A case of incest brother sister
treated by therapy online
J.-Y. Hayez [1]
Summary : The author describes in detail
a number of individual psychotherapy sessions with Jérémie ( 17 years of
age ) During these sessions, Jérémie revealed in the throes of a serious
crisis that over a long period he had engaged in incest with his sister, who is
one year younger than himself.
The
aims of this article are :
◊ - to
describe and discuss the therapy used to deal with this difficult
experience ; and
◊ - more
specifically, to show how the Internet ( webcams ) led to success in
the handling of Jérémie’s profound crisis.
The
main purpose of this paper is not to present all the different aspects of the
individual psychotherapy applied in the case of Jérémie ( almost 17 years
of age ), with the different technical, ethical and confidentiality issues
that it raised, but rather to demonstrate how the use of the Internet was
useful in enabling Jérémie and myself very quickly to come to terms with and
overcome what was a very delicate phase.
Jérémie’s
parents separated when he was five years old. Since then, he lived mainly with
his mother, in a small rural village, and he has had regular conflict-free
contact with his father. He has one sister, Joanna, who is one year younger
than himself, and he gets on well with her. He is of average to above-average
intelligence. He attends a mainstream school. His academic results are mediocre
( a combination of laziness and passivity along with a lack of motivation
and, as I gradually discovered, a number of secret preoccupations that were a
distraction to him )
Since
he was 15 and a half, Jérémie had been coming for consultation off and on in
connection with his poor results at school and his abundant use of the
Internet. This was nothing more than some friendly support therapy, along with
a few father-child and mother-child interviews. I had not seen him for four
months when his father phoned me to tell me that he was still using the
Internet a lot, but, he said : « that’s
not the problem any more »
Something was wrong with Jérémie. He was sullen, withdrawn and increasingly
lackadaisical. We therefore resumed the therapy. We still had a good
relationship, but it was a conventional and evasive relationship that focused
on fairly general subjects ( school, young people, the Internet,
etc. )
§ I.
Overwhelmed by fear of death
Three
weeks later, his father called me on the phone. He was very worried because
Jérémie was getting worse. He had an overwhelming fear of death that made his
life a misery. I gave him a quick appointment during which I told Jérémie about
the phone call from his father ( who had not concealed this from him )
He told me that it was true that he was afraid ( how it was so bad that he
couldn’t keep up with his schoolwork and how he would feel his pulse to check
that he was still alive ) He told me that he couldn’t connect this
recurrence to any specific experience or to any change in relationships or to
any new questions he had recently come up with about life. I told him that what
he said made me think that one possibility was guilt and self-aggression :
« It’s as if part of yourself is
attacking you and trying to kill you (...) Could it be that you’re blaming
yourself for something, that you feel guilty about something serious that you
daren’t admit? Or something you can’t remember right away? » Off the top of his head, nothing
came to mind. Then, as the session was over I asked him to see what he could
find for next time.
Because
he lived over a hundred kilometres away and it was urgent and because we are
both interested in the Internet, I suggested we do the next session five days
later over the Internet and MSN, using a webcam and a microphone. He gladly
agreed to the idea, as did his father when I informed him.
§ II.
The first webcam session
Five
days later, we turned on our webcam and our microphones and communicated via
MSN. Jérémie told me right away that his anxiety had not abated and that he
wasn’t working at all at school. I listened as he described his concerns in
some detail, then I reiterated the idea that perhaps he was blaming himself for
something and that he was perhaps punishing himself. I discerned right away
that he was very ill at ease[2],
sad and ashamed. He told me he had something very serious to tell me, but that
he would never dare say what it was, as he was really too ashamed. I took this
seriously and at the same time gave him some general encouragement (« Try, Jérémie. It’s important for you to
express yourself ») Then, as he was inhibited, I suggested, half
joking, a few specific ideas which by intuition I felt were probably not
pertinent to him [3]
(« What ! Are you
telling me that you have these really sadistic fantasies when you wank it
off ? Or do you sometimes drink your piss ? ») That made him
laugh ( well, a little ), and then he gave me an answer that I
understood as « If that was all it
was ! » He kept
saying that he felt too ashamed and then he said he was willing to write it to
me, but not to say it out loud and especially not when he could see me when he
said it [4]. So I agreed
to turn off the video function and cut off the sound from him to me. Jérémie
could still hear me, but the writing appeared gradually on my screen, like in
an ordinary Internet chat session. I went on talking to him, except at the
beginning when, to encourage him, I wrote a few ideas that revolve around two
fundamental human transgressions : « What do you have to tell me that you think is so serious? Have you
killed somebody? Have you sex with your mother? » J : « It’s almost that. » Dr H :
« Come on, Jérémie, explain »
Then, spurred on by my reactions and my specific questions, he wrote in brief
sentences that for seven years he had had incestuous relations with his sister
Joanna [5]. He felt
utterly ashamed, and he was convinced that he was totally to blame for it,
because he was one year older than her. However, they both took the initiative.
