Why Hope Matters After Childhood Sexual Abuse

Mental health professionals frequently hear childhood sexual abuse (CSA) survivors express feelings of hopelessness, powerlessness, and difficulties with trust. These emotions are often linked to negative outcomes such as chronic depression, anxiety, and PTSD symptoms.¹ This sense of hopelessness is understandable, as childhood abuse can profoundly "shatter" survivors' sense of safety and control.

Many of my clients have expressed similar challenges, especially regarding mistrust, whether it's a lack of trust in others, in themselves, or in their ability to feel secure in their environment and relationships. It's common for survivors to face challenges with trust,^2,3 so I'm not surprised when clients share their struggles.

A few years ago, I worked with a client who challenged my approach to treating a CSA survivor with a PTSD diagnosis. The client, whom we'll refer to as Sarah, had already spent a year in therapy with another clinician, receiving widely recognized gold-standard treatments such as eye movement desensitization and reprocessing and prolonged exposure, with limited progress.

Sarah reported persistent symptoms of depression, anxiety, hypervigilance, and panic attacks. I initially thought her difficulties were primarily due to a lack of safety. However, I quickly realized that this was only part of her story.

Over several sessions, Sarah shared, “I don’t feel safe sharing my thoughts and feelings with others because I feel unsafe around everyone. That’s why I have panic attacks. The fear overwhelms me. I’m constantly worried bad things will happen to me. It’s like I have a sign on my head that says, ‘Abuse me.’ I’ve lost hope that things will ever be normal for me. How can I trust or feel safe when I know people will hurt me?”

Sarah, like many survivors of CSA, had come to believe that her future would mirror the painful, traumatic experiences of her past. I knew if Sarah regained the hope overshadowed by her traumatic childhood, she would become more resilient, see the potential for less pain in her future, and ultimately feel more hopeful. Even though traditional trauma treatments didn’t seem to work for Sarah, I was determined to explore alternative approaches to help her cultivate hope for the future.

So, how can we support survivors like Sarah in rebuilding the hope that was shattered during their childhood?

Fostering Hope in Therapy

Since the standard PTSD treatments hadn't worked for Sarah, I chose to take a different approach. I focused on helping her identify and embrace her strengths, reframe trauma-related beliefs, and practice emotion regulation through mindfulness. Below are the key focus areas I implemented with Sarah and other survivors that highlight how therapists can cultivate hope in their work with survivors:

1. Create a safe and trusting environment. Building hope starts with establishing a safe environment where survivors feel genuinely heard and understood. While Sarah expressed feeling safe with me, she also shared that she often expected "to be hurt." I recognized she might fear being misunderstood by her therapist. This insight led me to prioritize encouraging Sarah to take the lead in our sessions, focusing on areas she felt would help her regain autonomy and control. By empowering her to guide our work, she gradually felt safer and more comfortable opening up. Over time, this approach helped her rebuild a sense of control.
2. Celebrate small victories and focus on strengths. Healing is a gradual journey, and it’s important to celebrate even the smallest victories along the way. Like many survivors, Sarah struggled to recognize and celebrate her achievements. To support her, we explored her values and strengths and created a list of ways she could acknowledge small accomplishments. From recognizing her first time discussing her trauma to taking steps toward self-care, we focused on highlighting each forward movement. A strength-based approach helped Sarah acknowledge and embrace the strengths that supported her survival, such as her survival instincts, empathy for others, and her past efforts to overcome adversity. By doing so, we reinforced her belief that progress is not only possible but within reach. These small successes empowered her to realize that change is attainable.

3. Reframe unhelpful beliefs and mindfulness. CSA survivors often hold deep beliefs of worthlessness or powerlessness, which can impact their sense of safety and hinder their ability to cope. Schema therapy and cognitive-behavioral therapy are both effective approaches to aid survivors in confronting and reframing these unhelpful beliefs (schemas) that often develop from early trauma,^4,5,6 while developing helpful coping strategies. This shifts their perspective from past trauma to one of possibility, fostering a sense of safety and control. Mindfulness techniques can further support this process by helping survivors stay grounded in the present and manage distressing emotions.

   In our work together, Sarah identified unhelpful schemas like "I am powerless" and "The world is unsafe," along with thoughts such as "Bad things will always happen" and "I am broken." Our therapeutic focus was on recognizing these patterns and gradually replacing them with more helpful ways of thinking. Some of these schemas triggered intense emotions for Sarah. To help her become more aware of how these thoughts, emotions, and physical sensations affected her and to encourage staying grounded in the present moment, we practiced mindful acceptance.⁷ This technique helped Sarah observe her emotions without judgment and build greater tolerance for distressing situations.

How These Strategies Foster Hope

When survivors feel safe and heard, it creates a foundation of trust and hope. A strengths-based approach empowers survivors, boosting their sense of self-worth and resilience. Instead of focusing solely on traumatic memories, this method encourages survivors to recognize the coping strategies and personal strengths that helped them endure. This shift in perspective, along with practicing mindfulness, helps survivors focus on the present while fostering a greater sense of control and safety.

For Sarah, this approach provided exactly what she needed. Upon completing therapy, Sarah reported a significant decrease in anxiety, fewer PTSD symptoms, no panic attacks, increased hope, and a stronger belief in her ability to make decisions that would shape her future.

To find a therapist, please visit the Psychology Today Therapy Directory.