Christiane Sanderson gave her workshop on unlocking the trauma of childhood sexual abuse with Brighton Therapy Partnership in November 2015. This was a sold out event, so we know some of you may have missed out – that’s why we’ve neatly packaged some of the key takeaways for you here, looking at the more common experiences of a survivor, the therapeutic model, and the presence of shame.
The Survivor of childhood sexual abuse – 10 key points
It’s important to understand those elements of the experience and behaviour that can be common to many survivors of childhood sexual abuse. The themes of power and control have lasting impacts and weave their way into many facets of the survivor’s life. Here are ten key points to help you better understand a survivor of childhood sexual abuse.
- Childhood Sexual Abuse (CSA) is predominantly about power and control and it is this that is the single most defining factor in CSA.
- Some survivors of childhood sexual abuse can experience difficulty in defining their experience as CSA because they perceive that they were compliant. This may be because they experienced sexual arousal, or because they didn’t ‘resist enough’, so they may perceive that their experience wasn’t abusive. This may be a large part of the therapeutic work for some people.
- Survivors may need to regain control of their experience, and some may do this by blaming themselves. This can help survivors feel less of a victim and more in control of the situation. Self-blame prevents them from feeling entirely helpless.
- Re-enactment of an abusive childhood experience can be viewed as the survivor trying to gain mastery over experiences that they had no mastery over when they first occurred.
- Clients who experience the trauma of childhood sexual abuse may also ‘take control’ in unhealthy ways, for example, by controlling their eating, perhaps becoming bulimic or anorexic, but this is best seen as a reactive response rather than a meaningful way to take control of their lives.
- One of the biggest fears of people who have been abused is that others will think them potential abusers, yet the vast majority do not go on to abuse others.
- It can be quite common for childhood sexual abuse survivors to miss many therapy sessions and to struggle with the difficult dichotomy of being visible/invisible. This can be diagnosed as borderline personality disorder, but it is worth considering whether the client who misses many sessions is doing so because of the impaired attachment that can often be experienced as a result of childhood sexual abuse.
- Missing sessions may also be about survivors needing to take the control back, and this influence is often seen in the consulting room. The challenge to the therapist is whether they can relinquish control; whether they can keep appropriate therapeutic boundaries in place but allow flexibility.
- There is danger for both survivor and therapist in over-identifying and remaining ‘stuck’ with the ‘survivor’ label, and not being able to move beyond that.
- Bessel Van de Kolk is a leading world specialist on trauma, and his latest book The Body Keeps Score (2015) tells us that survivors can become insensitive to their own feelings and either over or under report what has happened to them.
The Safe Trauma Therapy Model
The Safe Trauma Therapy Model follows a process, which may not be linear, that covers the key skills and tasks of the therapist in working with a survivor of CSA. The process will
- Build on resources and resilience
- Stabilisation and self-care – identify needs
- Restore internal control – affect regulation, grounding techniques
- Process trauma narrative – integrate fragmented memories
- Loss and mourning
- Therapeutic relationship
- Post Traumatic Growth
Learning to cope with the trauma of childhood sexual abuse
Psycho-education on affect regulation can help survivors to understand what happens to them when they become anxious, angry or frightened for example, and help them cope with the trauma of childhood sexual abuse. It can also provide them with the skills to learn so that they can influence how they feel.
The Window of Tolerance
Pat Ogden’s Window of Tolerance model can be used to work with survivors in session, by providing an opportunity to experience feelings in the safety of a therapy session (pleasant ones to start with, like getting excited or laughing) and also the experience of calming these feelings (i.e. through breathing exercises or other mindfulness techniques). Later, the survivor and therapist can move on to practicing with less pleasant feelings.
Any ‘right-brain’ techniques can also be helpful – creative work, using drawings, play-doh, nesting dolls, bubbles (you have to breathe if you blow bubbles, so this can be helpful for clients who become breathless and stressed), playing catch with a ball (you have to be present to catch a ball, so this can be a useful antidote to being dissociated).
Physical activities are also worth pursuing. It is worth being aware that traditionally restful activities such as yoga may not be appropriate for a client who has experienced childhood sexual abuse, as in the initial phases of therapy the slowness and ‘floppiness’ of such activities can feel more dangerous than activities that allow for more muscle-tensing and physical exertion (such as kick-boxing or martial arts). Often it can be safer to stay with more ‘active’ activities until emotional stability is reached.
Therapy and the position of power
As a therapist it pays to be especially thoughtful of how the therapeutic relationship is conducted, as a very hierarchical structure within therapy may well replicate the abusive relationship, so the therapist needs to be mindful of the power structure within the therapeutic dyad.
Coping with flashbacks
Flashbacks are raw unprocessed memory (whether they occur during the day or at night). One of the key ways to work with flashbacks is to work on stabilising emotions generally and allowing the memory to be processed safely. With flashbacks (especially night time ones) survivors may find it helpful to record the flashback (by writing it in a journal, for example), then do some emotional stabilisation exercises (breathing, mindfulness, for example), before moving on or returning to sleep.
Understanding shame and guilt
It is important to distinguish between shame and guilt when working with survivors of childhood sexual abuse. Guilt is defined as an emotion that is experienced cognitively and about which it is possible to make reparations. Shame, on the other hand, is described as being an embodied emotion which, in the words of Jung, “infects the soul,” and impacts on the whole person.
Defences that the survivor might use against shame include…
- Might act out sexually – the perceives this as no better than the abuser, however.
- Minimise the abusers acts – so that their act is not seen as bad, or they magnify the abuser and their own behaviour.
- Stop themselves from feeling compassion for self – they see themselves as the abuser – this is magnified if they see the world through the abuser’s eyes, or have ‘pure O’ (see below)
- Shame – act itself, submission, shamelessness of abuser, own sexual acting out, failure to protect siblings, horrible to non-abusing parent
- Withdrawal, attack self, avoidance or attack other – perfectionism, narcissism, grandiosity, addictions
Pure-O is a type of OCD (Obsessive Compulsive Disorder) that is a common experience of many childhood sexual abuse survivors. Pure-O tends to have few, if any, external manifestations typically found with OCD, such as the need to perform rituals, but is experienced solely within the mind of the sufferer. For example it might be experienced as constantly running thoughts, ruminations, obsessing on thoughts such as ‘what is the worst I could be’ (and for a survivor of CSA that is likely to be an abuser or rapist or to be the person who abused them). It is thought to be the result of a failure of self-soothing. The OCD-UK Charity have produced a leaflet on Pure-O.
Thank you for reading – we hope that this article has provided useful insights into the trauma of childhood sexual abuse. If you’ve found the article interesting and useful, please don’t forget to share it with your colleagues and fellow therapists! We hope to see you at a Brighton Therapy Partnership event in the near future.