Therapy For Sexual Abuse in Adults and Children
Recovering from sexual abuse can feel like a slow plod through thick mud, steadily reclaiming the safety, dignity, and a sense of self that was never meant to be lost in the first place.
As a clinical psychologist with 15 years working directly with women and children with the most horrific experiences of rape, incest, and childhood grooming, there is little I have not seen in this field.
Whatever the sexual abuse experience, a recurring theme in the therapy room is shame and terror. Survivors spend many years minimising what happened, behaving in anxiety driven ways, and blaming themselves before they finally seek help.
Many appear to be functioning highly on the surface, but carry the blame and shame of what happened, along with unrelenting terror of something bad happening again. This terror comes with a sense of distrust or hypervigilance that never seems to go away. It also makes engaging and trusting other people impossible, and gets in the way of developing relationships.
Everyday experiences include flashbacks and nightmares to the abuse, or an inability to tolerate being around certain types of places and people. For example, if someone was date raped by a blonde man by the beach, blond men, or even men and beaches in general become triggers for intense feelings of fear and discomfort.
What Are The Most Common Forms Of Sexual Assault?
Rape by strangers:
Sadly, forced vaginal, anal, or oral sex is common in both children and adults. It’s the stuff that grabs headlines, but rape by strangers is less common than rape by people known to the victim
Rape by people known to the victim:
A big chunk of reported sexual abuse happens in families, by parents, trusted aunts, uncles and cousins. Incest is unfortunately common, and the betrayal that the victim feels makes recovery and trust in future relationships extra tricky.
Date rape or rape within a relationship:
Many clients present after experiencing date rape, or even rape by long-term partners who engage in non-consensual acts. Date rape victims are a growing group in my therapy office, and such forms of rape often involve deliberate or accidental intoxication.
Grooming :
Much of childhood sexual abuse takes place this way. Abusers seek out children, building trust both with them and sometimes their families (offering to babysit for a busy single parent etc). The groomers treat their victims exceedingly well at first, and the child is enticed to engage because of the affection, attention and the gifts they may receive. Many survivors of childhood sexual abuse report intense shame in the years, confused by the fact that they sometimes enjoyed the sexual contact and addressing this shame becomes a big part of the “work” that is done in therapy.
Unwanted Touching:
While seemingly less serious than penetration, non-accidental groping of private areas, or being made to touch someone else’s genitals can be traumatising in its own way. For example, victims may report being deliberately brushed up against, feeling someone’s erect penis behind them on a bus or train. Children may be asked to touch a groomer’s private part or allow themselves to be touched.
Image based sexual violence:
These forms of sexual violence are skyrocketing with technology. While in the old days, it was not uncommon to experience someone flashing genitals, these days, it looks more like being forced on the first date to watch porn or gory sex acts. A growing number of clients are traumatised by nude photos taken without consent by previous sexual partners. These can feel immensely violating, and never-ending as the images can show up again at any time, and the trauma is never truly over.
What Are The Common Effects Of Sexual Abuse?
Studies across many countries show that sexual abuse, whether in childhood or adulthood, is linked with higher rates of post‑traumatic stress, anxiety, depression, dissociation, self‑harm, substance use, and difficulties trusting others or feeling safe in relationships.
In practice, survivors often describe intrusive memories or nightmares, and feeling constantly on guard. They feel intense guilt or shame about the abuse, discomfort with touch and their own sexuality. They also report a deep sense of being “damaged” even when they function well externally.
In my practice, it is common for clients to come in for help with problems with intimacy and , relationship issues, only to realise a few sessions into therapy how much their current struggles are tied to unprocessed sexual trauma or trauma from a non-sexual experience.
Is It Ever “Too Late” To Start Healing?
Research and clinical experience both show that meaningful recovery is possible – even many years after the abuse. Many childhood or teenage victims only get help in their 30s, 40s and 50s.
Unfortunately, the fact remains that child victims are often ignored when they bring attention to the abuse. In my practice, many clients report that they were told to “Ignore it” or “Just forget about it”, when they talk about the abuse to parents or grandparents who had to tolerate similar abuse. Many survivors delay seeking help because they were not believed or actively supported by parents and loved ones.
With no other way forward, survivors learn to cope only by shutting down memories and feelings. Dissociation becomes common in sexual abuse survivors and memories of the abuse are blocked by the mind in an effort to protect itself.
But feelings of anxiety, grief and shame often seep through, and the victim never fully gets in touch with why they feel so anxious or unhappy until years later. Many clients only feel safe enough to talk once life is more stable or when they are no longer children dependent on the people who enacted the abuse.
