Editor's note: This is Part 4, the conclusion of "Hell, hope and healing," an NCR four-part series on sexual abuse. You can read the series introduction, Part 1, Part 2, and Part 3, which are also available at the feature series page Hell, hope and healing. Special feature: Download the complete report here.
When someone decides to embark on healing from adverse childhood experiences (ACEs), and/or when concerned loved ones of a survivor want to help that person begin to heal, it can be confusing to know how to start. This last article in the series focuses on finding the best healing resources.
It is a slice of all the resources available to someone and does not represent either endorsement or rejection of any particular source. Many of the resources listed here provide links to still other sources of information or help.
Best first responders
The sad truth is that abusive families or institutions are unlikely ever to consistently put the interests of children before their own, no matter how many laws are passed or promises made. We are the best hope of preventing child abuse and responding to it quickly when it occurs.
If enough of us believe that every child is our child, that we are responsible for the safety of every child we know, we can be the most effective instruments of change.
If we believe, with Pope Francis, that churches are field hospitals, then we are the nurses, paramedics, doctors and, of course, the patients in our own communities. Any one of us can pick up the phone at any time if we know or suspect a child is being abused or neglected. It's anonymous and it is the right thing to do. Here's how to do it:
Childhelp National Child Abuse Hotline (1-800-4-A-Child). This is a number every one of us should memorize. Although each state has its own laws regarding child abuse reporting, any person can anonymously report known or suspected child abuse to the hotline and they will contact appropriate local investigative authorities within 24 hours. It is easy. Use it. Use it if you know or suspect that a priest, a teacher, a bus driver, your best friend's husband, your next-door neighbor or, yes, your own Uncle Louie is abusing or neglecting a child.
There are no good excuses not to call. You can save a life and even a soul.
Choosing a therapist
It can be a daunting task to begin looking for a therapist to assist in the journey of recovery from sexual abuse or other ACEs. It may be difficult to know what to ask, what not to ask, what are generally appropriate treatment parameters, etc. Since it is important to work with someone you trust, as well as someone you "click" with, these guidelines may be helpful. (These were originally published on the website of the Survivors Network of those Abused by Priests.)
Consultations: You are looking for another human being whom you can trust to guide you through the sometimes treacherous shoals of recovery from ACEs. You have both the right and the responsibility to gather data to help you make a good decision. It is not unusual for someone to have one consultation session with at least three therapists before choosing someone with whom to work. Most therapists will charge for a consultation, and it is money well spent to be sure you make a choice that is healthy for you.
What to ask at a consultation: In addition to being a person in need, you are a consumer. Again, you have the right and the responsibility to ask a potential therapist enough questions to get a sense of the way he/she works and how comfortable you are talking with him/her.
Ask about the therapist's years of experience. How many years has this person practiced as a psychiatrist, psychologist, clinical social worker or other kind of mental health professional? Are they licensed in the state in which they practice?
Ask about the therapist's trauma training. What specific training and/or supervision has the therapist had in working clinically with abuse survivors? Until the 1980s, there was little formal training available in trauma. Since then, many academic programs and postgraduate institutes have added trauma courses. Other therapists have sought out seminars, conferences and supervision with clinicians more experienced with sexual abuse survivors.
Look at the bookshelf: If the therapist displays a collection of books, look for titles on psychological trauma. It gives you a sense of the person's interest in this field. Some people keep their books at home, though, so don't leap to conclusions.
Personal therapy: Most clinicians feel it is imperative to have gone through their own therapy before or during their professional careers. Some postgraduate programs require that the therapist be in treatment during training. Some people disagree with me, but I think it is a fair question to ask a potential therapist if they themselves ever have been in treatment.
It is not fair to expect the therapist to talk about how long they were in therapy or for what reasons. Most therapists also will not say if they themselves were abused, at least until well into treatment, if at all, and this is appropriate boundary setting.
Approach to therapy: This can be a little tough to answer, but you can ask a therapist how they generally work. What do they think is important in therapy: changing behaviors, changing beliefs, identifying how past relationships continue to be played out unconsciously in the present? Are they active therapists who engage in a "conversation" or are they quieter, speaking mostly to make interpretations?
There are no right or wrong answers here, but the responses help you get a feel for what it might be like to work with this person.
Therapeutic frame: What is the therapist's cancellation policy? It is not unusual for a therapist to charge for missed sessions depending on the circumstances, and insurance cannot be billed for those sessions.
What is the person's policy regarding between-session contact if you are having a difficult time? Is the therapist available for more than one session per week if you need it?
What is the fee, and how does the therapist expect to be paid? For instance, some therapists collect only the copay from insured patients and wait for insurance to pay them the rest. Others want to be paid in full and let you collect the insured portion of the fee. Again, there is no right or wrong, but it's good to know ahead of time.
Psychiatric referrals: Does the therapist work with a psychiatrist who is also knowledgeable about trauma and to whom the therapist can refer you if medication is needed? Don't be surprised if it is needed. Many survivors of sexual abuse greatly profit from antidepressants, anti-anxiety agents or mood stabilizers for various periods. One has to suffer to recover but not beyond what is necessary to do the work of therapy. Medication often allows someone to make better use of treatment and recover more quickly. We know now that trauma affects the brain, not just the psyche. The new medications help a lot.
