For survivors of childhood abuse, there are both internal and external barriers to getting help (therapy, bodywork, medical care, etc.) with their healing process.
Neglect and abuse cause invisible losses, skills and experiences that simply did not happen. For example, a bodily sense of safety from being tended and held with gentle hands. A deep sense of deserving care from having physical and emotional needs consistently met. The confident knowledge that there are larger, stronger, wiser people by your side who will do their best to protect you.
The first internal barrier is realizing that help is needed. Kids tend to assume that their home life is normal. A survivor struggling with depression and anxiety might assume that everyone has similar struggles, or that they are simply defective or broken.
Another internal barrier is awareness that effective help exists. Psychotherapy and psychiatry might appear threatening and alien, part of a different world. The stigma of a diagnosis might outweigh the possibility of receiving help. When a survivor does not know anyone who goes to yoga or acupuncture or bodywork, it is hard to imagine receiving help there. Abusive families might imply or say outright that practitioners are adversaries.
A survivor who does decide to seek help quickly encounters external barriers, needs for: money and/or insurance to pay for care, nearby kind, skilled, trauma-informed practitioners with space in their practices, transportation, and time and energy to get to appointments and do emotional processing between appointments.
Physical disabilities and marginalized identities make getting help even more complicated. Perhaps the office needs to be wheelchair accessible, or fragrance-free. Practitioners can offer better care if they understand the implications when a client is bisexual, or has immigrant parents, or is a person of color. Finding a cultural match in a practitioner can bring relief in itself.
Good fit for now
Searching for practitioners is a skill that a survivor might not have learned growing up if they did not see their parents seeking help. It can feel overwhelming to step into the unknown world of finding and sorting through practitioners for a good fit.
At the beginning of the healing process, the survivor is probably in emergency mode and needs to learn the basics of managing triggers and overwhelming emotions. They can benefit from a lot of approaches, since everything is new to them.
Years into their healing process, survivors have learned the basics that most trauma-aware practitioners offer, and it will be harder to find a good match. Some survivors find a long-term practitioner who can help throughout their healing process. Others find pieces of what they need in different places and learn to look for a good fit for now, rather than a good fit forever.
Navigating initial appointments is also a skill. Some practitioners want a full trauma history up front, which can be re-traumatizing in itself. Some survivors feel ashamed of pent-up emotions that spill over in a first conversation, while other survivors warily avoid self-disclosure. It makes sense to be a mix of scared, off-balance, and guarded when getting to know a new practitioner.
Pain around needs
For survivors whose parents reacted with disgust when they expressed needs or shaming when they asked for help, developing a trusting relationship with a practitioner is a healing process in itself. They might find it excruciatingly hard to ask for anything or name that something makes them uncomfortable.
When the main nurturing parent (often the mother) is abusive, a child is left with deep longings for safe nurturing, as well as bodily terror in response to nurturing or closeness.
For the adult survivor, there is a small window of tolerance for receiving help. The sessions have to be beneficial enough to keep returning, but gentle and slow enough to avoid triggering terror of being invaded.
This can lead to awkward sessions at first to figure out what works and establish enough trust to continue. It helps if the practitioner and survivor can be on the same side through that initial struggle, sharing the goal of discovering and meeting the survivor’s needs.
Sometimes the practitioner and survivor join in a reenactment of old dynamics. For example, the survivor has a recurring pattern of being given too much advice, and the practitioner notices a repeated tendency to give them advice. Ideally the practitioner will notice and name the reenactment. Over time, survivors will recognize repeated patterns and can bring them up to address together.
Many survivors are exquisitely sensitive to hidden power struggles and victim blaming. Some practitioners are invested in seeing survivors as small, helpless, and broken, rather than as strong, capable people who need some help.
The practitioner might get triggered into their own issues. Over time, survivors begin to recognize when that happens and be able to say, “That isn’t mine.” If it happens occasionally, it can be an opportunity for repair. If it happens too often or is not repaired, then it is not a good fit.
The practitioner’s world-view might be threatened by what happened to the survivor. The survivor ends up protecting the practitioner from their story, which does not contribute to their healing. For example, the practitioner might want to believe that “Women can’t be abusers,” or “Mothers always care about the well-being of their children.”
Interacting with a practitioner is inherently practice with boundaries. How much to let them in, how much to keep them out. How much to ask for. When to say “No” to a treatment, technique, or exercise to protect an irritated nervous system, and when to risk opening to the unknown. How much to bring in our whole selves, both the parts we are proud of and the parts we are ashamed of. How much to smooth things over and how much to allow conflict to arise.
When to stay, when to leave
All along the way, a survivor holds the difficult balance between the benefits of treatment, and the costs in time and energy and money. How long to wait to see positive results. How much of a mismatch to tolerate before seeking a different practitioner, or going without treatment for a while. How much to attribute issues to “resistance” and how much to trust our own process.
Knowing when to stay and when to leave is a skill many survivors simply do not have at first. We may stay in harmful situations, or leave quickly when a repair might have been possible. Over time, we gather more knowledge about internal signals, and about what sorts of care are available. We learn to make sincere attempts to repair a problem, and then give ourselves permission to walk away if it does not improve.
Sometimes there will be no right answer to a dilemma. We can widen our focus to include our ongoing healing process and say that any answer is okay. We are still okay no matter what we choose. There comes a point when working harder at healing is not the answer. We need to take a break from telling ourselves we are not good enough.
When the first people to care for us also hurt us, when our injuries are relational, of course it will be difficult to manage relationships with practitioners. We can soften the difficulty when we can keep ourselves company through the process, witnessing our struggles with compassion.
- Emma Love Arbogast’s post The Myth of Trying to Become a Better Person touches on the difference between healing and fixing.
- Robyn Posin’s new book Choosing Gentleness warmly encourages us around healing from mean mothering.