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Sexual Violence 3/5: Working Relationally

How can we sustain a safe relational connection with survivors of sexual violence? In the third part of her series about working with survivors, Erene Hadjiioannou, author of a forthcoming textbook, addresses the therapeutic challenges and opportunities – and shares her work with one client for whom playing cards was vital groundwork.

As we explored in last week’s blog about Disconnection and Connection, understanding the truth of sexual violence includes learning how relationships with one’s self, other selves, and the wider world are re-configured in its wake. For therapists working with survivors this means the way we understand relational work also needs to be re-configured to meet multiple needs.

In this blog, I will focus on how sexual violence impacts relational therapy inside the room. Crucially, we need to remember that we live in a world where sexual violence is a reality – and that therapist and client bring the impact of this world in with them every time they meet. 

I might sense that a client feels unsafe with me when eye contact is low, speech becomes difficult, and their body moves to brace itself or seems to want to leave the room. Sometimes the mind will also follow suit, becoming disconnected from the present moment through dissociation or flashbacks. In such instances, the same neurophysiological and psychological mechanisms used to survive the original incidents are visibly re-triggered.

How can client and therapist stay connected via relationship under these circumstances?

Simply being available to hear and respond in a validating manner is reparative, as an act of witnessing within a victim-blaming society that largely does not want to know the truths voiced by survivors.

Having an awareness of how the wider world contextualises sexual violence for our clients is also helpful, enabling both parties to identify triggers that could jeopardise connection between them. As an example, the latest news headline about an overloaded criminal justice system may exacerbate a client’s post-trauma symptoms as they consider whether or not reporting is a viable option.

Powerful transference and countertransference dynamics entering the room give trauma an unconscious channel to challenge relating. But as therapists, we can also gain valuable information on the client’s experiences of relatedness from how much or how little we are able to grasp a sense of their overall self. Again, the counter to this is connecting wherever possible, even for a moment, to try to push back against the force of trauma.

Max: negotiating safety and countering the internalised perpetrator

Max approached me for therapy in the later stages of his life, saying that he thought he was coping with childhood sexual violence but noticed sudden mood changes as well as struggling to want to be around his loved ones. When we first met, Max would ask for the door to be open, saying he felt better this way. I offered to collaboratively manage this need for safety, so we began with an open door, and transitioned to re-arranging the furniture in the room with the door closed.

We also began each appointment playing a short card game, to relieve the psychological pressure of having to verbalise his trauma, and to regulate his physical anxiety so that his body could feel safe in the room. Finally, doing this together solidified our relationship in navigating his traumatic experiences.

My countertransference response of feeling a little anxious before appointments was not a direct response to Max’s behaviour or expressions, as I felt generally comfortable with him. It was a wariness of the presence of the perpetrator between us. This reflected Max’s everyday living with the internalisation of the perpetrator’s forceful presence. To counter this we explored some of the negative beliefs he had about himself, which were created by the verbal abuse from the perpetrator.

Over time, this verbalisation enabled a pushing back against these beliefs to create new ones that were empowering. We had to sensitively stay in touch with all aspects of Max’s struggles, finding each other in the here and now rather than being pulled into re-experiencing violation in relationships.

Sexual violence is something that has to be repeatedly survived even when the perpetrator is absent. This is because we all exist within society and relationships, and this was the context in which the trauma originally occurred. The intrusive person-to-person contact that led a survivor to therapy is repaired in part by our provision of benign, transparent, and collaborative care.

Therapy can be a place to practice being amongst others safely, re-configure the self on the survivor’s terms, and re-connect with the relationships and spaces previously denied to them by a perpetrator’s traumatic actions. This is all part of living as a survivor, rather than simply surviving. For Max, this began with re-arranging his bedroom to have a safe space for restful sleep, as well as starting to opening up to others, in order to find more safe spaces in relationships outside of therapy.

Psychotherapy with Survivors of Sexual Violence: Inside and Outside the Room, by Erene Hadjiioannou, will be published by Routledge in September.



Erene Hadjiioannou

Erene Hadjiioannou is a UKCP Integrative Psychotherapist. She has worked with adult clients since 2010 in statutory, third sector, higher education, and private settings, and is currently solely based in her private practice, Therapy Leeds. Between 2014 and 2018 Erene created and co-ordinated two specialist services for women with complex needs (offenders, and survivors of sexual violence).

Erene's work is firmly based in relational, humanistic, and empowerment perspectives and she incorporates activism into her work around sexual violence, believing that as practitioners we have a responsibility to advocate in service of our clients and our shared world. You can view her writing and speaking engagements here. Erene is part of a steering group for the Crown Prosecution Service guidelines on pre-trial therapy. She covers this topic, and a range of others, in her book Psychotherapy with Survivors of Sexual Violence: Inside and Outside the Room.

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