**4. A case study in growth and healing from CSA**

The following story outlines some of the major themes explored in this paper, and is taken from a women in her 40's who has participated in the authors' research project looking at pathways to health and healing after CSA. Kate (not her real name) experienced on-going, intrusive, contact sexual abuse by her older brother from the age of 8 till 14. She did not disclose her abuse in childhood, and when her abuse was made known to her family as an adult, she was not believed or supported by them. The story is punctuated with reference to the themes covered in this chapter to connect the theory and research discussed to the story of one woman's journey to healing.

#### **Secrecy and shame**

The reaction to being asked by someone to come out about the abuse is often too confronting. Kate had a typical reaction to the suggestion: "NO! Imagine what that would do to the family!"

#### **Subjective distress at the time of abuse**

Kate was asked to use a five-point scale (1 = a little upsetting – 5 = extremely distressing) to describe her levels of distress at the time of the abuse. She said: "(when it was happening) I don't think I knew enough, but maybe 2 ½ - 3. Looking back now I would say a 4. I feel as a child, with more time and knowledge, and because it had carryon effects and the effects were more after then during. So then I would say 4 ½, give it a 5!!! It is interesting how it changed!"

#### **Negative effects of the abuse**

"Depression, suicidal ideation, being scared of everything in the world, headaches, low selfesteem, poor body image, fear, guilt, shame, perfectionism. It made me feel worthless, not loveable. I thought the world was scary. I had a sense that there was something wrong with me and that I was all alone. Lack of trust, I couldn't trust myself. Really, really poor selfesteem. Always wondering what people were thinking of me and did people see through me? There was just this fear that I could not cope, lack of trust in myself. Poor relationship with my mother".

#### **On how the attachment relationship was more impactful than the abuse**

"I remember before I was eight, I thought I had the best mother in the world, and there was a time when I was eight or nine when it all changed. I feel strongly that the poor relationship with my mother has had more detriment than the actual abuse, and the way she reacted to it (the abuse) too, it has a bearing on that. The first reaction (from my mother) was "No, it didn't happen", and she has said "well this is just the things that kids do". And whether it is just in my mind thinking that "your mum doesn't love you", I have learnt that this has a BIG impact; it has had one on me".

#### **Acknowledgement of abuse started the healing process**

"The first time in my adult life that I ever had talked face to face with (the offender) he said, "It was nothing", and I said "It's not like nothing happened". That was the first time that I had acknowledged it in his company. And then, because I was having flashbacks and not sleeping after that phone call, I then rang the SA (sexual assault) unit and started the first real counselling that I had". Prior to this phone call, Kate had brief discussions with her husband about her abuse, but would minimise the impact it had on her, saying: "It wasn't much; I was one of the lucky ones. I think I allayed his (her husband) anxieties by saying I was one of the lucky ones, I am fine". After verbally acknowledging the abuse to her offender, this brought to the surface all the latent emotions that were still within her and started Kate on her path to healing.

After a process of active engagement in her healing, these are some of the pathways Kate identified in her eventual resolution of the past and her new appreciation of herself and her life.

#### **Growth as a process**

46 Sexual Abuse – Breaking the Silence

constant revisiting of the trauma that causes people to terminate CBT interventions early, often with reports that range from dissatisfaction in the therapeutic process by not exploring the core issues relating to their inner experience, through to feeling more traumatised than before therapy due to the constant revisiting of the abusive acts via the process of desensitisation. Far from needing to talk about the specifics of their abuse and to de-sensitise to their traumatic memories, the well-functioning women in Bogar and Hulse-Killacky's (2006) study reveal that actively connecting to the impact the experience of CSA had on their lives and on their sense of self, and changing the way in which they viewed themselves, was

The following story outlines some of the major themes explored in this paper, and is taken from a women in her 40's who has participated in the authors' research project looking at pathways to health and healing after CSA. Kate (not her real name) experienced on-going, intrusive, contact sexual abuse by her older brother from the age of 8 till 14. She did not disclose her abuse in childhood, and when her abuse was made known to her family as an adult, she was not believed or supported by them. The story is punctuated with reference to the themes covered in this chapter to connect the theory and research discussed to the story

