves in our dreams (I sometimes reported my dreams) in ways that recognized our inner life, including disappointed desires and frustrating scenarios that had gone unnoticed for decades.

As much as I enjoyed recognizing feelings within myself before, during and after group, I must admit that I also became a little concerned that I might be too self absorbed, and worried that I should be focusing more on the emotional experience of the individuals in the group and in individual therapy with Isabel. I took solace in the following author’s thought about both the therapy process and the process of groups. Racker (1968) described how the analyst’s verbal and nonverbal behavior “continues to be variable – inconsistent, professional and personal, mature and immature, healthy and neurotic, and regulated by the emotional state of the relational matrix. The analyst’s internal and external dependencies, anxieties, and pathological defenses ‘ (respond) to any event of the analytic situation”(p.32). Billow (2003) says that the best the therapist can do is to eradicate, as much as he or she can, not anxieties, resistances, wishes and fears, but their repression. “In being receptive to the infantile, primitive and neurotic aspects of one’s own personality, the therapist may more fully experience his or her own experience, and this is, I believe, the precondition that allows the therapist to help the group members do the same”(p.45).

Although Isabel was strong, it was sometimes at the expense of what we came to call together her ‘little girl.’ It took some doing to help Isabel admit that there might be a younger, less controlling, softer part of her personality that was also in search of a voice during the therapy session. Pierre Janet (1997) defined memory as an act of creative integration. He felt that when an event was too terrifying or over-stimulating to emotionally process at the time, that the event could be split off from consciousness into a separate system: untouched, out of proportion and not yet integrated into the personality system as a whole. He, like Bromberg (1998) and Davies & Frawley (1994) among others, believed that this ‘selective inattention’ (Sullivan, 1956) this ‘unformulated experience’ (Stern,1997) can happen to the point where an almost separate sense of self acts, as opposed to tells, of its values and imperatives. This part of oneself, heretofore not officially recognized, uses behavior as a substitute for words that have yet to be found. Working with Isabel involved hearing a lot about her children: an adolescent son of whom she was very proud, and a beautiful little daughter still at home that she loved very much. I would often think of this little girl, whom I had met once when Isabel couldn’t find a baby sitter, when I would allow myself to just sit with and explore my reverie while in Isabel’s presence. I liked using the metaphor of the little girl self-state with Isabel, to help her develop and tolerate a more emotional sensibility during our time together. Her face would soften at the mention of her daughter, and eventually at the mention of the ‘little girl’ she might be experiencing, emotionally, deep inside herself. Dreams involving a little girl being touched inappropriately and manipulated by strange men, and little babies being shut away in closets and bathrooms, gradually gave way to dreams where the entire family with which Isabel grew up, were lying in a large bed together on a Sunday morning, laughing and telling jokes, and enjoying one another. She began to dream happy dreams of her sister who had died, and dreams (some happy, some frightening) about her brothers who had had been gone for many years. I noticed that Isabel’s appearance began to soften as we talked of how much she liked taking care of her own children, and how grateful she was for that opportunity. Eventually our discussion turned to Isabel’s lack of a romantic life with a man, and her ambivalence about actually needing somebody. For years Isabel had felt too busy for anyone besides her children and she had kept men at a distance. The children’s father, who Isabel had been seeing many years before, had been discovered to have a wife he hadn’t mentioned, but even before that Isabel and he had lived separate lives, in separate apartments. Every man she knew, whether potentially ‘datable’ or not, seemed to have flaws she couldn’t tolerate. But Isabel’s “little girl” in addition to other parts of her we began to discuss, longed for companionship and parties; someone to dress up for and to feel appreciated by. Isabel wanted to have someone to feel close to in a way that wasn’t possible with someone who was ‘just a friend.’ She got brave enough to search the computerized dating world but said that nobody ‘leaped out at her.’ One day she came into my office smiling and said she had just renewed an acquaintance with a guy she had known in high school. She liked him then and said that she still liked him now. Within a few weeks they were dating and a satisfying intimate relationship became the topic of inquiry and conversation in her therapy for a long time after that. For the first time in her life, without being part of a triangle and without the use of drugs and alcohol, Isabel was able to really allow her older and younger selves to know and be known by someone. I reflected within myself about how Isabel had been able to let someone in emotionally after remaining alone for such a long time. It seemed to me, in addition to all the things that can contribute to a paradigm shift within somebody, that discussions in therapy centering on Isabel’s choice to be a single mother had been critical. I had struggled to find an analogy with her with regard to the issue of intimacy with men. And one day I asked her what her life would have been like if she had decided to not have children’ what if she had decided to forego the experience of becoming a mother? She got very upset. She said very adamantly that she would never have wanted to miss out on that. Then I suggested to her that some women did, and that they thought it was better to not have children, and that they were at peace with their decision. I suggested that maybe that is what Isabel felt about intimacy and that maybe she didn’t need that experience with a significant other in order to feel complete. She forcefully disagreed. She said she didn’t want to miss it. A few more weeks later she met the friend from high school. She is still with him.

