Is trust an essential therapeutic goal in working with childhood sexual abuse (CSA)? – a body of empirical research

ABSTRACT

Impaired ability to develop trusting relationships, self-dysregulation, poor emotional regulation, poor self valuation, and relational sensitivity are key challenges for survivors of Childhood Sexual Abuse. These increase the risk of ruptures in the therapeutic relationship and dropouts. Nevertheless, there is little evidence of the role of therapeutic trust in CSA. We collectively present the findings of a 15-year research journey into CSA recovering. Central to recovering was the establishment and maintenance of trust. Trust was also key for client satisfaction and facilitating the recovering process. Trust mediated regulation of threat responses, facilitated empathy, and enabled accurate symbolisation and re-contextualisation of traumatic narratives. In an increasingly traumatogenic world, more clinicians will be called to respond to disclosures of abuse and maintain engagement. Given the lack of effective interventions for CSA/complex trauma, trust-based person-centred psychotherapies are a promising alternative for managing dropouts, supporting the therapeutic relationship, and facilitating change.

KEYWORDS:

• Childhood sexual abuse
• complex trauma
• trust
• therapeutic relationship
• drop outs
• recovery

Acknowledgements

The author thanks all participants for their time and effort. The author also thanks the Scottish Government and Edinburgh Napier University for funding the research.

Disclosure statement

No potential conflict of interest was reported by the author.

Data availability statement

This is submitted as theoretical/position paper, so supporting data is not available.

Author note

Zoë Chouliara, Formerly Professor in Mental Health, is now in independent Practice. She is a Consultant Psychologist, SE NHS Trust, Ulster Hospital, Psychology Post COVID Service.

Ethical statement

No ethical permission was required for this paper. The studies discussed were ethically approved by a University in East of Scotland and relevant NHS ethics for research committees.

Additional information

Notes on contributors

Zoë Chouliara

Zoë Chouliara is a Former Professor in Mental Health, currently in independent practice. She is an Awarded Consultant Psychologist, Senior Consulting Practitioner Counselling and Health Psychologist, Person-Centred Psychotherapist/Counsellor and supervisor/trainer. She is named on the Top 100 Nation’s Lifesavers List (Made-At-Uni Health Pioneers Campaign, May 2019) for the development of “Acts of Recovery” self help resource for survivors of Childhood Sexual Abuse (CSA) and the application of the person-centred approaches in working clinically with survivors of CSA and complex trauma. She was part of the Dermatology BJN award – Dermatology (2016) for her work with people who live with severe and/or complex appearance distress, usually seen in plastic surgery and dermatology services. Through her research and therapeutic work in complex trauma/abuse, Zoë has been developing expertise in psychological survival and reinventing identity through adversity.