Getting the Right Treatment for Sexual Abuse? 7 Questions to Consider

You will find the theme of sexual abuse all over the news these days, from clergy sexual abuse to teacher-student improprieties. This level of public discussion allows some victims to feel empowered to speak about past abuse. Hopefully these same individuals find the courage to seek out a counselor to address ongoing struggles with memories, shame, and self-doubt.

But will just any counselor do?

How can you know if the counselor you’ve picked is the right one? Are there questions you can ask to determine whether you are getting good care? Check out the following questions.

How does my counselor handle my disclosure of sexual abuse?

It takes great courage to tell another person about violations of body and soul. Victims fear not being believed, blamed, or worse, having their secret told to others. Thus, when a person sets aside those fears and speaks of what has been hidden, it is a great honor to be blessed with that story. Consider these questions to see how your counselor rates:

• Does my counselor show evidence of great care for my story? Do they treat it as precious? Once you have told the story, what do they do next? While we counselors hear many tales of woe, it can be tempting to ignore sexual trauma, especially if it happened many years ago or is especially horrific. Some counselors think that past experiences should remain there. They choose to focus only on present problems. Or, counselors can dive into the story and unintentionally force the client to talk too much about the abuse before trust has been fully established.
• Does my counselor seem in a rush to “get beyond” my abuse to forgiveness, confrontation or reconciliation? There is a place and time to talk about these matters. However, if you have just started telling your story and these topics are their prime focus, then you know that they are most interested in getting to the end of the story, the happily ever after part. The impulse to get to the end will inevitably make you feel like your abuse was a mere trifle.
• Does my counselor seem to have an unhealthy interest in all the details of my abuse? Counselors who ignore your abuse story are not the only danger. Counselors who dive into your story with great relish may cause you to feel re-victimized. There is a time and place for telling the story in greater detail (so as to process what you have come to believe about yourself and others). Those who rush in to the gory details seem to think that all story-telling is beneficial (see this link for the difference between bad and good trauma storytelling). By the way, a counselor who offers you private access (texting, emailing, late-night phone calls, house visits) without limits and boundaries may be offering you something that is for them and NOT you.
• Does my counselor let me set the pace of counseling? The heart of abuse is oppression and stealing voice and power (I’ve written more about that in my chapter in this book). A good therapist may unintentionally re-enact abuse when they use their position to coerce clients to meet their own agenda. A benign dictator is still an oppressor! A common question I have received from beginning counselors goes something like this, “How can I make [name] tell me about her abuse?” My answer? You should not try to force her. What happened to her was coercion. You can provide a small modicum of healing by allowing her to decide when and if she will tell you anything. “But, won’t that mean that [name] will not get better?” Yes, it means her recovery will take longer. But consider this: you are undoing her abuse experience by giving her power to decide what she does with her body, including her mouth. It is true that there will be some pushing and prodding, but it should be gentle with the client feeling that he or she has the power to say no or to slow down the process.
• Does my counselor educate me about trauma symptoms and typical treatments? Trauma symptoms (intrusive memories, hypervigilance, attempts to avoid triggers, numbing, etc.) are not just a psychological phenomenon. The whole body has been traumatized. Your counselor should be able to talk about the effect of trauma on the brain at a lay person level. Further, your counselor should be able to tell you what we *think* we know about the biology of trauma and what we still do not know. (By the way, if they are too enamored with one particular theory or cure-all treatment…RUN).

 A quality counselor will also talk to you about the typical 3 phase model of trauma recovery. They will educate you why it is important to develop good self-care strategies and to eliminate harmful behaviors (addictions, cutting, risky behaviors) before entering into the work of processing memories. They will tell you that safety and stabilization phase (first and ongoing) is about finding ways to stay in the present and to reduce dissociation. When you do tell your story in greater detail, the effective counselor always leaves room in each session to help you leave the office well.

• When my memories are fuzzy, does my counselor urge me to try to remember? The very nature of talking about past events (whether happy or horrific) brings old memories to the surface. Inevitably, a client will recall some feature of their abuse they had not remembered for some period of time. Or, they will recall something in a very different light and as a result it will feel like a brand new memory. However, your counselor should not be intent on finding lost memories. There are two reasons for this. First, memories can be constructed. When details are vague, our minds may have ways of filling in the blanks with false ideas (However, the likelihood of constructing an entire memory of abuse ex nihilo is rather rare. In my 24 years of counseling, no abuse victims in my office ever reported having NO lasting memory of abuse. All recalled many details even if some details were not). Second, God may have a reason for keeping certain memories from you. Not everything needs to be remembered to get well.
• What goal does my counselor seek? Counseling works best when counselee and counselor agree on goals and the means to get to those goals. Do the goals your counselor seeks make sense to you? Some goals are unrealistic and even dangerous. “Completely healed” or “as if it never happened” are unlikely and could even be dangerous in that they would make you vulnerable to re-victimization. Goals to confront, cut-off, or reconcile may be legitimate but expectations and safety plans must be reviewed ahead of time. Consider also that reconciliation may not be a good idea.

Your Questions?

I have just touched the surface on a few questions. You might have many other questions you’d like answered. Feel free to suggest questions here and I will attempt to answer some over the next few days.