The reaction to being asked by someone to come out about the abuse is often too confronting. Kate had a typical reaction to the suggestion: "NO! Imagine what that would

Kate was asked to use a five-point scale (1 = a little upsetting – 5 = extremely distressing) to describe her levels of distress at the time of the abuse. She said: "(when it was happening) I don't think I knew enough, but maybe 2 ½ - 3. Looking back now I would say a 4. I feel as a child, with more time and knowledge, and because it had carryon effects and the effects were more after then during. So then I would say 4 ½, give it a 5!!! It is interesting how it

"Depression, suicidal ideation, being scared of everything in the world, headaches, low selfesteem, poor body image, fear, guilt, shame, perfectionism. It made me feel worthless, not loveable. I thought the world was scary. I had a sense that there was something wrong with me and that I was all alone. Lack of trust, I couldn't trust myself. Really, really poor selfesteem. Always wondering what people were thinking of me and did people see through me? There was just this fear that I could not cope, lack of trust in myself. Poor relationship

"I remember before I was eight, I thought I had the best mother in the world, and there was a time when I was eight or nine when it all changed. I feel strongly that the poor relationship with my mother has had more detriment than the actual abuse, and the way she

**On how the attachment relationship was more impactful than the abuse** 

the most important determinant of wellness and being able to move on.

**4. A case study in growth and healing from CSA** 

of one woman's journey to healing.

**Subjective distress at the time of abuse** 

**Negative effects of the abuse** 

**Secrecy and shame** 

do to the family!"

changed!"

with my mother".

"There were times (after the disclosure) when I was feeling very vulnerable with two young children and all this going on and lots to carry once it had blown up, and I stood on my own. And it was all good, for me to prove that once I am in the firing line I was able to trust my own judgement, and that helped me get through too. Circumstances transpired that put me in situations to enable me to have a chance to prove to myself that I can cope". This quote indicates the perception of manageability and also of psychological preparedness for future life experiences that may threaten her sense of self, and being able to trust that she could cope.

When describing the turning points for her that were gained through a therapeutic process, Kate said: "Something in counselling that has really helped is that I am only responsible for myself, but I AM responsible for my stuff. That was very powerful, and it helped me release old feelings of responsibility for others and for the abuse. Overcoming the mind talk, that has been a wonderful gift. Just being able to know that I am not my mind, I am not my collection of thoughts, I am so much more. I have come a long way; I was so in my head and could not get out – knowing now that I am not my collection of thoughts. I read a lot about CSA and perpetrators and got all this knowledge. I think the knowledge helped too, once I saw that it wasn't just me and I read it is NEVER YOUR FAULT - that was a turning point, once I stopped blaming myself it was a real unblocking. Also, moving from the 'victim mode' (was important). I think the victim phase served me, it helped, because if I never felt like that I would not have been able to release all the stagnant energy and toxicity in me. I had to feel it to heal it, but I didn't know that yet. And victim is not a good place to be so I wasn't going to stay there". In this quote, Kate reveals her new-found capacity for comprehensibility of her experiences. She also demonstrates that she has found a new sense of personal strength through her suffering. This quote also highlights the importance of connecting to the pain of being a victim, and how it is described as a necessary place to be,

A Salutogenic Approach to Healing Following Child Sexual Assault 49

but generally it was with people in my life that I felt real love. I felt my husband loved me for who I was underneath and it just helped me get rid of the shame, the guilt. It was acceptance" This is obviously another example of the power of acceptance, and also of validation and connection; being able to connect with the truth of herself as being worthy of

There were also significant others who assisted Kate on her healing journey. The following quote explains the importance of emotional and instrumental support in promoting wellbeing: "And something significant in my healing, I had an uncle and as a young child I idolised him. I thought he was kind and gentle and handsome, strong and a man of his word, held his own. He met a partner and she and I connected, she was the most beautiful woman in the world, to me she was an angel on this earth, and I think (the relationship) had an impact on the rest of my life. It was a really significant relationship connection. I saw the love between the two of them, so I saw what was possible. That good, healthy modelling and I think it opened my eyes up and started to connect to the real me, and I resonated with that. And I would hang out every evening for hugs, because I would get a hug every evening before bed, I wished it would never stop that hug, particularly from her, but my uncle as well. I could trust, there was no mistrust there, but I did not disclose to them".

