Working with Survivors of CSA: The Essentials

Working with survivors of childhood sexual abuse (CSA) can be extremely challenging, and yet it can also be immensely rewarding and transformative for both the survivor and the practitioner. While each survivor is unique, and responds differently to the therapeutic model used, there are some fundamental trauma principles that are common to all.

When working with survivors of childhood sexual abuse (CSA) practitioners need to have an awareness of the Power Threat Meaning Framework (PTMF) and the core principles of Trauma Informed Practice. These provide a scaffold to support your preferred therapeutic model and manage trauma symptoms more effectively.


The Power Threat Meaning Framework and Trauma Informed Practice

The PTMF was developed by Johnstone and Boyle in 2018 as an alternative to psychiatric diagnosis. It is a new perspective to understand peoples’ experiences of distress, confusion, fear and despair. It also helps them to make links between their symptoms and distressing behaviour in the present and what has happened to them in the past, and to make sense of their experiences and their responses to these.

Rather than focusing on ‘what is wrong with you?’ or ‘what is your problem?’, the PTMF asks ‘what has happened to you?’ to validate their narrative. The emphasis is on understanding how their experiences have affected them, what they had to do to survive, and the meaning they have made of these. It also focuses on identifying the strengths of the client and cultivating these in order to empower clients to have more agency and choices in their lives.

This approach echoes the core principles of Trauma Informed Practice (TIP), which enable practitioners to look at trauma though the eyes of the client and to work with survivors of trauma. These are safety, trustworthiness, collaboration, promoting autonomy and choices, and empowerment. TIP also emphasises that recovery from trauma is possible and there is hope.


The Tri-Phasic Model

In addition, when working with survivors of CSA, it is important to titrate exposure to the processing of the trauma through three phases, known as the Tri-Phasic Model. This model consists of three main phases: stabilisation, processing and integration.

The stabilisation phase focuses on safety and helps survivors better understand their trauma symptoms through psychoeducation. This is accompanied with skills to manage emotional dysregulation, unbearable emotions and trauma symptoms and to expand their window of tolerance and distress tolerance. This helps them to process their traumatic experiences and any returning memories and flashbacks. This is best achieved through grounding skills and mindfulness so that they can start processing the traumatic experiences in Phase Two.

In Phase Two, survivors can explore the traumatic experiences, process them, mourn the many losses as a result of CSA, and begin to make sense of their experiences. From here, survivors can enter Phase Three, the integration phase, in which they can integrate their experiences and begin to reconnect to themselves, others and life, and begin the process of post-traumatic growth.

Throughout these phases, practitioners need to be able to re-frame symptoms as adaptive survival strategies and emphasise existing resources and promote empowerment. The therapeutic relationship is central throughout in order to restore relational worth and rebuild a healthy attachment system, so that they are more able to connect with others and form relationships that are safe rather than filled with fear.

With this in place, survivors can become more embodied to live in the present and allow themselves to feel, rather than being catapulted into the tyranny of the past.

Working with Survivors of Childhood Sexual Abuse, a 2-day live PESI UK webcast workshop with Christiane Sanderson, takes place this week from Friday 18^th-Saturday 19^th June. For more information and to book your place, click here