"Therapy: it's a two-way thing": women survivors of child sexual abuse describe their therapy experiences

Abstract

This thesis gives a voice to women who have been sexually abused and subsequently received therapy. It contributes to the scarce international literature on evaluations of therapy by women survivors of child sexual abuse (CSA). It is hoped that policies and clinical practices for survivors of CSA will be improved as a result of this research. The study was advertized in the general public to women survivors of CSA who were over the age of 20, who had had at least five therapy sessions but were not currently in therapy. One hundred and ninety-one women completed a postal questionnaire that included open and closed questions about their CSA and disclosure experiences and about what they found helpful and unhelpful in therapy. Twenty respondents took part in follow-up interviews of up to two hours. Themes from the questionnaires and the interviews were analysed using EpiInfo6 and the data management tool NVivo. The majority of participants (91%) experienced CSA to the level of genital contact, or attempted penetration or penetration. Participants took over 16 years on average to disclose the CSA. The majority of participants (86%) reported that, overall, therapy was either somewhat or very helpful. Participants who had over 50 sessions of therapy were significantly more likely to report improved emotional well-being compared with those who had 50 sessions or less. Obstacles to participants gaining sufficient therapy for their needs included the cost of therapy and/or a restricted number of therapy hours subsidized by ACC. Participants reported that helpful therapy included a supportive, interactive therapy relationship with a therapist who was knowledgeable about the dynamics and effects of CSA and of abuse-focused therapy. Acknowledgement, understanding, normalisation and assistance to talk about the CSA and work through the effects on their lives were valued. Unhelpful therapy included a therapy relationship where the therapist was not affectively available or knowledgeable about the dynamics and effects of CSA. Therapists who were unable to support participants to talk about the CSA and work through the effects on their lives were criticized. There were also a few examples of harmful practices. The limitations of the study are the lack of a control group, the fact that participants were self-selected and the retrospective nature of their reports. It was concluded that most therapists were doing an effective job in difficult circumstances. However, some therapists need to develop a more open therapeutic relationship that would allow clients to give feedback about the impact of the therapy.