Survivors arrive at PARCS wanting to move on from what has happened.

Understanding the impact of their traumatic experience on the brain and the body can really help a survivor to move on from issues of self blame and to give back some sense of control over their safety. This in turn interrupts the pattern of repeated victimization and provides survivors with an opportunity to address the psychological and emotional impact of relational abuse.

We know that inter-personal trauma (trauma that happens in a relationship i.e. perpetrated by one person onto another) is the most devastating. In order to go about our day to day business we need to be able to trust that others wish us no harm. Sexual abuse undermines this trust at a fundamental level, particularly childhood abuse because it is in childhood that our relational blue prints are formed.

Relational abuse has an impact on an individual’s sense of whom they are and who they can be. Coupled with this survivors (particularly children), tend not to disclose sexual abuse, consequently not only are they unable to escape but they are denied the reparative opportunity to talk through and make sense of what has happened to them.

Clients who access PARCS often feel ‘stuck’. Whilst the abuse may have ended they are unable to look forward because they are psychologically held back by what has happened to them. Survivors commonly express a want for relationships in which they will not be hurt, abused and re-traumatised but are at a loss to know how this might be possible. As one client said “why do I always end up with lousy partners?”

Survivors often present with trauma symptoms including, intrusive memories, nightmares, a feeling that the abuse is re-occurring, distress when exposed to reminders of the abuse and a tendency to avoid thoughts or feeling related to the trauma. The misuse of alcohol and drugs, self harm, self injury and eating disorders can all be understood as attempts to manage these overwhelming feelings.

Negotiating day to day life and forming new relationships can be difficult at the best of times but it is particularly hazardous for survivors. How can somebody be expected to negotiate a relationship when they are plagued with sensations, thoughts and feelings related to past relational traumas? How can they disentangle the ‘here and now’ of their relationships from past relationships? Therapy can help survivors negotiate a new path through these various hazards rather than treading a well worn and familiar one.

To begin with, it is often helpful in trauma based therapy to talk through what happens in the body when under threat. So here goes….

In situations which threaten our life or integrity our survival instinct takes over. The primitive part of our brain is triggered into action. The amygdala, sometimes referred to as the ‘smoke detector’ because of its ability to sense possible danger, triggers the autonomic nervous system to take action. This part of the nervous system is not under our conscious control. Under threat we need to act first and think later.

The autonomic nervous system will usually firstly trigger the sympathetic nervous system response of fight or flight. Adrenaline and other hormones are released into the body in order to prepare us for action. The heart races, breathing increases, pupils dilate and we are on full alert.

If the amygdala, or smoke detector, assesses that this response will be unsuccessful, then a freeze response may be triggered. The muscles stiffen, breathing is held and we keep very still. This response can be seen in animals that 'play dead', dead meat is less inviting. It is also a sign of submission in many species, sending the message to an aggressor that their dominance is not being challenged - this can avert an attack and ensure survival. Remember the instinctual part of our brain is not bothered about whether or not we will feel bad or guilty later; it is only interested in survival.

If these responses are unsuccessful the amygdala will switch from the sympathetic to the parasympathetic nervous system, triggering the ‘submit’ response: The heart rate slows, tension leaves the muscles and the body goes into flop.

One client described this as a feeling of physical weakness as if all the fight had left them. A floppy state lessens the damage from any physical attack. During this state the mind provides protection through ‘dissociation’ - this is most commonly experienced as being detached from our emotions, our body and immediate surroundings. Day dreaming is a form of dissociation. The body cannot run away so the mind finds a creative way of escaping. This ability to psychologically escape can also protect survivors from acknowledging that the person who is meant to love and care for them is also the person who hurts them.

I'm sure you can see how difficult it may be for a survivor or anyone around them to understand this. Faced with a reminder of an abusive incident survivors may freeze or dissociate. Later they may be angry with themselves and vow to act differently in the future only to find themselves repeating the same pattern of behaviour.

Survivors are often triggered by events in the present that, outside of their awareness, remind them of a past traumatic event. The amygdala which is responsible for triggering our survival responses tends to generalise. Like a smoke detector it cannot differentiate between somebody smoking nearby and a full scale fire. For example: A survivor who was abused by her father after he had been to the pub feels paralysed when she smells alcohol on her friend and has to work hard to remind herself that it is not her father. A survivor who has experienced domestic violence wonders why she can’t stop freezing every time she hears keys in the door even though she knows it is her son coming home from school and not her partner who repeatedly raped her.