There was no constraint. Sometimes he had the idea, and sometimes it was her.
It was he who decided to stop when he was about 14 « because it was going too far »
( incipient penetration and ejaculations - « three drops, no more »,
he added, quite ingenuous ) Except towards the end, to use his words, it
remained « basic » ( i.e. no penetration of
any kind ) These intimate encounters took place while they were at their
father’s house or mother’s house, and they always kept it a secret.
As
he was explaining how this had gradually developed, I mentioned that in my view
this sex-activities had gradually changed from being banal sexual games and had
become incest because for a very long time they had been like partners and that
they had been each other’s only company and because, as Jérémie admitted, there
was a lot of affective complicity between him and his sister (« We got on very well. It was almost love » [6] )
His recent fear of death had started a fortnight after he found out that his
sister was not in good mental health and that she herself had consulted a
psychotherapist (« That
destroyed her too, and I was to blame for everything », he said :
« But she says that it’s not because
of that. We talk a little about it, but she says that it hasn’t affected
her ... that she remembers it like a nice dream »)
Of
course, this description didn’t come out all in one go. Once Jérémie started
writing, short phrases came up in quick succession, some of them spontaneously,
like a confession that has to be vomited out once it has started, and some of
them prompted me to ask questions about specific details. A few times I got the
impression that he was playing down some of the more embarrassing aspects
( the fact that it had gone on for a long time, the onset of puberty,
etc. )
Eventually
I had the feeling that Jérémie had just about said everything he had to say in
this first written session, so I asked him to switch the sound and video
functions back on. He didn’t object, so I could see live what happens after
someone confesses to serious wrongdoing. Initially all I could see on the
screen was part of Jérémie’s forehead, turned the other way and almost lying on
the desk. However, little by little, sometimes spontaneously and sometimes at
my prompting, he lifted his head and moved his face back into the field of
vision, and I was delighted to see that he stared at the camera two or three
times. In other words, he had the courage to look me in the eye.
We
then spoke for some time during the following part of the session.
◊ - First
of all, we engaged in a little ritual. I asked him to repeat after me, bit by
bit, the following sentence : « Dr
Hayez/with my sister/I engaged in/heavy/sexual activity/for several
years. » Although he was initially somewhat taken aback and
embarrassed, Jérémie quickly went along with this ritual [7],
then at my prompting he repeated the whole sentence on his own, and he was
relieved. It was just after this ritual that I once again had eye contact with
him. By acting in this way, I could be accused of being a control freak and
quite naive ( with an approach redolent of the Coué method ) However,
I have no regrets : I didn't make him say anything he hadn't yet said, but
I simply collated snippets of his own language and made the text into a unified whole.
The text is not of course of trivial and it strikes at the heart of the
confession he was brave enough to make, but I get the impression that this
helped us save time and that it was at this point that he understood that I
still wanted to listen to him and that I still had respect for him, despite the
fact that he had admitted and that I had heard the full extent of his
« crime »
◊ - We
then talked about the nature and meaning of what he had done ( incest or
simply sexual game ) and the responsibilities involved. Among other things,
I suggested he should get the book I had written about child sexuality [8]
and read what I said about sexual activities between brothers and sisters and
then discuss it with me.
◊ - Finally,
we talked about the seriousness of his actions, his self-esteem and any esteem
that I might still have for him. I didn’t want to reassure him too quickly
about this, but rather I wanted to listen first to what he had to say. After
that, I reminded him about the episode in the Gospel of John [9]
when Jesus spoke about the woman who had committed adultery : « He that is without sin among you, let him
first cast a stone at her [ to stone her ] … [they] went out one
by one, beginning at the eldest, even unto the last » [10].
He also asked me if it was just in the context of my work that I said that I
still had some esteem for him. We talked about this a little. I told him that I
basically continued to have esteem for him in my position as a human being, a
representative of the community in whom he had confided.
Before
signing off, we made an appointment for six days later, either by webcam or
live, whichever he preferred.
§ III.
