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How to Intervene - Assessing Trustworthiness
to Develop a Treatment Strategy
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let's look at the healing experience, first for Mary, then for a client I'll call
Lynn. Let's see how the healing experiences of Mary differ from those of Lynn.
When asked to describe "healing experiences," here is a summary of what
Mary stated through several sessions:
♦ 6 Steps of Mary's Healing Experience
1. Talking to a health care professional
who believed me and wanted to help in the best way for my process of healing.
My own personal ways of healing myself which were: being in nature; telling
myself healing thoughts; doing some of the things I used to love doing and was
good at; staying in a relationship with a loving man, even though many difficulties
3. Telling my friends and family about it. Having one close friend with whom I could share details of the abuse and the intense
feelings about the mental health professional. My friend believed me even when
I found it so unbelievable.
4. Knowing that my life is good.
Looking at the work relationships that intimidate me and (seeing) how this
was related to the abuse, and getting help to work through it and do some "damage
6. Feeling like I'm moving on in my life.
♦ 7 Steps of Lynn's Healing Experience
the literature, Lynn, a social worker who was sexually abused by her therapist,
wrote that her healing experiences included:
1. Leaving her subsequent
therapist when she realized that he did not believe that she had been abused.
2. Finding another therapist, who believed her and who arranged for some very
practical cognitive and biofeedback treatment for Lynn's severe insomnia.
3. Moving to a new community.
4. Making an ethics complaint to the
abusive therapist's professional organization.
5. Getting involved herself
in a committee dealing with ethics complaints.
6. Addressing conferences about sexual abuse by mental health professionals and teaching about the sexual
boundary power imbalance.
7. Receiving support from colleagues.
5 Therapy Strategies I use with Victims of Sexual Abuse
is the therapy I use with Victims of Sexual Abuse. It is hoped the listener can
broaden out these concepts to apply to clients with which they deal that suffer
from abuse. Victims
of abuse who have sought me out or have been referred to me have already learned
of my therapy experience in this area. This reduces, but certainly does not eliminate,
the anxiety and distrust that victims feel about starting therapy with another
mental health professional. Some abuse victims are so anxious at first, so scattered
and fragmented in their presentation, that it is hard to get a clear idea of their
♦ Strategy 1: Helping Victims Assess Trustworthiness
fragmentation often comes from an inability to trust. As you work with abused
clients, you might recall a specific client at this time. Think back to their
issues regarding trust. The steps involved in your client assessing your trustworthiness
may be as follows.
Awareness of your client's process of assessing trustworthiness may assist you in developing treatment strategies.
a. Gathering information(include your "sixth sense" or "gut reaction" as references).
A question the client might ask herself is: Is there someone whose opinion I respect
with whom I can check my perceptions and who can help me sort out the information
I do have about this person?
b. Forming an opinion (hypotheses,
guesses) about that person. Questions the client might ask herself are: Can I
devise a test whether this person is caring and trustworthy? Is there some small
test I can take towards trusting this person that will not be too costly to me,
to help me judge this person's trustworthiness?
c. Testing that opinion
or watching to see whether your opinion matches the person's behavior in real
life. Am I over-generalizing from my trauma experience to the present in any of
d. Revising your hypotheses or guesses as a result
of the new information; questions the client might ask herself are: What did I
learn about him or her? If this person disappointed you, does this mean that he/she
is not to be trusted at all, or that there are additional areas where this person
isn't to be trusted? If so, what are these areas?
e. Repeating the
process as necessary. As you know, "gaining perspective" refers
to individuals' expanding the frames by which they judge events, themselves, and
others. The expanded frame of reference facilitates seeing an event in a broader
vista. By applying a calibrated measurement, individuals can obtain a more relative
concept of magnitude, seriousness, and duration. In contrast, people who have
lost perspective think in absolute terms, as though the present instance is of
utmost importance and will go on forever.
♦ Strategy 2: Creating a Safe Environment
first I concentrate on creating a safe environment and making sure that victims
know that there are firm boundaries. Some victims, whose abuse happened in a private
office, after the secretary left, say they feel very reassured by coming to a
clinic setting where there are always other people about.
