Working with Clients who are Survivors of early life Trauma, Sexual and Ritual Abuse
by Mike Fisher, Chair of TAG
One of the things that counsellors ask for, from time to time, are guidelines for
working with survivors of ritual and extreme early life abuse. Whilst it is important
to be careful about over generalising, the following may be helpful pointers in this
area of work. There are likely to be three parallel processes of on going work. These
are unresolved insecure attachment, post traumatic stress disorder and dissociative
disorders (possibly including Dissociative Identity Disorder, referred to as DID)
as well as possible co-
The first and foremost thing to appreciate is that recovery from early life trauma and abuse is going to be long term, unlike many conditions that present themselves in the counselling room. It may take many years of regular, and often intense, work to see someone through to recovery. Preparedness from early on to work with someone over a number of years, rather than weeks will be important.
The second is that the therapeutic relationship is always important in counselling. It will be even more important when counselling someone who has experienced early life trauma and abuse. It will take time for trust to build up, to the point that deep and effective work can be undertaken. The power of a reliable, consistent, dependable and accepting relationship cannot be underestimated. It will be the vehicle by which the trauma, pain, guilt, shame, fear and anxiety will be processed and resolved.
The third is that counsellors will need to develop good “containment” skills. Working with someone who has been through ritual abuse or extreme early life trauma can be experienced as a bit of a roller coaster. The counsellor will, also therefore experience the confusion and dissociation that the client experiences,, and a capacity to stay with the uncertainty will be needed. Most survivors will also have an insecure disorganised attachment pattern, in which they will be experienced as being very ambivalent in their relationship with the counsellor, (or at times avoidant) and, in the “middle phase” of the work extremely dependent. Again it is important for the counsellor not to get fazed by this, but have the capacity to stay with the client as they try to work through their attachment issues. It will be alarming for the client as they risk, possibly for the first time, allowing attachment to take place. It will also be alarming for the counsellor if they have a fear of dependency, or equally unhelpful, if they have a need to rescue.
Without a safe, close, accepting relationship it’s unlikely that the client can risk
the journey of recovery. If not they will have no choice but to maintain the dissociative
defences that are needed to keep such overwhelming pain sufficiently at bay to cope
with life’s demands. They will have a highly developed level of hypo-
Most counsellors and carers, who work with survivors, would probably agree, that the best source of understanding comes from the person themselves, who has survived the abuse and trauma. I believe, as a therapist, my role is to accompany them on their journey of recovery. Far from having any expert contribution to give them on their journey, I have found that they truly are architects of their own recovery, and indeed they have taught me a lot in the process, including about myself.
Perhaps above all else the power of listening in a very attentive and attuned way is the greatest skill a counsellor can bring to someone’s journey. This is not to dismiss the wide body of understanding, or the range of skills and techniques that can help, but without effective listening such knowledge will be ineffective.
A particular challenge that will come to counsellors in this field of work will be the fact that the client will be able to “read” the counsellor more easily than the counsellor may be able to read the client. For many survivors their very life depended upon developing very highly attuned insights as to what was going to happen next. Because of this highly developed skill, they will pick up the least little inconsistency or incongruence in the counsellor. They will be aware of the counsellors vulnerability and be able to register any defensiveness in the counsellor, all of which will be an obstacle to them feeling safe enough to risk exposing their pain.
This does not mean that survivors are especially difficult to work with, indeed they
are often highly rewarding people to work with. It does mean however that counsellors
do need to attend to their own “needs” both in supervision and in personal therapy,
if they want to avoid such obstacles occurring in the work. It is unfortunately not
unheard of to find counsellors who will blame or scapegoat clients who become resistant
because they are feeling unsafe in the therapeutic relationship. An awareness of
what is happening in the therapeutic relationship will be as important as addressing
the ongoing trauma. Self-
Another factor that makes this area of work somewhat different is that a fifty minute or one hour appointment once a week is not on its own usually sufficient to keep the client sufficiently stable particularly in the middle phase of recovery. Many clients find they need either longer sessions of one and a half or two hours or more frequent sessions of two or in some cases even three a week.
For clients who suffer from Dissociative Identity Disorder, their personality will have been fragmented into a number of parts, known as Alters, as a result of the severity of the early life trauma. This was formally known as multiple personality disorder.
This will particully be the case if the client is suffering from Dissociative Identity Disorder especially if there are a great many Alter parts. There are two reasons for this, the first is that there would not be sufficient time to help the “internal system” process sufficiently the current trauma and at the same time give attention to the therapeutic relationship as well as develop internal mechanisms for coping. The second is that the “child” parts will need regularity and frequency to sufficiently attach. Many survivors may find the duration of a week, and certainly a fortnight’s gap too much to cope with in managing their daily life when traumatic memories are emerging.
The consequences of insufficient support are that they may resort to less satisfactory coping mechanisms or move in and out of chaos. This is why many survivors of more extreme trauma or ritual abuse and most clients with DID often seek regular telephone or other forms of contact between sessions. If this is going to be necessary, it is much better to plan this in, when it is needed, as part of a negotiated agreement than to leave it too open and loose, as the client will be less sure of where they stand and of what support is available.
Boundaries will be an important part of the security for the client and these should be clear, but not overly rigid, as the client’s stability will fluctuate from time to time, and some changes in arrangements may be required. This will need to depend on both the client’s need and what the counsellor feels they can realistically provide.
Perhaps the last area to mention is coping with traumatic disclosures. This will constitute the other main challenge for counsellors, particularly if their client is a survivor of satanic ritual abuse. It is not uncommon for counsellors to experience vicarious trauma when working with survivors of ritual abuse. This should not constitute a problem provided that there is good supportive and “containing” supervision. It might be that the counsellor may benefit from some counselling for themselves, or would find it helpful to belong to a network such as the Trauma and Abuse Group (TAG) where they can chat to other counsellors and carers in the some field of work.
References
“Attachment, Trauma and Multiplicity” by Valerie Sinason, 2002
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