Kate continued to discuss how her uncle's partner was a pivotal person in her life. She said: "She taught me that the most simple things in life are to be celebrated. Every meal she would set the table beautifully, clean sheets on the bed, daily a fresh towel, and if it was raining she would cherish the rain. And that is with me now to this day and that has just grown bigger and bigger. Love of nature and that hope that you could have a marriage that was beautiful, happy, loving. So to me that put a standard in my head that that is what I wanted. So that was a really significant thing in my healing, she was an angel on earth and I have no doubts about that, so that bought the real me out that I knew was there. It seemed pure, clean, loving. Pure love without all the games. Trust." It was through this relationship that Kate connected with a feeling of self-love. Kate describes this particular relationship in her life as reminding her of: "A faint memory of love for myself" that she drew upon as a

Describing processes that lead to healing, Kate said of herself: "She [the Lomi Lomi therapist] told me to do a burning ceremony and that really helped, the visualisation. She came up with good things to read. I read so much"!! Kate also engaged in journaling. "Gratitude journaling, I would highly recommend it to anybody. That got me in touch with who I am and what resonated with me. That is self-love, because it made me stop and actually think 'what do I like'? And one thing led to another and then I could see, even just sensing, what kind of things I was writing down – beauty. It showed me what was important in my life; relationships, nature. Yeah, so gratitude journal is right up there for power for me". In this quote, Kate is describing how the process of learning to connect with herself, and what is important to her, allowed for a deepening relationship to her inner life,

Kate was also asked to reflect upon any benefits she felt had come out of her healing journey; elements of her life that perhaps may not be there, had she not engaged in healing from her experiences of CSA. To this Kate stated: "A deep desire to be happy and content. Spiritual awareness. Spiritual development. Peace. Self-love. Living in my heart more,

source of strength whilst working through her healing.

and connected her to the truth of who she really is.

love and respect.

for a time. It also shows the transformative power of moving on from only seeing one's self as a victim to feeling more in control.

A very important component in growth from trauma is the notion of acceptance (e.g., Shakespeare-Finch & Copping, 2006). Acceptance does not mean that you are accepting of the abuse but rather, that it occurred: "I let myself FEEL. And there was SO MUCH STUFF IN THERE!! I felt it pushed down to my toes, burying, bottled, and pressure. And whenever I cried, it would just let it. At first I would stop it because it hurt, but I learnt very quickly that the more I let out I felt lighter and better. And rather than trying to stop it I just let more come up and I got very good at it, and it would come up and up and up, and in the end I just loved it because when I went through those periods I saw past it as another big step forward. So cry, cry, cry! It's all good" In the latter part of this quote, Kate is describing a sense of meaning that she attached to this process, and how the process of accepting the reality of the pain of her felt experience of her emotions allowed her to gain a sense of mastery.

#### **Growth as an outcome**

The following quote demonstrates a belief that Kate has; that she has changed fundamentally: "In terms of the old self-beliefs, they are non-existent now. I know they are non-truth. Now I think of myself as pure, intact, not damaged, very loving, I don't need to judge myself. The shame has gone, and the guilt. Knowing that the way I do it is right – because that is something that I grappled with from a self-esteem point of view, feeling damaged – (I felt that) everyone knew how to do it (life) right but I didn't. And I didn't trust my own intuition. But the way I do it is the way that is right". Her change in her view of herself was described as "That was amazing". Kate also expressed that she had experienced changes in relationships with others through the conscious struggle she engaged in to come to terms with her abuse: "I think my growth has affected my parenting in that my children, they have to KNOW that I love them**.** I also have a paradigm that I live with now, that everything is part of a perfect plan. And I have an appreciation of nature! Through healing, growth, and looking within, by connecting to self I realised I am connected to nature" This comment describes a fundamental shift in philosophy of life.