In my work with survivors, we quickly see significant shifts, even if therapy is started only decades after the abuse. Clients report sleeping through the night after years of nightmares, feeling present during intimacy instead of dissociating, or finally being able to say “what happened to me was not my fault” and believe it.
Children especially tend to think that the abuse is their fault, or that they should have somehow stopped the abuse. Self compassion takes time for survivors, and the biggest part of the work in therapy is undoing years of misplaced self-blame.
What Happens In Therapy for Sexual Abuse?
Therapy can be invaluable to victims of sexual assault, as it is often the only setting in which they feel they can acknowledge their experience.
In my office, I work with victims to first establish a sense of safety with me, and a sense of safety in their body. We then work to increase their understanding of trauma and the effects it has on their mind and body before introducing skills for managing overwhelming emotions.
We practice somatic techniques so the client feels safe enough in their body to fully tell their story. Once they can tell their story, we begin gradually and carefully processing their traumatic memories at a safe pace.
The point of reviewing traumatic memories is not to re-live the pain, but to provide context for current struggles. The thoughts, feelings and beliefs that were laid down around the time of the assault can have life-long implications. Processing traumatic memories using somatic techniques for grounding and self-compassion also helps reduce flashbacks and nightmares.
Once a client is no longer suffering flashbacks, nightmares and other acute PTSD symptoms, we work on current relationships, boundaries, and self‑worth. Often abuse experiences lead clients to believe that they deserved the abuse, and there is a tendency to ignore red flags and accept poor treatment from friends and intimate partners.
A final phase of therapy often involves re-establishing the ability to engage in sexual relations as this is often compromised after a sexual abuse experience.
In summary, in my therapy room, clients first learn grounding techniques so they can have control over flashbacks and no longer feel terrorised by them. Then they become slowly able to tell their story in a way that no longer leaves them shattered. The re-telling prompts discussions around mistaken beliefs about their role in the abuse. The final phase is to experiment with new patterns—saying no, choosing safer relationships, or reconnecting with creativity, sexuality, or spirituality on their own terms.
How Do I Support A Child Or Teenage Victim of Sexual Violence?
For children and adolescents, the difference between surviving a sexual abuse experience, and thriving boils down to one thing: Support.
I have met children who never quite recover from their sexual abuse, and live their whole lives riddled with difficulties associated with PTSD. But I have also spent time with other children who come to see their trauma as one terrible experience, amongst many good ones.
The difference between these groups lies is in the reactions and responses that they receive from the adults around them.
If a child reveals a sexual assault, talk about it, try to understand it in a sincere way. Acknowledge their hurt, the damage it caused, and reinforce the fact that the child did nothing wrong.
This sets the tone for a completely different recovery story, than for a child who is told “it never happened”, or “get over it”.
Parents and family members who acknowledge the child’s hurt allow the children to see themselves as victims, rather than being to blame for their assault. In allowing children to talk about their experience, we allow them to also test any problematic beliefs that arise such as that they “were bad” or that they somehow “invited the assault”.
While it is clear that parents and family members have a powerful role to play in how a child copes, caregivers don’t often have the right words or understanding to play this role well.
It is therefore important to seek therapy early. Trauma work with children and teenagers has strong evidence for reducing PTSD symptoms, depression, shame, and behaviour problems, especially when caregivers are actively involved.
Therapy with young people uses developmentally appropriate tools—play, drawing, stories, body‑based regulation—alongside structured trauma work. Therapy for abused children also includes coaching for caregiveers so they can respond in ways that are validating and protective rather than blaming or avoidant.
Sex Feels Impossible After Trauma. How Do I Bring Myself To Enjoy Intimacy Again?
Restoring intimacy after sexual abuse is one of the most delicate yet profoundly rewarding parts of recovery that I have witnessed in my 15 years working with survivors
Women describe being in trusted long-term relationships, but unable to engage in sex because of a resurgence of trauma triggers.
For example, one client was sexually assaulted during a date in her teens, but now had a long-term partner whom she trusted completely. Nonetheless, whenever he physically approach her for sex, she would find herself horribly triggered to the sexual assault experience she had in her teens and she wouldn’t be able to continue with the sex act after. This was devastating to their relationship, and she sought therapy to restore her ability to enjoy sex.
Many survivors like her arrive in therapy describing intimacy as a minefield: triggers like touches, smells, or positions yank them back to the trauma, leading to dissociation, panic, or shutdown. Often they come to therapy with a deep shame about their responses, or a lingering belief that they’re too “broken” for sex.
In this and other cases, the aim of therapy is not to rush back to “normal” sex, but about painstakingly rebuilding a sense of safety, agency, and pleasure in their own body, before involving a trusted partner.
If you or someone you love has experienced sexual violence, or is having trouble with intimacy after trauma, please get in touch.
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