By Dr. Jem Tosh CPsychol AFBPsS FHEA RCC
Content warning: Discussion of sexual abuse and trauma responses to sexual trauma
For over twenty years I have specialized in the psychology of sexual violence, from research and teaching, writing books on the subject, to counselling survivors. When I tell people what I do, I often get a response like, ‘oh, that must be very difficult and upsetting work’. Some days it is, because I’ve seen yet another headline that blamed victims or minimized the impacts of rape, but my work with survivors is one of the most uplifting and exciting parts of my job. You would probably be (pleasantly) surprised at how often my clients and I laugh during sessions. In my view, just because the trauma was awful, doesn’t mean the healing needs to be awful too.
You don’t need to ‘sit with it’
I often see people online saying that the key to healing isn’t making difficult feelings go away, but learning how to hold them and manage them. As someone who specializes in working with survivors of sexual abuse (including childhood sexual abuse and incest), I disagree. Feelings of shame, disgust, and terror can be a near constant sensation. Being ‘in your body’ - feeling connected and present - can be overwhelming and unbearable. Dissociation and numbing can be the predominant way of managing these sensations, as can any form of physical distraction that gives the body momentary relief (e.g. eating, drinking, or intoxication). So, in my opinion, you’ve probably been ‘sitting with’ those overwhelming feelings for long enough, and now it’s time to reduce them instead.
I don’t need you to provide a detailed description of events if you don’t want to. It’s entirely up to you how much you share with me.
While everyone’s trauma and healing journey is different, and not everyone heals in the same way or in the same time, it’s not uncommon for my clients to bring a memory to session that is overwhelming and very disturbing to them, and leave that session with it no longer bothering them. This is done through a combination of what is known as neurobiological therapeutic approaches, like Eye Movement Desensitization and Reprocessing (EMDR) and Observed Experiential Integration (OEI) therapies, that I have carefully adapted specifically for working with survivors of sexual abuse. This combination of therapeutic tools allows for me to provide therapy that is as quick as possible and as gentle as possible, because I don’t want you having to think about that experience or feel the emotions tied to it any longer than you have to. You will still have to tap into those sensations to process them - but only momentarily and they will reduce as we process the trauma.
Your feelings are manageable
Sometimes people are scared that if they open the Pandora’s box of their abuse, they will unleash a tsunami of emotion that will never stop. They fear becoming so overwhelmed in session that the tears will turn to sobs and their body will respond with intense discomfort, like shaking and feeling sick. This is why the most important part of my job is guiding you carefully to the edges of your trauma, and monitoring your nonverbal reactions for signs that we’re getting too close to the pain that is overwhelming. Sometimes clients have no idea this is happening because they are numbing or dissociating, others are well aware of that balancing act of approaching a painful memory rather than diving right into it. This is why I do something that might seem odd in talking therapy - but I might ask you to stop talking about it if I notice that you’re activating too much trauma at once and are a risk of becoming overwhelmed.
You would probably be (pleasantly) surprised at how often my clients and I laugh during sessions. In my view, just because the trauma was awful, doesn’t mean the healing needs to be awful too.
This is also why I address your sexual abuse trauma bit by bit, rather than all at once. Like any seemingly overwhelming task, breaking it down into more manageable pieces makes the task less intimidating and less intense. It can also prevent the therapy itself from becoming traumatic. So, while I’m trained in a variety of ways to bring down high levels of intense emotions (so if you did get overwhelmed, we could ground you again), I don’t use them often because I feel that prevention is better than cure. Knowing where your limits are in terms of that emotional intensity allows for me to reduce the chances that we’ll ever get to that point. Learning this back and forth of just touching the edges of a trauma, being able to reduce it, and grounding yourself as needed, can also be skills that empower you between sessions to manage your trauma responses while we focus on addressing the root cause in session.
You don’t need to talk about it
Talking therapy is a wonderful thing that can be helpful for many issues and experiences, but in my opinion, it’s not enough to heal sexual abuse and sexual trauma. Sometimes I split sessions, half the time is talking therapy and half is trauma processing. During the talking portion of the session, clients try to make sense of their experience and appreciate being able to ask questions with an expert on the topic and someone with lived experience of sexual abuse. I provide validation, encouragement, and answers.
As we process trauma tied to a particular abuser, clients can feel less afraid. This can feel like taking the power away from that individual, of how our mind has built them up to be an inescapable threat.
Some clients either don’t want to talk about the abuse or can’t because it’s too painful or they don’t have the words to describe it. It might be surprising to you, but you don’t need to talk about your experience to complete trauma processing. For these clients, I guide them through the trauma processing despite having very little or absolutely no information about the traumatic event (other than it was sexually abusive or traumatic). The more you tell me during sessions, the more I can plan a course of healing for you, and the better I can understand the problems you’re having (like difficulty sleeping, chronic anxiety, or relationship problems), but I don’t need you to provide a detailed description of events if you don’t want to. It’s entirely up to you how much you share with me.
You can take your power back
After a processing session my clients can feel a lot of things. Tiredness is common because the brain has just done a lot of work, but they often describe feeling lighter, taller (because the weight on their shoulders has lessened), more hopeful or optimistic, and freer. As we process trauma tied to a particular abuser, clients can feel less afraid. This can feel like taking the power away from that individual, of how our mind has built them up to be an inescapable threat. This can be particularly significant for those who have been physically free from their abuser for years (or decades) but still feel mentally imprisoned by them. This psychological imprisonment shows up as acting in ways we did when the threat was still there even though it’s long gone, or remaining terrified, jumpy, and hypervigilant despite being safe now.
You can also get closure, let go, and move on. All those things people talk about (or say we ‘should’ do) but are really difficult to do in practice. Once a memory has been processed, that ‘letting go’ can happen without additional effort on our part, because to the brain, that trauma is finally over and it no longer feels ‘stuck’ or that it needs to ruminate about it endlessly.
We can also provide you with closure in a safe space. Rather than confronting an abuser in person, which could be unsafe and dangerous, or impossible, with EMDR therapy, we can process a conversation or confrontation with an abuser in our imagination in a way that allows our brain to feel like it’s really happened - without the in-person risks. It’s just one of the many ways that we can heal sexual abuse trauma without it being scary.
Dr. Jem Tosh (they/she) is a Doctor of Psychology and an EMDR and OEI trained Trauma Therapist. They are also an award-winning Academic and Author. Jem provides counselling to survivors of violence and abuse, in-person at her practice in Langley, BC and online to residents of BC, Canada.