In mid-crisis
A. In the two days that followed, I thought about Jérémie quite often and
after going over things in my mind for quite some time, on Sunday evening I
sent him an e-mail ( see annex 1 ) When I read it now, I still agree
with all the suggestions I made to him, except the first : if there is any
shared responsibility, it is 33/33/33 or, to be more precise, each party is also
100 % responsible ( the third party are the parents, for their lack
of vigilance !)
B. On Monday evening at about 5 o’clock, Jérémie called me on his mobile. He said
he was in a kind of quandary. He was relieved, but he also felt worse. He
mentioned my e-mail, which he said he agreed with, but he said that there were
some points he wanted to discuss again. I told him that if that was the case it
was probably because there were still some serious things to be said in the
20 % of issues that we had not yet broached. He agreed and asked me if he
could talk to me sooner, but « like
the last time, because I couldn’t look you in the face » I gave him an appointment by webcam
for the same evening at half past eight.
C. Monday 8.30 p.m. :
Jérémie kept the video and the audio channels on, but he hardly spoke or looked
at me. He expressed himself in writing, sometimes spontaneously and sometimes
in reply to my questions. I expressed myself orally.
◊ - Generally,
he was sleeping very badly ( he fell asleep at about 2 o’clock in the
morning ), and he was still very anxious. He asked me to give him medicine
to help him, but he knew the name of the medicine and had direct access to it,
because his father is a chemist. We put together a treatment based on
benzodiazepines, provisionally and subject to further adjustments and
prescriptions.
◊ - He
told me more about his feelings and the ideas that were then going through his
head about what had happened, partly in reaction to the hypotheses I put
forward in my e-mail. He still got on well with his sister, but at this point
they tended more to « tease » each other ( perhaps to keep their
distance ), and she no longer aroused sexual thoughts in him. Not only was
he ashamed, but he was afraid, fearing that his sister would talk about what
had been going on to the (female) psychologist she would be going to see and
that the therapist would then tell her mother ( she is a friend of her
mother’s ) This could mean for him a « terrible tongue-lashing » He would get all the blame, not only
because he is the elder brother, but also because, as he now admits, his sister
didn’t always consent - « But
neither did I ... »
Of
course, I promised to discuss this with him again. At that point, however, I
put forward my new hypothesis : that is, I said I had made a mistake in my
e-mail when I assessed the responsibility as 50/50, whereas it was rather
33/33/33. I got him thinking about the third 33% ( lack of vigilance on
the part of the parents ), and as he couldn’t find the solution right
away, I said I would leave it as an enigma for him to think about. He once
again stressed that it was he who wanted to stop when he was 14 years old
because « I felt I had been an idiot
for long enough »
◊ - Finally,
I asked him to tell me about some aspects of his incest in more detail. I told
him that he was probably still feeling bad because he hadn’t yet told me the
most difficult part. He claimed that he couldn’t remember right away, and then
he said « Oh yeah, it’s coming back »
I
tried to get him to describe what happened the first time. Initially he could
just remember one thing : they were in pyjamas in his bedroom and they
were giving each other a back massage. I also asked him what they were saying,
how each of them referred to the other’s sexual organs and the things they did
together, but he told me that all this happened in complete silence, and no
words were used to refer to the parts of the body or to what they were doing.
He told me once again that it was « basic [11] :
we looked at each other ... I touched her ... I didn’t masturbate at
the time » I asked him how he started masturbating. He discovered how
to practice himself when he was about 11 years old. I told him that that was
the way things happened for many boys and that that was the way it was with me
too : initially you have no idea, and then all of a sudden it’s as if a
little lightbulb appears from nowhere. I felt it was important to make him
understand that I was also sexual. When I insisted a little (« So you said to her, show me your ... ? »), he told me that he was hurt
by the words « show m »,
because that made it look as if he was giving orders.
Time
went by, and it was soon time to sign off. I told him that we still had work to
do and that we needed some more actual details for him to feel more free
inside. He replied that he didn’t have the courage to tell me face to face, but
that he would no doubt send an e-mail to explain. We made an appointment to
have a webcam session the following Wednesday at 7 p.m.
