An Interview with Steven Levenkron, MS on Women's Childhood Sexual Abuse
Dr. Van Nuys interviews psychotherapist Steven Levenkron, author of many books, the most recent of which is "Stolen Tomorrows: Understanding and Treating Women's Childhood Sexual Abuse". Accordingly, the interview focuses upon the nature and treatment of women who were sexually abused as girls.
Levenkron defines sexual abuse broadly as sexualized contact between an adult and a female child between 1 and 13 years old. Girls who have been abused experience pain and terror. They come to believe that "no one will ever protect me again" and come to act accordingly. Attachment and behavioral disorders may follow, as well as depression, social withdrawal, obsessional symptoms, and trememdous self-blame and self-hatred. The longer abuse remains a secret, the more opportunity occurs for these symptoms to become institutionalized in identity. More severe cases of abuse may result in dissociation, and dissociation-related psychosis (not schizophrenia-style psychosis). Clinically, abuse victims may present with eating disorders, a tendancy towards self-mutilization (e.g., cutting and burning one's self), presumably personality disorders (although these are not described), and precocious addiction and/or sexuality. Victims may also avoid sexuality entirely, and go so far as to make themselves physically and emotionally unattractive (e.g., by becoming obese, by dressing poorly, etc.). Victims may slide into further victimizing relationships, as abuse has become normalized, or may act out pseudo-abusive relationships with others through sexual domination activities.
Levenkron's approach to therapy is long term and based on the formation of a trusting therapeutic alliance, and a lot of psychoeducation. Essentially it appears to be old-school process oriented psychodynamic therapy although he has labeled it the Nurturant-Authoritative approach. He describes working to help patients find a language through which to communicate their experiences and emotions. a therapy goal is to help patients redirect anger away from the self towards the perpetrator, which seems admirable until you realize that angry traumatized patients are only slightly better off than depressed traumatized patients. There may be more to the approach (e.g., anger management?) but it is not described in the podcast.
Though Dr. Van Nuys states in the podcast that he feels comfortable recommending Mr. Levenkron's book, I (Mark Dombeck, Ph.D.) came away from this podcast with the impression that Mr. Levenkron's approach to therapy is perhaps not as scientifically sound as it should be. No connection was made between sexual abuse and "cluster B" personality disorders (e.g., borderline personality disorder) though the connection is surely there given the symptoms he describes (e.g., self-mutilization, dissociation, etc.). Making this connection is vital becuase many advances have occurred in how best to treat such conditions. There is no mention of dialectial behavioral therapy which is the state of the art for treating borderline personality, or even of the more recent but still empirically studied transference focused therapy. Mr. Levenkron's grasp of the neuropsychology of memory and trauma, which he volunteered without prompting, also seems distorted (e.g., while the amydala may become enlarged in traumatized patients (I'm not sure if this is the case, but let's assume it is true for the moment), it is most certainly not becuase trauma memories are taking up "extra room". I can't tell if this is simply figurative language for the benefit of listeners or if it represents a real misunderstanding). I don't doubt that Levenkron is a compassionate, caring, knowledgeable and in many ways expert therapist, but I am nevertheless left with some concerns.
Links Relevant To This Podcast:
About Steven Levenkron, MS
Steven Levenkron, M.S., along with his wife, is author of the 2007 book, Stolen Tomorrows: Understanding and Treating Women's Childhood Sexual Abuse. He is a well known psychotherapist in New York City and the author of seven books, both fiction and non-fiction. He is known for his original and groundbreaking work in both the theoretical conception and clinical treatment of Anorexia Nervosa, Self- Mutilation, and Obsessive Compulsive Disorder. His clinical work with patients, began in 1970 and is based on the Nurturant - Authoritative approach that he developed as a direct result of treating the victims of these endangering disorders. In his private practice he has assisted many young people in their recovery from these serious disorders, helping them back to healthy productive lives. Together with his wife and co-therapist, Abby Levenkron, he continues to see patients in his New York office.
Mr. Levenkron is an outstanding therapist - KL - Oct 7th 2010
I completely disagree with Dr.Van Nuys! As a survivor of years of abuse from my childhood & youth, I had the opportunity to consult with Mr. Steven Levenkron about my midlife issues with eating disorders, depression, family traumas, etc. & Mr. Levenkron knew EXACTLY what I was dealing with & worried about (including my current thyroid-related problems...) & spoke with me in a way that really resonated because I knew he understood. As far as Dr. Van Nuy's argument about borderline personality disorders & abuse, etc., I would disagree again. It is well known that nearly everyone who takes such an assessment WILL come out as borderline. Despite clinics & psychiatrists who still search for such problems in their patients ... it is an area that is not being tested well or necessarily understood or treated well. To single borderline personality disorders here in this review as a criticism of the excellent Mr. Levenkron is, well, silly (IMO).
forgiveness offsets rage - chris - Oct 27th 2007
Having been a victim of sexual abuse, and witnessing the effect my father's abuse had on my oldest niece as well, I admit that the abuse causes serious psychological distortions and defects. Working through is excruciatingly painful, and the residual anger impairs one's capacity to have healthy relationships. Eventually a moment arrives when one forgives and experiences an expansive sense of connection, grace and inner peace. Without the capacity to forgive and perceive abusive traits in oneself, the cycle of rage and acting out will continue. A benefit of trauma is that once resolved it enables greater understanding and appreciation of the world and other people. A humbling yet ultimately ennobling and enlightening experience that adds depth, breadth and clarity to one's perceptions of humanity. Levenkon retains a simplistic grasp on what is actually a complex and arduous process, which allows entry into horrific then exhilerating inner and outer realms. Evil and goodness are not binary opposites or mutually exclusive, but intertwining realities capable of being triggered in all human beings. Consider the abuse Jews committed among themselves while in concentration camps to try to comprehend this notion. Sons stole bread from their fathers to survive. At root level, all of us are capable of atrocious acts of cruelty and supreme acts of kindness. Most perpetrators were once victims. Deflecting anger merely fuels the continuation of the cycle of abuse as victim switches to abuser. I now have a positive relationship with my father. People change. I too have warmed and softened. Rage melts into grief then transforms into compassion and broad awareness. Trauma can facilitate intellectual, psychological, emotional and spiritual growth. Levenkon truncates and minimises a potentially liberating process by paying too little regard to the perils of condoning anger against the perpetrator as the final solution. He lacks insight and wisdom.
and men - The man called Anne - Sep 6th 2007
A very interesting and important issue of Wise Counsel. Since I know also a couple of male victims of sexual abuse, in my mind I was comparing Levenkron's remarks to their cases, while he was seemingly exclusively taking about female victims.
A lot seems applicable. I wonder what the doctor would have to say about this.