Continuing care - the role of the GP

Home: Workers: Medical and Dental Workers: Beyond sexual abuse

To simplify your work with adult survivors of child sexual abuse, allow these three principles to guide your work:

General guidelines

Listen - believe - do not blame: survivors of child sexual abuse fear they will be blamed, not believed, not heard. Listening, believing and not blaming are powerful therapeutic responses.
Safety and containment: your patient's physical and emotional safety are paramount. Attending to your patient's safety and sense of containment means not only assessment of suicide risk, but work on strategies to deal with overwhelming situations such as self harm, anxiety, nightmares, sleep difficulties and flashbacks.
Empowerment and control: during the abuse your patient did not have any control over what happened to them or their body. Their needs and rights were violated. The helping process should be the antithesis of this. Present choices to your patients, ask what they want or need. Encourage your patients to make decisions for themselves.
Be patient: survivors sometimes struggle with the same issues(s) over some time. You may find you are supporting them with the same issue time and time again.
Respect your patient's knowledge about coping strategies that work for her/him. Ask 'What have you done in the past to help you when you were feeling bad, anxious, having panic attacks ...' Build on their strengths.
Recognise that survivors of child sexual abuse may need longer appointments and allow for this. When someone is rushed, they may feel they are not being listened to.
Let you patient know you are willing to talk, and to listen.
Remember the links between somatic complaints and trauma.
Develop a joint responsibility with your patient for monitoring symptoms.

The core experience of psychological trauma is disempowerment and disconnection from others. Recovery is based on empowering the victim/survivor and creating new connections with them. Locus of control is returned to the survivor. Assisting a survivor means being a resource and ally.
_{Based on
Judith Herman's work (Trauma and Recovery 1992)}

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