♦ Strategy 3: Hearing the Life Story
the early sessions, I ask clients to give me as much as they can of their life
story, including family background, and I assess symptoms of PTSD, Post Traumatic
Stress Disorder, depression, or any other problems. Sometimes referral for a medication
evaluation is useful, particularly in this first phase of therapy, for instance,
if the client is very depressed. I feel giving information about PTSD is important.
I always make a point to emphasize that therapy is a collaborative endeavor, that
clients are the best experts regarding themselves, and that my role is more as
a catalyst than as a director.
clients that have cognitive dysfunction due to the trauma, some clarifying direct
questions to get an accurate picture are usually needed. However, for the survivor,
who has been abused by a therapist the usual questions like, "What exactly
happened? When did it happen? Tell me everything that happened?" and so on,
are all postponed until trust is established and the flow of information with
the client is open.
♦ Strategy 4: Dealing with PTSD
you know, post traumatic stress disorder is a normal reaction to an abnormal amount
of stress. I feel it is important for the client to know that given enough stress,
anyone can get PTSD. I often give the following example to my clients. Perhaps
you might evaluate my method of explaining PTSD as it compares to the method you
use to explain PTSD to your clients.
"During the Second World War, some soldiers
with exemplary records of mental health and family stability developed PTSD after prolonged combat exposure. It was concluded that 200 to 240 days in combat would
break even the strongest soldier. Many studies showed that the best protection
against the development of PTSD in wartime was the presence of support from close
buddies. However, this kind of support is often absent for the child or adult
who is sexually abused."
Is this example of PTSD a tool you might gain from this
home study course to use with your next PTSD client or patient?
know, the person with PTSD often alternates between an intrusive phase of re-experiencing
the trauma and a phase of numbing and avoidance, when the person tries to
bury the memories. A person with "delayed onset" PTSD may be symptom-free
for months or years. Some see this as a very prolonged phase of numbing and avoidance.
The person is propelled out of the symptom-free phase and into the intrusive phase
by life changes or stresses, or by "triggers" or reminders of the original
use of the diagnosis has been criticized and seen as a way to pathologize the
client and medicalize a normal response to a traumatic event, I've found in my
practice that survivors welcome being told that such an entity as PTSD exists.
The client finds it comforting to know that their frightening perceptions, and
unpredictable emotions, are totally normal in view of the disastrous and intrusive
nature of the ordeal they have suffered.
experienced at least three episodes of delayed-onset PTSD. One occurred when she
first started therapy with a therapist immediately following the abusive incident,
and the second was when she was remembering the sexual abuse of her father. She
continued to have some symptoms of PTSD, on and off. She was often tense and irritable,
lost weight, had nightmares, and suffered terrible insomnia, often staying awake
until 3 or 4 am. The third episode came much later, and was precipitated by increasing
stress at work.
♦ Strategy 5: Supporting Feelings of Betrayal and Anger
abuse survivors tell their story, I have found, like you probably have found,
it is key to show I understand, accept, and support their feelings of betrayal
and anger. The next phase is they begin to grieve for what has been lost as
a result of their abuse and its after-effects. In Mary's case the abusive encounter
at first hindered and then terminated the therapy she needed when she first went
to a mental health professional. Mary felt she lost touch with the person she
was before the abuse started.
this stage, Mary was consumed with anger and wanting revenge. Some abuse victims
decide to make a report to the police or a licensing authority or to embark on
a civil suit. Because of the re-traumatizing nature of many survivors' experiences
with these systems, I help them to face realistically the pros and cons, and if
possible and appropriate, put them in touch with a survivor who is knowledgeable
about the legal system.
addition to recalling the abuse and grieving, clients need to understand how the
abusive experience is affecting their current behavior, attitudes, feelings, and
relationships. Previous issues, problems, and family difficulties that occurred
before the abuse may need to be addressed. Remembering and mourning alone are
not enough to repair the damage that many have sustained.
What is a key in working with a client who has been abused by a therapist?
To select and enter your answer go to .