Counselling a Survivor of Child Sexual Abuse

A Person-Centred Dialogue

Richard Bryant-Jefferies

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781315344799
• Edition: 1
• Topic: Medicine
• Subtopic: Pediatric Medicine

This book provides a vivid insight into working with a client who is a survivor of child sexual abuse. Using fictitious dialogue it illustrates the person-centered approach and relates it to how memories can surface, and the impact that this can have on the client and counselor. It provides a deep insight into the counseling relationship and the counselor's use of supervision, highlighting discussion points throughout to aid training and reflection. It is essential reading for all counseling trainers and psychotherapists and all other health professionals dealing with people who have suffered sexual abuse in childhood.

CHAPTER 1

Background and review

It had been 11 months since Jennifer had begun attending the counselling sessions with Laura, her counsellor. She had felt depressed and had generally been feeling that life was just one big struggle. Over the next few months she had spent a lot of time looking at herself, how she behaved and why, and what she really wanted out of life.

Jennifer was 32 now and had had what she regarded as being a successful life in a great many ways. She had left school at 18 and had begun work for an advertising agency, initially as a secretary. She had stuck this for a couple of years before deciding to go to college on a part-time basis, undertaking a course in media and advertising. She had then worked for a variety of different agencies and had worked her way up to being an advertising consultant at one of the more prestigious companies.

In her personal life she had had relationships during that time, but had never really felt that she wanted to commit herself. Through her work she was involved in a lot of entertaining and it offered her a lot of social opportunities. The money was good, and she could afford to travel abroad regularly on exotic holidays.

It had therefore been something of a surprise to her in many ways when she had met Ian at an advertising promotional party. They had found themselves having so much in common – an interest in the theatre and the arts, an enjoyment of travel, an appreciation of good food. The list had seemed endless as they had chatted away over the buffet meal that evening. It hadn’t been long before they had started living together. At first, they had commuted back and forth between their homes – they lived about 30 miles from each other. But later, Jennifer moved in with Ian and rented out her own home.

It had felt really good for a couple of years, but then she found that her mood had dipped. She had begun to lose interest in things and it was then that she approached Laura after finding her name in the British Association for Counselling and Psychotherapy Resources Directory. (This directory is updated annually and available from BACP – see Useful contacts.) She had also asked around and a friend had recommended Laura as well. This had left her feeling more reassured.

Laura offered counselling from her own home. She had her own dedicated counselling room and the house was detached so loud voices were not an issue.

The room was deliberately kept simple, but without having the feel of being devoid of stimulation. Bright pastel shades, a simple table and lamp, comfortable chairs and a couple of framed prints on the walls.

Working from home where there can be a problem with loud voices is an issue that does arise. Counsellors need to have thought this through and to be aware of it when they are working with clients who may feel unable to express themselves fully because of the feeling that they will disturb people. Where a person is clearly feeling unable to be themself because of this, then there is a need to discuss this and consider an alternative venue that will suit the client’s needs.

Laura arranged to see Jennifer on Tuesday evenings, although this occasionally moved as circumstances demanded. Laura liked to offer a consistent time slot to her clients, but this was not always possible and both had agreed to work around this when necessary.

Jennifer had never done anything like this before, and it had felt strange at first. She had felt awkward, unsure of what to say, and sure that something wasn’t quite right somehow. The way she kept describing it in the counselling sessions was ‘something isn’t right, but I can’t get hold of what it is’. It frustrated her. Yet she had found over the months that Laura’s listening and warm acceptance of her had somehow encouraged her to change. At least, her mood had lifted and she now had a much clearer sense of who she was. She had spent a lot of time looking at her lifestyle and how she had spent her time in recent years, and exploring what it was that felt unsatisfying.

