On the last track we discussed the technique of releasing
emotional energy to relieve the pain of childhood sexual abuse.
this track, we will demonstrate the use of "leaning into", empathy and
taking a one-down position to assist in building rapport in potentially volatile sessions with a sexually abused child or their parent.
you know, efforts to build rapport are often times misinterpreted by parents
or clients who have been coerced into attending therapy or who have had previous
negative therapy experiences. Here is how I avoided and diffused potential escalation with Anita and her daughter, Angel, age 13. Anita and Angel were referred to me
after Angel told the school counselor she had been sexually abused by her Aunt's
boyfriend, Stan. She had been seven and staying at her Aunt's home for the weekend.
you are aware, especially in the case of childhood sexual abuse, any behavior
that can be construed as even slightly as blaming, criticizing, accusing or disagreeing
undermines the connecting process. Oftentimes in these initial therapy sessions,
I envision myself walking a tightrope. Do you? Here is how I walked this tightrope
with Anita and her daughter.
Therapist: I looked at her and stated, "What
I'd like to do before we get started is get to know you a little bit. It often
helps us to
Anita: (interrupted groaning) "Oh, here we go
again! Do you people not keep records!? Wouldn't it be easier to just read the
records instead of wasting time going through the whole history? Seriously, I
don't mean to be facetious; it just seems a waste of time to go through the whole
family's history time after time."
Taking a One-Down Position
Therapist: Taking a one down position, I softly
said, "I wasn't referring to your history. I was actually referring to just
getting to know you as a person."
Anita: "Fair enough!" (responding
sarcastically and clapping her hands) "You won't find much in me!"
Therapist: Leaning (into) toward Anita, I responded, "Sometimes it just makes it easier
Anita: (voice dropping slightly) "Again, I don't mean
to be facetious. Don't get me wrong. I just really didn't want to have to go through
Responding with Empathy
Therapist: Responding with empathy I stated in a soft tone, "It
sounds like you've really been through the mill with everything so far. Is that
Therapist: Taking a one down position again I
stated, "Well, maybe we'll scrap getting to know each other. Maybe you can
tell me where you would like to start."
Anita: "I really can't say.
I'm sorry. As much as I've already said that I don't really want to go through
the whole family history again, I honestly couldn't say where I would want to
start. I am not the psychologist, so I don't really know what is actually relevant.
So probably I was speaking out of place. But I really wanted you to know my feelings."
Therapist: Empathetically I responded, "It sounds like you have been through this many
times. How many times have you been through it?"
lost count, (pause) but it's been all Angel's life. The whole 13 years. I think
the problems have varied, but they have been basically the same."
maintaining eye contact, I empathetically asked, "What I would like to try
and understand is why the help that has been offered you hasn't helped you so
far. What has your experience been in trying to get help?"
Anita: "Because we've been to so many different people who have told us so many
conflicting things. I am going to have to go through it, I know
. You ask
me why it hasn't helped. And I don't know. All I know is that I just feel like
I've been alone. I haven't had a supportive family to start off with. Quite apart
from that, I've just been totally confused by so many so-called professionals
giving us their opinions, everything from food allergy to dyslexia."
Therapist: While maintaining an open position, I sought clarification, "Of the people
you have seen, have they been primarily supportive or unsupportive?"
Anita: (pausing) "That's a difficult one to answer. I think that my
opinion would be that they were doing a job."
Therapist: Empathetically I asked,"Did any of them seem to care about you as a person?'
Anita: "I was just another number".
Therapist: Seeking clarification, I asked Angel,
"Angel, who do you think out of everybody that your family has seen, who
do you think has been most supportive? Do you know what I mean by supportive?"
Angel: "Dr. M., I think. But he's hard to work out. He doesn't show
what he's thinking."
Therapist: I asked, "What do you think, Anita?Who in the rest of the world would be most supportive of you?"
Therapist: Empathetically, I softly asked, "Is that right?"
Anita: "Yes, I always have done
" (Voice dropping and eyes
Therapist: Seeking clarification, I asked, "When you say it always has
been, does that mean just since you had Angel, or in terms of your whole life?"
Anita: "Do I have to answer that?"
Therapist: I empathetically responded,
Angel: "At least make an attempt. I have to."
Anita: "OK, my whole life. But there's a lot Angel doesn't know."
use of empathy with Anita's perception of mistreatment at the hands of professionals
lessened her negative stance enough to connect with me as their therapist. As
you can see, the use of the basics in small steps such as appearing warm, respectful
and responding empathetically also helped avoid a negative escalation; while offering
a positive interaction to build on.
This track has discussed
and demonstrated the building rapport basics by use of "leaning into";
responding with empathy; taking a one-down position, as well as, a quiet tone
and eye contact to assist you in building rapport in potentially volatile sessions.
So why do you suppose I decided to include such basics skills on this CD track?
I find when a client is volatile, I sometimes over look the basics of my body
language and voice tone. Think of the last volatile client you treated. Would
it be a good idea to replay this track prior to your next session with that client
to review some of these basics you may be overlooking?
know the volatile client is probably involved in transference. On the next track,
we will look at transference as well as splitting.
Peer-Reviewed Journal Article Reference:
Ensink, K., Borelli, J. L., Normandin, L., Target, M., & Fonagy, P. (2020). Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties. American Journal of Orthopsychiatry, 90(1), 115–124.
Jones, T. M., Bottoms, B. L., & Stevenson, M. C. (2020). Child victim empathy mediates the influence of jurors’ sexual abuse experiences on child sexual abuse case judgments: Meta-analyses. Psychology, Public Policy, and Law. Advance online publication.
Schuler, M., Mohnke, S., Amelung, T., Dziobek, I., Lemme, B., Borchardt, V., Gerwinn, H., Kärgel, C., Kneer, J., Massau, C., Pohl, A., Tenbergen, G., Weiß, S., Wittfoth, M., Waller, L., Beier, K. M., Walter, M., Ponseti, J., Schiffer, B., . . . Walter, H. (2019). Empathy in pedophilia and sexual offending against children: A multifaceted approach. Journal of Abnormal Psychology, 128(5), 453–464.
Online Continuing Education QUESTION
What are three skills that de-escalate a volatile session? To select
and enter your answer go to .