Treating the adult survivor of childhood sexual abuse: a psychoanalytic perspective / Jody Messler Davies, Mary Gail Frawley

Copyright 1994 by BasicBooks

CHAPTER 10 Transference and Countertransference: A Case Example

TO CLARIFY FURTHER the way in which transference and countertransference develop and are analyzed within the treatment of a sexual abuse survivor, this chapter is devoted to an extended case vignette. Belinda is a strikingly attractive, 36-year-old woman who has long wavy black hair and big green eyes. She has been in twice weekly psychoanalytic psychotherapy for 6 years. This patient was the only child in an upper middle-class family in which both parents were successful professionals. After graduating summa cum laude from a small, regional college, Belinda's mother attended on scholarship an Ivy League professional graduate school where she met Belinda's father, Timothy. Angela and Timothy married the week after they graduated, and Belinda was born 3 years later. The pregnancy was unplanned and resented by Angela who felt that it had cost her an important promotion. Timothy, on the other hand, welcomed the birth of his daughter. Belinda's perspective on her parents' marriage was that Angela belittled her husband for failing to live up to his potential and to promises he had made to her before they were married. Although successful, he was not as career-driven as his wife, and Angela apparently resented this. By the time Belinda was 7, her mother's verbal denigration of Timothy was consistent and vicious. Angela worked later and later more and more often; Timothy frequently slept in the guest room, and he began to drink heavily at night. Belinda now surmises that her mother engaged in one or more extramarital affairs during Belinda's childhood. Belinda's childhood relationship with her mother seemed focused around a morning ritual during which the child watched in fascination as her mother carefully attended to dressing and arranging her hair and makeup. Except for this daily interaction, Belinda saw little of her mother and was left primarily in the care of her father and a series of nannies. Belinda's sense was that, as a child, she yearned to be as important to her mother as Angela's career seemed to be. Belinda felt inadequate and somehow "wrong" for her inability to win her mother's interest or affection. On the other hand, Belinda adored her father and also felt sorry for him. They often dined alone together in the evening. Sometimes, Belinda sat in her mother's chair and "toasted" her father as she had seen the grown-ups do at parties. After dinner, father and daughter frequently watched TV together; eventually, Belinda learned to mix her father's scotch and sodas. Occasionally, when Angela returned home and found Timothy and Belinda together, she made sarcastic remarks that positioned her husband and daughter as a couple. Belinda recalled one such remark, delivered scathingly by her
1

mother, "Well, isn't this a lovely little domestic scene. I must admit, Tim, she's about your speed. But, Belinda, darling, you could do so much better." Belinda was 6 years old at the time. When Belinda was 7 years old, her father began to sexually abuse her. As they watched TV together, with Belinda on Timothy's lap, he kissed her inappropriately, licked her ears and neck, and fondled her thighs, telling her how soft and sweet she was and calling her "Daddy's special little lovey." One night, shortly after these activities had begun, Belinda awoke to the smell of scotch and found her father lying next to her, pressing against her with his erect penis. Terrified, confused, but also wanting to care for her father, Belinda lay still while Timothy placed his penis between her legs and moved both of them back and forth until he had orgasm and ejaculated. As time went on, the molestations began to occur almost nightly and escalated to include fondling of Belinda's breasts, digital penetration of her vagina, fellatio, and cunnilingus. The abuse ended abruptly when Belinda was 13 after her father had intercourse with her for the first time. After that incident, which may have frightened Timothy, Belinda perceives that her father withdrew from her completely; he was seldom at home, spending most of his evenings at a downtown bar. Once, when she was 9 years old, Belinda tried to tell her mother about the abuse. She said to her mother, "Mommy, Daddy sometimes comes into my room at night and his thingy gets big, and he rubs it on me." To this, Angela sarcastically responded, "Belinda, please, don't be ridiculous. Your father is totally incapable of getting it up, even with a 9year-old. You just wish he was that much of a man. But he never was, and he's not now. So we're both out of luck." At some point, Belinda began to dissociate her father's abuse and also split off her mother's hostilely neglectful response to her disclosure. By the time she arrived at boarding school, a year after the sexual abuse ended, Belinda had few memories of the sexual traumas and, in fact, recalled few specific details about her childhood at all. Her parents seemed like dreamlike figures to her with whom she would feel vaguely uncomfortable during visits home. Belinda began to arrange to spend holidays at the homes of friends, stayed at school for two summers, ostensibly to take extra courses, and convinced her parents to send her away as a camp counselor for another two summers. At boarding school, Belinda performed well academically and made two close friendships that have lasted into adulthood. Other than these two girls, Belinda remained removed from most of her classmates; she remembers being on the periphery of a number of groups but never entered the center of any of these. During her high school years, she dated a number of boys from a brother boarding school; she did not engage in sex with any of these young men, and, in fact, several relationships ended because the boys found her sexually unresponsive. At the same time and unknown to any of her school friends, Belinda was sexually promiscuous with "townies," older, workingclass boys and young men she met in a bar in the city in which her school was located. During her boarding school years, Belinda also began to drink; by her senior year, she was consuming more than a pint of scotch every night. Although she tried marijuana once or twice, she never became involved in any drug except alcohol. Also during her high school experience, Belinda began to cut herself occasionally with a razor, carefully making nonlethal slits in her upper thighs, between her legs where her father had once placed his penis. In addition, she developed a bulimic pattern of bingeing on sweets several times a week,

