About a year ago, a woman in her early 30s came to see me about a problem that seemed innocuous enough: She was having trouble with her boyfriend and wasn't sure that her relationship was going to last much longer. As soon as we began our work together, I recognized the cavalcade of psychological and emotional guards she'd erected over the years in response to the sickening sexual abuse she'd endured as a child at the hands of a depraved uncle.

This woman, who had just passed her thirtieth birthday, was still suffering from the psychological effects of the abuse. In fact, her chosen method in surviving the abuse and in later carrying its legacy into other parts of her life is not unique. To give you some context, it's noteworthy that one of the most common questions I am asked as a clinical psychologist in media interviews relates to which childhood problems tend to leave the most significant emotional marks on a child. My answer never varies: Sexual abuse is the ultimate trauma.

Before you jump to conclusions and mistakenly interpret my answer to mean that sexual abuse is the death knell for the healthy and well adjusted emotional lives of sexual abuse victims everywhere, I want to clarify that sexual abuse does not necessarily mandate that its victims will live tragic, pain-filled lives forever more. True, some who experience abuse will reenact the trauma later in a sadomasochistic form, some will escape into drugs or alcohol, and others will spiral into an equally dysfunctional relationship with a romantic partner years later.

Yet there are cases in which victims of sexual abuse learn to explore the experience of abuse and, in doing so, transform their identities from victim to survivor. Transcending this step can be empowering and can significantly increase the survivor's self-esteem and sense of control over his or life. After all, it's precisely one's sense of control that is lost when a person sexually violated - there is usually no way to move and nowhere to go in the moment of the attack.

If, as I believe, sexual abuse can be the ultimate destroyer, and that it leaves a legacy of anger, sadness, and fear, what separates those who haven't successfully coped and those who have? In a word, the single most important element in coping with sexual abuse is confrontation. This involves gaining awareness of all the feelings you had during the abuse, as well as all the feelings that you still have years later. True confrontation of the abuse means that you are patiently sitting with these feelings, and examining each of them honestly, rather than acting them out and regurgitating them thoughtlessly in present-day relationships.

I don't believe that you necessarily need therapy to confront past abuse. However, it can certainly help. Therapy provides a ready-made environment for the kind of confrontation I'm talking about, including a quiet therapy room, a neutral-but-compassionate professional who's available to listen, and a time frame which allows the client to sift through memories and explore them. If I were to set out to deal with such a problem, doing it through therapy would sound like a decent way to get started.

But there are other outlets that can help one to heal from such a traumatic experience. For instance, writing in a journal and expressing thoughts and feelings about the abuse is incredibly helpful. I always tell clients that journaling is not restricted to documenting your thoughts with a felt-tip pin a leather-bound notebook - it could be scrap paper that you later throw in the trash. The goal: getting the feelings out, regardless of whether you're writing on linen or scratch paper. I have also found that some clients have successfully confronted their abuse histories through art or through deliberate, orchestrated movement, such as yoga.

Many singers or musicians can go into a mental world that feels safe and restorative with their instruments, and learning to develop such a sophisticated coping mechanism can do wonders for the soul. Similarly, I have also seen survivors find a sport or type of exercise that allows them to feel both free and totally in-control, which is a hard mix to achieve when you are striving for this balance using positive coping mechanisms (as opposed to drugs or other negative coping mechanisms). I always advocate exercise for clients who have repressed sadness and anger, and will often prescribe such nontraditional and nonverbal coping mechanisms as a kick-boxing class at the gym to help them access feelings of strength and empowerment.

If you have been a victim of sexual abuse, you know how traumatic the experience can be. Moreover, you are probably painfully aware of the impact this experience has had on your ability to trust others later in life. If you know someone who has been a victim of abuse, you have probably witnessed firsthand how such an experience can be one of the most effective forces in corroding a young person's self-esteem and hopefulness for the future. It's important that you and I, as well as the community at large, work to become more empathetic when it comes to the legacy of sexual abuse, and do our best to point these individuals in the direction of something - or someone - who can help them. Perhaps when we raise our awareness and do a better job of guiding these individuals to what they need emotionally and psychologically, we can make sure that sexual abuse leaves in its wake more survivors than victims.

Feel free to explore my book on dysfunctional relationships, Overcome Relationship Repetition Syndrome and Find the Love You Deserve, or follow me on Twitter!

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