The #MeToo movement has exposed powerful men who leverage their positions to abuse and manipulate. The courage these women and men exhibit as they step forward to confront this behavior is inspiring.

May it continue to motivate other survivors to come forward, because as statistics show, roughly 2 out of 3 sexual assaults go unreported [1]. What a jarring reality, especially since nearly 1 in 5 women and 1 in 71 men reported experiencing rape at some time in their lives [2].

Survivors may have many reasons not to publicize their story. But if and when they do, are we as mental health providers prepared to help? A thorough manual on how therapists can propel them toward recovery is beyond the scope of this article [3], so what follows are 5 concepts to remember when working with survivors of sexual abuse.

1. Enable Empowerment.

One of most insidious parts of abuse is that a victim can lose power in determining their own course of action. As such, we need to help them reclaim the seat of control through therapy.

There are many ways to accomplish this goal. For instance, we can help our clients feel that they are in the driver’s seat when it comes to setting the pace of treatment, because we will not rush them to reveal any details.

I also like to ask my clients’ permission prior to introducing any emotionally loaded intervention, so that they can feel at liberty to turn me down if they’re not ready.

Structuring the way we conduct therapy in a way that empowers our clients to exercise their will signals to them that they matter.

2. Curb Curiosity.

Working with sexual abuse survivors can, at times, present a tantalizing temptation to inquire for juicy details to satisfy our curiosity. But it’s paramount not to give in.

Does it matter what kind of sexual perversion was forced on our clients? Probably not. If a particular piece of information doesn’t advance treatment in any way, let’s refrain from peppering our clients with questions for the sake of our curiosity.

At the same time, if a client volunteers details, prepare for content that may be difficult to hear.

3. Receive Their Reality.

So many clients have confided the horror of their history with nonchalance, which initially puzzled me. But their reaction became understandable when I realized that they expected me to doubt their story – just as many authority figures had done previously. The unhelpful, disbelieving reaction they encountered ranged from mild skepticism to outright dismissal that a serious violation had truly occurred.

May I implore you to refrain from committing secondary victimization by doubting these survivors? Even if – and this is a big if – our clients exaggerate certain details, it’s not our job to investigate the truth, the whole truth, and nothing but the truth.

A more helpful stance is to listen to, and side with, our clients. Our job is to create a safe haven for our clients, where they can expose their emotional wounds without any reprisals.

It’s also essential to abstain from victim bashing. Let’s rid ourselves of any notion attributing the diabolical deed to the victim’s behavior. Debating whether the victim should have ditched her provocative outfit to prevent the abuse is to act as an amateur philosopher – not only does this blame the victim, but it also prevents us from providing effective therapy.

4. Inhibit Insensitivity.

Our caseloads may have survivors with various degrees of trauma and traumatization: the Wednesday client might have survived a one-time incestuous act, while the Thursday client might still be reeling from a gang rape and various molestations. Let’s refrain from cataloguing one client’s pain, or recovery, as better or worse in comparison to another.

Moreover, it’s crucial to extol our clients’ humanity. The odious abuse does not define them; they’re more than just survivors of trauma, abuse, or intimate partner violence.

Our clients are also strong women and men; tenacious teenagers; up-and-coming entrepreneurs; resilient human beings and brave souls who are on their way to reclaim their lives.

We must grasp this strength-based identity for them because they may not have the mental capacity to embrace it yet. If we falter from believing in them, how can we help them cultivate—and eventually own—this perspective?

5. Examine Your Emotions.

Working in the mental health field means that managing our own mental health is pivotal. But working with trauma survivors increases the need significantly, because the relentless pressure inherent in this emotionally intense work can sway us to adopt either of these unhelpful attitudes:

The Messiah Complex

A therapist with the messiah complex thinks they can solve their clients’ problems for them, and in doing so deprives clients of important opportunities to direct their own lives.

I once heard of a therapist whose client survived a string of sexually abusive relationships. In therapy, Samantha (not her real name) routinely complained about her residential program. After a while the therapist decided to help Samantha leave the program: she picked Samantha up at an agreed upon offsite location and drove her to find another program.

But this therapist’s action was anything but therapeutic. For one thing, the therapist conveyed the unrealistic message that she was so powerful that she could bail Samantha out of an unpleasant situation. In doing so, she taught her client a lesson that’s contrary to how the real world functions.

Growth is attained when we struggle with, and survive, hardship; not when someone from a more powerful position deigns to deliver us from our dungeon.

Pointless Personalization

When clients make life choices we disagree with, we must respect our clients’ autonomy, and not take the decisions personally. The ability to empathize with clients is an asset—except when it’s taken to the extreme. Personalizing our client’s unwise decisions as a reflection of us, or our imperfect work in therapy, is neither necessary nor helpful.

Our client might decide on a course of action that’s antithetical to what we’ve been espousing—perhaps by returning to their abuser, or relying on self-destructive methods to cope, or walking away from their program, or prematurely ending therapy—but we don’t need to take it personally.

While it is proper to remain introspective in the quality of work we provided, it’s equally important to remember that our clients’ decisions may have little or nothing to do with us.

 

Working with sexual abuse survivors is challenging no matter what. For therapists with similar backgrounds of abuse, the load can be even greater—particularly if their personal traumas are yet to be dealt with.

As therapists, it’s our ethical responsibility to seek the salve for our own wounds first in order to keep our issues from spilling into the therapy room. After all they’ve been through, the least we can do for sexual abuse survivors is to provide them with quality work—free from our own emotional baggage.

 

References

[1] https://www.rainn.org/statistics/criminal-justice-system

[2] https://www.cdc.gov/ViolencePrevention/pdf/SV-DataSheet-a.pdf

[3] Many excellent books and articles have been written on this topic. For instance:

Clark, C., Classen, C. C., Fourt, A., & Shetty, M. (2015). Treating the trauma survivor. New York, NY: Routledge.

Courtois, C. A. (2004). Complex trauma, complex reactions: Assessment and treatment. Psychotherapy: Theory, Research, Practice, Training, 41. 412-425.

Pearlman, L. A., & Courtois, C. A. (2005). Clinical applications of the attachment framework: Relational treatment of complex trauma. Journal of Traumatic Stress, 18, 449-459.

van der Kolk, B. A. (2015). The body keeps the score. New York, NY: Viking.

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Dr. Audrey Davidheiser

Dr. Audrey Davidheiser

Dr. Audrey Davidheiser is a licensed psychologist, writer, and word lover. She has a PhD in Clinical Psychology, an MA in Theology, and a BS in neither (it’s in Biochemistry). She supervises pre-doctoral graduate students at the Dream Center Counseling Center and sees clients at her private practice. Her passion is to work with trauma survivors, single adults, and graduate students, but not necessarily in that order. Visit her writing space at DrAudreyD.com.
Dr. Audrey Davidheiser