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Catherine GildinerA modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Content Warning: This section contains references to child abuse and substance misuse.
At the beginning, Gildiner explains that what unites the five patients she has selected to profile is their exemplification of heroism. All five, although their circumstances differ, survived particularly traumatic childhoods. In all cases, this trauma involved some form of abuse by a parent (or, in the case of Danny, authority figures in the absence of parents). The abuses endured by the five patients are objectively shocking. Gildiner stresses that, despite these painful circumstances, none of the patients gave up on themselves or their lives; instead, they developed unconscious coping mechanisms. In all cases, too, it is not the childhood experiences or abuse that causes the patient to seek out (or be referred to) therapy initially, but the effects of these coping mechanisms that are shaping their adult lives, and which are becoming obstacles for them. For Laura, this is stress; for Peter, erectile dysfunction; and for Madeline, an irrational fear of flying. These coping mechanisms have become unsustainable for the patients but they are not framed as simply negative or non-normative responses: The patients’ creation of these responses has been key to their survival as “heroes.” It is as Gildiner uncovers the extent of the patient’s respective trauma that she and the patient are able to address and remedy the negative impacts of that trauma on the patient’s present life.
Key to Gildiner’s notion of heroism, then, is resilience in extreme adversity and the ability to find hope. Gildiner also points to the ways that, in one respect or another, each child developed outlets to endure their situation. In the case of Laura and Alana, it was the reliance of a younger sibling upon them that caused her to continue with her life. For Peter, it is an intense love of music and the piano that brought his life meaning. Madeline, too, acquires her passion for antiques at a young age, through her loving grandmother. Both of these passions lead to successful careers for Peter and Madeline. Danny, aware of the damage alcohol addiction has brought to others in his family, vehemently refuses to engage with substances of any kind. In all instances, the resolve of the patients plays a role in not only their reaching adulthood, but leading “normal” lives that appear, from the outside, to be stable.
Important, too, to Gildiner’s assertion of each patient as a hero is the patient’s denial of their specialness, and their refusal to be defined by their trauma. Laura, though she was forced to become an “adult” at age nine, insists there is nothing remarkable or commendable about such maturity. Peter and Danny, though both survivors of abuse, display humility in their interactions with other people, putting them before themselves in a way that demonstrates compassion: Peter, despite his discomfort around other people, offers free piano lessons to his neighbor. Danny, though he is unable to experience emotion, loves his young daughter and treats her with kindness. Each patient lacks a frame of reference to recognize the ways in which the trauma they endured is not a universal experience. It is this quiet strength that Gildiner finds inspiring and heroic.
Common to all of the patients is that the difficulties they face in their present lives—the initial issue that brings each to therapy (or causes another person to refer them to Gildiner)—ultimately are rooted in the way they have been impacted by one or more of their parents as young children, though Danny Morrison’s case is somewhat of an exception here. In the cases of Laura, Peter, Alana, and Madeline, all were subject to traumatizing abuse by a parent. Although the form the abuse took varied for each patient, the resulting lasting impact the abuse has on the patient’s adult life is highlighted as a commonality. Gildiner explains that it is when a child is very young that their sense of self and ego is formed; because each of these four patients experienced abuse by the parent, they were not able to form a healthy and whole sense of self, ego, and identity. Moreover, children naturally form attachment to parental figures and will find ways to blame themselves when their love is met with cruelty or neglect, in order to protect themselves from the terrifying reality that those they rely on are at fault. Laura was abandoned by her father after her mother’s death and this neglect forced her to become, at age nine, the “adult” caregiver and decision maker of her younger siblings. What results is stress when Laura must learn to survive without necessary resources. Peter, physically prevented from attaching to his mother (or father) at a very young age is thus unable to form bonds as an adult. This is similar to Danny’s circumstance; after abuse by the authority figures of the residential school he is forced to enter at age five, Danny detaches emotionally, training himself to be numb. Both Alana and Madeline are so belittled by their father and mother, respectively, that they manifest physical ailments in their adult life and regard themselves as unworthy of love or success.
Thus, although all five patients are well into adulthood and beyond the developmental stages of their lives when they meet Gildiner, it is the negative influence of parents and guardians that is at the root of their difficulties. The mental “tapes” Alana hears of her father’s voice are a manifestation of the way in which childhood trauma continues to echo in adult life. Further, Gardiner points to the ways in which this abusive behavior is usually learned behavior. Abusers were often abused as children themselves and were never provided with a loving parent to role model effective parenting. This is the case for Laura’s father, Peter’s mother, Alana’s mother, and Madeline’s mother. This generational trauma continues to impact descendants even after the abuse itself is no longer taking place. In helping her patients to understand the cycle of generational trauma, Gildiner is able to free them from it. All of the patients are shown as ultimately able to form healthy attachments, and most of them are able to raise children in loving and responsible ways.
As an educated, trained, and experienced psychologist, Dr. Gildiner is able to uncover the “mysteries” her patients present to her more quickly than the patients themselves. This is largely due to her knowledge and training—a benefit that her patients do not have—as well as her position in viewing the problem from the outside. The patient’s subjectivity often gets in the way of their understanding of why they behave or respond in the way they do. Moreover, much of the patients’ patterning may be unconscious.
Getting at the heart of the patient’s dilemma is necessary for healing and growth, and this starts by helping the patient to perceive that the ostensible reason for why they are in therapy is in fact a symptom of the real reason. In order to start the process of self-discovery, Gildiner must persuade her patient that such a journey is necessary and may meet with considerable resistance, as in the cases of Laura and Danny.
Once these obstacles are removed, the patient must be helped to find their own path of self-discovery, and to do so in their own time. This is key to the process of reframing which allows the patient to see their past trauma and reactions to it in a different light. Gildiner explains the way in which the unconscious mind buries such information—sometimes as a mechanism for coping with the trauma the patient has experienced—and is unwilling to release it to the conscious mind. That is, Gildiner could simply tell Peter that his erectile dysfunction is due to his failure to go through the attachment stage of development, but this information would be useless to Peter. It is only when he is able to not only understand how attachment works, but also more objectively evaluate his mother’s behaviors that he begins to understand for himself what is truly bothering him. This self-discovery is a central goal, then, of therapy. As the patient uncovers for themselves the forces that have shaped them, the patient gains a fuller understanding of their present situation and is thus able to remedy it. Gildiner emphasizes that this process is a long and arduous one. In the cases of the patients profiled, at least a year or two is needed just to call up memories of the past and explore them, before the patient can even begin to make sense of their impact on them. Gildiner’s role in this process, then, is to guide the patient in doing this. It is as if the therapist holds a map to the location of the “true problem” and the patient must follow the path to arrive there. Gildiner notes, too, that as a therapist she does not always arrive at the “true problem” more quickly than the patient. She points to her missing the clues that Alana had multiple personalities, or dissociative identity disorder, which prevents Gildiner from effectively counseling Alana at certain junctures. It is when the patient is able to reach conclusions for themselves that the impact becomes meaningful.
Most often, when Gildiner identifies a mistake in her approach to her patients it is because she has pushed them too quickly toward reframing their experiences. Her identification of this as the most significant type of mistake highlights the importance of the patient’s self-discovery.