D. I sent him a second e-mail on Tuesday morning (see annex 2)
E. On Tuesday evening, his father left a message on my answering machine :
« My wife and I are worried. He says
he has a big problem that he talks to you about that he won’t discuss with us
and that he will be better after the Easter holidays. He’s not sleeping. Last
night he went to sleep with his mother, and held her hand until four o’clock in
the morning. He also told her that it would be better if he didn’t exist and it
would be best for him to die »
F. I phoned his father on Wednesday at 11 o’clock. I listened as he explained to
me once again how worried they were as parents. After listening, I replied that
the situation was similar to the example that I would give him, but that of
course the example does not concern Jérémie : « An 11-year-old boy pushes his enemy down the stairs, who is then
confined to a wheelchair. The boy doesn’t get caught and doesn’t own up. How
will he feel when he is 17 years old ? » [12]. Based on this hypothetical
situation, I discussed a number of ideas with his father connected with
tolerance and support. I told him that my feeling was that it would be better
for Jérémie to find a way to talk about it to him and/or to his mother, but
that it was important not to pressure him. Finally, I mentioned that it would
be good for him to say to his son at some opportune moment : « Children sometimes do things that are really
wrong, but real parents can listen and forgive »
G. On Wednesday evening, Jérémie missed his appointment and didn’t reply to a new
e-mail in which I asked him for news. I thought : Maybe I got carried away
with my desire to save him with a quick fix, and maybe I asked him too many
distressing questions, especially surrounding the question of « force or
no force » Of course, he would have to face it sooner or later, but had I
perhaps harassed him without meaning to ? I hesitated to send him another
e-mail to explain some of these thoughts and to remind him that he could talk
at his own pace. However, I eventually decided to let him see that he could win
and that I wouldn’t insist or try to pressure him. I decided to wait until
Friday, when we would have the next session, except if any emergencies came up
during the week.
I
felt that the fact that he missed his appointment was very good for
Jérémie ... and for me too. He could see that he was still free and that
he was not under my control as his therapist. As for me, it helped me cool off
in my zeal to save him. Lastly, it once again gave him - and not
me ! - the initiative to decide (freely) if he wanted to see me [13].
§ IV.
Emerging from the crisis
I. On Friday afternoon, his mother phoned me to ask if Jérémie had an appointment
for that evening. I said that he had, and that he could either come to my
office or use the webcam. For my part, I would agree to either arrangement.
II. He appeared on the webcam at the time we had arranged. Unfortunately, the audio system
didn’t work, so we had a written chat session, with the video function on. He
was concentrating on what he was writing ( that definitely suited
him !) He smiled from time to time, breaking the dialogue that I purposely
tried to « lighten up » Now and again, he would look furtively right
at the camera ( so he could see that he was looking at me straight in the
eye ), and a couple of times I said : « Come on, Jérémie, look at me ! », and he had the courage
to look me in the eye for a few moments. I still feel that this kind of
prompting was good for him. When I asked him to look at me, it wasn’t to judge
him, but to make him appreciate my fellow-feeling for him. Here is what we
talked about, in no particular chronological order :
□ - He
wanted to talk to me again about my e-mail from Tuesday, about what he saw as
the true and the false bits. I wrote : « Come on, man, I’m listening », then I put a smiley [14].
He once again stressed that he had never physically forced his sister. Of course, convincing me - and perhaps convincing
himself - was one of his most important objectives. The image he had of himself
would have been seriously dented if he found himself being accused not only of
being very sexually precocious but also of being an abuser! When either
of them didn’t want to, whoever did used charm and said « please », and this often got
results. I told him that if that was the case, no, it wasn’t force, but rather
a kind of game of seduction that is a feature of any loving relationship. What
was abnormal was the nature of their
relationship, which consisted of much more than simple sexual frolicking,
not the mechanics of their relations.
He then
talked to me about the fact that he still gave himself most of the blame,
because he was one year older. I replied that, if he had told me everything, I
still disagreed and that by giving himself all the blame he could be showing
what was tantamount to male chauvinist thinking and culture, as if girls were
brainless creatures. This made him smile. I asked him if he had solved the
enigma of the three 33%. No, he hadn’t. We talked a little about it again. He
could of course find two of the three parties ( his sister and
himself ), but he still couldn’t work out the third element ( his
parents’ lack of vigilance ) I asked him to keep searching.
□ - It
was then that he focused the discussion on what had triggered his sexual desire
for his sister when he was seven years old. He told me that it was something he
had seen that then became a picture in his mind that had often come back to him
from that very early age. For him, that was the enigma : why did that scene have such a profound effect on him ? Why did he think
about it so often ?
And
then, without realizing it, he described to me a beautiful wildly primitive
scene : his sister and he had seen horses mating [15]
and wanted to do like them. And this mating scene was branded in his mind in
fiery letters, triggering incest the first time and many other times and
remaining in his mind as a painful and lasting enigma.
