By Dr. Ari Bernstein

According to the American Psychiatric Association, childhood sexual abuse breaks the delicate balance of responsibility, trust, and power in children’s relationships. Abuse happens in gradients, and its impact can last a lifetime. This is especially true when abuse happens at a young age, within a network of people someone’s trained to look up to and depend on. The website Good Therapy states that 93% of childhood sexual abuse survivors know their abusers well, and more than a third of them are a part of the child’s family.

As a childhood sexual abuse survivor myself, I know the importance of therapy. My good friend, Dr. Risa Gold, opened my eyes to how I as a survivor can inspire others to embark on their journey towards healing. One of my goals is to be the voice of the voiceless and part of that is advocating for the treatment of childhood sexual abuse through therapy.

Finding Strength as a Survivor

There is a tangle of boundaries and internalized fear that leads to a range of mental health conditions. But as stated by Good Therapy, “Having a mental health concern does not make you ‘weak’ or ‘broken.’ People cope with trauma in different ways.”

One of the most common manifestations of childhood sexual abuse is Complex Post Traumatic Stress Disorder (cPTSD), something I have dealt with. In the aptly named article “It never stops shaping you: the legacy of child sexual abuse – and how to survive it,” survivors are described as having cPTSD, a pervasive and rigid negative belief system towards themselves. But like PTSD, cPTSD also comes with dissociation when being threatened, nightmares, flashbacks, and difficulty experiencing feelings in real-time.

Other common emotional responses to childhood sexual abuse are depression, anxiety, anger, attachment issues, sexual re-victimization, as well as substance abuse and eating disorders in response to disgust, numbness, or holding onto control. Due to societal stigma or, as the American Counseling Association describes it, “amnesia containing parts of childhood,” many survivors will seek support for their consequential conditions before even disclosing or remembering their survivor status. A vast majority of childhood survivors do not disclose within the year of the abuse taking place, and Good Therapy notes that at least 45% of survivors wait at least five years to tell anyone.

Thankfully, there are many avenues for therapy and support for childhood sexual abuse as public awareness continues to grow. Psychiatrist Bryony Farrant assures that, “The brain is far more plastic than we’ve previously understood, which means there are far more opportunities for people to repair some of the impacts from childhood trauma.”

The Importance of Therapists and Mental Health Providers

The American Psychiatric Association believes that most childhood survivors looking for treatment may benefit from cognitive-behavioral therapy (CBT). This offers a direct, thoughtful education about trauma and its impact. It can also offer guidance for developing positive coping thoughts and breathing exercises when confronted with unhelpful feelings, such as guilt and self-blame, to eventually develop supportive, anti-violent relationships.

“Gradual exposure” is noted as one of the most important elements of CBT. Continuing to revisit the sites of trauma over time allows space for processing and negating knee-jerk emotional or behavioral responses. The American Counseling Association adds that gradual exposure through talking and listening can decrease levels of depression and anxiety by offering the survivor a “sense of control and increase their ability to accurately attribute responsibility” for what happened. The slow unfolding of stories and feelings can make room for the survivor to reframe their emotions to better “help define their rights and needs.” While there are no specific medications or prescriptions for intervening with childhood sexual abuse — some survivors receive a pharmaceutical plan in their recovery. This proves most beneficial for those coping with PTSD paired with other common responses to childhood trauma, including depression and anxiety.

For those with financial, societal, or personal barriers to CBT or finding a supportive physician, there are other ways to seek treatment for childhood sexual abuse recovery. For example, for men who do not feel included in public conversations around sexual abuse, there are groups like Male Survivor. For people who identify as LGBT, there are online portals like to search for therapists educated on intersections of gender and sexuality. For people who want to work independently and in their own time, there are guides, such as The Courage to Heal Workbook by Laura Davis. For people looking for healing circles that support childhood survivors, allies, partners, and perpetrators ready to take responsibility for their actions, there is Hidden Water.

As survivors continue their healing — encourage kindness and listening. The past will not go away, and it will never stop shaping even their smallest behaviors. However, help is available and you are never alone.