Child Sexual Abuse: A Case Study and Treatment Process

  • ​part 1
  • ​part 2
  • ​part 3

​I am seeing Jane for the third time. After a few sessions there is more trust between Jane and I (the client and therapist) and it will be a lot easier to get started and pick up where we left off last time. I still check in with her about what's happened during the week since I have last seen her; if there have been any changes, etcetera.

This is our 3rd session. In the last week she'd been feeling lighter in her body with fewer headaches and joint-pains. She did have some flashbacks to what happened to her, but there seems to be more of a sense of objectivity to it, and she mentioned having tried to work with it, as we did in our session, whenever she could.

Me: How do you feel Jane?
Jane: I am in a good space for now. I do think we have a lot to work with still but am less dual mind about it - like wanting to run and at the same time knowing something needs to be done.
Me: OK, sounds good to me. Let's continue, if we can, from where we have left off last time after we settle you in. As before just close your eyes and tune into the body. See where your energy is - right here and now. Mostly likely it will be a bit in the head if you have been busy doing things. Start there... with the sensation of it, without associating it with the things that you have been doing today.
Jane: I am OK now actually. I have had a few days off and haven't done too much.
Me: Right. Good. So last time we worked with anger that came up and how it related to some of your physical symptoms, your headaches, pain in the liver area and possibly also connected to pains in the joints. How is that level of anger for you right now?
Jane: It is a lot less. It has been coming up now and then but I'm looking at it in a different way, from a different perspective, and taking out any blame that has been connected to it, has really helped me to let go of it. I have been having more sad feelings in the last few days and also feelings of shame. Maybe we can work with that a little more this time.
Me: Right. Now I want you to see if you can let yourself go back again in time to where we were last time..... so..... you are alone with your uncle, sitting in the living room and he is coming onto you..... He is sitting very close to you and it is making you uncomfortable. You will likely feel all of that again as we are there now... but less... we have worked with this last time so there is less resistance, less overwhelming. Or possibly you are quite OK to stay with it as it is now..?
Jane: I am OK yes. This part is more just a memory now without the strong infusion of emotion attached to it.
Me: OK good. I would like to go a little further then, if that's OK with you. Tell me what is happening next?
Jane: He is starting to touch me and kiss me.
Me: OK, how do you feel now Jane... I mean in the body – here and now.
Jane: I don't know. As I talk about it now it seems like it is not really happening to me but to someone else.
Me: OK, and how does that feel in the body?
Jane: I am not really in the body. I am more in my head... or not even there...
Me: Right. Now, just hold that for a while. Stay with that blankness or disconnection if you can. You see when something has been too overwhelming, one of the ways to deal with it is to disconnect from your feelings. It is a way of coping - a survival mechanism. If you can hold there for a while, and I know it is not a comfortable state because it will stimulate some nervousness... it will get some energy going there... but that blankness is a protection... it has a certain weight to it... emotions attached to it....
Jane: << Jane starts crying now and it is involving her whole body – I let this happen for a little while before I start talking again – giving her some boundaries and containment by doing so.>>
Me: OK, that's OK... just stay with me... stay with the body when you feel the release of emotion. It's perfectly fine.... just make sure you are not drowning yourself in it... in the sadness... while at the same time feeling the depth of it... of the emotion.... keep with it so you are giving it some sense of limitation, of containment... and my voice..., my talking to you now helps this... helps to give you some grounding. And you will see that these emotional releases will come in waves... they will subside a little before the next wave comes. Just stay with it, let it pass over you... it will relax some pressure and you will feel different in your body.
Me: How is it going Jane?
Jane: Yes... I am OK. I feel I am surfacing again a bit. I didn't expect to have so much emotion in me about this, although it has been bothering me for so long.
Me: I understand. I guess you have protected yourself well, not to get too close to this, so as to be able to carry on with your life – albeit having to suffer some form of compromise. Could you tell me what emotions came up for you so strongly and what they related to.
Jane: A lot of sadness really, also shame. Yes, shame. It feels as if that has been bothering me even more than the sadness.
Me: Right. OK. Tell me first: how is the sadness now and where in the body did you feel it; are you still feeling it now?
Jane: I could feel it releasing from the whole of my body but very concentrated around my solar plexus and chest.
Me: Right and how is it now?
Jane: It feels really warm in my body and waves of tingling still. Although I feel there are still parts that we have to work with.
Me: I know... we will get to that shortly. For now, I just want you to give a little attention to that pleasant feeling... that space in your body.. that newness. Let it become an integral part of you.. of who you are now.....
Me: Could you tell what made you feel sad?
Jane: I don't know really. I think it's because this whole experience has just kept me from living more fully for so many years. Worse still, every time I had a new partner it took so long for me to let that person come close, especially sexually, and just the weight and pain of it in my body. It sort of took a lot out of me.
Me: Right, that makes sense doesn't it, what you are saying?.... And all these different emotions are connected to each other. The anger, blame and disconnection kept you from feeling deeper within the body... feeling into the sadness, the fear and the overwhelming shock of the experience itself., thereby keeping the trauma alive. Now let that sink in a bit, on the cognitive level. It is important to work through the emotions and the releasement that comes with it, but it is also important to see how it all hangs together. Once you understand what is involved; when that perspective as to how you look at it has changed, and you can see that what you have perceived and allowed were natural responses, natural ways of coping and you have dismantled the blame and guilt... you will not develop that emotion again. And this is very important – we don't want you to become dependent on me - going into releases and then the development of that emotion again. Once we have worked through it and put things in perspective it is finished, over. It doesn't need more work, management, or maintenance, nothing of that kind. Are you still with me Jane?
