Working with Clients who are Survivors of Early Life Trauma, Sexual and Ritual Abuse
by Mike Fisher, Chair of TAG
Counsellors often ask for 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 ongoing 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-morbidity with other conditions.
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 hyper-vigilance and will have learned that being compliant was necessary for their survival. Without an adequate level of effective support, the opportunity to address the extent of the trauma and disrupted attachment experience will not occur. In the words of Valerie Sinason, “It’s the relationship that gets individuals through to recovery, not a particular therapeutic modality.”
Most counsellors and carers who work with survivors would probably agree that the best source of understanding comes from the person who has survived the abuse and trauma themselves. I believe that 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 counsellor’s 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-awareness and personal insight will therefore need to be worked on consistently in order to maintain optimal effectiveness. This may be one reason why recovered survivors make good therapists.
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 enough 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 - 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. The need for additional or longer sessions is often the case for DID clients, especially those with a large number of Alter parts. There are two reasons for this: firstly, there is not enough time to help the ‘internal system’ to sufficiently process the current trauma and give attention to the therapeutic relationship as well as develop internal mechanisms for coping. Secondly, the ‘child’ parts will need regularity and frequency to attach adequately. 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 both on 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 same field of work.
Attachment, Trauma and Multiplicity by Valerie Sinason, 2002
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