Sexual abuse of children by family members varies in its incidence depending on the reports used but its presentation among the adult population has largely been under-reported and unrecognised by mental health workers. Since 1984 we have become increasingly aware of survivors of childhood sexual abuse within our own district service presenting initially as psychiatric cases and more recently seeking help directly for the distress which their childhood experiences have caused them. Gradually we have come to recognise the persistent negative effects of this trauma and have attempted to evolve a model for therapy which deals with this and is suitable for use within a district psychiatric service. The pattern of therapy follows the usual psychotherapeutic rules in that it is on a one-to-one basis at the same time and same place each week. It differs, however, in that the therapist is active and when necessary, directive. Our experience has taught us that each patient will present with certain common basic issues that need to be worked through. We have recognised that to do this work sensitively and efficiently it is important that all the relevant questions are asked and feelings explored. We have evolved a list of themes which we expect each therapist to cover during the contracted sessions. We believe that this ensures work is carried through to resolution. If any of the points on the list are omitted then a patient's ability to be free from the past might be impaired. The majority of our patients have been dealt with as out-patients or in a community setting, but a number may already be within the in-patient unit or day hospital setting, and, for a few, attendance at the day hospital is arranged whilst undertaking individual therapy.
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