Consider the fact that the client may have never spoken about the abuse until the first session. Therefore, be mindful of how much information you ask of the client as you don’t want to re-traumatize. The client may have trust issues so a therapist needs to work towards building a good rapport and a trusting relationship. I would certainly advise against asking too many questions, which may feel like an interrogation to the client, and it might make the client feel judged and anxious.
Tell your client that they can have comfort breaks if they wish. Anxiety can lead to an increased need to go to the toilet, and unfortunately if a counsellor doesn’t offer comfort breaks, the client may suffer in silence. Counsellors may need to consider physically offering tissues to the client if they don’t ask. Survivors of trauma are generally terrified of expressing needs and may endure physiological discomfort rather than ask for help.
Silence can be a dangerous place for survivors, so counsellors need to manage it carefully. Counsellors should generally speak less than clients, but if there is silence, a counsellor may feel the need to fill it with speech. The resulting problem is the fact that a survivor is not given the opportunity to find their voice. So gently encourage the client to speak and check how he/she is feeling.
Be mindful of the fact that the client might be so out of contact with their body that they only inhabit their head and lose contact with all inner sensations. Survivors may avoid all sensations, feelings and thoughts, so it is important to help them integrate inner experiences. A good suggestion for survivors is physical exercise, which can allow them to regain contact with their body and feel in tune with their body.
Survivors will often feel intense shame that they will have carried around for a long time. Therefore, if a counsellor is non-judgemental and emphasises that a child is never to blame, a client may feel comfort and dissolve the feelings of shame. Once the survivor realises how vulnerable they were, feelings of anger and grief may surface and the healing process will begin.
Education about the psychological effects of abuse is important. If difficulties in life and ways to cope are explored, survivors will be able to better understand their range of behaviour or responses. This will enable a survivor to take control of his or her own life rather than be controlled by maladaptive behaviour.
The points I’ve mentioned may seem obvious to the reader, but unfortunately not all counsellors bear these things in mind when working with abuse survivors. I’ve heard a fair amount of horror stories from survivors, which I won’t mention here, but I only hope that counsellors will remember to be extra sensitive when dealing with people who don’t have a voice let alone self-esteem. Counsellors need to help survivors build self-esteem and enable their voice to be heard. Just being heard by one person can be such a release in itself and the starting ground for the healing process.