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Section 13
Stages of Child Sexual Abuse Treatment: Part 1

CEU Question 13 | CEU Test | Table of Contents | Child Abuse
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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In the last track we have reviewed countertransference and use of the Losses and Gains exercise.

On this track, we will look at the first two parts of the Healing Cycle for those living with the secrets of childhood sexual abuse of exposing the wound and re-experiencing the trauma. Sheila, is a 13 year old, who came to me for therapy when her mother discovered Sheila's 30 year old cousin, Nate had been sexually abusing her since she was 8 whenever he baby-sat.

A fact to consider as stated by Finkelhor & Williams is, "an average of 5.5 children per 10,000 enrolled in day care are sexually abused, and an average of 8.9 children out of every 10,000 are abused in the home."

Stages 1 & 2 of the Healing Cycle

Stage #1: Exposing the Wound
As Sheila and I began working together, I felt it important for Sheila to understand the process. I explained to Sheila, "The first two stages of the healing process include exposing the wound and re-experiencing the trauma".

Technique: Body Scan
For the first stage of the healing cycle, exposing the wound, I like to use a Body Scan as illustrated in the following dialogue, as a means of reclaiming repressed and denied memories.

I stated, "What are you feeling now?"
Sheila stated, "Nothing. I feel numb."
I stated, "Close you eyes and mentally scan your body to see if you can find any places with tension."
Sheila stated, "My chest feels tight. My heart hurts."
I stated, "Focus on you heart."
Sheila stated, (crying) "It hurts."
I stated, "What emotions are you having?"
Sheila stated, "Sadness"

Sheila was unaware of her emotions at first. Think of your Sheila. Would it be appropriate to use a body scan in your next session? As I encouraged Sheila to focus on her body, she became aware of not only her physical feelings, but also recognized the emotions that she felt with the pain.

I have found body awareness plays a central role in reclaiming repressed and denied memories. When focusing on the body or emotions, Sheila is eventually led back to her original wound. So as Sheila became aware of what her body was experiencing, as you may know, it allowed her to move to the next step of re-experiencing the trauma. As you listen to Sheila's story, consider if your Sheila has body awareness or would benefit from this exercise.

Here is another example of a body scan. Tara, a 13 year old, who remembers her arms being held while being abused by her grandfather during the years before he died, stated when asked what she was feeling replied, "I'm feeling angry!" Let's look at the Body Scan as I used it with Tara.

I asked Tara, "Why are you angry?"
Tara replies, "I don't know."
I asked, "Where in your body do you feel anger?"
Tara (hands clenched in fists) weakly replied, "I don't know."
I encouraged her by stating, "Focus on your hands."
Tara, stated, "I wanted to hit him, but I couldn't. He held my arms so I couldn't. (Pause) I never remembered that before."

Stage #2: Re-experiencing the Trauma
After exposing the wound, the second stage as you know, is re-experiencing the trauma. I find it important to remind my client of the difference between the memory of the abuse and the actual abuse. So as terrifying as the process can seem, the goal is to release not only the pain of the memory, but the varied emotions (including fear) that accompanied the memory.

As Tara re-experienced her trauma, she explained, "I keep wanting to get away, but I'm scared. I just lay there frozen. I'm looking up at the ceiling and pretending to fly around the room, like a bird trying to escape. He touched me where I don't want to be touched. It hurt! But parts of it felt good. I'm so confused. I loved my grandfather! It hurts and I'm scared! I want to hit him and I can't! It's hard to breathe and my heart is pounding. I'm scared."

I have found the "Body Scan" exercise allows clients like, Sheila and Tara to begin to explore either what they think is a lack of feeling or the opposite, their strong feelings. As you consider your Tara, would she benefit from exploring her emotions that will surface as she re-experiences the trauma emotionally?

Now that we have discussed exposing the wound and re-experiencing the trauma, the next track will deal with the last two stages of the healing cycle externalizing the pain and healing the wound and the techniques of creative drawing and writing "unmailed" letters.

Peer-Reviewed Journal Article References:
Chard, K. M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73(5), 965–971.

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. 

Ferrajão, P. C., & Elklit, A. (2020). World assumptions and posttraumatic stress in a treatment-seeking sample of survivors of childhood sexual abuse: A longitudinal study. Psychology of Violence, 10(5), 501–508. 

Webster, G. (2018). Psychoanalytic complexity theory: An application to the treatment of child sexual offenders. Psychoanalytic Psychology, 35(1), 83–92.

Wolfe, V. V. (1992). Review of Child sexual abuse: Critical perspectives on prevention, intervention, and treatment [Review of the book Child sexual abuse: Critical perspectives on prevention, intervention, and treatment, by C. R. Bagley & R. J. Thomlison, Eds.]. Canadian Psychology/Psychologie canadienne, 33(2), 211–212.

Online Continuing Education QUESTION 13
What is one technique you might use to assist the client in exposing the wound and re-experiencing the trauma? To select and enter your answer go to CEU Test.

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