Over the years, I have gotten a lot of emails asking for information about effective therapy for adult survivors of child abuse and neglect. I am not a clinician, however, after successfully completing 23 years of therapy to recover from Major Depression, PTSD, and Dissociative Identity Disorder or DID (I integrated about 20 alters), as well as conducting in depth research over the past 30 years, I have a very good grasp of the issues and first-hand knowledge of what it takes to recover. That said, I am writing a series of articles about what I believe are key issues in the treatment of survivors.
When treating clients for Depression, PTSD, and DID, it has been shown that the most effective method to use is a 3-step staged treatment process.
Stage 1: Preparing for the Trauma Work
This involves developing the therapeutic relationship; helping the survivor understand the need for outside support systems, and fostering action in that area; a discussion of personal safety; supporting the survivor’s strenuous efforts in identifying and labeling his/her feelings; and practicing self-management skills. The purpose of this stage is to:
- Build capacities within the client,
- With the therapist’s support , to manage the powerful emotions that will come forward as traumatic material is discussed, and
- To do it in a manageable and safe way.
This phase is centered around skill-building, self-management, and self-care. If this piece is not done upfront and the traumatic material is brought forward too quickly from the client’s unconscious mind, both the therapist and the client will spend an inordinate amount of time and energy just trying to keep the client stabilized before the next bit of material comes up.
The skill building involves affect management, impulse control, and the development of support systems. Self-management involves affect management, impulse control, and the development of support systems. Self-care focuses on a commitment to learn how to alleviate his/her symptoms, understand boundary techniques, and to practice a gradual trust in verbalizing distressing material with the therapist. As much as possible, discussions of abuse should be educational in nature to help him/her maintain his/her defenses. It would be helpful for survivors to understand attachment styles and dependency issues as well.
Of course, this is the textbook approach, and everybody is different, but the more these skills can be learned upfront, the better the overall treatment.