One
of the specific benefits of written chat sessions came out when I saw that he
spelt the word « saillie » (mating) wrong ; he wrote
« sallie » ( with undertones of dirtiness ) and then
« saďe » ( that may suggest the idea of pain ) He added
that he could never spell the word « saillie » properly [16].
The point is that many children of his age entertain dirty or sadistic ideas
about the primeval urge behind the sexual act, and he had had unnatural
relations with his sister. From a therapist’s standpoint, the serendipity of
this Freudian slip was almost too neat to be true. I thought it best simply to
show him the correct spelling but to make no other comments ( as it would
have been rather churlish at that particular juncture )
I
asked him if at that time he had any intuition that what he had witnessed was
something to do with the transmission of life or if at that point he already
knew something about parental sexuality and where babies come from. He said
« No »
He
said no, but he wanted to imitate with his sister that powerful sense of oneness
between animals, and it was this imitation that he felt guilty about. He hadn’t
yet told me exactly how they had gone about it, and I told him that in future
sessions he would have to give me more details, to get more off his chest. In
the meantime, I suggested that perhaps he felt so ashamed because he wanted to
imitate animals - adult animals - whereas he and his sister were human and,
what’s more, children. No comment.
□ - Later
during the session I mentioned again to Jérémie that I was worried about his
sister’s possible psychological health. I told him that I didn’t believe that
it was as easy for her to live with it as she claimed. I told Jérémie once
again that he could talk to her about our sessions and that it might be good
for her to come and see me with him and talk about what had happened. He wrote
back that he would no doubt do that, but he wasn’t sure if she would agree to
come. But he said that she might agree to talk to me over the webcam. I replied
that I would be only too pleased if she did.
□ - At
one point during the session, we discussed the sense of inner release that he
now felt more strongly. Nonetheless, I asked him to get a sheet of paper and
got him to make a graph :
Ř
On
the x-axis, I asked him to put on a scale from 0 to 100% how difficult he felt
it was to tell me certain things : from relatively difficult, i.e. a
source (++) of shame and guilt, to very difficult (++++)
Ř
On
the y-axis, I asked him to mark off three levels ( 70 %, 90 %
and 100 % ) From these, I asked him to draw a horizontal line, and I
asked him to write the three phrases below. I then asked him to hatch the areas
that I represented as hatched, with a margin with question marks. I then
discussed the table with him.
If my sister agrees, I will talk
about it to my father.
?
?
?
?
Comments :
◊ - This
is how I represent his striving after an inner
release and reconciliation. The
hatched rectangle is the possible intensity of the release. I don’t know
exactly where it is on the x-axis, but I guess he’s already come a long way
( i.e. at least 80 % or even more )
◊ - On
the y-axis, the fact that he has already expressed himself to me as a
representative of the human community is in itself very positive, but I imagine
that his inner release will further increase if one day he tells his father
about it and asks forgiveness. However, his sister also has to agree to take
this step, preferably together. The father, who is separated from his wife and
doesn’t get on well with her, might agree to keep the secret. But the ideal
situation would be if one day the father and the mother could know about it,
react and extend their forgiveness ( 100% on the y-axis )
I
noted Jérémie’s reaction to the x-axis (« I feel much more of a release than you think ») and to the y-axis (« Woah ! » then « Woah!
Hold on ! ») I told him that I would never put pressure on him to
go faster or pressure him into taking decisions in this regard, but I told him
that I couldn’t help but think that if one day he could do it it would be
better.
□ - The
session ended. The Easter holidays were coming up, and I wouldn’t see him for
ten days. I told him that he could write to me if he wanted to ( and I
gave him my holiday address ) I then made the next appointment for a live
session.
III. The rest of the therapy is not uninteresting, but I think I have told you
enough to prove my point, that is, that the Internet was useful in this case.
One
final point. I know that Jérémie keeps Chilean degus in his room and that
he’s very fond of them. I know this because during a webcam session I heard a
noise and asked him what it was. He told me about the degus and showed me the
cage and one of these little animals.
In
this context, I think of Dolto and the importance she gave to direct and
symbolic payment of her sessions by her young patients. Given that to a modest
degree I have become intimately involved in Jérémie’s life ( I was
familiar with his room, etc.), I decided on a plan: towards the end of the
therapy or the first phase of the therapy, I would ask him to give me one of
his favourite degus, along with a cage and instructions on what to do with it.
I thought about finding a place for it with some children or in our waiting
room. I was thinking that he owed me that and that anyway that wouldn’t be a
problem. He would be quite pleased at the idea of this living, real and
symbolic representation of a kind of link between him and me.
§ VI.
