Childhood sexual abuse is associated with a range of detrimental effects on interpersonaland intrapsychic functioning and is a significant factor for some survivors in seeking psychotherapy,as they struggle to find ways of managing or overcoming the damaging impact of their experiences. Within this paper, I shall explore these dynamics through analysing part of the therapeutic journey of Penny, a young white woman, who presented for individual psychotherapy at the age of 17 following a childhood of intrafamilial sexual (and physical) abuse. All names and identifying factors have been changed for the purpose of confidentiality. The therapy took place weekly in a multi-disciplinary clinic setting within the UK and a two-year period of the work is considered in this paper. My discipline is Integrative Arts Psychotherapy this is an approach which draws on a range of arts modalities (visual, auditory and kinaesthetic) in order to maximize the possibilities for the client s expression, communication, growth and containment (IATE, 2004; also see, for example, Levine, 1997; McNiff, 1992). My theoretical base synthesizes object relations, attachment and gestalt perspectives with various arts approaches, as appropriate. As well as considering the impact and dynamics of sexual abuse more generally, this paper will explore the usefulness of metaphor and imagery (used by both client and therapist) in understanding, containing and processing the traumatic sequelae of abuse for this client who had some resistance to using the arts, alongside other therapeutic elements such as working with the relationship.