Abuse Survivors: Living through a period of physical, sexual, or severe emotional abuse can leave psychic wounds that are harder to heal than almost any bodily injury. Whether the abuse was inflicted as a child or an adult, survivors often struggle to move on and lead happy, peaceful lives. Therapy is a proven aid in understanding, expressing, integrating, and letting go, of the pain and confusion that may stem from abusive experiences.
Intense, often negative feelings are not uncommon, and survivors should understand that having difficulty coping with upsetting memories, blocks to intimacy, anxiety, and other remnants of abuse is fairly typical, and can be worked through, in time, with good therapy. Survivors of abuse may manage and express their experiences and feelings in a variety of ways:
Anxiety: Survivors may be afraid of people or situations that remind them of their abusers. They may be sacred to be alone or of the dark, scared of strange men, fearful in sexual situations, or intensely triggered by anger. Disrupted sleep, compulsive behaviors, panic attacks, and other indications of anxiety are somewhat common in survivors of abuse.
Anger: Survivors may feel great anger at their abusers, at anyone who knew of the abuse but did not stop it, at people who remind them of the abuser, and even at themselves for being abused (sometimes believing they could or should have stopped it.) Anger is not an inappropriate response to being abused; dealing with anger in a constructive way is a good goal for an abuse survivor in therapy.
Dissociation: Survivors may find themselves numb, or experiencing a feeling like “being out of one’s body,” floating above oneself, and even forgetting where or who one is. These experienced may have begun while the abuse was occurring, as a way for the survivor to avoid the intense pain and fear that can be caused by abuse.
Mood issues: Depression and/or mood swings is a somewhat common response to abuse.
Post Traumatic Stress: Survivors may find themselves having nightmares or otherwise reliving their abuse. They may avoid situations that remind them of the abuse.
Shame: Survivors often feel guilty or ashamed about their abuse, as if they deserved it, brought it on themselves, or should have been able to stop it. Examining and challenging such beliefs is an important part of therapy for survivors.
Self-Destructive Behavior: Survivors may cope with conflicting feelings by self-medicating. They may act out their abusive situations compulsively, finding themselves again and again in similar relationships. The may avoid success and sabotage themselves, revealing deeply wounded self-esteem and difficulty caring for themselves. Survivors of sexual abuse sometimes allow their hygiene and health to deteriorate, perhaps unconsciously believing that this will make them less attractive to perpetrators.
Trust issues: Survivors may have great difficulty trusting others, especially in intimate situations, even if the survivors recognize that a certain person deserves trust and that the survivor’s mistrust is not entirely rational. A positive relationship with a therapist can go a long way to reversing this stance.
Diagnostic and Statistical Manual of Mental Disorders (DSM): The medical model recognizes several syndromes that often stem from abuse, particularly Post-Traumatic Stress Disorder and Dissociative Disorders.
Special Concerns: Memories of abuse may be repressed, so that the survivor does not have any conscious memory of the abuse. However, this is actually quite rare, and everyone should be cautious about concluding that abuse occurred in the absence of clear memories of the survivor. Not all of the above difficulties come from being abused – and abuse does not always lead to significant emotional or psychological problems.
Survivor of Abuse Case examples:
Patricia, 45, seeks therapy because she is in her first sexual relationship after more than two decades of avoiding intimacy. As a teenager, she was sexually abused by a male relative and feels great anxiety and anger whenever a man shows sexual desire for her. She has recently met a man who seems safe and compatible, but does not trust her judgment. She is also very triggered, almost to the point of having panic attacks, anytime they initiate physical intimacy. Learning relaxation skills, exploring ways to take care of herself and stay physically and emotionally safe, and achieving some catharsis of her grief and anxiety allows her not to escape her fears and triggers, but to be able to move forward in the relationship in the presence of such triggers, and eventually she develops a deeper level of trust not just with her partner, but with human beings in general – although anxiety remains an issue for her for many years, diminishing slowly in stops and starts.
David, 27, was physically and emotionally abused by his parents as a boy, and feels great anger and shame. He has a need to understand why this happened to him, and cannot shake the sense that he must have deserved it. Cognitive behavioral work helps David to reality check his beliefs, and he begins to see his parents as the imperfect people they really are. This allows him some way to forgive himself, greatly improving his mood and self-image.
Julie, 32, has been in and out of several abusive relationships with men over the last decade. She recognizes the pattern but continues to forgive abusive behaviors by her partners and blame herself for their actions. Therapy helps her see how her abusers are like her father, and this insight alone improves her ability to set boundaries. The support of her therapist, over about a year, helps Julie to accept her own needs as legitimate and begin advocating for herself with her partners.
Devon, 12, was severely beaten by caretakers and has little ability to form attachments to adults. He picks on other children at school and has been shuffled around the foster care system. His current caretakers want to adopt him, but only if they can find a way to manage his behaviors and win his trust. Family systems work begins to alter the dynamics of the family’s interactions, and after many years of intense and difficult sessions, Devon is able to feel that he is safe.
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