A note on language: the terms ‘sexual violence’, and ‘sexual abuse’ are used interchangeably in this blog. They are intended to reflect the wide range of ways that a person can be affected by non-consensual sexual contact.

By its very nature, sexual abuse forces individuals to inhabit smaller spaces within themselves, their relationships, and the wider world. This begins in the moment of surviving sexual abuse as the body’s automatic responses to threat are activated in the form of flight, fight, or freeze. There is a crossover between bodily survival and psychological survival, particularly in the aftermath, as an individual is forced to re-frame their understanding of everything they know.

As practitioners, we experience elements of a client’s emotional distress within their narrative as we work with them in psychotherapy. In survivors of sexual violence, the impact on the client’s sense of self is often palpable at multiple levels. I have found that what also takes up space in the room is disempowerment, which can come in many forms including: silencing, oppression, and re-traumatisation.

How, then, do we enable survivors of sexual violence to re-inhabit all of their personal domains when empowerment seems nowhere to be found?

INCREASING ACCESSIBILITY

We may understand access as only relating to clients who have a disability of some kind. However, it is worth extending this term to include practical and dialogical interventions that can promote empowerment of the survivor’s self in psychotherapy. Appropriate, ethically considered, boundaries can be extended to increase a survivor’s freedom of movement, autonomy, and speech during the often-challenging process of recovery. These might include:

• Being able to complete referral forms face-to-face
• Being introduced to the premises, and the Psychotherapist, before the first appointment
• The therapist checking whether the placement of furniture is comfortable, for example: ‘Would sitting nearer the door feel safer?’, ‘Would it be easier to talk if my chair was angled in a different way?’
• Asking what the body needs as well as the mind, for example: ‘What would you do if you were at home, and you felt this tension there?’, ‘Would standing up for a moment release some of that tension?’

LANGUAGE

Psychotherapists should consider the role of language within talking therapy as another vehicle by which to progress the work. This is especially important for survivors from different cultures, and countries, where co-creating a meaningful language may need to start from scratch. It is also important for survivors who identify outside of cisgender, and/or heterosexual categories. Such clients have often had no opportunity to see sexual abuse of queer people defined in public narrative, nor legal systems.

As a starting point, I find it useful to ask a survivor to identify (in writing, or speech) which words are triggering, and which make sense to them. Mirroring the words used when we refer to sexual abuse with a particular client is a form of respect of their process. This includes instances where there are no specific words, or when physical sensations are easier to identify.

As much as possible, psychotherapy is an opportunity to sensitively promote empowerment by meeting the survivor where they are, rather than repeating the experience of being forced to comply. Our skills can be adapted to meet this need, and welcome a more diverse range of clients into the services we provide.

The original version of this article was published on the PESI Blog on 6th February 2020.