Healing After Sexual abuse: A Therapist’s Perspective
This year, Sexual Violence Awareness Week takes place from 3rd to 9th February, marking an important time to raise awareness, challenge stigma, and support survivors. This annual campaign highlights the prevalence of sexual violence, the impact it has on individuals and communities, and the need for education and prevention. It’s also a crucial opportunity to amplify survivor voices, share resources, and encourage conversations about consent, safety, and healing.
In my work as a therapist, I have had the privilege of supporting survivors of sexual violence through their journeys of healing. Writing about this topic feels essential to me, as it highlights the importance of breaking the silence that so often surrounds trauma and challenging the societal misconceptions that can make recovery more difficult. Sexual Violence Awareness Week is an opportunity to not only raise awareness but also to affirm that healing is possible—and that no survivor should feel alone in their experience.
the impact of sexual abuse
For survivors of sexual violence, the impact can be deep and far-reaching, affecting not only emotional wellbeing but also relationships, self-perception, and the ability to feel safe in the world. Therapy provides a space where survivors can process their experiences at their own pace, without pressure or judgment. A key part of this is regaining a sense of agency—being able to make choices about what feels safe, what needs to be explored, and when.
Many survivors experience shame, self-blame, or difficulty trusting others, often as a result of the way society responds to sexual violence. As therapists, our role is to create a space where survivors feel heard and validated, helping to dismantle internalised messages that may be keeping them stuck. Therapy can also support survivors in understanding their trauma responses, such as dissociation, hypervigilance, or avoidance, and finding ways to navigate them with self-compassion.
Another key focus in therapy is reconnecting with the body. Trauma can disrupt a person’s relationship with their body, leading to feelings of detachment, discomfort, or distress. For some, grounding exercises, movement-based therapies, or simply developing an awareness of bodily sensations can be helpful in re-establishing a sense of safety.
What are trauma responses?
Trauma responses are natural, protective reactions to overwhelming situations and are common among survivors. These responses often arise instinctively to shield us from harm, both emotionally and physically. In abusive situations, traditional responses like ‘fight or flight’ may not be feasible due to various barriers—such as the potential for the abuse to escalate. For many survivors, these limitations mean that alternative coping mechanisms, such as freezing or dissociating, become adaptive strategies for survival.
Freeze: Our body might close up, become rigid, and we won’t be able to move. This is our body’s way of immobilising itself in the hope of keeping the threat from noticing us when escaping or confronting the danger isn’t an option.
Flop: Dissociation and emotional numbness act as defense mechanisms that allow us to distance ourselves from overwhelming emotions and sensory input during abusive situations.
Friend/Fawn: Engaging in efforts to appease or placate the abuser to maintain safety and reduce the risk of harm, a response driven by our instinct to create a sense of security through compliance.
In the face of threat, our nervous system has to make these choices almost instantaneously. While you may not understand the choice, or agree with it afterward, it’s important to know that your body is taking care of you the best it knows how. Understanding these responses in therapy can help survivors release the shame they may carry for not resisting or escaping the abuse.
Therapy for survivors of sexual abuse
In therapy, the themes we explore will be deeply personal and unique to your experiences. While the effects of sexual abuse often involve common challenges—such as feelings of shame, anger, and profound loss—each survivor’s journey is different. The goals, focus and pace of our work together will always be guided by you, ensuring that therapy is tailored to what you need most. The below are some of the topics that might emerge during our work together.
Addressing Guilt and Shame
Shame and guilt are profound and pervasive emotions for survivors of sexual abuse. As a therapist, creating an environment of unconditional positive regard is essential. I help clients explore their feelings of shame and guilt by validating their experiences and emphasising that their responses were natural, given the circumstances. Through gentle, non-judgmental dialogue, I encourage clients to untangle feelings of guilt and self-blame, reinforcing that responsibility lies solely with the abuser. Psychoeducation about trauma responses, such as involuntary physical reactions, helps clients understand that these are normal physiological responses and do not indicate complicity. Building this understanding can gradually ease the weight of shame and open the door to self-compassion.
Working Through Anger
Many survivors can’t express anger overtly, particularly if they’re female. This is partly because women are socialised not to express anger. Anger can also be deeply connected to responsibility and guilt, which can cause survivors to direct their anger internally, e.g. through self-harm or disordered eating. On the other hand, many male survivors externalise their pain through anger, aggression, or substance use, viewing these expressions as more socially acceptable than vulnerability. In therapy, I support clients in recognising the roots of their anger as stemming from trauma and powerlessness. I provide a safe space where they can express and process their anger without judgment, teaching healthy coping mechanisms and emotional regulation strategies.
Navigating Relationships and Trust
Trauma stemming from sexual abuse can disrupt the ability to form healthy relationships. Often survivors will struggle with intimacy, trust, or feel compelled to recreate dynamics from their trauma, whether as victims, perpetrators, or rescuers. In therapy, I help survivors address these relational patterns by fostering a strong, safe, and reliable therapeutic relationship. This relationship becomes a model for building trust and understanding boundaries. I help clients identify how their trauma impacts their interactions, from avoiding relationships to becoming trapped in abusive ones to testing boundaries or isolating themselves.
Negative self-image
Sexual abuse can have a profound impact on a survivor’s sense of self, often leading to feelings of worthlessness, self-doubt, and a distorted self-image. Many survivors internalise the abuse, believing that it defines them or that they are fundamentally flawed, broken, or unlovable. These beliefs may stem from messages—spoken or unspoken—received during or after the abuse, as well as the broader cultural stigmas surrounding trauma and survivorship.
In therapy, I help clients recognise that these negative self-perceptions are not a reflection of their true worth but rather the lingering effects of trauma. Together, we work on reframing their narratives, moving away from self-blame and towards a more accepting, self-compassionate view.
For many, this work also involves reconnecting with their body and identity in a way that feels safe. Trauma can create a sense of alienation from the body; by incorporating grounding techniques and somatic awareness, we explore ways to rebuild a kinder relationship with oneself.
Processing Losses
The abuse that survivors experience often represents profound losses—of childhood, innocence, and safety—that can deeply affect how they perceive themselves, others, and the world around them. In therapy, I support clients process these losses by acknowledging the pain and grief that comes with them. Together, we explore how these early experiences shaped their sense of self and their relationships, allowing space to mourn what was lost.
Addressing Sex and Intimacy
When working with survivors of sexual abuse, I approach discussions about sex and intimacy with sensitivity, allowing clients to set the pace and ensuring a safe environment. I validate the complex emotions, such as shame, guilt or confusion, that may arise and help clients understand how trauma has influenced their current experiences. Through gentle psychoeducation and grounding techniques, I support clients in exploring their relationship with intimacy and in disentangling trauma from present sexual experiences, guiding them towards a healthier, more autonomous understanding of sexuality.
Conclusion
If you are a survivor of sexual abuse, I want you to know that you are not alone, and there is support available. In therapy, I will work with you to create a safe, non-judgmental space where we can explore the emotions, beliefs, and experiences that have shaped you. Whether it’s processing your trauma, improving your relationships, or redefining your sense of worth, I will be there to support you every step of the way. If you're ready to begin this journey, please do not hesitate to reach out.