after which she vomited. After vomiting or cutting, Belinda would "feel better," although she was never sure in what way she felt "bad"; she simply remembered a release of tension after the selfdestructive activities. After graduating from boarding school, Belinda attended a Seven Sisters college where she majored in literature and history. Repeating her boarding school experience, she did well academically, made two close friends while remaining only peripherally connected to other women, and split her relationships with men between primarily nonsexual dating relationships with college men and promiscuous sexual adventures with working-class, usually older men. By the end of college, her drinking had escalated to a fifth of scotch a day, and she continued to cut and binge and purge. After commencement, Belinda spent several months in Europe at her parents' expense. These 6 months are still a blur of drunken partying, hangovers, and sexual promiscuity to Belinda. Often, she awoke with a man and had no memory of who he was or how they had ended up together for the night. Frequently, these were older men, sometimes married, whom she had met at parties or in a bar. Returning to the United States, Belinda obtained a job as an assistant to an account executive for a major advertising agency. Professionally, Belinda did very well, quickly being promoted until she reached a position of account executive for one of the agency's most important clients. She was respected by agency and account people alike for her ability to understand and address both the business and creative needs of the client. A persistent criticism during performance reviews, however, was that Belinda drank too much during the entertaining that was a part of her job. Unfortunately, her alcoholism worsened during the 6 years she was with the agency; when she was 29, she was fired. At that point, she was drinking more than a quart of scotch a night. The following year, she began therapy. During the 6 years she worked in advertising, Belinda lived alone. She maintained relationships with her four friends from boarding school and college, seeing one or more of them weekly, but, beyond that, had no friendships with women. Belinda also continued her pattern of nonsexually dating "nice" men while promiscuously sleeping with older men, many of whom were married, heavy drinkers whom she met in bars. Occasionally, she never learned the name of a man with whom she had spent the night. She had little contact with her parents through these years, and she periodically continued to cut herself and to binge and purge. Shortly after she was fired from the advertising agency, one of her boarding school friends had a serious talk with her. This woman confronted her about her drinking, about the episodic bulimia, and about her sexual acting out, which Belinda's friend suspected despite Belinda's attempts to keep it a secret, even from herself. Something about this woman's concern moved Belinda; the next morning, she attended her first AA meeting. Over the next year, Belinda became well connected in AA, selecting and working with a caring sponsor. As she sobered up, she began to examine the chaos and contradictions in her life; she also started to experience disturbing physical sensations-her vagina contracted whenever she saw a bottle of scotch, she sometimes felt her thighs get big and swollen, and she became intensely nauseated at the smell of Old Spice men's cologne. Finally, she dissociated; she often felt numb and "spacy," with time taking on a dreamlike quality. An AA associate, who was an incest survivor, recommended that Belinda go into therapy. She decided to do so and obtained a therapist's name from

