As part of the Personalized Recovery Oriented Services program at the Mental Health Association of Rockland County, Inc. that began earlier this year, a group named Survivors of Sexual Abuse-Women was launched. This closed group, led by Marian Rhein, LCSWR, was designed to serve the needs of women suffering from post-traumatic stress after enduring horrific sexual trauma. Initially, eight women were enrolled in the group. Two left as a result of positive discharges to a lower level of outpatient care. One participant decided to drop out finding it difficult to discuss her history of abuse; leaving five women to complete the 6-month program.
During the first session general guidelines were delivered establishing a safe place which embraced confidentially, respect and trust. Individual goals were explored (i.e. eliminate feeling responsible for the abuse, and learn to identify emotions connected with trauma). Each session was ended with a conversation as to whether or not expected outcomes were met. Positive and negative life experiences were shared pinpointing the effects of the abuse and grief endured. Participant’s supported one another by acknowledging the courage it took to participate in challenging group discussions. Using the Victim-Survivor-Thriver continuum from Bonnie Collins and Kathryn Marsh’s Healing for Adult Survivors of Childhood Sexual Abuse (1998) participants identified whether they saw themselves as a victim, a survivor, or a thriver in order to establish a baseline. Participants conceptualized their recovery as the process of moving from Victim to Survivor to Thriver.
Participants discussed often feeling criticized or foolish in the past when expressing their emotions to others. As illustrated in Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993) by Marsha M. Linehan, PhD such difficulty has been conceptualized as the effect of an individual persistently encounter an invalidating environment. For example, Collins and Marsh (1998) assert an environment that is shaped by “shame-based family” embraces the following disabling characteristics:
- Feelings are denied, avoided, discounted, and suppressed.
- Family secrets are protected at all cost.
- Control is maintained by fear and secrecy.
- Perfection is expected with no mistakes allowed.
- Blame is freely placed whenever anything goes wrong.
- Love is conditional
- A “no talk” rule prohibits the expression of feelings, needs, or wants
- Trusting no one assures one will never be disappointed.
To help unpack this reality, a selection written by Betsy Rose, “House Full of Secrets” was read silently, then aloud as a group. Each section was analyzed and discussed. Participants connected with the symbolism shown the phrase “and you’re caught in the crossfire like a kite in the storm” allowing participants to open up and reflect on the impact of shame on one’s sense of self. Participants made a list of things they have difficulty saying No to and what they thought influenced failure to deny or reject when appropriate. Other discussions focused on how individuals think others see them and what individuals would like people to know about them. Difficulty in accepting compliments from others was also shared as well as why individuals tend to hold onto the negative. The participants analyzed another passage by Betsy Rose entitled “Circle of Light” and then wrote a journal entry about how their abuse impacted their lives. Doing so helped individuals to increase participant’s sense of control over their lives. Factors in one’s life affecting the healing process were discussed including identification of support systems, eliminating self-blame, as well as facing fears were explored. As a result participants grow to understand that there is more than anger, sadness and terror in their emotion spectrum. They find there is also HOPE. Participant grew to accept their anger learning that it can be expressed in a variety of ways or could be perceived as energizing an individual into healthier behaviors or actions.
Continuing through the therapeutic process of understanding and regulating emotion, participants wrote journal entries about their experiences. Prompts included: writing about earliest memories, memories they would want to forget, and organizing timeline of significant life events. In group dialogue, intimacy, trust, and betrayal were defined by relating to experiences in each participants life. Participants increasingly identified people in their lives whom they trusted. Steadily they began sharing how being sexually abused impacted their ability to trust others. Participants wrote additional journal entries about reasons why they may have felt betrayed and what happened to promote these feelings. In the following sessions, participants identified a safe person in their lives and a safe place to spend their time. The impact of how experiencing recurring nightmares and low self-esteem on how individuals perceive trauma was also explored.
Participants celebrated working together while in the course of taking on their own personal journeys. The prevailing theme at the end of six months was added insight, validation and acknowledgement of the possibility that life does not always have to feel as has felt. Participants processed the endpoint of the group for closure, leaving with a sense of growth and a deeper knowledge of themselves. By taking part in the Survivors for Sexual Abuse-Women participants discovered how it the value of trusting themselves equipping them with feelings of empowerment and control that had been stripped due to inerasable events of the past.