Gain and Loss in Psychotherapy for Adults Who Have Been
 Sexually Abused in Childhood

Mary Canavan

When I listen to the wording of the title I am struck by how separate and distinct 
the loss, the gain, sounds. Then I remember the woman who has chosen to speak to a gathered audience about her experience of therapy for sexual abuse. The 
gathering was attentive respectful, knowing the listening may be challenging, 
possibly painful, but content this woman had gained.  The fright was palpable when
 she declared, “I am sorry I ever darkened the door of therapy.” She elaborated: whilst she had discovered her own humanity, her feelings, needs, opinions, she also found it was (at that time) very difficult to live in a world where so many others lived as she had – unknowing and unknown.

The irony for her was seeing how, at a time when she felt so isolated and impaired,
 she had so much in common, in the way of living, with those around her. What
 was understood as positive and gainful, held shards of regret, loss and
 displacement unimagined by the observer. Thus, the concept of gain and loss is
 problematic if they are held apart, like two goal posts. If they merge in a spiral,
 retaining their respective colour, it is a spiral that has a momentum of its own to 
create designs not yet recognised.

Over the Threshold

And yet some things are defined. The experience of sexual abuse in childhood is 
traumatic and chilling, demanding that a person growing into adulthood holds fear, 
loneliness, shame at the heart of things. The experience of therapy is a fragmenting
 of this tightly-held world. The journey itself is fraught with memories, feelings, 
hurt from which the person is yearning to escape. J.’s devotion to months, years of
 therapy was counted as more life taken by the abuse; taken from her, from her
 spouse and her young children, despite a clear understanding of how imperative 
and valuable it was.

When D arrived for our first meeting, it represented defeat and humiliation. I 
listened to her life of forty years: second child abused by father from a very young
 age, scant visual memories, a courageous life of incessant endeavour in music and 
drama whilst rearing children in the context of her devoted marriage to a distant
 man. She was bone-weary and frightened. Her sense of imminent loss was 
terrifying her: loss of all she had worked for, of why she had been living this way 
or was it sanity she was losing? The ‘good-enough’ infrastructure and relationship enabled by the ‘good-enough’ therapist will provide holding for a person though
 this time. However, it is incumbent upon us to recognise that the fear of loss can,
 paradoxically, be actualised in the context of an inadequately skilled professional. 
In the language of his time, C.G. Jung reminds us. The patient’s treatment begins with the doctor.” I puzzled over where there could be gain for D at this early stage when she defined gain as happiness, a return of control, to be pain-free, unafraid of
 authority figures in work, retrieved sexual desire. I knew I perceived gain in her
 greater connection with feeling, a dawning awareness of difficult realities of the 
past (painful though it was), letting go of some independence and control, greater
 awareness of nausea, anxiety, trembling. And already beneath this apparent 
divergence is the underpinning relationship in its elementary stages. This is the
 core of the process and may be a completely new experience. An experience of 
gain which may not be named.

I don’t want to lose my Mam and Dad”

M. knew her greatest fear in undertaking therapy was that she would lose her
 father. By some non-verbal revelation he would know she knew, he would 
perceive strength in her and know she was talking to a stranger. There was a
 gradual erosion of the idealisation of mother and father which she had needed to 
keep intact while visiting daily. “My father was kind, gave me things, looked after
 me, only hurt me through drink”, held little comfort as the bulimia became
 palpable and, in time, intolerable. It became clear the self-sacrifice in bulimia was
 the shadow companion to the cups of tea. Samuel Beckett talks about “small steps 
and steps in the right direction.” As time passed things dawned sadly…drink is no
 excuse, trinkets do not ease shame….What had been unimaginable began to
 happen: the initial fear and calamitous loss, should the chats become difficult,
 became less certain. The home visits became resented charades: change was 
imperative. The courage to change was another issue. No hurry, a slow depletion 
of visiting time, a gradual moving in or out of conversation with mother or father 
(as level of pain or difficulty allowed). M.’s inner experience determined the 
length of the stay.

The nature of transformation is quixotic and mysterious. In Sylvia Brinton Perera’s
 illumination of the Sumarian myth of the Goddess of Heaven and Earth she
 described Enki, the father in this descent myth. “He is wily water and wisdom god. 
He lives deep in the abyss. He cares little for roles or precedents of high principled
 patriarchal gods. He moves with feeling.”¹ Inanna is imprisoned without hope in 
the Underworld having tried all avenues of rescue and retrieval. Enki takes the dirt 
from under his red painted nail, creating two servant mourners who transform the 
destructive force of Ereshkigal’s grief to a generative force, thus liberating Inanna.
 The rejected, insignificant remnant of earth’s primitive material has the unforeseen 
effect of turning fortunes.

At many points it may be inconceivable that feelings could ever subside. For N. 
the feelings of rage and disgust with her parents fired her to tear down the family
 temple: to roar and rage, to rend all relationships asunder, thus freeing her from 
her past. She did not act upon it, knowing the fantasy of gain would not 
materialise. She held the skeleton of connection with her mother while her father 
withdrew. In the years that followed, the pain of childhood receded into the past.
 These tentative connections faced into the adult experience of dying and death
. She reflected on the relationship transformation from that first death of childhood
 parental bonds, to the sincere companionship with her dying father a decade later
. Her words are borrowed from T.S. Eliot: 
”Those who have crossed with direct eyes, to death’s other Kingdom 
Remember us.”²

She noted her time of ‘unending’ rage, recognising the great loss she could have 
incurred had she acted on the violence within. It was unimaginable for her that
 anything but cinders could emerge from such hot coals.