Thinking logically is difficult when we are under threat. The structures involved in responding to danger are largely located in the right hand side of the brain; the most crucial of these being the amygdala. The right brain is associated with emotions and sensations. The left brain is associated with logical thinking.

Under threat the left and right brain initially work together. We are most effective when we can integrate information from our left and right brain. However, if the amygdala continues to detect danger the chemicals that are released into the body overwhelm the functioning of the left brain causing it to temporarily go ‘off line’. Consequently clients may struggle to make logical sense of what has happened to them but instead are flooded with sensations and images of the event.

Therapy can help survivors with these fixed patterns by explaining what happens when we are under threat (whether that threat is real or imagined) and teaching strategies to anchor them to the present. This may include learning to track their bodily sensations whilst teaching grounding techniques. This enables survivors to gain some control over their nervous system and this sense of control can be very empowering for survivors.

Survivors learn to track and monitor their own responses whilst developing strategies to calm themselves. This, in turn, leads to a reduction in trauma symptoms as the client becomes curious about their responses rather than frightened by them. Survivors can then start the process of making sense of what has happened to them without being overwhelmed by intrusive memories.

Sexual abuse happens in relationship and long term trauma therapy provides an opportunity to work through and understand this relational aspect. Indeed, many of the people accessing our service describe relational difficulties including difficulties with parenting.

We all have a ‘blue print’ for relationships. These blue prints act as a guide. We form these blue prints through our experiences with our early care givers – how they relate to us and each other. These interactions give us messages about ourselves and how we are perceived in the world – this shapes our expectations about how others will relate to us.

I will use the metaphor of a dance to illustrate this further. We learn relational dance steps in childhood. The steps we learn are influenced by those we come into contact with. Some will be interested in helping us choreograph our own dance steps others demand we dance their dance and no other. Each relational dance will have its own tempo, rhythm and steps. Later in life we tend to be drawn to relational dances that are familiar to us, even when we long for something different. This may include trying to get the other to dance our steps.

Thus, someone who has experienced abusive relationships may find themselves dancing a familiar dance of submission with a partner who needs to dominate. It’s what they know and the more they repeat it the harder it is to learn a new routine, especially if submission has been the ‘safest’ option. Even when they meet a partner who doesn’t dominate they will be waiting for the dance of dominance to emerge because this is what they know.

Therapy can provide an opportunity for clients to learn new steps. To begin with they need an opportunity to study the dance steps they are familiar with. In order to do this it is, as I have described, important to reduce the instinctive responses of the amygdale because this will hi-jack any attempt to dance a new dance.

Survivors also need the relational support of the therapist to begin experimenting with new dance steps.

If you watch Strictly Come Dancing you will know that over a number of weeks we see competitors learn and try out new dances. Some are familiar with following others want to lead. Some are good at all dances, whilst others excel at ballroom but struggle with Latin. Others sustain injuries which take time to recover from and there is much toe treading.

The older members of the group take longer to learn the steps, not only because their bodies creak a little, but because their familiar patterns are more entrenched. All have to overcome set beliefs about themselves; ‘I can’t dance’, ‘I’m no good at this’. The competitors need practice and support and a willingness to pick themselves up when they fall, along with opportunities to analyse and learn from their mistakes.

Therapy is similar. We offer clients the opportunity to learn about their preferred dances and how these have supported and limited them. We support them in updating their dance steps, experimenting and choreographing new dance steps whilst challenging fixed beliefs about themselves as relational dancers. We introduce them to different dances in the therapy room without imposing any particular steps. We recognise that learning new steps can be both exciting and scary and that learning something new takes time and there will be hurt toes and a few falls along the way.

To sum up, therapy provides an opportunity for survivors to learn about the impact of trauma on their brain and body and to begin the process of understanding, addressing and interrupting fixed relational patterns. It provides an opportunity to choreograph something new.

Survivors of sexual abuse need access to protection and justice but they also need access to specialist therapy in order to fully address the emotional and psychological impact of interpersonal trauma and betrayal.