One factor that had emerged in her counselling was her use of alcohol and cocaine. She had been a fairly heavy drinker for a number of years, really since her late teenage years. It had never become a problem to her, but she did tend to drink most days, up to a bottle of wine in an evening, sometimes more when at parties. A lot of this had gone with the job, but it continued when she was not at work or was on holiday. Alcohol had become a regular feature of her life, an important part of her relaxation at the end of a day, and her reward for the effort she put into her work.

The cocaine use had been more recent and had actually been a feature of a pressured advertising campaign. She had felt so energised by her cocaine use and had come to use it more and more. It had turned out that I an had also used cocaine recreationally, although he seemed to have much less of a need for it. He seemed to be able to take it or leave it. But Jennifer had found herself needing to use it regularly.

Laura had been prepared to work with Jennifer on her cocaine and alcohol use. She didn’t take on a role of a specialist drugs or alcohol counsellor, rather she treated it as another feature of Jennifer’s lifestyle for her to bring to counselling if she wished to. She put no pressure on Jennifer to stop or cut back in any way, rather she allowed her to develop her own insight and understanding into her use, and to make her own decision to finally stop the cocaine and to cut back on the alcohol.

Jennifer had appreciated Laura’s acceptance of her drug-using choices. It had felt like a huge thing to disclose, but she had begun to realise that the cocaine and alcohol use had become linked, giving her a rollercoaster of highs and lows which she had begun to find increasingly unmanageable. It had started out to be a great way of giving herself a boost to keep up with her work and it had really seemed to help the ideas flow to begin with, but eventually began to leave her struggling to come up with anything original.

She had stopped the cocaine, in fact she and Ian had decided together that they wanted it out of their lives. The mood swings that Jennifer experienced and the fact that it was a drain on their finances had led to them making this decision. At first, Jennifer’s alcohol use had gone up but it had settled back down to a bottle a day. Now she had reduced further and she and Ian shared a bottle of wine each evening with their meal. Both felt comfortable with this, though there were times when Jennifer seemed to drink the bigger half of the bottle. And sometimes she might also have a gin afterwards, or a brandy, just to feel a warm glow into the latter part of the evening.

Substance use and misuse is becoming an increasing feature of Western society and it is unrealistic for counsellors to expect to avoid clients using substances and/or seeking to resolve problems associated with past or present use. Basic drug and alcohol awareness can be helpful for the counsellor, not so that they can assume the role of expert within the counselling relationship, but simply to be informed and have some degree of confidence and credibility. It is also important that counsellors have approached this topic from a personal development angle, uncovering their own attitudes towards substance misuse in order to ensure that they have the capacity to offer unconditional acceptance, empathy and authenticity towards any client who may happen to be using substances, not necessarily as their primary problem, but more often as their way of coping with difficulties, pressures, stress and trauma.

Jennifer had been a regular attendee throughout the 11 months of counselling. So far they had had 32 sessions. The fact that the sessions would not always be weekly had been agreed in the initial counselling contract. Laura had felt comfortable with this. She could see that Jennifer was a busy woman and that she was fitting the counselling around other demands. Yet she was also mindful of not wanting to become simply ‘a counsellor of convenience’. She recognised the importance and value of the therapeutic relationship that she formed with her clients, and recognised that consistent contact and a sense of commitment to the counselling process was important.

Laura had really grown to like Jennifer. She seemed to be quite a gutsy individual in many ways. Jennifer came across as being quite goal-orientated in her approach to life, and this certainly seemed to be reflected in her work, in which she was responsible for, or involved in, a succession of projects with clearly defined aims, objectives and target dates. However, as the counselling had continued she had noticed how Jennifer was becoming more laid back, more able to introduce other things into her life. One thing that Jennifer had gained from the counselling was a greater sense of spontaneity. Both she and Ian had found this a helpful change and it had freed them both up in many ways to make different and more satisfying choices in their lives.