Discussion
I will confine myself to discussing the impact of the
Internet on this phase of Jérémie's therapy.
I. Rightly or wrongly, I was convinced that if we had had only physical meetings,
because Jérémie was paralysed by inhibitions it would have taken months for him
to pluck up the courage to talk to me about the incest, or he might not even
have ever talked about it. He felt the need to get it off his chest, of course,
but he also benefited from this strong feeling of security afforded by Internet
chatting that allows many people very quickly, once a sense of trust has been
created, to feel comfortable enough to express many intimate things. Sometimes strict anonymity makes it easier to
talk about oneself ( sometimes this is not the case when the chatters know
each other ) However, whether communication be via a webcam or a simple
written dialogue, without any visual implications, what is said is always
coloured by the following paradox : the impression of tremendous
closeness, warmth and encouragement ( for example, we could see each other
close-up attentively listening to each other and our voices resonated ),
and, what's more, there is the certainty of
total protection from any intrusion by the other person.
Colleagues
have told me that in certain circumstances the webcam can be a modern-day
confessional. I think the comparison holds. In a confessional, a thick timber
frame is there to protect the penitent from the thunderbolts he imagines may be
hurled down by the gods. And then the pattern of holes in the screen creates
the same impression of a moving face. Moreover,
an experienced father confessor is supposed to be empathetic and open ...
just like a psychiatrist.
In my notes on the sessions, I hypothesized that when
Jérémie was looking straight into his webcam he was looking me in the eye. This
is actually what he appeared to want to do whenever he became aware that I was
looking at him too ( because my face was displayed on his screen )
Is that what we do at these times : looking at each
other, divining the person behind the image ? I think I can answer in the
affirmative: all webcam users whatever the circumstances ( whether it be
festive, informal, etc.) confirm their impression that they are not in fact
navigating in a virtual world, but they are genuinely in contact with real
people who communicate by electronic means.
Does
this form of expression have the same power to offer inner release as the
physical meeting of two people, i.e. the therapist and the patient ? I
would say more or less. It is even an accelerated release, but it is, I feel,
only definitive if it is followed by one or more physical encounters of the two
people concerned. They can then see whether they were under an illusion when
they were talking on the web. This is the ultimate test. It applies the
indelible seal of reality. It is only then
that each side dares to open up to the other person ( spiritually and
physically ), giving him something of himself, risking the
unpredictability of the reaction of the other person who is quite close. The
breath of life then envelops both of them and confirms - in a good case
scenario - that what they experienced on the net was not an illusion. Therefore,
even for patients who live very far away, it is essential to alternate between
webcam sessions and live sessions, even if the alternation cannot always be
perfectly coordinated (1/1)
II. Two more advantages of using the Internet
1. An encounter with a teenager in one of his favourite
worlds : Although both our computers were on, symbolically it
was I rather than he who had stepped into a different world, a territory that
is highly favoured by teenagers. I had gone to visit Jérémie, and he
appreciated that. This increased his desire to confide in me, as I could show
that I was close to him [17]. Not all
adolescents would have been so appreciative! This is a possibility, therefore,
that we should take the time to negotiate, on a case-by-case basis, and it
should not be undertaken if the teenager regards it as an intrusion of his
privacy. Moreover, even with adolescents who accept this communication, I don't
think it is good to be too often hanging around their world. There's a need to
alternate. Sometimes they too have to enter the adult world from time to time
and think.
2.
Speed and flexibility as regards the scheduling of chat sessions : Combining e-mails and chat
sessions ( written or audiovisual ) with physical sessions [18]
provides for tremendous variety in terms of timing, duration and meeting
format. It helps the therapist to adapt to the teenager’s schedule and to his
very intense, fluctuating and fast-moving emotional life. For example, I responded to the acute feeling of
distress expressed by Jérémie on Monday by taking him by surprise and
suggesting an appointment for the same evening. He probably felt that he was
being taken very seriously, which was very positive for the quality of our
relationship.
Nonetheless, the therapist should not feel obliged to
respond to what the teenager sees as urgent needs, calls for help that are
prompted more by attention-seeking than any tangible
concerns. It is the professional himself who retains control of the process. He
can always - indeed, he must - keep to a set schedule while remaining
receptive to the ups and downs in the life of his young patient. Being
attentive to his deep emotions can certainly help him to open up the floodgates
and to express deep-seated thoughts, feelings and issues. Also, inducing him to
keep within the boundaries of the ritual of bilaterally agreed appointments can
help him to savour more tranquil moments of reflection and to work more
effectively on the principle of social reality. One really interesting aspect
is the combination of ritualization ( that in most cases includes physical
face-to-face meetings ) and more unpredictable moments when the therapist
has to be immediately responsive to the intense experiences that the patient is
going through.
