Valerie Sinason Talks to Graeme Galton, Spring 2003

Article in journal “free associations”, Vol 10, part 4, No 56, Autumn 2003, Karnac Books

Valerie Sinason is a child psychotherapist and adult psychoanalyst who is well known for her pioneering work with learning disabled patients.

For the last decade she has also been at the forefront of the growing awareness and understanding of ritual abuse and the ways that psychoanalytic psychotherapy can be used to treat its victims. Sinason has played a key role in developing the current understanding of the psychodynamics of this abuse.

This controversial work has also focussed on establishing the traumatic aetiology of dissociative identity disorder (DID) and has highlighted its link with ritual abuse. In 1998 she founded the Clinic for Dissociative Studies, which has seen more DID patients than any other single treatment centre in the United Kingdom.

This interview took place on 16 April 2003, sitting in the garden of the clinic in north London.

INTERVIEW

Graeme Galton: You're perhaps best known for your learning disability work, and it's now 24 years since you saw your first learning-disabled patient and I was wondering what feelings you have about your pioneering work in that field?

VS: It feels very strange because that's the field that I thought would be my only field for the rest of my life. So I have a sense of loss, despite the fact I'm still deeply involved in it, both with working one day a week at St George's Hospital and also working with learning-disabled clients who have been ritually abused or have dissociative disorders.

I also have an incredible sense of pleasure that things which were seen as impossible or mad, that amount of time ago, are now really deeply accepted and established.

The Government's White Paper on valuing people is now saying what we were saying 25 years ago, things that we were really seen as mad or pollyanna-ish for even considering, at best. So I have a sense of one part that is complete, in terms of the need to make something get properly into the mainstream social arena and not be marginalized.

There is sadness over the fact that although access for treatment is accepted, in principle, and it's understood that having a disability does not diminish your feelings or fantasies or thinking about it and about life, the lot of an individual with a learning disability is, in itself, not that much improved.

The outer covering might be better and somebody might be in appropriate clothes for their age. They might actually have teeth, instead of having them pulled out because it was such an effort taking people to the dentist and bothering about the communication when they couldn't say where the pain was.

There were hospitals that, out of what they thought was kindness, removed peoples' teeth. Of course, that led to them looking different, as well.

Now you're more likely to see well-dressed people, where their appearance doesn't carry a great signpost, `I have a learning disability'. But the emotional experience of that difference is not likely to have improved much. (...)

GG: You said that learning disability was the field where you expected to work for the rest of your professional life, and I'm interested in knowing what it was that led you, in that case, into the work with ritual abuse and dissociative identity disorder.

VS: The irony is, of course, that it was through a learning disabled woman, otherwise I may never have got there. It was a Swedish psychologist, Anders Svensson, ringing me at the Tavistock Clinic because of his terror at the kind of things a woman in Sweden, with a severe learning disability, was saying.

He asked me to send what I'd written about abuse and disability - this is 12 years ago - and I did and he said, `That doesn't help. Have you anything on more sadistic abuse?' I sent something else. He said that didn't help. I then sent something unpublished concerning torture and he said that was closer.

I felt a twinge of narcissistic injury that nothing I'd written approached anything near the subject, as well as curiosity. What could this be? He asked if he could ring me at home and I worried whether there was something really disturbed about him. There was something so palpable about his terror that I arranged for him to ring me at home.

He was working with a woman with a severe disability whom he had been asked to see because she had suddenly started self-injuring and no one understood why. She was able to show him she had been hurt and there were marks on her and so, because it was Sweden, and not England, the police were called immediately.

But no DNA was taken - we still have not got to a point where that's automatic - but it was accepted she had been raped and hurt. At the same time, there was also a highly publicized recent murder of a child in Sweden that had not been solved.

Anders and I began a period of, ironically, nine months, where both of us, in our unpaid time, gave an hour a week for joint discussion. For Anders it was more. He would tape the patient, send me the tape - so I could hear her intonation in Swedish, to get a sense of the emotions - and an English translation, and then phone me for an hour's supervision.

Every week the narrative of the patient would go a bit further. We put some examples in a joint chapter in the book I edited, Treating Survivors of Satanist Abuse (Sinason, 1994).

For instance, the patient would say to Anders, Mummy's cold and hard and smells'. Anders sounding shocked,But your mother's dead'. The patient crying, I don't know, I don't know'. In the luxury of the supervision position, I could say,Whenever a patient says, ``I don`t know'', they do know but they don't know you can bear it.

And it could be a bereavement psychosis, we don't know what it is, but you pre-empted her response by saying, ``But your mother's dead'', sounding so shocked yourself'. The next week Anders would go back, You said your mother was cold and hard'. Then she could carry on,Yes, but they said if I lie on Mummy, now she's dead, they won't hurt her any more, now she's dead'.

Each bit where Anders could not bear it, and I supported him, the patient was then able to tell something a bit more that was even worse. I felt sick and petrified every week and I had no means, at that point, of understanding the difference between being struck dumb and confidentiality. In other words, I used confidentiality as a defence against hiding the fact that I was terrorized, even living in another country, by the traumatic secondary counter-transference. And I didn't realize.

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