Themes that Jennifer had been addressing recently in the counselling were issues concerning her relationship with her mother. She had rarely talked about her father, somehow he had always come across to Laura as being somewhat remote. But Jennifer certainly had issues with her mother and these largely revolved around her mother’s tendency to keep interfering in Jennifer’s life. She had been forever phoning up, asking questions about what Jennifer was doing, voicing her own opinions and generally leaving Jennifer with a sense that she couldn’t please her mother whatever she did. The problem had eased. Jennifer had asserted her boundaries more and was less sensitive to her mother’s comments. There were fewer tensions between them, although it was still not the easy-going relationship that Jennifer hoped for.

The difficulties had been around for a long time. As a child, Jennifer had always felt that her mother had been hypercritical of her, and had never really offered her the warmth she wanted. This had been a sharp contrast to Jennifer’s younger sister, who always seemed to have received the love and attention that Jennifer had never really felt. She had talked a bit about her childhood, but more about the present and the challenges and struggles she was having in her adult life.

Angie, Jennifer’s younger sister by two years, had taken quite a different direction in life. She had got married early to a chap she met whilst on holiday and had two children. Jack was now 7 and Susie was 4. They were great kids and Jennifer loved them both dearly. She saw them, but not as often as she would have liked. Angie now lived in Devon, a long way from Jennifer’s home on the Sussex/ Kent border. They would usually meet up at weekends five or sixtimes a year, and for Christmas.

Jennifer kind of liked her sister, but it wasn’t an easy relationship. Or at least that’s how it had been for a long while. It had become easier more recently and Jennifer put this down to her counselling. She was finding herself less resentful of what Angie had received and she had not, in terms of her mother’s affection.

Jennifer had come to realise that she could not change her mother, but that she could change her own reactions and behaviours. She recognised that the relationship had not been very good throughout her life, as far back as she could remember. She had distanced herself more from her mother, and contained the contact that they had. Jennifer had developed greater resilience to the criticism, realising that this negative conditioning had affected her and left her wanting to try to please her mother in a desperate attempt to receive the unconditional love that she now recognised she had been lacking and was still searching for. She realised that she was unlikely to gain what she wanted from her mother, and this had been incredibly painful for her, and it had taken many sessions to come to terms with this.

Much of our self-concept emerges from the interactions that we have with our parents and significant others in earlier life. The kind of negative conditioning that Jennifer has experienced is likely to have left her with a sense of self that might be summed up by the words ‘I am unlovable’ or ‘no one hears my needs, I am invisible’. These beliefs, when re-enforced over time, become facts in the person’s experience. Because they are aspects of the person’s sense of self they then have to be satisfied in order to maintain psychological survival. So the person may then initiate actions and behaviours to re-enforce their negatively conditioned knowledge that they are unlovable, or invisible. Yet, at the same time, there will remain that part of them that yearns to be noticed and loved, creating an inner tension. The constant living out of the negatively conditioned sense of self creates a state of incon-gruence in the person, leaving them fundamentally anxious and to some degree fragmented.

So, it was now 11 months into the counselling and Jennifer did not have any sense of wanting to end it. She felt she was still gaining a great deal, learning about herself and discovering hidden traits that were the result of ‘conditions of worth’ from her past, and finding it valuable to have someone to talk to about issues that came up generally in her life – work, her relationship with Ian, general stresses and strains.

She had begun to feel more on top of things, somehow more in control of herself and her own direction in life. She was clearer about herself and what she wanted, and only recently she and Ian had been talking about starting a family.

Laura felt good about Jennifer’s progress. She had gone through a tough time breaking her cocaine habit, but she had done it. She had stabilised her mood and had adjusted to her life with Ian, who seemed very supportive and caring. Laura had sensed shifts in her relationship with Jennifer as well. Laura was older than Jennifer, she was 48, and had ten years’ experience in counselling. She had gained her diploma in person-centred counselling and psychotherapy and, whilst the course did address the issue of child sexual abuse, what really drew her interest was that during her training she had a placement at a rape and sexual abuse centre. This had involved further training additional to her diploma course. She later followed up with a module specifically focusing on working with survivors of abuse, not just sexual abuse. She did not feel that she was an expert on the topic, that had not been her purpose. Rather she regarded it as providing her with an opportunity to identify and work through her own issues and to gain an appreciation of the damage that arose and the impact sexual abuse could have on people both in childhood and later throughout their adult lives. It was not an issue that had arisen with Jennifer.

