07 August 2005
	Help for Adult Victims Of Child Abuse. A non-profit making organisation based in the UK dedicated to provide help, support and information to any adult who is suffering from past childhood abuse.

Survivor Issues in Group Therapy
By Catherine McAlpine, LCSW-C, and Barbara McCormick, LCSW-C

In 1989, we began working with female
survivors of childhood sexual abuse in small, supportive groups. Survivors
frequently feel isolated and believe that they are unique in being subjected
to the trauma of abuse and the associated neglect, loss of trust, and loss
of self-esteem. Survivors often face post-trauma symptoms of depression and
anxiety, and have trouble maintaining personal relationships. In bringing
women together in structured, confidential, and supportive groups, we help
survivors "normalize" their experiences and post-trauma responses to abuse,
and enhance their progress in individual therapy. Factors that influence the
group members' feelings and self-images are recurring topics for discussion
in survivor groups.

The Healing Process
As therapists we have listened to and
learned from dozens of women who have called or met with us for consultation
and those who have spent many hard, painful hours in therapy sessions. We
have consistently been struck by the depth of commitment these women have
made to moving beyond their feelings and experiences of victimization to a
sense of wholeness, competence, and strength. These women have been devoted
to their own work while being sources of strength and encouragement to each
other in group.

As with other forms of human or
self-development, the process of healing occurs along a spectrum. Phases
are not separate, distinct steps: they are more of a gradual back-and-forth
movement toward wholeness. Imagine the ebb and flow of a tide washing upon a
shoreline. Movement is subtle, change is gradual. There is a state of
constant motion.

Groups are powerful therapeutic tools for
sexual abuse survivors. Providing an opportunity for recovery and
developing self-awareness in the context of relationships are essential to
healing. The tasks of the group allow for identification and understanding
of post-trauma symptoms; personal development of the core self;
socialization; and a practice arena in which to test new emotions, thoughts,
and actions. Additionally, the influence of and validation by peers who
have similar life experiences and the genuine ability to "know what it was
like" are freeing and healing forces for the survivor. No longer isolated
and "different," the group members join together around their common secrets
and shame.

Goal-Setting
We begin our groups by helping each member
develop goals upon which to focus as they work within the group. This
process is handled in a confidential and supportive manner. Each person
writes down her areas of concern. These notes are collected, and members
participate by reading an anonymously written issue. This initial step
enables all members to participate without expressly disclosing their own
experiences, thus avoiding the anxiety of direct personal disclosure. In
the process of discussion, members move toward a consensus of group goals.
Shared and agreed upon tasks are important for establishing an agenda for
the group's therapeutic work. Group members immediately experience a sense
of relief and the dissipation of feelings of isolation.

The dynamics of families in which sexual
abuse occurs include family rules of "don't talk" "don't trust," and "don't
feel." As survivors define their personal recovery goals, recurrent themes
that encompass the stages of healing (included within the broad categories
of self-esteem, power and safety, trust and intimacy, and developing
feelings or an emotional repertoire) emerge. These form the foundation of
survivors' lives. The process of group therapy allows women to experience
relationships that are caring, reflective, and validating. Through the
transference and mirroring of these relationships, personal growth and
progress toward wholeness are achieved.

Worthlessness and Guilt
Typically, children raised in abusive
families experience emotional deprivation as well as physical abuse and
neglect. This absence of caring relationships further complicates how
survivors view themselves and intensifies problems with development of
self-esteem and feelings of self-worth. When one parent is perpetrating
abuse, survivors frequently receive little nurturing or positive feedback
from the non-offending parent, who tends to be emotionally absent and has
few resources to help the child develop. Understanding these dynamics helps
survivors build the confidence and self-care skills necessary for recovery.

The post-traumatic effects of sexual abuse
distort beliefs in how the world responds to survivors and their perceptions
of how they fit into their families, social situations, and work
environments. Feeling good about oneself, one's body image, and one's
sexuality are often concerns for survivors. It's difficult to feel positive
about oneself when the physical pain and emotional confusion inherent in
sexual abuse is perpetrated against a child who has not yet developed a
strong sense of self. Survivors' experiences teach them that they are not
able to control what happens to their own bodies, and that their bodies may
be dirty. Many survivors disassociate from physical feelings as a result of
the abuse. It often seems like an insurmountable task to survivors to
perceive themselves as healthy sexual adults later in life or even to cope
with feelings of sexuality.

Improving confidence, independence, and care
of oneself is a necessary step for survivors to improve their self-esteem.
Feelings of worthlessness and guilt need to be closely examined at the root
and then challenged. Understanding the impact of abuse on the self-worth
and how this has delayed growth through appropriate developmental stages is
an important task for survivors. Education is essential for survivors to
reach genuine understanding.

In addition, guilt is often experienced by
survivors because they perceive that they have participated in sexual abuse
or allowed it to occur. They may feel shame because they have not disclosed
the abuse, or perhaps they have enjoyed the physical sensations of the
body's natural responses to it. Sharing this shame in group allows
identification with others as well as emotional release. Disclosures often
help dispel feelings of shame about the abuse. If not dispelled, guilt and
self-blame may cause survivors to sabotage themselves or act out when
progress occurs.

