The Therapeutic Relationship: a Blueprint

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As therapists, we take journeys with our clients. We embark on long trips to uncover and discover the past and imagine possible futures. In the case of people who have been victims of childhood sexual abuse, this journey is especially difficult. Survivors entering into the therapeutic process feel profoundly damaged. They often come with little hope and a lot of shame. They desperately seek a connection with another[1] human being, yet are utterly afraid to trust.

Whatever clinical approach one takes as a therapist when treating survivors of sexual abuse, the quality of the therapeutic relationship is the most important aspect of the healing process. The relationship between the therapist and the client will become the foundation for all other relationships. The therapeutic relationship will offer the space both mentally and physically for the survivor to revisit old wounds, and also to learn new ways of being in the world. The consulting room becomes a place where survivors share memories, understand the past, and explore relational issues. It also lays the groundwork for a “corrective” experience by showing and experientially allowing the client to feel how one can have a nonabusive relationship with another.

Following Courtois (1988) and Herman (1981; 1997), I believe that when treating adult survivors of trauma, especially sexual abuse, the therapist needs to acknowledge the experience of the client. As Courtois (1988) states: “The reality of incest and child sexual abuse is at the core of this therapy. While this point is self-evident and redundant, it must be continuously reemphasized due to the societal tendency to deny, discount, or dismiss such intrafamilial abuse, as well as the denial inherent in some theories of personality and on the part of some practitioners. … The client is believed and is actively encouraged to remember what happened …” (page 167).

The therapist’s role is one of validation and support. Attitudes of “therapeutic neutrality” can repeat the pattern of abuse experienced by survivors by reinforcing isolation and self-doubt, and the silence on the matter might be perceived as siding with the aggressor. In treating survivors of sexual abuse, the clinician must first address the interpersonal damage survivors feel as a result of the trauma. The therapeutic relationship must withstand stories of horror, anger, shame, and fear. It must remain a constant in the face of disappointment, conflict, projected demands, and profound ambivalence to the therapeutic process and the therapist. Finally, the therapist must work with the client to understand that wounds can heal, even though scars remain.

As survivors come to understand their personal stories of abuse, an important part of the healing process is to encourage them to look at systemic oppression and how systems can promote abuse.  Through active dialogue, therapists should engage with their clients in a process of critically analyzing the world by looking at mechanisms of oppression and dehumanization that foster sexual abuse (beliefs and practices regarding power, sexuality, gender inequality, ideas about children, and ownership) and how systems of oppression (schools, police, military) create the conditions for child sexual abuse. Because we live in a society that teaches and privileges power-over rather than power-with, an intrinsic part of therapy with sexual abuse survivors—and all our clients—should be an open interrogation of power, including an analysis of power in the therapeutic relationship.

When we engage in therapy that analyzes both personal and structural problems, we allow our clients the possibility to become not only agents of personal change but of social transformation as well. While understanding his/her power in the world, the client can heal by knowing that child sexual abuse is about having power over another person and using that power sexually. The client can then begin to have different types of relationships with others, allowing them to understand their own power while creating safer spaces for all of us.

References:

  1. Courtois, C. (1988). Healing the incest wound: Adult survivors in therapy. New York: W. W. Norton.
  2. Herman, J. (1981). Father-daughter incest. Cambridge, MA: Harvard University Press.
  3. Herman, J. (1997). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. New York: Basic Books.

[1] The Other as a concept of difference, other than the self. Otherness is part of understanding the self.

© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Silvia M. Dutchevici, MA, LCSW, therapist in New York City, New York

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Inez

    Inez

    October 22nd, 2012 at 4:36 PM

    While I think that this is an important relationship for someone in therapy to develop, I also think that it is wise to make it clear that there are still boundaries within these relationships that must be observed and preserved, and I think that that is a line that is too often crossed by both the patient and the provider.

  • amelia

    amelia

    October 22nd, 2012 at 11:29 PM

    to talk about something that has haunted you for a long time is difficult for anybody.I felt the same when i first walked into my therapist’s office to talk about the physical abuse I suffered in my childhood.and although it does become easier to talk after a little discussion with the therapist,I think the therapist plays a very important role in enabling a setting where in the client can really open up about the things that are bothering her.

    and once the client has begun to speak,what the therapist does and how he responds also plays an important role in the continuation of the client’s talk and her levels of comfort.so this is not a one way street but rather commitment needs to be shown from both the therapist and the client so as to ensure the therapy is received right by the client and that the intended results are obtained.in addition to all this,a cheerful and enthusiastic therapist does not hurt at all!

  • Preston

    Preston

    October 23rd, 2012 at 4:00 AM

    I find that the one thing that is lacking in many trauma survivors lives is that they have never been able to find someone who will not only acknowledge the experiences that they have been through but who will also give them a path to recovery. I think that many times they have encountered those who say that they are sorry for what they have been through, but then want to ignore the fact that this happened and move on. Moving forward from trauma and abuse is not an easy trip to take, there are so many obstacles that they must encounter and get through that many times it can feel impossible to do without a good therapist who can help to show you the way.

  • Jason

    Jason

    October 23rd, 2012 at 7:33 AM

    I made quite a few visits to a counselor myself and though I was skeptical at first I gained confidence due to the reciprocation I got from the other end.I think empathy,compassion,and a non-judgmental attitude,combined with some experience of similar issues, really makes for a great relationship with the client.

  • fabia

    fabia

    October 23rd, 2012 at 2:04 PM

    spot on,preston!I cannot begin to describe how shattered I was after my nightmarish experiences in childhood.And when nobody was understanding of me even after years I began to lose hope.that was until I decided to see a therapist and I was so much more comfortable talking about and sharing everything once I saw some reciprocation to listen.It helped me to a great extent no doubt.and with the right therapist,you can turn things around too!

  • Penni

    Penni

    June 24th, 2016 at 7:52 PM

    I ran across this article tonight and it rings true for me on so many levels. I started trauma therapy just over a ago after initially hiding my childhood experiences w/the military. My psychologist was amazing and very patient. EMDR allowed me to process and feel sensations I blocked out as a kid and in time I began to trust her and was able to verbalized things that haunted me my whole life. Im happy to say my memories no longer bother me but my therapist just separated from the service. I haven’t dealt w/that very good. After a suicide attempt and being hospitalized w/a great military unit I’ve come to terms w/my actions and I realized it was hard letting go of her. Even though it was strictly a therapeutic relationship I felt her loss. I owe her a great deal of appreciation but I’m now attempting to find her replacement. My new therapist isn’t working out and after a couple months I’m changing again.
    Trust is really hard for me and I acknowledge that. I’ve spent a lot of time discussing my grief and suicide w/my old and new therapists. Nothing is ever easy but one day at a time. I often hear some very familiar words; you’ve got this and just breathe echo in the silence. Phrases that were often spoken to me after a hard EMDR set!

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