Jane: Yes, I am very happy that we're doing this. It's really helping me. I am a thinking person and this just fits and suits me. Or: (fits me like a glove).
Me: Right. You're also a feeling person Jane. Now let's go back a bit to our experience. You mentioned feeling ashamed. Can you tell me a bit more about that?
Jane: <<she is getting nervous now and is hesitant about going further>>
Me: Again, just feel where you are... go slowly into it... firstly, feel the resistance to talk about this, and stay with it for a while. There is no need to use force.. it will come when you quieten down, when the resistance loses momentum. It's very likely that you're back again, right now, on that couch with your uncle. You don't have to go into the details of what occurred, really. It is not all that important. I want you to stay more with, or pay more attention to the feeling, the emotion itself. What's happening for you now Jane?
Jane: Yes, it feels like I am back there again. He is still touching me and making me touch him. I feel so confused as I know he should not be doing this; it is wrong, I don't want it, but at the same time I also like it; I'm aroused by it.
Me: OK, let's slow down here, if we can, because there are lots of scattered feelings happening here and it seems to me that they are quite disorderly....... and also, the meanings that you have given to these feelings are a bit confused... so we want to see if we can untangle them... or put them in their right order. Maybe we should start with the shame, as you mentioned that earlier..... and I want you to go slow with it because I feel that it is there.. just under the surface waiting to take over. Begin by staying with the body sensations.... the flush of heat in the face.... the nervousness..... and see if you can breathe into it... giving it space... till you find that it is not taking you over so much. How is that going for you?
Jane: I am trying to stay with you, following the body sensation but it is hard, I feel it is all mixed up and confused.
Me: I know... we are just working with it, firstly: to give it some boundaries. You see... getting sexually aroused has become something bad for you, something to be ashamed of..... on a certain level.....and it seems like, from what you have told me so far, it is because of this forced experience...... I want you to look at it... also what you told me earlier. - “I don't want this” but part of you also liked the feelings of arousal.... - this is where the mix up is, it seems to me. Now I am relaying this to you on a cognitive level, just to get it clear to you mentally....but the emotion and shame are still there... coupled with the event. So let’s look at it at a more experiential level........ I want you to move your attention to the belly, to the groin area... and let your energy go there... your attention. We are going to go slowly into this and I will bring you to the surface, if we need to. Again, be there where we just left off.... in our experience. Feeling sexually aroused... this time, however, I want you to just stay with that... the sensation of it..... letting the event be just what it is..... taking what happened to you when you were so young for exactly what it is.... just follow that feeling, that sexuality.... not letting it take over.... not going into it..... but also not pushing it away...... and this is what has probably been happening in your life..... either you have wanted to indulge in it... lose yourself in it, or there has been this hard refusal to it... that rejection of sexuality.... now I want you to stay with... holding it lightly.... seeing those movements for yourself... this wanting to go into it..... and this pushing it away...... till that becomes lessened. Knowing that the wanting to indulge in it is a reaction to wanting to forget what happened to you, and also the rejection of it is in pushing the shame away..... Keep staying with the sensation, the feeling while I am talking.... I am just helping you to see what's going on in it... where your reactions are coming from, so that you can let it go .... you can work through it on a feeling level.... and once those reactions.... those wants and don't wants are becoming lessened... when you are able just to stay with being sexually aroused... the energy moving through the body... the sensations..... feeling the beauty of it.... the simplicity of it.... the feeling it gives you. Experiencing it as a natural feeling, is to be in that natural state..... How are you doing Jane?
Jane: Yes
Me: Are you still with me Jane?
Jane: Yes, I sort of want to stay there... with that feeling a little longer.
Me: I know... there will be time for that... and you can do it now without me.. It's just our time is running out and there are a few more things to get clear. How is the shame now?
Jane: I think around this it has eased a lot, if not gone completely..... I am still feeling it a bit and also anger towards myself now for not having told my parents what happened then and there.
Me: Right. The anger with it... is it something new or do you feel it just now?
Jane: No only now... I'd always been too ashamed.
Me: OK good... that anger has a certain power to it.... a re-establishing of parameters for you. And we will talk about this a bit more next time. Just for now I want to leave you in that sense of empowerment... that being more here and now. I think we have worked a lot today... we have done a lot. Is this OK for you to leave it at this point?
Jane: Yes... that's fine.

This is the last of this series of articles. We have gone through the main emotion and mechanism of trauma – both on the cognitive and experiential aspects. In the next sessions with Jane we keep working to process emotional residue related to her abusive experiences as well as repeating the understanding of it on a cognitive level, within herself when there is need of it.

  • Lana says:

    I think that what you fail to address is that what happened to Jane is a crime – a criminal act that should not have gone unpunished. Anger in survivors is a complex issue and the secondary victimization that occurs when others fail to protect, or to act appropriately upon learning of the abuse is what partly fuels the anger.

    • Roland says:

      Social justice and accountability most certainly has its place but is not part of the intention and content of this website or the work between ‘therapist’ and ‘client’. I am talking about what keeps trauma in place through blame, guilt or self-reproach coupled to an event, person or period in one’s life. It does not justify the aggressor’s behavior nor put blame on the victim but rather focuses on addressing and working through traumatic residue.

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