But the
question may be asked : Must the therapist be so generously available to
teenage patients ?
I
rather think that the answer must be yes. It must be remembered that not even
twenty years ago we unhesitatingly had our patients for sessions three or four
times a week. Evelyne Kestemberg used to say that in the course of an afternoon
of consultations with teenagers you always have to leave some free time for
unscheduled visits and not imagine that they are all going to fit neatly into
the slots arranged by adults, like little soldiers all in a row. You have to
give them much more time when they are going through more intense crises and
you must always be flexible. Of course, we shouldn’t feel that we have to be at
their beck and call every time they come to see us with what may be a pressing
or disguised need for affection or with what may be a rather hysterical bout of
anguish. The therapist has to strike the right balance for each young patient
and for each phase of the therapy.
3.
Flexibility in the use of communication channels : In addition to straightforward
face-to-face physical contact, written chat sessions that involve absolutely no
visual contact and e-mails, there is a whole range of intermediate
possibilities. I made use of these different degrees of contact according to
the situation, letting myself be guided by Jérémie’s tolerance or by my
perception of what was best for him ( I sometimes insisted that we switch
to a different level of contact )
Rather
than simply draw the conclusion that Jérémie’s need to hide sometimes from my
gaze was a harmful avoidance tactic, we should perhaps bear in mind the ritual
adopted in conventional psychoanalysis, where the patient cannot see his
psychoanalyst, but he can be seen by him. Was this position adopted to help the
patient think, without being distracted? Perhaps, but might it not also be the
case that this is done to create the impression ( or even the
illusion ) that he is out of sight and therefore beyond judgment ? Here, in practical physical terms, it is not the
same thing. It is Jérémie who sometimes decides that they should both go
off-screen. But isn't that just another way of getting the same result ?
Nonetheless,
when using this flexibility we must be prudent yet bold. The webcam sessions
can never completely take the place of face-to-face encounters. After all, a
face-to-face meeting is an irreplaceable human experience that involves the
geographical proximity of two beings ( body and spirit ) who can see
each other, dialogue and adapt to each other’s unrehearsed movements. The
therapist acts as a witness for the community and can therefore represent it
and extend forgiveness from the community for the error committed, but such
forgiveness can be embraced in all its forcefulness only if it is extended
through the intimate contact of two persons who are close. The teenager must be
willing to take a risk and sit a few feet away from the therapist and then see
for himself, as it were, in the flesh that instead of succumbing to the wrath
of God, he receives kindness, friendship and forgiveness. Until such time as he
has been through this real and symbolic experience, he will be beset by too
many doubts.
III. In the course of this series of exchanges with Jérémie, I came to appreciate intensely
what it is to feel ashamed, to feel the sense of shame gradually emerging. The
feeling of shame wells up when someone feels that he has not only transgressed,
but that additionally and very specifically he has done something that is
dirty, disgusting and degrading. An infantile sexual experience is often
portrayed in this way by adults. This notion had been inculcated in Jérémie,
and it caused his sense of shame coupled with guilt. Is a child therefore more
predisposed to shame when he pictures his naked body doing things that are not
very noble ( fondling a little girl, rather than « screwing » an
older girl of 15 or 16 ) ? No doubt ! However, it may also be
that he was concerned about the simple fact that they were naked, perhaps even
without having any sexual intentions, at an age when they might be expected to
have a sense of modesty. Does the Bible not teach that just after they
committed the original sin Adam and Eve saw each other’s nakedness ( they
were simply naked, without any suggestion of a sexual transgression ) and
they were ashamed ?
In
any case, that is the kind of shame that Jérémie felt, with its highs and lows,
when he came face-to-face with me. And in this context the Internet was a
tremendous asset that enabled him to express it and come to terms with it at
his own pace. Also, it enabled me to listen to him and observe him
respectfully.
I
believe that, even though it may appear to be inspired by the Coué method, one
of the tentative steps I took at an early stage in the therapy ( having him
repeat the phrase : « I engaged
in sexual frolicking ») helped show him that I wasn’t going to fuel
his sense of shame by pointing the finger at him, but rather that I wanted to
relieve his anguish.
When
we are ashamed, we are afraid of receiving reproof that makes us feel dirty or
ridiculous because we are naked ( metaphorically or literally )
Indeed, Jérémie said of himself : « I felt I had been an idiot for long enough » ( he didn’t
mention being bad )
When
we feel guilty, we are afraid of the wrath of Zeus.
