SEXUAL ABUSE SURVIVORS: CHOOSING A THERAPIST
Patti Geier, LCSW
Sexual abuse is a traumatic and damaging experience. By definition, sexual abuse is a boundary violation. For the survivor, the feelings of betrayal, shame, guilt and distrust are often long-lasting.
These feelings are very painful to contain and, containing them is toxic. Since shame is so prevalent among people who have been abused, keeping it a secret is not uncommon. But, by keeping it a secret, shame and guilt lead the person to blame herself (himself). This fosters self-hate, fear, distrust and self-destructive behavior.
Therapy is a place to explore all of your feelings and, hopefully, begin to heal. Sometimes, the mere act of telling a secret makes it less powerful. It can be freeing to open up and share the burden with someone who listens, supports, and wants to support you in building healthy relationships.
HOW TO CHOOSE A THERAPIST
It is important to find a therapist who has a good deal of experience and skill in this area. This is necessary and important, but not the only factors to consider.
You want to find someone you feel comfortable sharing all of the feelings and concerns you have. In order to trust a therapist, she or he has to be trustworthy.
The therapist needs to be able to listen, support, and give you the space to lead the pace of exploration. You need to feel that you have the control over how much you reveal in each session. If you reveal too much too soon, you may leave feeling too vulnerable to return. If the therapist pushes too hard, it can trigger feelings of being coerced to do something you do not want to do.
The therapist needs to have good boundaries. This means, that she (he) is consistent and predictable in the area of starting and ending on time.
This may not seem important, but if the session boundaries are not predicable and consistent, it can bring up feelings about other situations that were unpredictable, inconsistent, or felt out of your control.
I will offer an example of this dynamic. A patient, I will call Mary described a situation with her previous therapist that left her uncomfortable and eventually led to the end of treatment. There were times the therapist ended on time and other times she ran over. The times the sessions went over, Mary would leave wondering what she said that made the therapist interested enough to keep her longer. Mary interpreted her therapist’s actions as interest/disinterest. She felt she could control how long she got to stay by talking about what she believed her therapist wanted to hear. As you can imagine, this added an element to the treatment that triggered deeper issues for Mary.
To be triggered in a therapeutic situation can be re-traumatizing. When a therapist has clear, consistent, and predictable boundaries, it helps to make the space safer. You can trust that there is an adult who will be responsible to stay within the time frame.
I offer the concept of beginning/ending on time as one boundary issue that could bring up concerns around safety. Certainly, there are therapists who are more flexible around time. Time flexibility does not always mean a therapist has problems with boundaries in other areas.
The main point is that if there is something happening in treatment that triggers uncomfortable feelings, you can bring it up for discussion.
There are other boundary issues to consider. Does the therapist maintain a professional attitude? Is the therapist too casual and friendly for you? There is nothing wrong with self-disclosure if it helps to make you feel less alienated, but if you begin to feel uncomfortable and anxious about the focus shifting away from you, it’s a red flag.
You have the right to ask questions about anything. If you feel uncomfortable for any reason, bring it up. It’s a good idea to interview therapists until you find the right fit for you.