The Blue Knot Foundation, formerly known as ASCA (Adults Surviving Child Abuse) did an extensive literature review on the needs of adult survivors of child abuse and neglect. The following principles are important and should be incorporated into standard practice guidelines for professionals working with adult survivors.
1. PROVIDE A SAFE PLACE FOR THE CLIENT
It is often only in a perceived safe environment that those who have been exposed to danger can let down their guard and experience the luxury of introspection and connection. Childhood trauma and abuse, at their core, are about being and feeling unsafe. A framework of physical, emotional and psychological safety is vital. Most people who have been abused need to regain their sense of safety.
Building a trusting relationship with someone who has experienced childhood trauma or abuse can be challenging. People who have been repeatedly hurt in interpersonal relationships have acquired a range of ways to guard against future harm. They are often vigilant, cautious, suspicious and/or angry and instinctively hide certain aspects of themselves and may mislead or block helpers from knowing them too soon. It takes time for survivors to feel safe enough to reveal their feelings honestly in therapy and develop a trusting relationship with the therapist.
Even though many survivors may want to talk to their therapist about their feelings, their shame as well as fear of the therapist’s response stops them from doing so. Health professionals need to be patient with survivor clients, and willing to wait until the client feels ready to reveal painful material.
2. ENSURE CLIENT EMPOWERMENT AND COLLABORATION
Stress collaboration and empowerment is key to working effectively with adult survivors. Survivors benefit most when they participate actively in their treatment and have control over decisions that affect them. For many survivors, being cooperative and compliant can replicate feelings of being abused. Collaboration requires acknowledging our responsibility to our clients and the power we have in the relationship with deferring to each client’s personal expertise and authority.
Therapists who are patient, understanding, and respectful of a survivor’s need for a sense of control in working towards their own solutions are viewed as most helpful. Maintaining a sense of control over which therapeutic issues are addressed, and when, helps survivors to manage overwhelming feelings better. It is crucial that therapists allow survivors to reach their own solutions in their own time.
3. COMMUNICATE AND SUSTAIN HOPE AND RESPECT
It is vital to communicate and sustain hope and respect when working with adult survivors of childhood trauma and abuse. Ways in which therapists convey respect include:
- Forms of address,
- Respect for confidentiality,
- Sensitive use of language,
- Admitting when s/he has made a mistake or feels unsure, and
- Assuming that the client as well as the health professional have valid points of view.
Helping professionals, in their words, actions, and body language, communicate hope. While it is important to empathize with the survivor’s current hurt and despair, it is important to hold onto visions of the survivor’s potential future self. It is important to help the client identify the resources s/he already possesses (such as: as sense of humor and defense mechanisms, interpersonal resources such as friendships, family, pets, belief system, etc.).
4. FACILITATE DISCLOSURE WITHOUT OVERWHELMING THE CLIENT
Disclosure for survivors of child abuse may bring their abuse story back to the surface, and this can be very overwhelming. Facing memories and experiencing flashbacks can be painful and/or overwhelming, and can trigger automatic childhood responses such as running away, avoidance or denial. If a survivor does not want to disclose, they may not be ready.
Survivors sometimes minimize, discount and ignore the fact that they have been sexually abused during childhood or for most of their lives. The reasons vary from shame and embarrassment, fear of retaliation from their perpetrator, and concern that they would not be believed. This leads many survivors to discount their experiences, deny they ever happened, or choose to block them out.
Many survivors use the protective defenses they learned in childhood such as denying, minimizing, or dissociating to cope with their situation. Complete or partial denial, minimization, and even total repression of the abuse event/s inhibit the survivor’s ability to seek and receive help. These strategies keep the survivor from knowing just how terrible things actually were.
Another coping strategy commonly used by survivors of childhood abuse is ‘pleasing and compliant behavior’. Survivors of childhood abuse learn to anticipate the emotional reactions of another person to their behavior. They learned that pleasing the abuser was one way to reduce the amount of abuse. Preventing the abuser from seeing how emotionally upset they were was a coping strategy. The need to please may be carried over into the therapist’s office feeling that s/he will protect them if they are ingratiating.
Self-blame is another common sequela of abuse. The survivor holds him/herself accountable for the victimization. If s/he had not done something wrong, then the abuse would not have occurred. The attribution helps the survivor retain the illusion that s/he has power and control over not being hurt again.
Shame and guilt are common sequelae of abuse. Survivors of child abuse may experience guilt because they may have been blamed for the abuse. Survivors may even think ‘they asked for it,’ ‘invited it,’ or ‘deserved it.’ Survivors may be experiencing hurt, embarrassment, and shame over what happened, so it seems easier to remain silent about the incident.
Many survivors fear that no one will believe them, that their account of the abuse will be dismissed as a fabrication or an exaggeration. Sadly, those are the reactions they usually receive when they try to tell someone about what happened to them as a child.
Barriers that prevent survivors from seeking help (and inhibit disclosure) include:
Many survivors use the protective defenses learned in childhood such as denying, minimizing, or dissociating to cope with their situation. These behaviors inhibit the survivors’ ability to seek and receive help. However, these strategies keep the survivor from knowing just how terrible situations actually were.
The survivor holds her/himself accountable for the victimization: If s/he had not done something wrong, then the abuse would not have occurred. This reasoning helps the survivor retain the illusion that s/he had power and control over not being hurt again.
Shame and Guilt
Shame and/or guilt can make it difficult for the survivor to seek or to accept help. Shame is the internal feeling that comes from being exposed and vulnerable, whereas guilt is an externally imposed feeling that comes from believing that something wrong was done. Survivors may experience guilt because they may have been blamed for the abuse. They may even think they ‘asked for it,’ ‘invited it,’ or ‘deserved it.’ Survivors may be experiencing hurt, embarrassment and shame over what happened, so it seems easier to remain silent about the incident.
Survivors may feel especially confused if some aspects of the abuse felt enjoyable, exciting and sensually stimulating. In addition, possible mixed emotions of love for the perpetrator and hate for what they have done may also inhibit access to help.
Responding appropriately and safely to disclosure:
Active Listening Skills
Most survivors of abuse find talking, in general, cathartic and talking about the pain caused by their abuse history useful in particular. Therapists who listen to the survivor, ask clarifying questions, name the survivor’s experience, and do not overly challenge what the survivor says, help the survivor make the most progress. Active, direct participation in validating the survivor’s perceptions, feelings, and experiences, in addition to acknowledging the information being shared, and checking to make sure it is appropriately understood, are all important parts of treatment. In addition, research shows that ‘ignoring the disclosure’ or ‘rushing them’ is experienced as particularly harmful by survivors of child abuse.