another therapist who conducted an intake and suspected a sexually traumatic background. Belinda was almost 30 when she presented for treatment. Despite the years of drinking and self-abusive behaviors, she was strikingly attractive. For a long time, she arrived for sessions dressed alternately in very tight jeans, high-heeled boots, and provocatively low-cut, usually red or black tops; in loose-fitting, pastel sweat suits that evoked in the therapist an association to children's playclothes; or in expensive, sharply tailored, "preppy" clothing. The therapist would later learn that these outfits reflected different parts of Belinda's ego organization and, in turn, bespoke shifting levels of functioning. For the first 6 months of therapy, Belinda was in crisis. She was besieged by unsymbolized traumatic memories, body memories, and dissociative episodes that terrified and disorganized her. She wondered if she were going crazy. Often, the only way she could end a disturbing experience was to cut herself; this would temporarily return her to "normal" functioning. Transferentially, she sought in the therapist an omnipotent rescuer onto whom she could collapse and on whom she could depend to relieve her suffering. More subtly, she looked to the therapist to take control of her mind, body, and functioning so that she would not have to experience the pain and chaos with which she was trying to cope. The clinician responded to Belinda by assuring her that the disorganizing experiences she was having contained meaning, meaning that therapist and patient together could discover. Increasingly, these reassurances soothed her, reducing the panic she felt about the experiences. It was primarily outside of the sessions that Belinda experienced dissociations, unsymbolized body memories, and intense affects. In the consultation room, the patient usually sat rigidly still, reporting these events with absolutely no affect. Split off from her feelings, Belinda conveyed the emotional wallop of her experiences through projective identification; it was the therapist who felt nauseous, terrified, spacy, and who had seemingly inexplicable physical sensations such as vaginal pain and contractions and perceived shifts in body size. As Belinda became convinced that the therapist believed her experiences held meaning and indicated an ability to tolerate the power of that meaning, the patient began to associate to rather than simply report what was happening to her. When she did this, she started to recover the memories of her father's sexual abuse and her mother's hostile neglect. This occurred primarily through the emergence of a dissociated abused child imago. It was during this period of treatment that the therapist realized that there were, in fact, three aspects to Belinda's organization of self. The adult patient, embodied in Belinda's preppy look, had only hazy, impressionistic memories of her traumatic past. Interpersonally isolated, highly intellectualized, affectless, it was this part of Belinda who had worked successfully, organized the financial side of her life, and dated "nice" men. A dissociated traumatized child ego state, concretely represented by Belinda's playclothes, was much more primitively organized than the adult patient; it was this part of Belinda that remembered the childhood traumas. Finally, an adolescent part of Belinda, bespoken by tight jeans and sexy tops, acted out the rage and hatred associated with the traumas. It was this aspect of Belinda that drank, cut, vomited, and engaged in dangerously promiscuous sex.

A typical session during this phase of treatment often included the sequential emergence of all three aspects of Belinda. The adult part of her usually arrived for session. Her primary transference to the therapist encapsulated a yearning for the clinician to make sense of her experiences, to think when she could not and to integrate for her that which was fragmented. At the same time, Belinda feared the therapist's very ability to penetrate the chaos and confusion that, after all, protected her from knowledge of her traumatic past. Both these transferences of the adult patient had a distant, intellectualized quality to which the therapist internally responded with distance and some indifference. Here, transference to the clinician as a hopedfor rescuer and an abuser was conveyed by the patient through an identification with and enactment of her internalized mother's unavailability. In turn, the therapist also felt mildly indifferent toward Belinda, repeating, albeit to a much lesser extreme, Belinda's mother's neglect. When the dissociated abused child aspect of the patient emerged to verbalize and enact the trauma, more intense transference-countertransference constellations were set into play. There were two primary transferences of the abused child imago to the therapist. One was to the clinician as an idealized, omnipotent rescuer who would finally listen and alleviate the pain and terror inside which this child had long been trapped and isolated. To this transference, the clinician responded with intense feelings of wanting to save and nurture. Deeply moved by this abused child self's pain, neediness, and resiliency, the therapist often fantasized about mothering this aspect of Belinda. Another transference of the dissociated traumatized child was to the therapist as victimizer, one more adult who would ultimately betray or abuse her. Most specifically, the child part of Belinda feared that the clinician would "make" her get closer to the patient's adult part. Acknowledging that as the ultimate therapeutic goal, the therapist felt like an abuser and betrayer of childlike trust. Sometimes, the therapist was tempted to abandon the analytic work by promising to care forever for the dissociated abused child. This, of course, also would repeat Belinda's father's insistence that his daughter remain tied to him in a way that precluded growth and autonomy. Yet other transference-countertransference configurations coincided with the emergence and work with adolescent aspects of Belinda. Identified with the omnipotence, rage, and underlying terror enacted by both her parents, the adolescent part of the patient consciously and defensively viewed the therapist with contempt, as a bumbling, ineffectual intruder who only could "screw up the works" for her. Less consciously, the adolescent part of Belinda yearned for and simultaneously feared an adult figure who would set appropriate limits on her compulsive wrecking by helping her to contain and express her rage in more hopeful ways. In other words, the adolescent self longed to hope but, trusting no one other than herself, smashed hope in order to maintain control and to stave off a bitter, inevitable disappointment. This adolescent part of the patient also railed at the clinician who was experienced as trying to seduce Belinda into believing empty promises that healing could occur through the therapeutic work. In turn, the therapist frequently felt intimidated by the power of the adolescent self's rage and by the impressive array of acting-out behaviors this part of the patient displayed. When Belinda "proudly" displayed a fresh gouge she had inflicted on herself hours after the last session or "bragged" about sleeping with a newcomer to AA, thus enacting her father's abusiveness, the therapist experienced herself as viciously attacked, abused, helpless, and impotently enraged. On the other hand, when the clinician attempted to elicit cooperation