Limits of confidentiality: Review the limits of confidentiality with your potential therapist. All therapists will break confidentiality if you are a lethal threat to yourself or someone else. In those cases, the therapist must do everything possible to protect your life and/or the life of another person. If you tell the therapist that a child is being abused, by you or by anyone else, he/she must report it.
If you are in litigation, you should know that your therapist's records and/or sworn testimony legally can be subpoenaed. The therapist can argue client privilege, but if ordered by a judge to comply with the subpoena, she/he can be held in contempt of court for not going along.
Beyond those limitations, the contents of your sessions and any other information about you should be held in confidentiality by therapist. In no cases, beyond these mentioned, should a therapist share information about you or your treatment without your written and very specific permission.
Therapist's expectations: What does the therapist expect of you? What is his/her view of the therapeutic alliance and each party's role in it?
Contract: It is often helpful for you and the therapist you choose to contract for six sessions in order to come to a final decision about working together. At the end of six sessions, you both can review how you think it is going and whether or not it is a good match for you. This kind of beginning allows both of you a fixed time to decide to go further or to part company.
When you have begun to work steadily with a therapist, you may develop doubts about how things are going. Since therapy for an ACE often is rocky, it is important not to bolt without carefully considering with the therapist the reasons for leaving. If you don't hate your therapist at some point, the work probably is not getting done.
On the other hand, it is also important to feel that you can terminate a treatment if it really is not working for you. Since recovery from sexual abuse often involves a volatile therapy, it is a good practice to set the same kind of six-week contract before leaving that you did when you began.
Once you feel that you want to leave, talk to the therapist and see if you can contract for a six-week mutual discussion of the issues before reaching a final decision.
Many therapeutic partnerships that seem to be foundering have found it tremendously helpful to consult another therapist skilled in the area. Whether the therapy is then rescued or ends, both the therapist and the patient may feel validated and affirmed by having a consultation with a third party.
Alcoholism: Alcoholics Anonymous meetings exist throughout the world and the doors are always open to newcomers. Start here to find a meeting in your area: www.aa.org/pages/en_US/find-local-aa. Once you get comfortable, look for a sponsor who honors your trauma background.
If you are the loved one of an alcoholic, start here to find local Al-Anon or Alateen meetings: al-anon.org/find-a-meeting.
Other substance abuse: Narcotics Anonymous meetings also are held in many places. Start here to find a meeting: www.na.org/meetingsearch.
Childhelp: A resource about child abuse and neglect for kids, parents and teachers is at www.childhelp.org.
International Society for the Study of Trauma and Dissociation: a resource for professionals and the public. Its website includes a "find a therapist" link here: www.isst-d.org/default.asp?contentID=18.
International Society for Traumatic Stress Studies: Though primarily a resource for professionals, it does offer a "Find a Clinician" link at www.istss.org/find-a-clinician.aspx.
MaleSurvivor.org: This is, in my opinion, the best resource available for male sexual abuse survivors. It is directed by clinicians, survivors, academics, researchers and advocates who serve for limited terms. MaleSurvivor.org offers recovery weekends, a great reading list, resources for finding a therapist, safe chat rooms for survivors, and more.
Mental Health America: an advocacy and support agency with local affiliates all over the country (www.mentalhealthamerica.net). It offers a wealth of information about mental health issues and can help you find local affiliates and other mental health resources. They also have online mental health screenings that help individuals and loved ones get a sense of what mental health issue they may be confronting.
National Center on Elder Abuse: As more people are living longer, elder abuse is becoming a greater national problem. This group (www.ncea.aoa.gov) has online resources about elder abuse. Their elder care locator will help you find the local agency to whom to report elder abuse: eldercare.gov/Eldercare.NET/Public/Index.aspx or 800-677-1116.
National Domestic Violence Hotline: Resources for survivors and individuals in current domestic violence situations, including abusers: 800-799-SAFE, or www.thehotline.org.
National Suicide Prevention Lifeline: A 24/7 resource for anyone thinking about suicide and for friends and relatives concerned about a loved one: 800-273-TALK, or www.suicidepreventionlifeline.org.
RAINN (Rape, Abuse, and Incest National Network): RAINN is a good resource for those who have been sexually assaulted as adults or as young people: rainn.org/get-information.
Sidran Traumatic Stress Institute: Sidran's website offers a host of information for survivors and for loved ones (www.sidran.org/resources/for-survivors-and-loved-ones), an extensive reading list (www.sidran.org/resources/essential-readings-in-trauma) and links to many other resources (www.sidran.org/resources/links).
Survivors Network of those Abused by Priests: SNAP (www.snapnetwork.org) is an effective social justice advocacy organization that works to prevent child sexual abuse, especially by clergy.
I am grateful to the National Catholic Reporter for publishing this series. By doing so, it has opened doors to the field hospitals that Francis wants us to staff in our churches and has hung a red cross on the doors of NCR.
For me, it is tremendously rewarding to offer a psycho-educational series on ACEs that may raise consciousness and that provides resources for the many readers who have experienced ACEs or who know others who have.
I have been so privileged to accompany ACE survivors on healing journeys. My work has changed my life, imbuing with it grace, hope and awe for the resilience of the human spirit.
[Mary Gail Frawley-O'Dea is author of Perversion of Power: Sexual Abuse in the Catholic Church and a psychologist who has been working with sexual abuse survivors for 30 years.]
On the Web
Adverse childhood experiences (ACEs) have been referred to throughout this series. Details are available online at www.cdc.gov/violenceprevention/acestudy/index.html.