What we can do as counsellors is provide a safe environment and a structured process within which to help survivors acknowledge their memories and associated pain, assess the influence these have on their behavioural repertoire and begin to integrate them with his or her adult self. This integration will allow the survivor to process the memories and pain so that they no longer control their behaviour and responses. He or she will be able to take control of his or her own life rather than continue to be controlled by maladaptive behaviour patterns and responses as if they and their abuse experience are ‘frozen in time’.

Treatment phases and structuring the healing process

The early phase of therapy with adult survivors of childhood sexual abuse focuses on building up trust between the counsellor and the survivor and preparing the survivor for the healing process. During this phase of therapy the survivor is encouraged to tell their story which allows the counsellor to assess which therapeutic techniques may be the most beneficial.

Telling their story is difficult for some survivors. Their memories are fragmented and all jumbled up making it hard for them to relate what happened when. There is often a feeling of being overwhelmed by the abuse and just not knowing how to start. Many survivors just can’t differentiate between episodes of abuse and their whole sense of childhood was taken over by it. At this stage there are tools which can be used to help the survivor put their childhood back together into a recognisable whole by focusing on specific incidents or episodes of their lives to structure their stories.

The middle phase of therapy is where the brunt of the work is done which includes re-processing the trauma. Simply stated, processing the trauma of childhood sexual assault involves:

1. Acknowledging the fact of the abuse and its impacts.
2. Experiencing and releasing some of the feelings associated with the trauma that typically has remained unexpressed.
3. Exploring a range of feelings towards the abuser/s and non-protective parents, siblings or caretakers; and
4. Making cognitive reassessments of the abuse (i.e. why it happened, who was responsible etc).

If these avenues are explored, the traumatic events are faced and processed by necessity. The abuse can no longer remain frozen in time and continue to maintain the survivors status quo: The status quo that includes beliefs about vulnerability, helplessness, mistrust, stigmatisation, with a negative view of self and others. During this phase the abused child is integrated with the adult self so that they work together as a unified whole rather than being split and working against each other. Emphasis is also placed on cognitive restructuring, educating the survivor and the formulation of new coping strategies. Through this sort of trauma processing a clear line is drawn between the past and the present leaving the individual feeling more in control and determined to deal with the impacts the abuse has had on their lives.

It is at this stage that a stronger sense of self and changes in world view evolve and new coping skills can be incorporated into their behavioural repertoire. At this stage the survivor actively engages in healing making decisions about the options open to them. This is also a stage of exploration of possibilities which can lead the survivor further along the path to integration. This is a good time for group work, self-esteem and assertiveness training, stress management and/or self-defence classes.

The last phase of the healing process is the termination phase. This involves empowering the survivor to make their own choices and decisions without relying on the counsellor. It includes the survivor’s separation from the counselling process while establishing support networks. These might include self-help support groups as well as supportive friends, partners, or family members.

Treatment approaches

Treatment of adult survivors of childhood sexual assault incorporates a number of therapeutic approaches which reflect major the theoretical schools of therapy, emotional, cognitive and behavioural. Experiential or exploratory techniques focus on accessing emotions, re-experiencing the trauma and integrating these with the adult self. Cognitive therapy aims to identify the survivor’s distorted cognitions of themselves, others and the world and attempts to replace these with more accurate and realistic cognitions. Behavioural therapies focus on enhancing the survivor’s behavioural repertoire through the acquisition of more adaptive behavioural responses, coping strategies and learning new skills.