The Problem with Pleasure

ABSTRACT

Survivors of severe, chronic childhood trauma, including those with dissociative disorders, present for therapy with a wide range of symptomatology that interferes with daily functioning. Fragmentation and PTSD disrupt the capacity for integrated and satisfying relationship development, which affects the social, professional and intimate lives of survivors. The problem with pleasure–that pleasurable stimuli are often not experienced as such by survivors–is generally not addressed in the literature This paper posits that clinical attention to the problem with pleasure may significantly enhance therapy, engendering substantial gains in resiliency that may allow some survivors to more easily overcome the circumstances of extreme neglect and abuse. This paper discusses four primary domains that are affected and that have implications for problems with pleasure: excitation and hyperarousal states, the capacity for self-soothing and the problem of numbing, skill development and skill deficit, and core belief systems and attendant script decisions. This paper posits that by understanding more fully the interconnection between these capacities and deficits, therapeutic work with survivors can be enhanced, with greater engagement of their resiliency, and hastening their recovery through the restoration of pleasure.

KEYWORDS:

• Pleasure
• childhood trauma
• child abuse
• trauma survivors
• resiliency