Jérémie
was beset by these two feelings.
IV. Why did I suggest that he read extracts of my book?
In
addition to the fact that I felt that this might save time ( by getting a
general overview of my thoughts on a particular subject ), it was also a way
for him to find out what I thought « objectively », that is, without
any reference to himself. He could read my thoughts as I communicated them in
public. This would nip in the bud any notion that he may have had like « OK, he says that, but he’s just saying it
for me, because it’s me, but he doesn’t really mean it »
ANNEXES
Annex 1
: My first e-mail (the first Sunday evening)
Dear Jérémie,
I was very touched by the
courage and confidence you showed. Here are a few of my gut reactions :
- If things happened as you have explained,
you are wrong to assume all responsibility. Given the fact that you are about
the same age, it’s 50-50.
- Now that you have embarked on something
and, what’s more, you have come quite some way towards freeing yourself from
something that is very heavy on your mind, you have to go all the way. You have
probably told me 80 % of the problem, so there is still 20 % - the
most difficult bit, the things that make you even more ashamed ( for
example, I am somewhat puzzled by the episode of your three drops of
sperma ... Were you both in early puberty in the later years? Could she
have got pregnant if you hadn’t stopped ? etc.)
- I understand that this is very heavy on
your mind. Your experience is not something banal. It’s not just a case of a
few weeks of sexual frolicking one hot summer. In fact, as young partners you
were involved in a total and long-term relationship... If you read my book, you
will see that what you did was probably somewhere « in
between » real incest and sexual frolicking.
- Try to talk with your sister and
look her in the eye ... It might be just for show that she says that she
has come to terms with it. This is no more likely for her than it is for you.
Try to ask forgiveness of each other for a serious mistake from which you have
to move on ... Tell your sister that I would be glad to meet her some time
with you ... You can find some pretext to come over to my place for your
father, to safeguard your intimacy ( for example, to talk together about
your relationship with your mother, which I know is problematic )
- Aside from your guilt, are you also
afraid that your sister might let the cat out of the bag by going to see
another psychiatrist ? If so, ask her, but of course you can’t make any
demands.
- Lastly, is all this episode of yours over
for good ? Is your sister still an object of your sexual fantasies ?
As you see, we still have our work cut out
for Friday. Webcam or live ?
Annex
2 : My e-mail on Tuesday morning after the crisis session the evening before :
A. The actual e-mail :
Hi
Jérémie,
Here
are a few suggestions for tomorrow:
-
Work out the enigma of the 33/33/33 ( it’s not very complicated )
- Try to talk to your sister in
depth ... I don’t think she would be prepared to reveal such intimate
things to a psychologist who is her mother’s friend ... So she may still
be « burdened down » ... Suggest to
her again that she come to see me with you and find a pretext for coming
( after all, you’ve made hiding things from your parents an art form for
years ) ... You’ll think of something... And this isn’t something
wrong that you’re doing, it’s your RIGHT ... At your age, you’re entitled
to keep some things private from your parents, so find some way so that they
don’t ask questions.
-
Don’t open the attached document until tomorrow at 5 p.m.
- Tomorrow and on Friday, we’ll work on the
webcam, but next time I’d like us to have an IRL session [19].
Yours,
JYH
B. The attached
document:
Dear Jérémie,
For you to have real inner release, you’ll have to
talk about the most difficult bit, i.e. the few remaining percentage points.
Here are some ideas that sprang to mind
that might help :
- Talk about what really happened the first
time or the last time ( Did you penetrate at all ? Didn’t you breach
your sister’s hymen ?) Or talk about something that you are particularly
ashamed of.
Was it really done in silence, or is it
that you don’t like thinking about the words that were said or the kind of
scenarios that you devised ?
The most difficult question, and one for
which YOU have to be totally honest, is: How much of the time were you both
consenting ? When did you not agree to it ? When did she not agree to
it ? And when she didn’t agree to it, what percentage of the time did you
feel like it and you forced her ? And how did you force her ?
- etc.
All this isn’t easy, Jérémie, is it ?
OK, but that’s what it will take to make your future life a success ...
Yours,
JYH
Key
words :
INCEST BROTHER SISTER, incest
among siblings, sexplay among siblings, neurotic guilt in an adolescent,
online
psychotherapy, online therapy online,
psychotherapy via webcam, therapy via webcam, psychotherapeutic use of
Internet.
Notas