Powerlessness and Lack of Safety
The dynamics of childhood sexual abuse
require the victim to surrender to a perpetrator. A more powerful person
imposes his or her will on the child. This person is trusted and looked
upon by the child as the model or mirror of what is normal and correct in
behavior and perceptions. Boundaries within the self and in relation to the
outside world are violated. Control and the safety of one's body are not
learned. Feelings of being safe are never experienced.

Survivors often express this experience by
taking care of others, more than themselves: "If I say no to what others
want from me, they will leave me" or "I can't stand up for myself."
Therefore feeling okay about saying no and being in control of one's life
also emerge as recurring themes in the group. Upon entering group,
survivors often discuss how they have given all that they can give. The
need to learn to give back to themselves in a safe manner becomes the focus
of therapy.

Discovering and experiencing boundaries in
their personal lives are shared and tested in a group setting. Other group
members support and encourage changing behaviors. Developing ways to keep
safe while feeling and becoming more effective in relationships leads to
letting go of the past. As the group moves together through this process,
trust in the group grows. The individual learns that it is right to be self
caring. Internal and external boundaries are defined in relationships.
Most importantly, group members learn to trust themselves and their inner
voices.

Lack of Trust and Intimacy
Survivors develop defenses against a world
and relationships in which they have experienced repeated violation,
abandonment and assault. These necessary defenses often have the secondary
effect of preventing or inhibiting intimacy. Survivors may have frequent,
intense but brief relationships or may tend to the other extreme of total
isolation. Although survivors may crave normal physical and emotional
closeness with others, their defensive patterns and lack of basic trust may
prevent such intimacy.

In therapy groups, survivors have identified
the desire to feel less alone as one of their goals. Having felt themselves
outsiders, different from others because of their abuse and shame, survivors
now want to break through their isolation. They are ambivalent about their
desire for closeness, however, because of years of failed relationships.
Having decided to risk making the connections inherent in individual and
group therapy, survivors have identified their need for others as a means
toward recovering the self.

Group therapy allows a survivor to
experience a number of relationships in a controlled, limited way, which
allows gentle exploration and self-expression. There are opportunities to
try out new patterns of thinking, feeling, and behaving with little danger
of backlash or attack. Established patterns of avoidance and
non-confrontation are challenged. Survivors begin to feel validated in
making these changes and build some basic trust in themselves and others.
The learning or modeling component of group therapy allows survivors to
learn from each other and to visualize the support of the group when testing
new patterns in "real" life. These positive experiences allow for a
generalization from the group to specific relationships, then from specific
relationships to the larger context.

The most difficult places for trust and
intimacy to develop are in close friendships and with sexual partners.
Survivors often split into public and private selves. They have learned to
present an image which is designed to protect the 'true" self from hurt and
abandonment. This defense, which was developed as a means of protection,
becomes a barrier to closeness in the process of healing. An intimate
relationship or emotional bond is impossible through the barrier of a false
self. The removal of this mask is a slow process of "check-share-check"
through which survivors are slowly able to reveal parts of themselves in an
honest way while maintaining a sense of safety.

Intense Emotions
Therapists are familiar with dissociative
disorders and defense mechanisms, such as repression and denial, employed to
deal with overwhelming feelings. People develop the strategy of splitting
their minds from their feelings as a necessary response to an external or
internal threat to the self. Children who experience a reasonably safe and
loving environment do not need to separate their cognitive and emotional
selves. Because of the efficiency of dissociation, survivors often have a
hard time identifying and voicing their feelings. Survivors describe
themselves as being a "talking head and shoulders," not being aware of
physical pain, and not having an emotional response until hours or weeks
after an experience.

Building connections between thinking and
feeling can lead to crisis for the individual. Feelings are sometimes
described as an iceberg or glacier that suddenly thaws. The intensity of
sadness, guilt, rage, grief, fear, or disappointment is a flood of repressed
physiological and emotional responses.

In the past, allowing these emotions to
emerge was too threatening to a survivor's sense of self. Often,
expressions of feeling were followed by experiences of abandonment and
rejection or by an impulse toward self-harm. The therapy group provides a
safe environment in which intense feelings can be expressed without loss of
love or security. The ability of other survivors to identify with and accept
these intense emotions "normalizes" the individual survivor's experience.
The expression of highly charged content allows the survivor to work through
both the cognitive and emotional elements of their lives. Bringing together
the head with gut feelings facilitates integration.

As healing progresses, negative and strong
emotions become less threatening. After a period of intense affective
expression, a more moderate level is reached. Emotions are expressed as
they occur. There is less need to hold back or repress experiences. The
reliance on dissociation is replaced with strategies more consistent with
the present. Moderation of intense feelings allows for greater intimacy and
attachment with others.

Recovery from childhood sexual abuse is the
process of bringing forth the parts of self that have been damaged by abuse,
neglect, and deprivation. Tasks of the healing process are accomplished as
survivors gain control over their personal and emotional lives, establish
boundaries as well as bonds in relation to others, and can feel more alive.
Group therapy provides a safe, supportive environment in which survivors at
all stages of healing can learn from and help each other.

Catherine McAlpine and Barbara McCormick are
therapists who have worked extensively with survivors of childhood sexual
abuse.

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