#### **On-going healing**

As we have said throughout this chapter, healing and growth do not discount elements of ongoing distress such as intrusive thoughts. However, Kate said: "Things still come in to my mind but I recognise them straight away, I am not scared of my thoughts anymore, I see the thoughts for what they are". Below is a summary of some of the pivotal points along her journey that Kate states as being the most fundamental in her healing.

"I had a Lomi Lomi massage and I think that was a big, big, big turning point, and I haven't stopped growing. I just totally opened to receiving healing **(active engagement in healing)**. I first thought 'Oh wow, spirituality', but I was ready for it. She (the Lomi Lomi therapist) also sat and talked to me first, and it was who she was, and it was just an open, non-judging relationship "**(acceptance)**.

"My husband being a supportive partner has been very significant in my healing. I really respect him and he respects me. He saw through the manifestations (negative effects of the abuse) and saw the real me. And I have had snippets of the real me throughout this time,

for a time. It also shows the transformative power of moving on from only seeing one's self

A very important component in growth from trauma is the notion of acceptance (e.g., Shakespeare-Finch & Copping, 2006). Acceptance does not mean that you are accepting of the abuse but rather, that it occurred: "I let myself FEEL. And there was SO MUCH STUFF IN THERE!! I felt it pushed down to my toes, burying, bottled, and pressure. And whenever I cried, it would just let it. At first I would stop it because it hurt, but I learnt very quickly that the more I let out I felt lighter and better. And rather than trying to stop it I just let more come up and I got very good at it, and it would come up and up and up, and in the end I just loved it because when I went through those periods I saw past it as another big step forward. So cry, cry, cry! It's all good" In the latter part of this quote, Kate is describing a sense of meaning that she attached to this process, and how the process of accepting the reality of the pain of her felt experience of her emotions allowed her to gain a sense of

The following quote demonstrates a belief that Kate has; that she has changed fundamentally: "In terms of the old self-beliefs, they are non-existent now. I know they are non-truth. Now I think of myself as pure, intact, not damaged, very loving, I don't need to judge myself. The shame has gone, and the guilt. Knowing that the way I do it is right – because that is something that I grappled with from a self-esteem point of view, feeling damaged – (I felt that) everyone knew how to do it (life) right but I didn't. And I didn't trust my own intuition. But the way I do it is the way that is right". Her change in her view of herself was described as "That was amazing". Kate also expressed that she had experienced changes in relationships with others through the conscious struggle she engaged in to come to terms with her abuse: "I think my growth has affected my parenting in that my children, they have to KNOW that I love them**.** I also have a paradigm that I live with now, that everything is part of a perfect plan. And I have an appreciation of nature! Through healing, growth, and looking within, by connecting to self I realised I am connected to nature" This

As we have said throughout this chapter, healing and growth do not discount elements of ongoing distress such as intrusive thoughts. However, Kate said: "Things still come in to my mind but I recognise them straight away, I am not scared of my thoughts anymore, I see the thoughts for what they are". Below is a summary of some of the pivotal points along her

"I had a Lomi Lomi massage and I think that was a big, big, big turning point, and I haven't stopped growing. I just totally opened to receiving healing **(active engagement in healing)**. I first thought 'Oh wow, spirituality', but I was ready for it. She (the Lomi Lomi therapist) also sat and talked to me first, and it was who she was, and it was just an open, non-judging

"My husband being a supportive partner has been very significant in my healing. I really respect him and he respects me. He saw through the manifestations (negative effects of the abuse) and saw the real me. And I have had snippets of the real me throughout this time,

comment describes a fundamental shift in philosophy of life.

journey that Kate states as being the most fundamental in her healing.

as a victim to feeling more in control.

mastery.

**Growth as an outcome** 

**On-going healing** 

relationship "**(acceptance)**.

but generally it was with people in my life that I felt real love. I felt my husband loved me for who I was underneath and it just helped me get rid of the shame, the guilt. It was acceptance" This is obviously another example of the power of acceptance, and also of validation and connection; being able to connect with the truth of herself as being worthy of love and respect.

