Exploring therapists' understandings of childhood sexual abuse and the impact of this on their practice with adult 'survivors' : a discursively informed thematic analysis

Abstract

Childhood sexual abuse is often seen to have long-lasting effects. Consequences of the experience identified in the clinical literature include depression, interpersonal difficulties, anxiety and self-harming among others. How professionals understand the concept of childhood sexual abuse will potentially affect how they work with adults who have had this experience. This study aims to explore the issue of how therapists construct childhood sexual abuse and how their understandings impact on their practice in working with adults who have experienced it. The research was undertaken from a social constructionist perspective wherein the phenomenon of child sexual abuse is conceptualised as being understood by way of a set of interconnecting narratives. These include ways of talking about power, gender and what it is to be a victim. Semi-structured interviews were carried out with eight therapists who worked in specialist services for adults who have experienced childhood sexual abuse. The data were analysed using a discursively informed thematic analysis to explore therapists’ engagement with child sexual abuse. The participants’ talk only partially supported the harm narrative associated with the phenomenon of childhood sexual abuse, but refuted the often expressed view that the harm is irreparable. A level of ambivalence was expressed around the notions of power and the perceived effects of child sexual abuse. In addition how clients were positioned was seen to open up some avenues of conversation in the therapeutic encounter and to close others down. Clinical implications highlighted in the study were making explicit the power dynamic in the therapeutic relationship, the importance of avoiding assumptions, the need to work with ambivalence and complexity and being open to the client’s reality. Finally the impact of organisational context on the work of therapy was considered.