Being fascinated by the opportunity in BOL to explore commonalties among us therapists in the work we do, I thought of an experiment. Gil Levin was game to try it. My idea was to give more detail from sample sessions, with less background information. The result, I am afraid, was mostly to leave readers wondering about the context of the patient's difficulties. Nonetheless, Vic's posting allows me to think out loud about the relationship between what I do and what he does, in his case starting from a Control Mastery viewpoint.
There are some background questions that Vic raises, which I will address first. The main issue is whether Laura really did as a child encounter sexual abuse from a family friend. Repressed memory is a thorny matter. Freud, of course, ran into enough conflicting evidence that he had to abandon the easy presumption that patients' reports were always true. In Laura's case, I was not her therapist when she first recovered a more or less integrated sense of memory of such experiences. She struggled in therapy with the correctness of the memory for two years. Even after she and I started work together, she continued for a while to question herself about it.
My confidence in the likelihood of essential truth in what she describes comes from internal consistency in what she says, small but telling aspects of the accounts, and credibility in connections she seems to have made between those experiences and her ongoing life. The last I speculate about with her and feel to be meaningful when Laura subsequently seems less fragmented in her manner. To illustrate with one small memory, I asked Laura what it was like for her walking home after being at the man's house. (His daughter, whom he molested also, was her friend at the time, and they lived near Laura's and her parents' house.) Laura described walking slowly with her head down, feeling ashamed when she left; and gradually raising her head and feeling fine as she approached home.
As with many cases of sexual abuse, Laura was ambivalent about her experiences. I believe that was why she did not let her parents know what was happening. It is still possible, of course, that the postural memory only reflects the capacity of an intelligent person to create a believable narrative.
The internal consistency of Laura's reports is significant to me as she refers to them over time . Apparently, the man was gentle with her when she was very young, becoming forceful and bizarre in his behavior as she (and his daughter) developed toward puberty. Diapering experiences come to mind especially when there are instances of confusion of sex with elimination (as the man purportedly demonstrated). I have no reason to believe, however, that it was Laura's confusion from babyhood. She does not present further symptoms that suggest it.
In keeping with what all BOL-ers responding so far bring up, Laura's father was borderline inappropriate with her, especially when drinking. I think that we must be aware of the positive feelings that Laura had for him. She less sees him as dominant in the family than as someone who needed an ally against her powerful mother.
That does not mean that her feelings toward her mother are exclusively negative. As Vic points out, she also experiences her mother as reliable in contrast to the man in her life. When it seemed as if her mother's death were imminent, Laura became engaged to Tom. Laura felt it would please her mother. She was crushed when her mother was instead blasé about it. Her father was delighted and appropriate in his response. Tom's parents were gratifyingly welcoming. Laura retained her disappointment over her mother's indifference.
I speculate to myself that Laura felt it was a gift to her mother to show that she was not going to profit from her mother's death by keeping her father. As soon as it became evident that her mother would continue to survive, Laura broke the engagement. She and Tom, however, still live together.
I believe Vic is right that unconscious guilt over bettering her mother is a crucial factor for Laura. That is the basis of my understanding her need to vomit when Tom tempted her to hold good feelings about himself.
Interestingly, Laura was thrown into further conflict recently because her mother arranged (through a woman in the mother's support group!) for Laura to have an opportunity for a job in keeping with Laura's training. This expression of her mother's confidence and pride in her was appreciated, yet not entirely comfortable for Laura. The timing of this happened to coincide with Laura's verbalizing how committed she felt to seeing me. She has not come to her session with me since then, perhaps being unable to stomach two "good mothers!" I plan to call her to find out her reason.
To continue with Vic's questions: Even though secrecy is a regular part of the anaorexic/bulimic syndrome, Laura could not keep her vomiting a secret because the living quarters are too close. The compulsion has been one of her steady symptoms for many years.
I am glad that Vic mentions being comfortable overall with my way of seeing Laura. It is my belief that Control Mastery theory leaves room for recognizing inner conflict, which I more emphasize in my speculations.
The most interesting thing to me is that both theoretical slants emphasize the importance to a patient of the purpose of various behaviors. We assume that understanding the purpose of a behavior gives a person a chance to decide consciously whether to maintain the behavior, instead of being scripted by unconscious choice.