There were also significant others who assisted Kate on her healing journey. The following quote explains the importance of emotional and instrumental support in promoting wellbeing: "And something significant in my healing, I had an uncle and as a young child I idolised him. I thought he was kind and gentle and handsome, strong and a man of his word, held his own. He met a partner and she and I connected, she was the most beautiful woman in the world, to me she was an angel on this earth, and I think (the relationship) had an impact on the rest of my life. It was a really significant relationship connection. I saw the love between the two of them, so I saw what was possible. That good, healthy modelling and I think it opened my eyes up and started to connect to the real me, and I resonated with that. And I would hang out every evening for hugs, because I would get a hug every evening before bed, I wished it would never stop that hug, particularly from her, but my uncle as well. I could trust, there was no mistrust there, but I did not disclose to them".

Kate continued to discuss how her uncle's partner was a pivotal person in her life. She said: "She taught me that the most simple things in life are to be celebrated. Every meal she would set the table beautifully, clean sheets on the bed, daily a fresh towel, and if it was raining she would cherish the rain. And that is with me now to this day and that has just grown bigger and bigger. Love of nature and that hope that you could have a marriage that was beautiful, happy, loving. So to me that put a standard in my head that that is what I wanted. So that was a really significant thing in my healing, she was an angel on earth and I have no doubts about that, so that bought the real me out that I knew was there. It seemed pure, clean, loving. Pure love without all the games. Trust." It was through this relationship that Kate connected with a feeling of self-love. Kate describes this particular relationship in her life as reminding her of: "A faint memory of love for myself" that she drew upon as a source of strength whilst working through her healing.

Describing processes that lead to healing, Kate said of herself: "She [the Lomi Lomi therapist] told me to do a burning ceremony and that really helped, the visualisation. She came up with good things to read. I read so much"!! Kate also engaged in journaling. "Gratitude journaling, I would highly recommend it to anybody. That got me in touch with who I am and what resonated with me. That is self-love, because it made me stop and actually think 'what do I like'? And one thing led to another and then I could see, even just sensing, what kind of things I was writing down – beauty. It showed me what was important in my life; relationships, nature. Yeah, so gratitude journal is right up there for power for me". In this quote, Kate is describing how the process of learning to connect with herself, and what is important to her, allowed for a deepening relationship to her inner life, and connected her to the truth of who she really is.

Kate was also asked to reflect upon any benefits she felt had come out of her healing journey; elements of her life that perhaps may not be there, had she not engaged in healing from her experiences of CSA. To this Kate stated: "A deep desire to be happy and content. Spiritual awareness. Spiritual development. Peace. Self-love. Living in my heart more,

A Salutogenic Approach to Healing Following Child Sexual Assault 51

understandable way to deal with such an intrusive, physical experience. Within therapy, teaching modalities that assist in the development of acceptance of experience, such as breathing techniques, meditation, and tactile exercises such as body work, can all be used as ways of assisting clients to become more aware of, and comfortable with, their inner experience. Learning to reconnect with one's body through acknowledgment and acceptance of emotions is another avenue that provides opportunities to experience a sense of mastery and control. It is also of great benefit to clients if therapists have a personal and working knowledge of how the processes of meditation and breath work are both utilised and cultivated, and to this end it is suggested that therapists choosing to use such activities

Learning to see the truth of who one is, distinctly from the 'un-truth' of long-held intrapersonal misconceptions, such as the negative core beliefs often held by those who have experienced CSA, is another point demonstrated in the case study as being important in healing from CSA. Core beliefs based on feelings of inherent badness, wrongness, or deficiency are commonly expressed in the therapy room by survivors of CSA, and also by Kate. As Kate expressed, "Once I stopped blaming myself; that was a real unblocking". This point speaks to the importance of assisting clients in their development of a caring, unconditional acceptance of who they are. This process allows clients to move from a place of shame and guilt to a more honest view of seeing themselves as whole and possessing self-

Another aspect noted in the case study is the importance of a sense of mastery, self-efficacy, or a trust in one's own abilities; in being able to trust in one's own judgment and prove that one can cope. Being able to shed the identity of 'victim' requires a movement from helplessness into a position of knowing one can help one's self. Learning to trust one's own judgment is an essential foundation on which to begin to build, or re-build, trust in others; an issue that often is a point of difficulty for survivors of CSA, in light of the *abuse* of trust CSA often entails. Inherent within discussions of strength, mastery, and most importantly the judgment of self that occurs with such experiences, healing, as it were, is best discussed

with clients as something that should be viewed as a dynamic and on-going process.

negate the presence of other markers of positive development.