and trust from Belinda, she often felt shamelessly seductive and wondered if, in fact, she was beguiling the patient with a promise of hope and healing on which she could never deliver. As the adult Belinda became aware more fully of the heretofore dissociated child and adolescent aspects of her and became more conscious of their memories, motives, and defenses, she felt betrayed by the therapist who she experienced as forcing her to look at and work with memories and self and object representations of which she wanted no part. Why could not the clinician and the other parts of her just go away and leave her in peace? Frequently, the clinician identified with the hope the patient was afraid to feel and incongruently responded with optimism to the patient's pessimism and anger. Sometimes, this replicated Belinda's neglectful mother, narcissistically preoccupied with professional success, and thus out of touch with Belinda's internal states and affects. In addition to the transferences and countertransferences between the therapist and each aspect of Belinda, there were transferences and countertransferences bespeaking each part's reactions to the others. For example, Belinda the adult utterly hated the little girl part of her, blaming her for the current pain and disorganization, as well as for the original abuse. Belinda wanted to "kill that kid right out of me." The child self, on the other hand, felt that Belinda the adult had betrayed her by growing up and, thus, could not be trusted. In session the child self would petulantly refuse to share her memories with her adult counterpart, feeling that the adult Belinda would only hold them in contempt as once her mother did. Belinda's adolescent self, on the other hand reacted to the child with a superior protectiveness. She agreed that the adult should stay out of the kid's life, asserting that she, the adolescent, would take care of both the child and herself. The child, on the other hand, feared the adolescent's rage and potential for acting out encapsulated within the adolescent aspects of the patient while respecting the feistiness of this part of Belinda. The adolescent self held the adult patient in complete contempt, berating her for her "wimpiness" and refusal to acknowledge the sexual abuse. The adult patient, at the same time, feared the intense rage and hatred embedded within more adolescent parts of her; Belinda the adult wanted to just let the adolescent self "be." It was the therapist's task and challenge to introduce each part of Belinda to the others in a new way, interpreting the motives, fears, pain, and defenses of each to the others. At the end of about 4 years, the therapy entered a new phase. By now, the adult, child, and adolescent parts of the patient were acquainted and shared mental contents (e.g., traumatic memories, knowledge of each other's activities and moods). Although the patient was far from whole, disparate elements of her had achieved a modicum of acknowledgment and accommodation. The crisis period of extreme extratherapeutic dissociation and the recall of trauma through unsymbolized and body memories had passed. It seemed as if Belinda, now conscious of many aspects of her childhood abuse and neglect, once again put the sexual trauma to the side in order to more fully explore and work through her pre- and posttrauma relationship with her mother. For a protracted period of time, Belinda's therapy centered on her relationship with her narcissistically involved, hostilely neglectful mother. During this phase of treatment, Belinda often identified with her internalized mother, withholding from and depriving the therapist. There were long silences on the part of the patient during which she deflected any attempt by the clinician to make contact. Frequently, the therapist felt ravenously hungry after a session and, in general, experienced herself as rejected,