Looking back over the course of the counselling so far, Laura could see that something in Jennifer was settling down. The relationship had become less tense as time had gone on. This was not unusual, but at the beginning somehow there had seemed added tension with Jennifer and whilst Laura had highlighted this from time to time as she sought to achieve a congruent and transparent presence in the relationship, what it was had never really become clear. But it was easier now. The sessions still had a lot of emotional content, but not always. It felt comfortable but not to the point of being too cosy.

With longer-term working, greater familiarity can develop, particularly where the counsellor is offering a relational therapy, one that sees the quality and nature of the therapeutic relationship as the primary factor that induces positive personality change. The division of counsellor-client can become less obvious and what can emerge is more of a genuinely person-to-person relationship. This can prove extremely valuable; however, the reality of counsellor-client remains and should not be lost sight of. Where counselling becomes overly conversational, or the sense of ease begins to obstruct congruent responses from the counsellor which, by their nature, are likely to be challenging or unsettling, then it needs addressing in supervision and in the sessions.

Laura was not sure how long Jennifer planned to stay in therapy. They had talked about it from time to time. On a recent occasion when this had come up, Laura had expressed her feelings about whether Jennifer might be experiencing some degree of dependence on her and, if so, what role this might have in Jennifer’s life. ‘No, I don’t sense this as being dependence, but I do feel that I would miss it.’ Further exploration revealed that what she thought she might miss most was the unconditional acceptance that she felt was present within the counselling space, and how that felt liberating for her to experience. ‘It seems to help me to clarify for myself who I am without the interference of someone else’s beliefs, agendas and angles. You seem to be very present but you do not kind of get in the way of me.’

It was now June, and Laura was aware that there would be breaks in the counselling. She took a break in August and she had already indicated this to Jennifer. Laura was also aware that Jennifer was planning to be away in late July.

It is important for clients to be aware of this interruption to the flow of counselling. The person-centred counsellor will trust that the client, informed of a summer break, will adjust to this and take the necessary steps to prepare themselves. This could involve stepping back from in-depth work or avoiding particularly difficult or painful issues.

So, Jennifer has made a lot of progress over those 11 months and attends regularly. She has found ways of changing some of her habits and routines, she has learned to deal more effectively with her invasive mother and come to terms with the fact that her mother is unlikely to show her the afection that part of her has sought for so many years. She has a relationship with Ian that is going well and they are talking about starting a family. And Jennifer is less hassled by work and more able to give herself time to enjoy her life.

CHAPTER 2

Counselling session 33

It was 7.30pm and Laura was sitting in the counselling room waiting for Jennifer to arrive. The doorbell rang and it brought Laura back from her meditation on the colours in the sky as the sun reflected off the layers of cloud to the west. She smiled, got up and went down the hall to the front door to let Jennifer in. ‘Hi, ’ Jennifer smiled, ‘what a lovely evening. Feels nice and calm out there.’ ‘Yes, it is, I was just watching the colours in the sky myself. Come in.’

A bit of small talk is unavoidable in these circumstances, unless you wish to let the client in and maintain a silence, saying nothing until you enter into the therapy room. Perhaps some people follow this approach, but Laura wanted to communicate with her clients. She saw the conversation before entrance into the therapy room as part of the counselling process anyway. She was, after all, seeking to offer warm acceptance to Jennifer, to show she was attent...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Forewords
• About the author
• Acknowledgements
• Introduction
• Chapter 1
• Chapter 2
• Chapter 3
• Chapter 4
• Chapter 5
• Chapter 6
• Chapter 7
• Chapter 8
• Chapter 9
• References
• Further reading
• Useful contacts
• Index