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Counselling and therapy
ASCA believes that survivors of abuse can benefit from ongoing support as well as therapy/counselling, should they so choose. We encourage our members to seek help from an experienced and qualified mental health professional, and to understand that the many different forms of therapy that can contribute to a survivor’s well-being. These include:
 Narrative therapy
Somatic trauma therapy
Cognitive behaviour therapy
Psychodynamic therapy
Transactional analysis
Gestalt therapy
Attachment theory
Neuro-linguistic programming
EMDR (Eye Movement Desensitisation and Reprocessing)
Many of our members have also found comfort through alternative healing methods - through meditation, relaxation techniques and experiential approaches, including art therapy.
People respond to trauma in a number of ways. Some people adapt to the impact of trauma, in which case the symptoms are relatively short-lived. These people are left with few consequences as a result. Many survivors live full lives, are in touch with their creativity and are in productive relationships and jobs. They have adapted to their trauma, perhaps limiting contact with those who hurt them.
Many survivors however live lives that are largely influenced by the impact of the trauma. Often it is the reactions to the trauma, and the defences used to survive it, that can become a problem in the long term if the trauma is not addressed. Common reactions to trauma include:
Fear: Many trauma victims become chronically fearful and suffer from anxiety or panic.
Withdrawal: Withdrawal is a reaction to fear, but leaves the sufferer numb and distant, limiting contact with other people and the world.
Anger: This is a reaction to the injustice suffered, and can leave the victim agitated and obsessed by the trauma, seeking never to be vulnerable again.
Dissociation: Dissociation, learnt as a protective mechanism in childhood, becomes a way of managing affect in everyday life.
Embracing the trauma: Some survivors embrace aspects of abuse similar to those they suffered eg. prostitutes who were sexually abused. Most people who become abusers were themselves abused.
All of these mechanisms can exist side by side in various combinations. However, fear and pain underlie them all, whether these emotions are conscious or not.
Foundations for safe trauma therapy
Adapted from Rothschild, B. (2003) The Body Remembers Casebook: Unifying Methods and Models in the Treatment of Trauma and PTSD. Los Angeles.
Several principles are best followed to ensure safe trauma therapy. These include:
establishing safety;
developing positive client/therapist (counsellor) rapport;
providing tools that each survivor can use to help contain reactions or hyperarousal during therapy;
identifying, acknowledging and building on the client’s resources, both internal and external;
creating more choices with coping strategies/defences, rather than getting rid of them;
always working to reduce the pressure that can build up as a survivor faces his or her trauma;
adapting the approaches used to the needs of each client;
having a broad knowledge of the theory of trauma; and
considering the individuality of each client.
Types of therapies
Several different types of therapy can be used to help a client who has experienced trauma. Often a combination is most effective, with the approach being altered dynamically according to the individual’s needs and reactions. These include:
Narrative therapy
This works to separate the identity of the person from what happened to them. The majority of child abuse sufferers define themselves in terms of their abuse. Narrative therapy considers the person as a whole, rather than as a function of their abuse and gives importance to other aspects of life as well.
Somatic trauma therapy
This integrates many different techniques and models, while always ensuring that a client can slow the process down should he/she become overwhelmed.
Cognitive behavioural therapy (CBT)
This works on the principle that how we think influences the way we feel and behave. By changing the way a client thinks about his/her trauma, changes in emotion and behaviour will result. These techniques can be utilised to assist the therapeutic process within CBT:
journaling: writing about feelings with the non-dominant hand if possible helps the survivor get in touch with emotions, and to express and feel them.
reinforcing rational thinking (the ability to reason and think clearly) and behaviour.
assertiveness training: moving from passive, aggressive, passive-aggressive behaviour to becoming assertive…building self-confidence.
communication training: encourages active listening and learning how to communicate on an emotional level, also conflict resolution strategies.
problem solving training.
Psychodynamic psychotherapy
This is based on the idea that behaviour is influenced by unconscious motives and feeling states, and that changing any individual’s behaviour requires insight into these states. It encourages the individual to verbalise his/her thoughts, feelings and memories, so that they can be brought out into the open and considered.
Transactional analysis
This involves the analysis of communication - the interaction between the parent, adult and child ego states, both between people, and within an individual’s psyche.
Gestalt therapy
This monitors changes in awareness (including body awareness), and uses the ‘empty chair’ technique to help bring internal conflicts alive. The therapist may ask you to imagine holding a conversation with someone or something imagined to be in the empty chair. Thus, the 'empty chair' technique stimulates your thinking, highlighting your emotions and attitudes. Gestalt therapy is often used to supplement transactional analysis by encouraging dialogue between separate ego states.
Attachment theory
This focuses on the psychological impact of interaction between people, and is especially concerned with the relationship between a child and his/her primary caregiver, usually the mother. The development of a healthy bond between therapist and client can substitute for the dysfunctional bond of childhood and help address traumatic memories.
Neurolinguistic programming
This therapy believes that perception can be altered either by changing the sensation and/or the language used to interpret it. This can be particularly useful in dealing with the intrusive images of flashbacks.
Eye movement desensitisation and reprocessing (EMDR)
This combines the principles of CBT and Neurolinguistic programming with side-to-side eye movements (bilateral movements). Bilateral stimulation such as eye movements has been found to hasten the integration of traumatic memories. It works by identifying the disturbing elements of the trauma - visual/sensory/negative self image and their associated emotions and body sensations.
Others
SIBAM (Sensation (S), images (I), behaviour/movements (B), affects emotions (A), and meanings (M))
This is a model that helps to understand dissociation and can be used as a tool in trauma therapy. Unresolved trauma leaves one or more of these elements dissociated from their memories of the incidents disconnected from consciousness and the other elements. The aim of therapy is to integrate them by facilitating association.
Psychopharmacology (ie, the use of medication)
The use of medication can help manage insomnia, hyperarousal, concentration difficulties, re-experiencing of trauma, depression/elevated moods, anxiety, and numbness. Medication is useful for symptom relief, so that survivors can participate in therapy.
Neurofeedback treatment therapy
This treatment helps to normalise the part of the brain, which due to trauma, has started to ‘overwork’ and continues to do so, even though the abuse, trauma etc. has happened a long time ago.
Groups: therapeutic, self-help/support, psychodrama
Groups encourage survivors to start to relate to others again. Groups help to confront denial, normalise experiences, and to connect people. As group members achieve greater understanding and resolution of their trauma, they often feel more confident and able to trust. Gradually they can begin to focus on the present and the future, rather than the past.
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