frustrated, and in despair at not being able to connect with Belinda. The therapist found herself working harder and harder to engage with her patient, countertransferentially enacting Belinda's attempts to elicit her mother's attention and involvement. During this period of treatment, there was also a transference to the therapist as victim and as victimizer. Certain that she was incredibly toxic, Belinda recurrently fantasized that she was filled with small, filthy, black bugs that might crawl out onto her body, shocking and disgusting the therapist. The bugs represented remnants of the poisonous psychological feedings Belinda had received from both parents; she felt possessed by them and feared that they would frighten and disorganize the clinician as Belinda was once terrorized and rendered internally chaotic. When Belinda talked about her bugs, the therapist experienced a wish to rescue; she fantasized about cradling Belinda in her arms, gently picking off the bugs, or about allowing Belinda to vomit the bugs into the waste basket while she held her hair back out of her way. Beneath the transference to the therapist as victim of Belinda's toxicity was, of course, a paranoid fear that the clinician, reacting to Belinda with disgust, would victimize the patient by abandoning her. In fact, Belinda sometimes verbalized her fear that the therapist would "throw (her) out of therapy." This transference included elements of the therapist as seductress, offering an availability and constancy that was tenuous and could be shattered, and of the clinician as hostile mother who would abusively abandon the patient to her bugs as her mother once abandoned her to her father. Sometimes, the therapist responded to these transferences as an omnipotent rescuer and felt guilty about such necessary "abandonments" as vacations or sick days. At other times, the clinician experienced herself as victimized by Belinda's implicit demand that she continously prove and reprove her willingness to stay in relationship with the patient for the duration of the treatment. Toward the end of this phase of treatment, Belinda risked becoming more vulnerable with the therapist, explicitly expressing both loving and hateful feelings. Now, the clinician became in the transference a long yearned-for good-enough mother, neither ideal nor narcissistically neglectful. Belinda, at this point, seemed to move out of a paranoid/schizoid relationship with the therapist into a depressive position in which gratitude and disappointment could coexist, inform each other, and be openly expressed. The establishment of the therapist as a good-enough mother ushered in a phase of therapeutic work in which the sexual abuse was once again of paramount importance. Signaling entry into this period of treatment was Belinda's repeated discussion of extratherapeutic interactions that were portrayed as abusive or, conversely, spoken of with a contempt that betrayed underlying fear of both their power and their attractiveness. At the same time, Belinda wondered why the therapist would want to work with incest survivors, suggesting that perhaps the clinician "got off on" stories of abuse. Sometimes, the therapist felt abusive and unnecessarily voyeuristic, and questioned her own motives for involving herself in this work. Belinda frequently expressed fury at and contempt for interventions she experienced as intrusive or as ridiculously impotent. Here, Belinda unconsciously bespoke an identification with her internalized mother, belittling the clinician as inadequate as Angela had once devalued Timothy. At another level, however, Belinda adaptively was giving voice to the fury at having been abused that she had never been able to convey openly during the childhood victimizations. Now, the adolescent aspect of her grew closer to the adult patient, as Belinda transferentially hurled hate and

