And Even the Rocks will Cry Out: A Psychotherapy Story
Updated: Oct 12, 2020
By Terry M Pace (October 10, 2020)
He (Jesus) replied “I tell you that if these (people) keep silent, the very stones will cry out. Luke 19:40 (AMPC)
There are of course many interesting theological discussions over this New Testament passage from Luke. But I am not setting out to address any of these directly. My story is much simpler of one little girl in one time and place. Yet this biblical verse always comes to my mind when I recall my time of working with her as her psychotherapist. You see, I am a psychologist that for most of my career held a general practice with a holistic family care model for how I worked and who I saw. I also had received substantial experience and training in pediatric psychology, thus children with combined medical and behavioral problems were often referred to me.
The little girl in this story was around the age of 10 and was referred to me from a family practice doctor. She had been sexually abused by a much older adult male relative who had been tried, convicted and was serving a prison sentence. My patient had been having headaches and stomach aches since her school had recently started back. Her doctor had done a through medical workup and not found any obvious underlying medical diseases and believed her headaches were tension related from her distress. Though my clinic was a 4 -hour drive away from the small town where they lived, there were not many services closer and they trusted the physician who knew me well, so they had confidence in his recommendation.
Her mom always brought her daughter to her appointments with me. I usually spent about an hour with the little girl and about 30 minutes with her mom or with the two of them together as we first addressed the headaches and just getting to know one another and build rapport while I gained a deeper assessment of her life and the trauma she had suffered. Mom was a single parent who worked full time, but thankfully had a flexible schedule as a caretaker. Of necessity, her therapy was being paid for from a court fund reserved for such situations, otherwise, I am sure this family could not have afforded therapy. lol My patient had been an outgoing, socially active, sports loving little girl prior to being sexually assaulted over a period of a few months until her mom noticed behavior changes and was able to draw the painful experiences from her daughter. Legally, the case had been prosecuted rather quickly and the abuser had received a long prison sentence. However, until these sad events happened, he had been a close and trusted, loved family member. It seems hard to understand, but the most common child abuser is an older male family member who is trusted by the child and those around them. Of course, like most abusers, he had threatened to harm the patient’s mother if my patient ever told on him, thus the girl’s delay in speaking up, which is again a common tactic of abusers. In such cases, the trauma can become very complex, to include the actual sexually assaultive behaviors, the betrayal of trust and violation of love and the terror of the threats; all of which tend to cause shock, isolation, depression, fear, anger, memory, impulse control, and academic problems with altered moments of self-blame and sometimes efforts to try to please or reconcile the broken abusive relationship as a means to restore trust and reduce fear, helping in moments to manage the horribly disruptive emotions and accompanying physiological stress effects.
There are several approaches to helping children heal from such trauma, including a number of traditional play therapies, family and systemic therapies, cognitive behavioral therapies and narrative therapies. Often psychoeducation about abuse, trauma, sexuality, families and peer relationships are integrated over the course of most such therapies. Psychotherapy for child sexual abuse trauma has been found to be substantially effective at improving self-esteem, reducing traumatic triggers, engaging kids in normal peer relations and activities, improving sleep and reducing negative physiological health effects, improving academic performance, and improving parent child or family functioning; all important to a child’s normal development and quality of life. But it is a delicate form of therapy for a very complex problem.
My patient was such an outgoing little girl who had established a good sense of basic self- esteem and trust in her mom and others prior to being abused, so she had built up resilience gifted by an otherwise healthy and loving single mom, who placed her daughter’s well-being first in her life. Of course one of the predictors of a good response to child therapy or trauma therapy in general is having loving, trusting, adaptive family relationships, and so she had many strong indicators for a good prognosis.
I saw her roughly weekly for about one year. As is often the case if the abuser is out of the picture and there is a mainly stable and loving family, her headaches and stomach aches went away on their own after she had simply gained some reassurance and education with a focus on her basic strengths while also talking about the abuse (though often specific self-management coping skills or social skills may need to be taught). With a little time she was able to tell me about the abuse in detail, and to master the story without being terribly triggered and decompensating, which fosters desensitization and begins to take the power away from the abuse and place it back in the control of the patient. We developed a predictable routine in therapy which can be comforting, reduce anxiety and build trust. Generally we would begin with weekly “small talk”, or updates about home, school, friends, activities and move toward the topic of how she felt today, which I would share empathy for, provide education about and sometimes share a story of my own about coping with some event as a means to build connection or offer a model for coping (including serving as a model for being distressed and still knowing that distress can pass and be coped with).
We then typically played a game or shared an activity, often drawing or creating puppet shows for each other, though some days playing other sorts of cooperative building or imaginative games with the various toys in my office. Then, we discussed any remaining issues, shared in reviewing our time together and planned what we each felt we wanted to speak with mom about or how I could help the two of them talk over any concerns they had with each other.
While every patient is an honor to see, as with anything one does daily for a living, remembering each day and patient over the years is impossible. But there are many patients I do remember for one reason or another. In this case, it was this little girl’s self-guided creative expression with a pile of rocks I kept in a basket in my office. In my own youth, I loved playing with rocks, of course growing up on the farm and playing alone a lot, one has to find ways to make up things to play With. One thing I had plenty of to play with was rocks, so I learned to see them in the shapes of animals or faces or interesting designs. I had other kids over the years who enjoyed looking at the rocks, building them into fences or pretending they were buildings and so on. I recall several kids who turned the rocks into bombs to destroy other toy animals and figures with! Oh those were the days! But, I had never had a child see the art and expressiveness in my pile of rocks.
So one day, about midway through her year of therapy with me, she asked to look at the rocks. As she dumped them out on my office floor, she exclaimed that she saw faces in the rocks (of course so did I), but as expected we both saw only the faces we each knew. After naming a few of the rocks after family members or friends and telling me about each person, she became quiet and had soft tears in her eyes. I was quiet too, offering a head nod and gentle smile, but remaining still and saying nothing, as I knew whatever she felt or had to say was more important than any wisdom or reassurance or guidance I could offer at the moment. She picked up a rock with one side rounded and smooth and the other side full of cracks and breaks. With tears running down her cheeks, but no audible sobs, she calmly looked at me and said “this rock looks like my uncle” (who had abused her). She said he acted all nice and smooth and friendly, like one side of the rock, but became mean, hurtful and threatening at other times, like the “broken” side of the rock. While such an insight is common in effective therapy, it was also the sense of control she was gaining, the ability to separate her abuser from herself or from others and to act with hope in the face of adversity.
What happened next left even me with an amazement at the possibility for healing and human resilience. She softly said, “I don’t need him anymore, he is broken, I’m putting this rock back in the basket, so we can play with the others that are happy.” And happy they were! Though she was so much happier and healthier after the year of normal growth, our therapy, school success, enjoying friends once again, joining a basketball team, and mom’s relief and attuned parenting; trauma does impact the brain and is developmental thus is most likely to re-emerge at times of high stress or life transitions. But for now, she had gained all that was needed to carry on and build her own life. And so, I remember leaving the office the day when she found a healing message in the rocks and recalling Luke 19:40 “the very rocks will cry out”, and they did! Thankfully I was blessed to be there and to be a witness to this medicine in the stones.
PS: All identifying details have been changed and much left out of this story for the sake of telling it with confidentiality and brevity. Any resemblance to any person real or imagined is purely coincidental.
A good companion reading for this story is Annie Dillard's wonderful book "Teaching a Stone to Talk (2013) in which she explores the intermingling of nature and human meaning.