The Abused Child
Psychodynamic Understanding and Treatment
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Capturing the complexities of working with abused children, Heineman explores the intrapsychic worlds of these youngsters and examines many of the paradoxes and complications encountered when treating them. The book traces the interplay of neurobiological and psychological facets of behavior to show how abuse derails normal development and how psychodynamic psychotherapy can reestablish emotional connections.
Chapters highlight special issues involved when working with children who have been physically, sexually, and emotionally abused, exploring memory and disclosure, dissociation and externalization, and the relationship between action and spoken language. The book also addresses important factors in understanding and working with parents and caregivers and reviews such relevant legal issues as the process of court-ordered evaluations. Throughout, clinical vignettes illustrate the practical applications of concepts and theories discussed.
Table of Contents
1. What Is Abuse and Who Decides?
2. Treating a Moving Target: Developmental Considerations in Work with Abused Children
3. A Template for Developmentally Informed Evaluations
4. Neurobiology and Psychology: The Formation and Meaning of Symptoms
5. Memory and Disclosure
6. Looking Outward: Externalization and Dissociation
7. The Paradox of Language in Treating the Unspeakable
8. Good Guys and Bad Guys: The Temptations of Splitting
9. Collaborative Work with Parents of Abused Children
10. The Unconscious Transmission of Abuse
11. The Interface between Legal and Psychodynamic Considerations
"Toni Heineman's years of hands-on experience with children and families in distress shine through in this important book. The Abused Child is both scholarly and pragmatic, combining a sophisticated psychodynamic perspective with a command of the most recent neuroscientific findings about trauma. Most of all, Heineman's clinical work has enabled her to develop a finely honed sense of how it really feels to be an abused child, and how to work with children caught in the most torturous family and legal systems. Heineman is both a social worker and a psychoanalytic clinical psychologist, and she embodies the best of both professions. This book will enhance its readers' everyday practice, providing both a broad conceptual integration and a plethora of useful clinical examples. --Stephen Seligman, DMH, Clinical Professor of Psychiatry, University of California, San Francisco
"An indispensable, trail-blazing book. Rejecting one-dimensional formulations and resolutions, Dr. Heineman integrates the developmental, psychological, neurophysiological, and family dimensions of therapeutic work with abused children. Beleaguered (and often confused) clinicians will find Dr. Heineman to be a humane, thoughtful guide. Numerous and rich clinical examples illustrate inspired, effective therapeutic work in the face of extreme human pain and uncertainty as to historical truth." --Neil Altman, PhD, Postdoctoral Program in Psychotherapy and Psychoanalysis, New York University
"Dr. Heineman has given us a remarkable 'guide for the perplexed' as we make our way in this largely uncharted domain. Her book is an essential resource for coming to grips with the psychic impact of child abuse and for developing ways of working in depth with traumatized individuals of all ages....Through richly detailed, often brilliant clinical illustrations, Dr. Heineman reminds us that the capacity to tolerate contradiction and ambiguity is among the surest signs of wisdom....This is a book worth not only reading, but consulting again and again when we need to restore a sense of balance and direction to our work." --from the Foreword by Alicia F. Lieberman, PhD, University of California, San Francisco
"This is a highly accessible, informative work. One rarely encounters so much clinical detail, with such a plethora of cases handled with unerring skill and empathic understanding. The breadth of Dr. Heineman's knowledge encompasses the full range of neurophysiological, psychological, sociological, and legal aspects of dealing with these traumatized children and their families. We should all be very grateful for the gift this author has given us."--Morton Shane, MD, Estelle Shane, PhD, and Mary Gales, MD, authors of Intimate Attachments: Toward a New Self Psychology