Transforming Trauma: a Guide to Understanding and Treating Adult Survivors of Child Sexual Abuse is a book written by Anna C. Salter, an offender therapist, who collected the existing knowledge on the subject providing new tools, perspectives, and approaches to the problem. The book provides a profound analysis of both the micro and the macro context of molestation and attempts to incorporate the obtained knowledge into a practical therapy.
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Salter not only describes and explains the experience of the victim but also gives an insight into the psychology of the offender, which allows the reader to view the problem from a different angle. This awareness of the processes happening in the abuser’s mind is essential for providing a comprehensive abuse-focused therapy as it allows the therapist to understand what traumas the survivor must have received judging by the condition of the offender. Moreover, Salter recognizes and struggles against the tendency of the observers to blame either the offender or the victim separately.
The major novelty of the book is the way it expands our understanding of sexual abuses. The author steps aside from the commonly accepted perception of the offender as a maniac or a beast. Salter suggests approaching both the victim and the survivor therapeutically. She claims that it would be insufficient to study only one perspective of the crime. The human society, though it wants to stay detached from the atrocities of sexual crimes is hardly different from the parties directly involved in them.
Salter promotes the idea of savagery and vulnerability that coexist in our nature. Although she does not express any sympathy to molesters, she still manages to achieve an understanding of their motifs that become evident in the course of treatment. The ultimate goal of the book is to destroy the horrifying illusion that the trauma children receive is the making of an unearthly monster, whose actions can be neither justified nor even explained.
The author starts her speculations upon the essence of the problem and its possible treatment with the introduction of the existing approaches. The conclusions she makes can be summarized as follows:
- the treatments of sex offenders and survivors of child sex abuse are currently polarized and have very few points of tangency;
- the nature of contact between the offender and the therapist is drastically different from the one established between the therapist and the victim;
- aversive conditioning technique is the most commonly used practice with child molesters; they are often forced to take polygraph and plethysmograph tests and obey fully to the therapist’s requirements at the risk of imprisonment in case of misbehavior;
- trust relationships are rare and replaced by external observation;
- the basic technique of treating adult survivors is confirmation: its goal is to reduce the shame instead of cultivating it;
- offender and survivor therapists cannot provide effective monitoring of their patients unless they cooperate in order to analyze the thinking patterns of the opposite party.
The book addresses the following issues that could help develop a comprehensive program of treatment:
- what the therapist who treats adult survivors of child abuse must know about the psychology of molesters in order to have a comprehensive picture of the harm (both physiological and psychological) that was done to the victim;
- what are the basic differences between sadistic and non-sadistic offenders and their relations to the victim;
- what footprints different types of molesters leave on the psyche of survivors;
- in what ways an early psychological trauma affects further life, development, and self-esteem of survivors;
- what techniques can be implemented in order to help the survivor to get rid of the pervasive image of the intruder;
- what stages the therapy should include;
- which interventions are indeed therapeutic and which are not;
- what can be done to help the survivor not only to tolerate the traumatic experience but to transform it?
Before identifying what therapy is and how the treatment should be performed, Salter goes into detail about what the therapy is not. The point she makes is that not everything that the doctor does is treatment. A lot of therapists commit serious mistakes. Among the most outrageous ones is having physical intercourse with the patient on the basis of his/her vulnerability caused by sexual abuse in childhood.
The statics information the author provides is rather shocking: according to Salter, about 27% of the survivors experienced revictimization during the therapy. In many cases, the severity of the symptoms makes the survivor an easy victim for anyone who wants to take advantage of the situation.
Another common mistake making the treatment ineffective is self-disclosure on behalf of the therapist. Many of them spend much of the time discussing their own experiences and providing examples from their private life instead of treating the patient. Another extreme is turning the treatment into an intellectual discussion and analyzing the problem from aside.
What Salter suggests in order to achieve success is to start with an understanding that if the client came to the therapist’s office, it means that his/her usual ways of mitigating the pain failed. Thus, it implies that the condition of the patient is already hazardous as he/she feels unprotected and is close to a breakdown. In order to mitigate the patient’s anxiety, it is important for the therapist to follow the same ritual: to start with the same question, to repeat all the actions in the same sequence, and to avoid spontaneity.
The basic element predetermining the success of the treatment is its consistency: the therapist cannot ask questions that do not benefit the patient, no matter how curious he might be to know some private information.
Since the therapist does not touch upon his/her own issues, he/she makes space for the patient’s self-expression. For the treatment to be effective, the therapist must resonate with what the client says. Salter is convinced that it is easier for the one who was subjected to molestation to hear an echo of his/her own speech than the speech itself. The client’s pain, interpreted by the therapist, seems to have more sense and shape. For this to be achieved, the therapist must be always effectively present. He/she should get detached from his/her personal experience and concentrate on the emotions of the patient.
Salter also claims that the treatment is impossible without the intimacy that must be tolerated without going beyond the acceptable boundaries. The patient who does not trust his/her therapist is emotionally absent and unwilling to speak. However, excessive vulnerability may lead to an unhealthy attachment to the therapist, which must also be avoided. The point is that the treatment must be predictable and regulated. The therapist should never change the distance established between him/her and the patient. Neither can he/she become a real person outside the office. It is a very challenging task to preserve a delicate balance between abandonment and intrusion.
Salter emphasizes the fact that it is not enough to make the patient tell his/her story and acknowledge the abuse, humiliation, and shame. The way the story is received determines whether the patient will feel empowered or revictimized. As soon as the tale is told, the therapist must make sense of it arranging the facts and attaching meaning to each. It is important not to neglect any emotions that manifest themselves in the patient’s speech. If he/she feels that his/her words are perceived as insignificant, the transformation will fail.
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As it is evident from the summary, the book provides a detailed explanation of how to treat survivors of child sexual abuse. However, certain drawbacks of the author’s perspective can also be found. The major weakness is that the author provides no evidence from other studies when it comes to therapy development. There is no empirical basis for her conclusions and proposals. She provides examples from her own working experience in order to show which treatment techniques were the most effective.
However, no substantial research was made to prove her ideas. Thus, the reader can only believe or disbelieve what Salter says. Despite the lack of statistical evidence, it cannot be denied that Anna Salter is one of the few therapists who work with both victims of molestation and molesters with equal attention to each group. This is the novelty that makes the book worth reading for professionals as well as for laymen.