Research regarding the experience of negotiating childhood sexual assault has postulated numerous variables that apparently inform *outcomes*. The outcomes that research and literature have predominantly focussed on are largely deprivational, which is understandable, and arguably morally just, but are also largely void of hope, growth, or transformation. Trauma is labelled as such because it is an experience, or perhaps multiple experiences, of having one's inner core fundamentally shifted by something so profound, so threatening, and helplessness rending, that it affords significant life change. Literature has focused on the insidious impacts, overtly displayed or covertly expressed, and a number of potentially diagnosable pathological impacts of such life experiences. What is evident is that many more people than not are living *normal* lives as survivors of CSA, and other traumas, and most importantly, that one outcome measure denoting difficulty in adjustment does not

It is important in the pursuit of promoting mental health, to also acknowledge the many ways in which a CSA survivor may heal, learn, and/or use the experience of their lives in a

with clients are themselves practitioners of these things.

worth.

**6. Summary** 

trusting intuition. Art, painting, that has been wonderful. I was always good at art and somewhere along the line as a child I got the message that was a waste of time, but reconnecting to that has been a big part of my healing. Improved relationships. Improved parenting. Flowing with things that are happening without reacting". In this quote, Kate clearly expresses how the struggle to heal from CSA has not only provided her with a deep and fulfilling life, but that she also feels her life has been more enriched and meaningful for the painful experiences she has actively engaged in overcoming.

### **5. Implications for therapeutic practice**

There are many implications for main-stream therapeutic practice that can be taken from this case study. First, it is important to acknowledge that "mainstream practice" indicates the Western tendency in psychiatric and psychological literature to favour CBT as a therapeutic intervention of choice following any kind of trauma (e.g., Forbes et al., 2007). Although CBT clearly has its strengths, the processes outlined in this case study highlight aspects that speak to deep processes, such as the importance of healthy and authentic responsibility-taking, connection to inner experience, including the energy of emotions within the body, as well as the relationship one has with ones-self, including beliefs about the self and learning to trust, both in one's self, and also in others.

Feelings of responsibility and guilt for the abusive experiences, either in part or in full, are commonly experienced by those with a CSA history. In addition, there is also the assumed responsibility that survivors place on themselves in relation to the ramifications of disclosure of the abuse, which often impacts on relationships within their family of origin, particularly if the offender is intra-familial. This was highlighted in Kate's statement regarding her thoughts on disclosure "Imagine what that would do to the family". In the therapy room, assisting those who have experienced CSA to clearly understand the dynamics of abuse, including unequal power dynamics, grooming behaviours, and learned helplessness, is a most helpful way of assisting clients to begin transforming the way they see themselves within the abusive relationship. Searching for specific, concrete examples within the client's narrative that provide ways of showing how the offender is solely responsible for the abuse, and providing many opportunities to uncover the unique effects their experience has had on the way they come to terms with the issue of 'responsibility' in their day-to-day lives, can help to facilitate this change. Further to this is the importance of learning to accept a genuine and authentic measure of responsibility in order to gain control and mastery over one's life, thus facilitating the move from feeling like a victim, to knowing they can cope with what is in front of them.