In the movie Monster the actor Charlize Theron plays the serial killer Aileen Wuarnos, who in a voice over narrative talks about how she coped with stress as a little girl through the use of fantasy and dissociation. She dreamed of being a movie star and her experience of being sexually abused made her vulnerable to confusing affection with exploitation from a young age. When her family abandoned her for, among other reasons, embarrassing them with her sexual behavior, she ended up supporting herself through prostitution. It’s heartbreaking in the movie to see her, as a young prostitute, still looking for the transformative relationship that would help her realize her dream of making it in the movies. By the end of the film, the character of “Leen” has undergone a transformation. Her life unravels before our eyes as a sexual and romantic relationship with a younger woman appears to have inadvertently released a self-state which seeks revenge based on a lifetime of degradation. Fonagy (2003) addressed the psychological meaning behind acts of violence as attachment-related and asked the question “Why is the brutalization of attachment so potent a trigger for violence?” (p.245). He tells of a young woman he treated who regularly allowed herself to be maltreated by her boyfriend, saying that she normally felt ‘cleansed’ by the experience. But than on one final occasion she had seen, for the first time, contempt, rather than shame, in her boyfriend’s eyes. This led to her stabbing and killing him. Fonagy believes that with that woman and in general, there is a turning point for people who become criminals, a dramatic reconfiguration of the self, when the normal barrier against intentionally injuring another human being is penetrated. He calls the violent act the “perverted restoration of a rudimentary mentalizing function’(p.427). He believes that with such an act, “the person hopes to have killed her own self-hatred and humiliation”(p.425). Clearly Aileen Wuarnos, as portrayed in the movie, is attempting some type of new beginning when she finds herself murdering a man in self-defense at the beginning of the film. But the strategy becomes addictive, and the self-state running the show by the end of the movie, like many offenders have reported at times, appears to be dissociation run amok, with little or no capacity in that particular, probably paranoid, self-state (Kluft,1990) to cope with the demands of reality coherently enough to protect oneself or others from destruction.

It is my hope that in Isabel’s individual therapy and during the group process, that I may help these women learn to tolerate a more complex view of themselves, and the ability to ‘mentalize’ about the shameful and degrading experiences in their lives that have contributed to their feeling traumatized and with out an enlivened and feeling senses of self. My wish is that they can learn to mitigate the process of feeling under emotional attack as they pursue their lives outside of prison, permitting them to continue to conceive of themselves as meaningful thoughtful people in spite of the lack of recognition from many in society at large. So that further “desperate attempts to protect their fragile selves against the onslaught of destructive shame” (Fonagy 2003,p.425) can be attenuated, and so that their earlier dreams of the good life will have a better chance of being reinstated, and realized, rather than frozen along with the trauma.