A person-centred approach in working with adult survivors of childhood sexual abuse.
It was whilst I was in training that I first worked with a client who had experienced childhood sexual abuse (CSA). I drew upon the resources I had acquired through my training and practice – a working awareness of the person-centred approach (PCA). I relied, in part, on PCA developmental theory, as a framework from which to understand and work with CSA. Since that time, a majority of the clients I see have been survivors of CSA. This article outlines, in brief, how a person-centred approach is both suitable and beneficial for working with this client issue.
Childhood sexual abuse is endemic, and the NSPCC report: How Safe are our Children (2016) highlights the prevalence and incidence of CSA. The report suggests that in 2014/15 there were 47,008 recorded sexual offences against children in England, Wales, Northern Ireland and Scotland. This figure is an increase on the previous year’s figures, and is said to represent the increased willingness of victims to come forward, as well as a better recording of offences. The NSPCC (2016) define abuse as: ‘persuading or forcing a child to take part in sexual activities or encouraging a child to behave in sexually inappropriate ways’.
The impact of abuse can be far reaching. Abuse is a misuse of power, invading an individual’s sense of self, their psychological safety and the fundamental integrity of their being, thus having far reaching ramifications on an individual’s life trajectory. Survivors of CSA may experience mental health problems later in life, which include PTSD (Post Traumatic Stress Disorder), depression, anxiety, self-harm and suicide. Survivors may have difficulty coping and managing with everyday struggles, historically, in the present, and later in life. Survivors may also find adult sexual intimacy difficult. Survivors may develop non helpful ways of expressing their emotions – through aggression or other self-destructive ways, such as addictive behaviours and self harm. Abuse affects individuals differently, and nothing is set in stone. Working through, articulating and exploring the powerful conflicting emotions and experiences of abuse are crucial aspects of the work.
The person-centred approach explains psychological problems with the concept of ‘incongruence’. Rogers (1951; 1957; 1959) wrote that organisms are motivated by growth and development and, given the right environment, individuals can actualise and reach their full potential. The right environment consists of a climate where the person feels genuinely understood and unconditionally accepted. However, there are climates in which individuals do not feel understood and unconditionally accepted, leaving them to feel they are worth less in certain conditions than in others. The person introjected these values as if they were their own. It is when a significant level of experience is either denied or distorted, to fit self concepts that incongruence occurs. Joseph (2015) highlights how this way of thinking can account for the avoidant and intrusive features of PTSD.
As the self structure is formed, and a person begins to act in compliance with introjected values that are not congruent with the organism, conditions of worth develop. Power (2012) highlights conditions of worth as having a lasting impact with survivors of CSA and describes survivors of CSA as having many different conditions of worth when processing the trauma of abuse.
CSA experiences affect the client’s locus of evaluation, with survivors often developing more of an external locus of evaluation, which means survivors are likely to distrust their organismic valuing process. They have difficulty in trusting their ability to influence their own experiences, and may feel that their lives are in the hands of others and external forces which are beyond their control. This can, at best, put them in a difficult and frightening psychological position.
Thus we may come to understand that CSA happens at a time in individuals’ lives when they are developing ideas or assumptions of self and others. CSA happens at a time of the establishment of internalised states. We are relational beings and our earlier experiences are shaped by our caregivers. This no doubt impacts upon our intra- and inter-relationships, with our ability to trust others and develop healthy relationships being thwarted. Abuse ‘lives’ within relationships, in which – more often than not – individuals have no choice but to place their trust; trust in CSA is significantly broken and impacted upon. The feelings and experiences of which are palpable. Trust therefore needs to be developed within the therapeutic relationship, with the client’s space and pace of their therapy respected, with the counsellor acting as a witness.
In trusting and valuing the client’s process it is hoped the client learns to trust and develop those experiences that enhance their internal locus of evaluation. In utilising the core conditions it is hoped that, through a process of therapy, clients may move more towards an internal locus of evaluation. That is, they rely on their own thoughts, feelings and inner capacities and are less concerned with external influences. To function in this way is to be in the present moment, accepting strengths and weaknesses, seeking authenticity, and valuing the self; this is healthy functioning. Thus it is hoped they develop trust in their own intrinsic wisdom and abilities.