Sisters and Brothers

The bonding which siblings from incestuous families achieve, is deep and
 tenacious despite manifest conflict and alliances. F. lived her childhood in the East 
End of London in the midst of a large family. Father abused her and three sisters.
 Grandparent reminiscences of war-time danger when the enemy was clearly 
identified, when mother was too busy queuing to be around, when menial wrongs
 were overlooked were always judged against the ultimate and imminent threat of
 domination. She was confused by sibling relatedness she saw elsewhere, all 
”lightweight and anaemic, lacking in true intensity.” When she came into therapy
 it was as if the chain of connection snapped. She was pursued by a cacophony of
 disbelief and dissent which quietened as other sisters named their experiences, as 
brothers understood that to witness is harrowing, not “lucky”. The relationships 
changed utterly, never regaining the intensity she remembered. There was room to 
breathe but often she yearned for the war-time solidarity.

Letting Go of the Ropes

In recalling Perera’s book, The Descent to the Goddess, I am drawn to the time
 when “dealing with sexual abuse” or “therapy for sexual abuse” no longer defines
 the endeavour for the client. This re-defining may occur sooner or later. G. came
 for therapy for sexual abuse. The pain arose from an incident at the age of six when
 she was abused by her friend’s brother, two years older. In time, the pain of living
 as an invisible child, with mother out of reach and under the shadow of a
 disconsolate marriage, drew her into understanding the grief she had always 
carried: “It must be the sexual abuse because life felt so bad. I felt so bad. “
Despite the loss in seeing the truth, she felt on terra firma for the first time. On the 
other hand, B. has been in therapy for many years, having experienced great cruelty 
at the hands of her father. As she grew more confident at work, as her ties of
 present life dependency on mother eased, she headed into a vehemently resisted
 exploration (within herself) of the deeply wounding relationship with her mother. 
”It put my father in the ha’penny place.” The loss of clear parameters of the 
’problem’ can ignite turbulence and feelings of chaos which touch off the universal
 and most primitive conflicts with each person: fear of engulfment, of
 fragmentation, of loss of all that is familiar.


“Human sexuality is traumatic.” states Joyce McDougall. For an infant the discovery of otherness, the realisation of difference (gender likeness and non-
likeness) and later, the awareness of death, constitutes a maturational step achieved 
out of pain and rage: in essence, a mourning. “Some children receive more 
parental help than others in accomplishing the work of mourning that is imperative
 for security in personal and sexual identity.

It is apparent that in a home where sexual abuse is occurring, or is a prospect, little
 help is available. The secret is consigned to the person’s deepest self. In some 
measure the child ‘stores’ physically – in somatic or sexual expression or silence.
 The person’s relationship with his/her body is controlled by this inhabiting: a 
control which can range from a benign decorating or indifference to a regime 
which can be rigid, even dangerous. The therapeutic relationship, by its very 
nature, reawakens the anxiety of otherness, of difference, of dependency and
 constancy. Within the growing safety of this relationship, the bolts which have
 held pain stored begin to be released. This awakening of physical and sexual
 nature may frighten those who have felt “hollow”, “deadened”, “stuffed”,

However, it must undoubtedly be a “gain.” The loss in living another year in a 
physical posture of vigilance, or deadened in the expectation of pain, long past the 
time when the abuse has ceased, is a tragedy. For E. this awakening was unlike a
 new dawn, neither mellow nor restorative. She described it as “the gremlins in the
 works.” The turbulence of many early developmental tasks re-echoes the
 vicissitudes of sensuality and arousal, energies of bisexuality and homosexuality,
 power and rage, assertion and docility. In time there is a settling as feelings and
 words find pathways in the unfamiliar, transforming the inner relationship. ‘Self-
soothing’ is a beautiful word used by Joyce McDougall. There is a deep sadness
 for the lost years of ‘normal’ sexual exploring and learning, experience that can
never be retrieved.


When M. felt wilful and confident she placed new stresses on her out-dated marital 
relationship. P. responded with temerity and excitement. M. needed to renew her 
energies to face the prospect of marital change at a time when she was weary of 
change. With generosity of spirit and much patience, they held their commitment
 as P. tried to return to the old way, while he defended himself against what was 
emerging within, while he became confused, until he found his feet in the new

Being the loved one hurts the most because it means being known and knowing 
the other’s complexes in their depth. There are inevitable moments of ‘evil fate’
 since the intimate one opens the deepest wounds and lovers thus become enemies.
 And they are also beloved enemies, since the woundings create separations across
 which fresh passions leap:'(4)

Perera describes beautifully the courage and commitment often demanded of a
loved one in the far reaches of psychotherapeutic work. The “small steps and steps 
in the right direction” of Beckett mitigate the need for heroics but do demand
 endurance. Many couples need to enter therapy. They may be distressed or
 dysfunctioning and in need of help to renegotiate, or possibly discover for the first
 time, mutually rewarding interaction. It may only be in hindsight that the depth of
 commitment becomes clear.


In the Inanna myth, Enki’s waters of wisdom flow to oppose the desert,
 replenishing and transforming a wasteland. This symbolises the ebb and flow of
 life states and fortunes and, by association, the kinetic relationship of loss to gain.
 This unpredictable relationship is itself constrained and charged by the therapeutic 
relationship… a wrestler’s fall is cushioned by the ring, or as the father holding
 the mother holding the child.

Note: Each clinical vignette is strictly fictitious, though inevitably drawn from 
long professional experience.


1. Brinton Perera, Sylvia. Descent to the Goddess, 1981

2. Eliot, T.S. The Hollow Men, 1925

3. McDougall, Joyce. The Many Faces of Eros. 1995

4. Op. Cit.

[Mary Canavan is a psychotherapist. She works in the Avalon Psychotherapy
Practice in Monkstown, Co. Dublin.]