**11. Phase II**

146 Sexual Abuse – Breaking the Silence

understand that this lack of health assertive behavior emanates from fear, confusion, dissociation, poor health care modeling, and an over all sense that he/she does not deserve attention or good health care. Additionally, the psychotherapist can share and discuss information and how-to techniques on becoming a healthcare consumer with the patient. Many organizations produce informational brochures and flyers on health consumerism for

Psycho-education regarding health care needs and developing assertive behavior with health care professionals can improve the health outcomes for CSA survivors and is a

**Teaching the CSA survivor how to modulate stress and improve health outcomes through** 

Psychotherapy with CSA survivors is generally constructed around a three-stage approach that begins with establishing safety, stabilization and emotional regulation (Ford, Courtois, Steele, van der Hart, Nijenhuis, 2005). While there are a variety of treatment models addressing the issues of trauma available today, most of these treatments are phase-oriented and focus initially on establishing safety for the patient and the therapeutic relationship as the foundation of the work in which processing trauma occurs. The therapeutic relationship becomes the "container" – the holder of painful memories, thoughts, and issues related to the traumatic event. More importantly, the mental health practitioner becomes the model for containment through support that is consistent, boundaries that are well established, and empathic interest in the patient (Ford et al, 2005). The patient will explore and reprocess the

The mental health practitioner should be a warm, genuine individual who can provide an empathic stance, thus formulating the foundation for a therapeutic alliance. It is important for the therapist to retain this empathic demeanor as well as a calm façade when hearing distressing histories from the CSA survivor, generally not a minor feat to accomplish. Sessions should be consistent and the mental health practitioner should provide the CSA survivor with what has been called, "a corrective emotional experience" (Alexander &

There are many important components of the first phase. One is to take a history of the patient making sure to note previous abuse incidents and outcomes. Assessment should include patient symptomatology, previous treatment and/or hospitalizations, family history and current contact, health history, and vocational status. Psychoeducation includes defining and normalizing triggers, flashbacks, dissociative symptoms and problems in controlling emotions as part of the normal reaction to traumatic events, and can reveal strengths. Ford et al (2005) state, "The client's response to education also reveals strengths that can become a basis for overcoming helplessness without invalidating unmet dependency needs" (p. 438) ( See also Steele, Van der Hart, Nijemhuis, 2001). Safety is established in this phase and issues such as suicidality, and maladaptive behaviors such as unhealthy risk taking and self-harm are addressed (Pearlman & Courtois, 2005; Ford, et al, 2005). The patient will learn and practice skills to manage these

traumatic events and finally, achieve mastery and resolution of life issues.

sexual abuse survivors.

**psychotherapy** 

**10. Phase I** 

necessary part of psychotherapy with the CSA survivor.

French, 1946) throughout the course of therapy.

Once safety and stability have been well established, identifying, exploring, and processing the traumatic experiences can take place. Additionally, emotions such as shame, guilt, and helplessness need to be understood and processed. As acceptance of past actions takes place, and responsibility for abuse is correctly assigned to the perpetrator, internal conflicts can be addressed and resolved. The patient can slowly begin to give up the victim role, practice new more assertive behaviors and beliefs, and begin to 'deserve' good health. Additionally, the patient begins to review and predict where in this process they may have difficulty, and apply some of the basic principles of "relapse" prevention, e.g, falling back to old behaviors that negated his/her rights to good health.
