Phase I: Safety and Symptom Stabilization. Developing a sense of safety in the therapeutic relationship is absolutely essential to successful treatment of counselees who have been traumatized sexually. This is not as easy as it may sound! How does a sexual assault survivor (SAS) know that you (as a caregiver) are trustworthy when someone else they trusted violated them? If the perpetrator was a pastor or another Christian counselor (yes, unfortunately it happens), you may be even more suspect. Only with much empathy, compassion, patience, understanding, and time (often months or even years), where you will be tested many times over, will the therapeutic relationship be able to develop to the depth that is necessary. A solid, truly safe relationship is not only a prerequisite for doing Phase II trauma processing work, but can also be the key ingredient of broader healing.
Post-traumatic symptoms are often what bring survivors into counseling and can be a challenge to manage. Helpful interventions include teaching grounding techniques that use counselees’ five senses to help them stay in the room with you. For example, asking individuals to tell you five things they see or hear, suggesting they rub their bare feet against the carpet or encouraging them to suck on a sour candy or drink ice water, etc. can be helpful. Relaxation techniques and Christian-based mindful techniques (see Tan, 2011) can also be used.
Lesser-known, but particularly effective, symptom containment techniques involve what has become known as “parts work.” This involves acknowledging that we all have aspects of ourselves that we are not fully conscious of, but may be hijacking behavior. For example, there may be an eight-year-old inner child state that holds memories of a particular traumatic event that has been kept hidden from the adult self. While compartmentalizing in this way may have helped the individual function in the past, what was hidden may now be leaking into conscious awareness through nightmares, flashbacks or intense emotions that have become separated from the cognitive memory of the incident. These cut-off or, to use the technical term, dissociated parts of self can be negotiated with and helped to temporarily contain such memories, emotions or behavior (including suicidal behavior) until the counselee is ready to enter Phase II work.
Phase II: Trauma Processing. Trauma processing involves the SAS narrating incidents of trauma in detail, while experiencing (to some extent) the emotions, physical sensations, and behaviors that are connected to cognitive memories. Brain research gives support to what has been known by clinicians for several decades—that developing a trauma narrative is essential. However, proper pacing of the work and good use of Phase I coping and containment skills are also necessary in Phase II to prevent the SAS from becoming overwhelmed and potentially re-traumatized.
Bearing witness to a survivor’s trauma by listening to horrific, graphic details of specific memories is not for the faint of heart, but it is necessary. In addition, hearing the stories of how perpetrators intentionally inflict pain and suffering on others can produce depths of rage and despair. The intense mix of feelings of guilt, shame, rage, self-loathing, depression, self-blame, hatred, and so on, which are commonly expressed, can feel overwhelming to counselors, particularly if we also experience some of them. Rather than facilitating expressions of emotion, we can inadvertently shut down the process due to our own discomfort.
Dealing explicitly with the traumatic memories can turn an SAS’s world upside down. An SAS finds out, for example, that the family members he or she thought were close are actually a danger, or the youth pastor who he or she respected was a perpetrator. It takes time to pick up the pieces of their lives and adjust to a new view of the themselves, others, and their world.
