This article is by COSRT Accredited Member Silva Neves
I’m a Psychosexual and Relationship Psychotherapist and a trauma therapist, so I see adults who have been abused as children. I mostly see those who have been sexually abused as children, but it is not just sexual abuse that disrupts the relational and sexual lives of service users. Any childhood abuse and neglect can have significant detrimental effects on people’s mental health, which in turn, impact negatively on relationships and sex lives. Indeed, childhood abuse influences the core of who we are as people because it is in childhood that we learn how to attach, how to feel safe and what is our sense of self.
Sadly, most people who are abused in childhood are abused by someone they know, often, someone who was supposed to love them, care for them and make them feel safe. When this happens, it is hard for people to learn to attach and feel safe because the very primary attachment as a child is a place of hurt, abuse and neglect. How could they begin to understand that they are loveable if the very people who was supposed to love them unconditionally abused them instead? The abuse, as well as the context in which it happens, are both important factors in understanding the present effects of the past childhood abuse. Often, I hear people say that it was not the actual abuse that was the worst, but what happened or didn’t happen before and after. For example, the child was abused by someone who was loved and respected by everyone else around them, and couldn’t feel safe with anyone. Or they weren’t believed. Or they were told that if they spoke up, there would be drastic consequences.
It is not surprising that people who have negative core beliefs about themselves due to childhood abuse (ie: I’m unloveable, I’m worthless, I don’t deserve happiness), have significant issues in their intimate relationships. They may choose inappropriate partners who are similar to the relationships experienced in childhood.
Or they may make it very hard to be loved by an appropriate partner by keeping them at arm-length. It is also unsurprising that people will experience the wide range of sexual problems given that the effect of abuse may make it impossible to enjoy intimacy and sex with others.
While those issues are the most common ones, some service users may present with post- post-traumatic stress disorder (PTSD). The common PTSD symptoms are very distressing and disabling individuals from functioning in life. The first most important Golden Rule of trauma therapy is to develop their internal and external resources for emotional regulation before we attempt to do any trauma processing. Working on trauma without solid emotional regulations in place can re-traumatise people.
The therapeutic work is a long one that contains many challenges. The first challenge is to create a therapeutic space that is safe enough for service users to trust us. I do not demand service users to trust me just because I’m a therapist. Why should they trust me? I’m a stranger to them. I validate an individual’s mistrust towards me as a way to protect themselves, and it is a good resource, one that probably kept them alive. Slowly, I attempt to develop trust with them by being pro-active in offering that safe space, and by showing up consistently, even when they push me away to prove to themselves that they are unlovable.
It is also vital to maintain appropriate boundaries even if they push against this as they may do, often because they only have experienced relationships that break societal boundaries. Once the therapeutic alliance is strong, much of the trauma therapy work has already been done without even discussing childhood trauma. Then, the deeper work in helping service users process their trauma can begin. Although the therapeutic work is hard and delicate, for me, it is an absolute privilege to be chosen by service users to help them through the darkest parts of their lives, and it is a joy to see how much people can move from “I’m worthless” to embracing who they genuinely are, loving themselves and thriving in their relationships and sex lives.