What Survivors could be experiencing
Survivors of sexual violence who seek services from a range of helping professionals including doctors, chiropractors, massage therapists, and others, may experience anxiety and challenges in accepting treatment. Having experienced violations of the body and soul, boundaries and trust can be seriously affected. Feelings and experiences associated with childhood sexual abuse can impede the therapeutic process, by compromising the survivor’s sense of safety.
Many survivors experience:
- Fear and distrust: This can be related to authority figures, especially if their abuser was a professional or in a position of authority. This can also happen with female survivors, who may feel unsafe and uncomfortable with a male health professional. Male survivors may experience similar feelings.
- Physical pain: For many, the experience of physical pain is associated with their abuse. This may manifest in a number of ways. Some survivors may have learned to numb the pain, or dissociate from it. Others may experience its full impact, with the current pain being amplified by the pain of their past abuse.
- The need to feel in control: This arises from past violations in which the survivor had no control over what was done to them. If the survivor doesn’t feel like they have control, their sense of safety may be diminished, and that may impact how well they adhere to treatment.
- Ambivalence about the body: Survivors may feel loathing or shame about their bodies, and may be disconnected from their bodies. This may impact their willingness to seek, or respond to, treatment. Survivors may also self-harm as a way of coping and numbing the pain of abuse. They may try to hide this from health professionals, and resist opening up emotionally or physically.
- Conditioned passivity: Sexual abuse - especially against children - teaches them to stay silent and not to question authority figures. As an adult, a survivor may have difficulty expressing his or her needs to a health professional, who may be seen as an authority figure.
- Triggers: Many survivors experience flashbacks in which they relive the trauma of their abuse, and may experience overwhelming feelings of anxiety, grief, loss, or fear. This most often happens in the context of physical touch or intimate proximity.
- Dissociation: Dissociation is a strategy that survivors may develop to cope with the abuse. Survivors may feel like they’re outside of their bodies, and may be unaware when they have zoned out. Like conditioned passivity, this can make it difficult for survivors to advocate for themselves.
Principles of Sensitive Practice
A survivor needs to feel as though they are respected at all times. Respecting boundaries is a crucial part of creating safety, both physically and psychologically. Asking ongoing permission each time before touching, describing what touch is required and why, and checking in at each stage about how the survivor is doing, as well as being willing to adjust the treatment approach, is vital. It also helps to share power and responsibility, and empowers the survivor to be an active participant in their own healing. Some survivors may have difficulty tolerating any touch by a health professional. Over time, as trust develops, a survivor may be able to accept this, although some may not. Survivors who have had negative experiences in the past, with professionals who have minimized their pain or discomfort, may need more patience and support.
In order to build feelings of safety, survivors respond best to a warm manner instead of a cold and clinical one. Finding a balance between a positive and warm manner and being overly familiar, which can feel invasive and disrespectful, is critical.
Sharing information and control
Having experienced powerlessness and a lack of control during their abuse, it’s critical that a survivor is empowered to have, and share, control with a health professional, in order to establish and maintain safety. This works best when there is mutual learning, two-way information sharing, as well as the survivor being given power over their treatment.
Recognizing body language is really important when working with survivors, and helps professionals identify triggers, dissociation, unease and other physiological reactions to stress. These include, among others, cringing, pulling away, shaking, stiffening, muscle tension and inability to relax, strong emotional reactions, rapid breathing or heart rate, inability to focus, distance, or seemingly “out of it”. Helping the survivor ground him or herself in the present moment, reminding them that they’re safe, and even taking a step back in treatment, if needed, helps the survivor to begin to regain their equilibrium.
Survivors need to feel empowered to speak up when they are uncomfortable, to ask for adjustments in treatment if necessary, and to know that they can choose to discontinue their relationship with the professional if they feel unsafe, or feel like they’re not being appropriately supported.
For more information see Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse, by the National Clearing House for Family Violence, Public Health Agency of Canada, 2001.