Clients who present with severe, pervasive, and persistent symptoms may need considerable work in this initial phase; clients with well-developed self-capacities and support systems may start exploratory work relatively soon after beginning counselling. Adequate coping skills and psychosocial resources are crucial to the success of abuse focused treatment.
Chu-(1998) stressed that although intensive exploration of abuse is contraindicated before stabilization is achieved, it is important to acknowledge the abuse at this stage. If early in treatment the counsellor does not acknowledge the influence of childhood trauma on the client's life, the client's denial may be exacerbated. Counsellors should, therefore, state that they consider the abuse a significant life experience but explain that it cannot be explored in greater depth until the client has certain resources and supports in place.
Managing Trauma Symptomatology
Many survivors of childhood sexual abuse are troubled by trauma-related symptoms (e.g. flashbacks, nightmares, perceptual disturbances) that may increase once the client begins to focus on the abuse experience. A temporary increase in trauma symptoms may be a necessary and therapeutic part of the healing process, representing the loosening of defences. As Sgroi (1989a: 116) has pointed out, the goal of treatment is 'not to suppress flashbacks or disturbing memories but rather to experience them and process them as a necessary step in coming to terms with and moving beyond the entire victimization experience'. It is advisable, however, to help the client develop skills to manage the symptoms prior to exploratory work, so that these symptoms do not become overwhelming.
Counsellors should explore the nature of the client's flashbacks, nightmares, and intrusive thoughts; acknowledge how frightening these symptoms can be; and assist clients in gaining control over them. Clients may be taught to identify circumstances that trigger intrusive symptomatology. Some clients experience certain prodromal experiences or emotional 'markers' (e.g. a sudden onset of depression) that precede the onset of intrusive symptomatology (Gold and Brown, 1997). If clients can identify these internal cues, they can develop responsive coping strategies. Such strategies may include contacting a supportive other or going to a physically safe place.
When clients re-experience past trauma, grounding techniques, i.e., strategies used to focus on current reality, can be useful (BlakeWhite and Kline, 1985; Cole and Bamey, 1987; Meichenbaum, 1994). These strategies include physical methods (e.g. planting one's feet firmly on the ground or grasping the arms of one's chair during a flashback), or cognitive techniques (e.g. repeating one's name, age, and current location), to reinforce that one is not actually in the childhood situation. Clients may use an associational cue, an object that reminds them of safety and comfort, to maintain an awareness of current reality. They may also learn to find a 'safe space', either in actuality (e.g. the home of a trusted friend) or through imagery, to cope with intrusive symptoms (Meichenbaum, 1994). In a similar fashion, some clients can also learn to control the course of their nightmares. They may tell themselves before going to sleep, for example, that if they dream an intruder is chasing them, they will stop and turn and order the intruder to leave - and he or she will do so.
Clients should be given the opportunity to discuss, process, and understand the aetiology and function of trauma symptoms. Examinin the messages about the trauma that are encoded in flashbacks or frightening dreams, for example, can help the client make sense of his or her symptoms.
(Lionel Richie - "Truely")