Joseph (2005) accounts for the adequacy of a person-centred approach in dealing with traumatic stress. Merits of the person-centred approach toward therapeutic change include, as Levitt (2005) states, ‘non directivity’, which can be said to allow our clients to accurately symbolise their moment to moment experiences at their own pace. Hyper-vigilance may be common for individuals who have suffered abuse, and any attempt at pushing individuals psychologically may be seen as threatening. Therefore, providing conditions in which the client’s space and autonomy are respected are essential. This is demonstrated in the emphasis placed on the maintenance of the core conditions, creating the climate, the environment for growth and change to occur.
Empathy may offer clients the opportunity to remodel how they think of themselves. Clients may learn self-empathy. Clients may come into counselling and feel so ashamed, worthless, guilty and responsible, angry and confused. To experience the counselor sitting with these feelings, being a witness to them as they present themselves, has the potential of being incredibly healing.
Vernart and Webber (2012) concur that counselling with trauma needs to engender empowerment, working towards a positive self view. The embodiment of hope is significant too, in our ability to reflect back clients implicit strengths and resources as they are presented. There is a premise that it is relationship that can break us. Relationship can heal us too – by offering a relationship which involves deep empathic understanding, a relationship that respects and regards the individual positively and realistically. Given, then, an environment where trust is worked at, maintained and developed, and whereby the core conditions of acceptance, empathy and unconditional positive regard are held and attended to, post traumatic growth and resolution can and does occur.
It is, therefore, hoped that by offering a different relationship, individuals may better process and move forward, developing trust in both themselves and others, developing their self esteem, resilience, feeling validated, worthwhile and hopeful. It can be said individuals thus place meaning on their experiences, and reach a better place of self understanding, towards better healthy functioning.
Not feeling judged, feeling valued, heard and respected all go some way in aiding healing. The work can feel like a long road, with many bumps, but there is an implicit trust in process. We sit alongside clients, witnessing the terrible traumas they have sustained and the aftermath of such experiences. Providing a safe environment, attending to process, and listening to clients find meaning and a better understanding of their experiences, is a move towards potential growth and psychological change.
Joseph, S. (2005) Understanding Post Traumatic Stress from the Person Centred Perspective. In S. Joseph and R. Worsley (Eds.), Person Centred Psychopathology. A positive Psychology of mental health. Ross on Wye: PCCS Books.
Joseph, S. (2015) A person centred perspective on working with people who have experienced psychological trauma and helping them move forward to post traumatic growth. Person-Centred and Experiential Psychotherapies, 14 (3). pp. 178-190. ISSN 1752-9182
Levitt, B, E. (2005) Embracing non directivity: Reassessing Person Centred Practice in the 21st Century. Ross on Wye: PCCS Books.
NSPCC. (2016) How Safe are Our Children.
Power, J. (2012) Person – Centred Therapy with adults sexually abused as children, In Tolan, J. And Wilkins, P. Client Issues in Counselling and psychotherapy. London: SAGE publications. LTD.
Rogers, C.R. (1951) Client centred therapy: its current practice, implications and theory. Boston: Houghton Mifflin.
Rogers, C.R. (1957) The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting and Clinical Psychology, 21, 95-103.
Rogers, C.R. (1959) A theory of therapy, personality, interpersonal relationships, as developed in the client centred framework. In S. Koch (Ed.), Psychology : A study of science, vol. 3: formulations of the person and the social context (pp.184-256). New York: McGraw-Hill.
Vernart, E and Webber, J. (2012) Healing trauma through humanistic connection in Humanistic Perspectives on Contemporary Counselling Issues. Scholl, B, M. McGowan, A, S. and Hansen, J,T. Routledge: Hove
Justin Lee Slaughter is a Humanistic counsellor in private practice; he also volunteers as a sexual health counsellor in Brighton and Hove.