rage at the therapist rather than self-destructively acting it out. Although the power of Belinda's anger was impressive, the therapist was excited and enlivened by the patient's free verbalization of these feelings. It should be noted that, during this phase of treatment, Belinda would at times defensively retreat to enactment of transference reactions more reflective of her relationship with her mother. As Belinda's working through of her fury waned, she entered a phase of intense mourning for her lost childhood, and new transference-countertransference paradigms were set into play. During this period of treatment, Belinda acutely experienced the pain of her lost childhood, as well as the loss of her compensatory fantasied good parents. Now, the dissociated little girl became closer to the adult patient who keenly felt childlike neediness and bereavement. Belinda, at this point, reacted to the clinician as an evil seductress, who, promising healing and health, had stripped Belinda of her defenses, leaving her aware and alone. Also experiencing the therapist as a vicious abuser, Belinda accused her of taking control of an innocent patient and forcing her to face things that might have been better left untouched. The therapist, railed Belinda, knew what would happen if treatment went on, and now look at what had happened. Belinda's world was shattered. She knew too much. She knew more than she had ever wanted to know. And what, Belinda wanted to know, was the therapist going to do about all this. Now that she had robbed Belinda of her childhood and her defenses, how was the clinician going to make up for all this loss? Frequently, the therapist experienced the full measure of guilt that Belinda's parents should have felt for betraying, abusing, and negelcting her. She found herself fantasizing about all kinds of ways to make reparation, from bringing Belinda home with her to bake chocolate chip cookies, to planning trips to Disneyland that she and Belinda would share. It was difficult but, as the therapist knew, imperative to avoid truncating the patient's mourning process. At the same time, however, she encouraged Belinda to fantasize about and express ways in which she wanted the analyst to come through with reparation. Belinda and the therapist then played with these fantasies in session, with the clinician tacitly acknowledging the legitimacy of her patient's needs and relational strivings. Eventually, as Belinda's grief was worked through, the patient transferred her longings to appropriate extratherapeutic objects; she got a roommate, made new friends, and began dating an emotionally available and playful man, for the first time combining sexual and emotional intimacy in one relationship. Now, another phase of treatment began during which Belinda experienced and reworked an oedipal conflict. During this period, Belinda's transference to the therapist was as a fantasied romantic partner, a possible abuser who would inappropriately put into action romantic fantasies, and as a potentially dangerous sexual competitor. Romantic feelings about the clinician were primarily communicated nonverbally, through looks, tone of voice, and small gifts of flowers and food. Derivatives bespoke Belinda's attraction to the therapist as pretty and full of life. The patient also more overtly expressed jealousy about other patients with whom she had to share the therapist and about the clinician's husband, who had not been mentioned by the patient until this time. Countertransferentially, the therapist delighted in Belinda's shyly expressed romance and felt protective toward the patient, wanting nothing to disrupt the natural unfolding of this work.

Derivatives, including references to a friend who had been sexually abused by a psychiatrist with whom she was in treatment, allowed the therapist to know that Belinda was unconsciously attuned to the clinician's reactions to her, alert to any signs that the therapist might sexually abuse her. This increased her sense of protectiveness toward Belinda. At the same time that Belinda was engaging the therapist in an oedipal romance, derivatives suggested that she also was reacting to her as a potentially envious and dangerous competitor who would narcissistically crush her childlike sexuality. The clinician had a recurrent fantasy of herself as Snow White's wicked stepmother, so threatened by a child's loveliness that she was driven to have her killed. Finally, at least in terms of the transference and countertransference issues discussed in these chapters, Belinda moved into a period of startlingly powerful adolescentlike sexuality, during which she seemed totally immersed in identifying and experimenting with herself as a sexual being. She arrived for sessions appropriately yet seductively dressed, sporting new perfumes, colors, hairstyles, and makeup. Her transference to the therapist vacillated between come-hither seductiveness, competition, and terror that the clinician would either cling to her possessively or reject her entirely. Within the seductive transference to the therapist, Belinda's flirtations were more clearly sexually tinged than ever before, and she sometimes seductively draped herself on the couch, exposing more of her legs than usual. To this, the therapist responded with frank sexual arousal and wry amusement at the sexy teenager her once-terrified patient had become. At the same time, Belinda also competed with the clinician. She sometimes compared their outfits or hairstyles, subtly (or not so subtly!) devaluing the therapist as just not quite fashionably "with it." The therapist, in turn, found herself wondering if, in fact, it was not time for a new wardrobe and a makeover. In addition, the clinician experienced envy, but also appreciation, of Belinda's newfound sexual freedom and vitality; it was clear that, for the first time in her life, Belinda was finding comfort in her sexuality. Finally, Belinda openly expressed concern that the therapist disapproved of her deepening relationship with her boyfriend, indicating a fear of the clinician's potential possessiveness. Belinda also worried that the therapist might feel that she no longer needed therapy, thus abandoning her as her father once did. In fact, the clinician experienced deep satisfaction, albeit combined with a sense of loss and some envy, that Belinda was involved in a wonderful extratherapeutic romance. The therapist also recognized, however, that continued therapy would be needed for some time. This clinical vignette presents examples of the emergence of various transference and countertransference configurations in the psychoanalytically oriented treatment of one adult survivor of childhood sexual abuse. It is necessarily somewhat schematic and does not reflect all the shifts, dramatic and subtle, that occurred over the course of an extensive treatment. We think, however, that the work with Belinda outlined here does provide the flavor of the myriad of relational paradigms with which the analyst is confronted in psychoanalytic treatment with this population.