Europe 30 April 2008 Helping Elisabeth Fritzl Top psychologist Anne Carpenter - a specialist in helping adult survivors of childhood sexual abuse By Anne Carpenter COMMENTS Sign UpGet the New Statesman’s Morning Call email. Sign-up The story of Elisabeth Fritzl, the 42 year old woman who was imprisoned in a cellar and raped by her father over a 24 year old period, is so shocking it is inconceivable to most of the public. While this is clearly an extreme case of sadistic emotional and sexual abuse the need to treat victims of child abuse is unfortunately commonplace within the mental health field. And, in the last 30 years, academics and clinicians have developed a greater understanding of the complicated psychology of abuse survivors. Clearly this woman is likely to require extensive help and support to come to terms with her dreadful ordeal. However, those involved in her recovery will need to be cautious and sensitive particularly as she will have grown used to her emotional and physical needs being over-ridden by her abuser. In fact, she may be unable to articulate or even recognise them. She will be feeling a range of conflicting and confusing emotions – shock, disorientation, anger, guilt, sadness as well as happiness and relief. It is likely that she will shift rapidly from one emotion to another in the early stages of resolution and as such, above all at this time will need gentle support from those caring for her. Miss Fritzl will have to be gently encouraged to express her own needs and make her own decisions. Living in a cramped cellar away form normal social contacts will mean she has lost many basic life skills: meeting people, shopping, using a telephone, even crossing the road - all will be strange and daunting tasks. Intensive psychological therapy is often inadvisable in the immediate aftermath of extreme trauma, particularly at a time of extensive police and media interest. Research on counselling in the immediate period after distress warns against probing into feelings too deeply and too quickly. Any disclosure of abusive experiences can lead to the individual feeling that they are being abused all over again. People often describe traumatic “flashbacks”, where they feel as if they are being pulled back into the past and are being abused again. They may experience sounds, smells or sensations which can feel distressing; as if they are losing their minds. Such experiences are quite normal and are the mind’s ways of rationalising and understanding the incident. They are, however, very alarming. Disclosure of such events is particularly difficult where someone is not used to being treated with respect. She may expect to be punished or blamed. Miss Fritzl may even anticipate repeat abuse from those looking after her as it is what she has been accustomed for most of her life. She will look to therapists to tell her what to do, where to go, what to eat, who to speak to. In other words; will have lost all initiative. This is why the preliminary stage of providing gentle support is so crucial in helping her resolve and understand her feelings. At this stage, all involved should be telling her they believe her and know this is not her fault. Sexual abuse survivors commonly express feelings of extreme guilt: Guilt that they didn’t stop the abuse; guilt that they “let” it go on for so long; guilt that the abuser has been arrested. The public commonly ask “Why didn’t they stop it?” It is vital that such a question is not put so bluntly to Miss Frutzl. Working with abuse survivors and sex offenders has helped clinicians understand the very complex relationships that exist between them. “Stockholm Syndrome” was identified in the 1970s and recognised that, where a victim is dependent on their abuser for their very survival, a curious, almost infantile, attachment can develop. The victim may hotly defend the perpetrator and even apportion much of the blame to themselves; particularly where they have been told by the abuser that they are to blame. Again, such attachment is normal and Miss Fritzl will need help to express such feelings. This will not be possible if she feels that she will be labelled as “mad” or complicit. No-one freely consents to such horrific abuse. The final issue which she will face is in taking on her role as a mother to her six children. Children about whom she may have ambivalent feelings. Some were cared for by her parents; some may also have been abused; some were also the victims of the sadistic decision to imprison them in a cellar; all of them are active daily reminders of her unwanted incestuous relationship. The children will, of course, also need extensive support. Miss Fritzl’s reintroduction to Austrian society will be long and traumatic. It may even be as traumatic as her first few months in captivity. She will need above all to be protected from the eyes of the world as she is helped to reconcile the very complicated and often conflicting emotions that she will experience. From a world where she will have felt very alone, she will need to learn from her carers and therapists that, while her case may be extreme, child abuse is unfortunately not unique and her feelings will be very similar to those commonly expressed by our many abuse survivors. Anne Carpenter is a Consultant forensic clinical psychologist employed within the Forensic Mental Health directorate of Glasgow and Clyde health board. For over 20 years she has worked with victims of child abuse, female offenders and mentally disordered offenders. She has worked extensively with Victim Support Scotland and is a member of the Parole Board for Scotland. Subscribe To stay on top of global affairs and enjoy even more international coverage subscribe for just £1 per month!