I was recently fortunate enough to have been asked to speak on Mary Immacuatle College’s radio station on the subject of eating disorders and body dYsmorphia.
Click on the following link to hear the full interview with Shane O’Carroll on Wiredfm’s current affairs programme.
Date of original airing 27/10/15
The Role of Sensorimotor Psychotherapy in counselling adult survivors of Child Sexual Abuse (CSA) has been shown to facilitate clients in dealing with elements of Post-Traumatic Stress Disorder (PTSD) that commonly follow the survivors into adult relationships.
The primary function of Sensorimotor Psychotherapy is three fold; firstly to assist with calming and acting as safe guard as the brain responds in a ‘bottom up’ manner to the traumatic event ( Piaget 1952). That is to say the client is at the mercy of their somatic and kinaesthetic responses without cogent control over them and the role of the therapist is to harness and manage the clients experiences until such time as the client has re-established these differentiating lines; Secondly, to equip clients themselves with the necessary tools to deal with these abreactions and upsetting bodily responses and lastly to facilitate the reintegration of a ‘top down’ response, i.e. helping the client to retrain their responses to include a reasoned and logical response. (Pat Ogden and Kekuni Minton, 2000). Clients have also reported that through therapeutic relationship and the couple relationship sensorimotor psychotherapy helped them to limit the information they are processing at any one time; giving them the opportunity to investigate the cognitive and emotional aspects of the initial trauma without becoming so physically distressed as to prevent them from adequately doing so. As discussed in Coping with Child Sexual Abuse in Adult Relationships, Parts I and II, the role of the couple relationship is paramount in the rehabilitation of adult survivors of CSA, survivors of sexual abuse require safe and healing relationships from which recovery can most ably begin. (Courtois, Ford & Cloitre, 2009)
Sensorimotor Psychotherapy operates in a holistic way by attending to the physical, cognitive and emotional responses CSA provokes in its adult clients. By refocusing their attention away from the context and details of the original trauma and focusing instead of the bodily sensations in isolation form their context client have found they have been able to disassociate the physical reaction from the emotion and cognitive responses.
This gives rise to a feeling of safety that allows for the safe exploration of the cognitive and emotional impact of the abuse and furthermore may give rise to an increased feeling of safety as they begin to re-experience the trauma in a way that offers them the potential to physically protect themselves. By adopting a sensorimotor psychotherapeutic approach and concentrating on the physical responses, we are directly dealing with the somatic effects on the body and this in turn helps enable emotional and cognitive assimilation of the traumatic experience
In the psychotherapeutic treatment of adult survivors of Child Sexual Abuse (CSA) therapists are often mistaken in treating the survivor in isolation and fail to include in their therapy, the role of the partner in their couple relationship. This is to limit and detract from the therapy on offer as “If, as we can all agree, healing takes place in moments of secure attachment (Solomon, 2003) then the opportunity provided for healing within the current couple relationship is a vital and dynamic opportunity that ought not be overlooked” (Quinlan, 2013).
In my practice at Midwest Counselling I too have found it common that adult survivors of CSA seek out and replicate the trauma of their abuse (Briere & Scott, 2006). Attachment theory, (Bowlby, 1988) may account for why in some cases the “normal” attachment processes formed in early childhood are replaced in adulthood by this re-enactment of disruptive relationships, and may even lead to re-enactment of traumatisation (Allen, 2001). Because of unresolved issues arising as a result of the CSA, such as fractured impressions of how adult sexual relationships are supposed to work, or errant self-images as a result of childhood programming, then often the adult generalised view is fractured and errant. For instance they may view all physical contact as frightening, painful or abusive, or that all men/women are inherently dangerous. It follows then that these views shadow them into their adult couple relationships.
Subsequently then in treating adult survivors of CSA, the circularity of systemic family therapy may also be helpful. As mentioned in Coping with Child Sexual Abuse in Adult relationships, Part I, in couple relationships, it is commonly found that the partner of the survivor of CSA is bringing with them their own problems of equal measure. Therefore, as the therapy investigates the paradigm that exists between the couple, a pattern of co-dependant coping strategies may emerge. This iterates the importance of treating the client in a holistic way, and of looking at more than just the trauma of the CSA but also at the extended influence this is having on their couple relationships. So too, the benefit to couples counselling is massive, it can help raise a number of questions that could facilitate to a great extent the investigation into the nature of the couple relationship that exists that is been brought to couple therapy for “fixing”.
Given the aforementioned propensity for adult survivors of CSA to seek out and form relationships that emulate patterns and elements of the original abuse, then the benefit of including the partner in therapy is inherent. By engaging with both partners the therapist can work on limiting the re-enactments and re-traumatisation of the client. Furthermore and equally as importantly by soliciting the participation of the clients partner, the therapist can encourage and facilitate the growth of understanding and respect, and the identification of mutually beneficial goals that may ultimately lead to a constructive and nourishing adult relationship.
In my practice at Midwest Counselling, of the many long-lasting impacts child sexual abuse (C.S.A.) and one of the most prominent is the difficulty for adult survivors of C.S.A. to maintain healthy fulfilling couple relationships. The merits of focusing on the role the partner has in this recovery is becoming more and more apparent (The Australian and New Zealand Journal of Family Therapy, 2012) as too is the value of using a multidisciplinary approach (Ibid). For many therapists the focus of the therapy is the healing process for the traumatised individual rather than looking at the potential healing opportunities provided by a safe and trusting couple relationship. Furthermore, in many situations it is a couple who have presented with relationship, intimacy or sexual issues stemming from CSA and are looking for help from within dynamic of the relationship; and so the work of treating CSA needs to take place within a couples counselling paradigm.
Ignoring the impact of CSA on adult relationship or focusing only on the survivor of CSA or ignoring the role the other partner can play may limit the healing opportunities within the therapeutic relations and can level the client feeling let down or dissatisfied particularly if you are working within the confines of couples counselling. Similarly it is a well-established consensus within the psychotherapeutic and counselling communities that treatment of complex trauma, especially with regard to CSA that survivors of sexual abuse require safe and healing relationships from which recovery can most ably begin. (Courtois, Ford & Cloitre, 2009)
While this notion had generally been accepted to apply to the therapeutic relationship, it is important not to overlook the restorative opportunities and potential offered from with the confines of existing couple relations; especially when the clients have expressed a desire to work on and improve the sexual contact, intimacy or other aspects of their relations. If, as we can all agree, healing takes place in moments of secure attachment (Solomon, 2003) then the opportunity provided for healing within the current couple relationship is a vital and dynamic opportunity that ought not to be overlooked.
As per the attachment theory the security of the existing couple relationship (as well as the security of the therapeutic relationship) can allow the therapist to encourage the client to explore the trauma and its impact from a safe place.
In using this approach is it also important to recognise the frequency with which one finds that if one partner bring to the relationship a history of CSA, then the other partner will bring problems of equal measure, often, though not necessarily always, sexual abuse. Therefore it may very well be the case that as a therapist you may find yourself treating not one, but two separate victims of traumatic childhood or early life experiences.
Counselling and Psychotherapy Services Limerick and Midwest 