Acceptance of the emotional impact of CSA, such as connecting to the often painful, physical experience of *feeling* emotions within the body and acknowledging their existence, was an important turning point for Kate. Physical detachment, or dissociation, from emotions is a common coping mechanism in those who have experienced CSA, and occurs in varying degrees of detachment. However, a common occurrence is that, with the protracted use of dissociation from inner experience as a means of coping, comes a sense of not *knowing* one's self. Further, being detached from physical experience can impair one's ability to identify emotions within the body, and as such, people often report having a sense of existing 'outside' of their bodies. This again reaffirms the important distinction of this particular trauma happening *within the body;* shutting off one's connection to felt sensations is an understandable way to deal with such an intrusive, physical experience. Within therapy, teaching modalities that assist in the development of acceptance of experience, such as breathing techniques, meditation, and tactile exercises such as body work, can all be used as ways of assisting clients to become more aware of, and comfortable with, their inner experience. Learning to reconnect with one's body through acknowledgment and acceptance of emotions is another avenue that provides opportunities to experience a sense of mastery and control. It is also of great benefit to clients if therapists have a personal and working knowledge of how the processes of meditation and breath work are both utilised and cultivated, and to this end it is suggested that therapists choosing to use such activities with clients are themselves practitioners of these things.

Learning to see the truth of who one is, distinctly from the 'un-truth' of long-held intrapersonal misconceptions, such as the negative core beliefs often held by those who have experienced CSA, is another point demonstrated in the case study as being important in healing from CSA. Core beliefs based on feelings of inherent badness, wrongness, or deficiency are commonly expressed in the therapy room by survivors of CSA, and also by Kate. As Kate expressed, "Once I stopped blaming myself; that was a real unblocking". This point speaks to the importance of assisting clients in their development of a caring, unconditional acceptance of who they are. This process allows clients to move from a place of shame and guilt to a more honest view of seeing themselves as whole and possessing selfworth.

Another aspect noted in the case study is the importance of a sense of mastery, self-efficacy, or a trust in one's own abilities; in being able to trust in one's own judgment and prove that one can cope. Being able to shed the identity of 'victim' requires a movement from helplessness into a position of knowing one can help one's self. Learning to trust one's own judgment is an essential foundation on which to begin to build, or re-build, trust in others; an issue that often is a point of difficulty for survivors of CSA, in light of the *abuse* of trust CSA often entails. Inherent within discussions of strength, mastery, and most importantly the judgment of self that occurs with such experiences, healing, as it were, is best discussed with clients as something that should be viewed as a dynamic and on-going process.

#### **6. Summary**

50 Sexual Abuse – Breaking the Silence

trusting intuition. Art, painting, that has been wonderful. I was always good at art and somewhere along the line as a child I got the message that was a waste of time, but reconnecting to that has been a big part of my healing. Improved relationships. Improved parenting. Flowing with things that are happening without reacting". In this quote, Kate clearly expresses how the struggle to heal from CSA has not only provided her with a deep and fulfilling life, but that she also feels her life has been more enriched and meaningful for

There are many implications for main-stream therapeutic practice that can be taken from this case study. First, it is important to acknowledge that "mainstream practice" indicates the Western tendency in psychiatric and psychological literature to favour CBT as a therapeutic intervention of choice following any kind of trauma (e.g., Forbes et al., 2007). Although CBT clearly has its strengths, the processes outlined in this case study highlight aspects that speak to deep processes, such as the importance of healthy and authentic responsibility-taking, connection to inner experience, including the energy of emotions within the body, as well as the relationship one has with ones-self, including beliefs about

Feelings of responsibility and guilt for the abusive experiences, either in part or in full, are commonly experienced by those with a CSA history. In addition, there is also the assumed responsibility that survivors place on themselves in relation to the ramifications of disclosure of the abuse, which often impacts on relationships within their family of origin, particularly if the offender is intra-familial. This was highlighted in Kate's statement regarding her thoughts on disclosure "Imagine what that would do to the family". In the therapy room, assisting those who have experienced CSA to clearly understand the dynamics of abuse, including unequal power dynamics, grooming behaviours, and learned helplessness, is a most helpful way of assisting clients to begin transforming the way they see themselves within the abusive relationship. Searching for specific, concrete examples within the client's narrative that provide ways of showing how the offender is solely responsible for the abuse, and providing many opportunities to uncover the unique effects their experience has had on the way they come to terms with the issue of 'responsibility' in their day-to-day lives, can help to facilitate this change. Further to this is the importance of learning to accept a genuine and authentic measure of responsibility in order to gain control and mastery over one's life, thus facilitating the move from feeling like a victim, to knowing

