ARCHIVED: Chapter 9: Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse – Summary and concluding comments

Summary and Concluding Comments

Clinicians' contributions to survivor's healing from childhood sexual abuse

“I think that we're talking about really long-term partnerships with a number of medical people ... maybe a physiotherapist, a psychotherapist, a family doctor. We need these nuclei of support, and they need to be in touch with each other, and I have that, so I feel like I have a network of support.” (Woman survivor)^143p.259

All forms of violence and abuse can leave an individual feeling disempowered and disconnected from others. Healing from abuse involves re- empowerment and reconnection with self and others.⁸¹ Because the harm of abuse occurs in the context of relationships and because it affects individuals' ability to relate with others, healing can only occur in relationships. Relationships with caring others provide the substrate - the nutrient medium - for healing the parts of the self that were damaged by past trauma. The absence of trusting relationships leaves survivors isolated in their shame. Through engagement with others, survivors can learn to rebuild their basic capacities for autonomy, trust, and intimacy.⁸¹ Health care practitioners can be allies in that process by offering effective and sensitive health care in the context of genuine human connection. They can also facilitate reconnection by helping survivors learn about their bodies and how they function in health and illness.

Sensitive Practice and patient-centred care

Some would argue that the Sensitive Practice paradigm is redundant - that client-centred care, by definition, incorporates all that this Handbook describes. However, we have a different perspective. While the Handbook includes neither all possible ways that practitioners can be sensitive to survivors nor all of the ways that interpersonal violence can affect an individual's health or health care experiences, we have come to see Sensitive Practice as a refinement or "fine tuning" of patient-centred care. If all practitioners were knowledgeable about the association between abuse and health, then Sensitive Practice might not be necessary. Unfortunately, many curricula devote little attention to violence and abuse and their implications for health and health care,¹⁶⁹ and some practitioners remain convinced that our health care system cannot afford the few extra minutes it takes to enact Sensitive Practice. We suggest that, especially in light of the pressures on the health care system, failure to practice sensitively is tantamount to abdicating our ethical responsibility to do no harm.

Thus, we encourage all health care providers to become more aware of the effects of violence and abuse and to ensure that their words and behaviour communicate this understanding in a sensitive way. By fine-tuning our patient-centred approach, we will make greater strides in helping patients become healthier and better functioning members of society. Although a practitioner's contributions to an individual's healing are not always measurable, survivors have reminded us that the trust and safety that allow (re)connection within a strong therapeutic relationship can be hugely helpful to them. And the possibility that the survivor will be further empowered to make gains, however slow, holds bright promise:

“So, what we have is a relationship of ... mutual give and take ... [The clinician] gives me a lot of responsibility; I give her a lot of information; we negotiate how best to work [together] to help me to fulfil my needs and to let me have power over my own life.” (Woman survivor)^143p.260