Childhood sexual abuse is rampant.  Annually, an estimated 500,000 girls and boys are sexually abused in this country.  Over the years I have worked with people who were molested by parents, step-parents, older siblings, other relatives, neighbors, religious leaders, and teachers.  The aftermath of such trauma can affect how people form relationships, experience their own bodies, their sexuality, their self-image, and their ability to assert themselves.

Feeling safe with a therapist is an important component of knowing that you're working with the right therapist.  Safety and trust have particular meaning for anyone who, as a child, had an adult cross appropriate boundaries with them.  A significant part of developing trust includes allowing the time and space for any survivor of sexual abuse to reveal themselves at a pace that feels manageable.  Flooding with feelings or memories doesn't promote healing; it's simply retraumatizing.

I'd like to share with you how I worked with Carlos to help illuminate my thinking as to what helps promote healing from childhood abuse.  I've changed his name, of course, to protect his privacy.

Carlos came to see me during a period of emotional crisis.  Although he had been in a stable marriage for ten years, and had professional success as a musician, he was increasingly feeling "raw" and "out of control."  He had always slept well, but now, in his early 30s, he was having frequent nightmares of being chased by a scary, faceless man to the edge of a cliff.  Carlos would wake up in a panic and find the bed wet with perspiration.  He felt worn out during the day, found himself often distracted, and was getting into frequent arguments with his wife, Julie, who complained that he was increasingly distant.

During our first sessions together, Carlos just needed to talk about his anger, exhaustion and confusion.  He wasn't compelled at all to talk about his growing up years, his family, or any of his other relationships besides Julie.  Carlos just needed space to catch his breath, and also it seemed that he was testing if he could trust me.  When he'd talk about his nightmares, Carlos would often look away, and then suddenly his eyes would dart  toward mine and he'd ask if I thought him crazy.  But he'd quickly start talking about other things, not leaving a moment for me to respond to this repeated question.

After a good month of this pattern, he came in one day and abruptly said, "You know, from the time I was six until I was twelve, my uncle used to have sex with me."  This led  to many subsequent sessions in which Carlos elaborated on what happened with his uncle, and how absent it felt his parents were ---- they never commented that he'd started wetting the bed, he'd stopped doing his homework, or how he became increasingly isolated from his friends.  These sessions were exhausting for Carlos, and we were always careful to leave time at the end of sessions for him to relax and prepare to leave my office.

Carlos became less anxious and fearful about discussing his past.  We started making connections with how his parents' unavailability and his uncle's abuse led him to bury his feelings and how difficult it was for him to seek support from others.  In addition to our regular "talk therapy" sessions, we started integrating EMDR therapy into our work (see  This helped facilitate more rapid processing of his traumatic memories, and freed him up to connect with his feelings and develop more confidence in letting people be closer to him.

Three years into therapy, Carlos reports feeling more in control of his body, increasingly comfortable having and sharing his feelings, and more able to sustain intimacy with Julie.  He knows he still has work to do, but Carlos now feels safer, more hopeful and secure.