When a patient comes to my therapy practice to work on healing from childhood sexual abuse (CSA), the first step is helping them acknowledge the abuse and tell their story. This first step happens gently and over time. I would never insist that a patient talk about it until they trust me and feel safe with me. Often sexual abuse memories are unclear and a patient has difficulty believing that it really happened.
While I am working with someone who is uncovering an abuse memory, I ask simple, straight forward questions. I gently direct them to reflect on the feelings they have now around sex. Sexual dreams and fantasies can also help them put together the puzzle of what happened. Depending on the patient and their memories around the abuse, I may recommend EMDR.
Patients who have experienced CSA often have negative ideas about sex. Abusers make a victim feel like sex is out of their control. The patient may feel that sex is supposed to be painful and involves secrets and shame. “Undoing” these negative attitudes about sex is part of the work in therapy. I may coach on how to set boundaries - that you have the right to say “no” at any time. I may help a patient understand what they want sexually and advocate for that with their partners.
Another very painful aspect of sexual abuse is that the victim can feel enormous shame. Victims often accepted gifts in exchange for sex, felt pleasure during the abuse, or enjoyed special attention from their abusers. By normalizing and affirming the patient, therapists can help to neutralize the shame. “Of course it felt good…you were a child…this is not your fault…” Normalizing the patient’s experience of sexually arousal during the abuse is also key.
I am trained in EMDR, which is a technique used to treat trauma. When a patient feels ready, and we have had a few months of sessions talking about the trauma, I would advocate to the patient to use EMDR to help process any negative emotions around their abuse. I have found EMDR to be a useful technique to help a patient feel more empowered in their bodies.
I would also offer these resources to learn about surviving CSA:
“The Sexual Healing Journey” by Wendy Maltz
“The Courage to Heal: A Guide for Women Survivors of Sexual Abuse” by Ellen Bass and Lauren Davis
“The Body Keeps the Score” by Bessel Van Der Kolk
“The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms” by Mary Beth Williams and Soili Poijula
Adult Survivors of Child Abuses (ASCA) www.ascasupport.org
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