Acceptance of the emotional impact of CSA, such as connecting to the often painful, physical experience of *feeling* emotions within the body and acknowledging their existence, was an important turning point for Kate. Physical detachment, or dissociation, from emotions is a common coping mechanism in those who have experienced CSA, and occurs in varying degrees of detachment. However, a common occurrence is that, with the protracted use of dissociation from inner experience as a means of coping, comes a sense of not *knowing* one's self. Further, being detached from physical experience can impair one's ability to identify emotions within the body, and as such, people often report having a sense of existing 'outside' of their bodies. This again reaffirms the important distinction of this particular trauma happening *within the body;* shutting off one's connection to felt sensations is an

the painful experiences she has actively engaged in overcoming.

the self and learning to trust, both in one's self, and also in others.

**5. Implications for therapeutic practice** 

they can cope with what is in front of them.

Research regarding the experience of negotiating childhood sexual assault has postulated numerous variables that apparently inform *outcomes*. The outcomes that research and literature have predominantly focussed on are largely deprivational, which is understandable, and arguably morally just, but are also largely void of hope, growth, or transformation. Trauma is labelled as such because it is an experience, or perhaps multiple experiences, of having one's inner core fundamentally shifted by something so profound, so threatening, and helplessness rending, that it affords significant life change. Literature has focused on the insidious impacts, overtly displayed or covertly expressed, and a number of potentially diagnosable pathological impacts of such life experiences. What is evident is that many more people than not are living *normal* lives as survivors of CSA, and other traumas, and most importantly, that one outcome measure denoting difficulty in adjustment does not negate the presence of other markers of positive development.

It is important in the pursuit of promoting mental health, to also acknowledge the many ways in which a CSA survivor may heal, learn, and/or use the experience of their lives in a

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**4** 

**Do Alexithymia,** 

*1Leiden University,* 

*The Netherlands* 

*2University of Amsterdam,* 

**Dissociation, and CSA Explain the** 

*3Private Psychotherapeutic Center in Amsterdam,* 

**Controversial Topic of Memory Recovery?** 

In the foregoing chapter gender differences in symptomatology among victims of CSA were investigated. As alexithymia and dissociation are considered to be different manifestations of the same psychological state aiming at emotional disengagement from serious trauma first the affinity between alexithymia and dissociation will be investigated and then it will be explored whether specific abuse characteristics are related to alexithymia and dissociation. Because nowadays in the DSM the Janetian construct of dissociative amnesia instead of the Freudian construct of repression is seen as the mechanism behind recovered memories it will be tested whether dissociative amnesia is indeed related to having experienced episodes of inability to recall the traumatic event and its duration. In concreto

 More in particular: Is the severity of abuse characteristics with or without real body contact of crucial importance for developing abuse related symptomatology?

Following Freud and Breuer (1893/1924) and Janet (1911), intense anxiety, one of the most painful emotions in human existence, is regarded as the impulse leading to the disruption of the normal controlling functions of consciousness. As early as 1911, Janet gave a detailed

 *"With respect to this subject I have demonstrated the dissolving power of emotions on voluntary decisions, feeling states, and conscious sensations, and I consider the dissociation of memories to be part of the larger group where dissociation of coherent structures is induced by emotions"* 

**1. Introduction** 

the following research questions were posed:

**1.1 Dissociation and its affinity with alexithymia** 

*(translation from French).* 

 How are alexithymia and dissociation related to each other? Are alexithymia and dissociation affected by abuse characteristics?

Is Memory Recovery associated with Dissociative Amnesia?

description of this disruptive power of intense emotions (p. 532):

Peter Paul Moormann1, Francine Albach3 and Bob Bermond2

Zinzow, H., Seth, P., Jackson, J., Niehaus, A., & Fitzgerald, M. (2010). Abuse and parental characteristics, attributions of blame, and psychological adjustment in adult survivors of child sexual abuse. *Journal of Child Sexual Abuse, 19* (1), 79 – 98
