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Section 8
Using Empathy to Build Trust During
Unstable Sessions with Sexually-Abused Children

Question 8 | Test | Table of Contents

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In the last section, we discussed the technique of releasing emotional energy to relieve the pain of childhood sexual abuse.

In this section, we will demonstrate the use of "leaning into", empathy and taking a one-down position to assist in building rapport in potentially volatile sessions with a sexually abused child or their parent.

As you know, efforts to build rapport are often times misinterpreted by parents or clients who have been coerced into attending therapy or who have had previous negative therapy experiences. Here is how I avoided and diffused potential escalation with Anita and her daughter, Angel, age 13. Anita and Angel were referred to me after Angel told the school counselor she had been sexually abused by her Aunt's boyfriend, Stan. She had been seven and staying at her Aunt's home for the weekend.

As you are aware, especially in the case of childhood sexual abuse, any behavior that can be construed as even slightly as blaming, criticizing, accusing or disagreeing undermines the connecting process. Oftentimes in these initial therapy sessions, I envision myself walking a tightrope. Do you? Here is how I walked this tightrope with Anita and her daughter.

Therapist: I looked at her and stated, "What I'd like to do before we get started is get to know you a little bit. It often helps us to …"
Anita: (interrupted groaning) "Oh, here we go again! Do you people not keep records!? Wouldn't it be easier to just read the records instead of wasting time going through the whole history? Seriously, I don't mean to be facetious; it just seems a waste of time to go through the whole family's history time after time."

♦ Taking a One-Down Position
Therapist: Taking a one down position, I softly said, "I wasn't referring to your history. I was actually referring to just getting to know you as a person."
Anita: "Fair enough!" (responding sarcastically and clapping her hands) "You won't find much in me!"

♦ Leaning Into
Therapist: Leaning (into) toward Anita, I responded, "Sometimes it just makes it easier to talk."
Anita: (voice dropping slightly) "Again, I don't mean to be facetious. Don't get me wrong. I just really didn't want to have to go through it again."

♦ Responding with Empathy
Therapist: Responding with empathy I stated in a soft tone, "It sounds like you've really been through the mill with everything so far. Is that right?"
Anita: "Yes"
Therapist: Taking a one down position again I stated, "Well, maybe we'll scrap getting to know each other. Maybe you can tell me where you would like to start."
Anita: "I really can't say. I'm sorry. As much as I've already said that I don't really want to go through the whole family history again, I honestly couldn't say where I would want to start. I am not the psychologist, so I don't really know what is actually relevant. So probably I was speaking out of place. But I really wanted you to know my feelings."
Therapist: Empathetically I responded, "It sounds like you have been through this many times. How many times have you been through it?"
Anita: "I've lost count, (pause) but it's been all Angel's life. The whole 13 years. I think the problems have varied, but they have been basically the same."
Therapist: While maintaining eye contact, I empathetically asked, "What I would like to try and understand is why the help that has been offered you hasn't helped you so far. What has your experience been in trying to get help?"
Anita: "Because we've been to so many different people who have told us so many conflicting things. I am going to have to go through it, I know…. You ask me why it hasn't helped. And I don't know. All I know is that I just feel like I've been alone. I haven't had a supportive family to start off with. Quite apart from that, I've just been totally confused by so many so-called professionals giving us their opinions, everything from food allergy to dyslexia."
Therapist: While maintaining an open position, I sought clarification, "Of the people you have seen, have they been primarily supportive or unsupportive?"
Anita: (pausing) "That's a difficult one to answer. I think that my opinion would be that they were doing a job."
Therapist: Empathetically I asked,"Did any of them seem to care about you as a person?'
Anita: "I was just another number".
Therapist: Seeking clarification, I asked Angel, "Angel, who do you think out of everybody that your family has seen, who do you think has been most supportive? Do you know what I mean by supportive?"
Angel: "Dr. M., I think. But he's hard to work out. He doesn't show what he's thinking."
Therapist: I asked, "What do you think, Anita?Who in the rest of the world would be most supportive of you?"
Anita: "Me."
Therapist: Empathetically, I softly asked, "Is that right?"
Anita: "Yes, I always have done…" (Voice dropping and eyes tearing)
Therapist: Seeking clarification, I asked, "When you say it always has been, does that mean just since you had Angel, or in terms of your whole life?"
Anita: "Do I have to answer that?"
Therapist: I empathetically responded, "No."
Angel: "At least make an attempt. I have to."
Anita: "OK, my whole life. But there's a lot Angel doesn't know."

My use of empathy with Anita's perception of mistreatment at the hands of professionals lessened her negative stance enough to connect with me as their therapist. As you can see, the use of the basics in small steps such as appearing warm, respectful and responding empathetically also helped avoid a negative escalation; while offering a positive interaction to build on.

This section has discussed and demonstrated the building rapport basics by use of "leaning into"; responding with empathy; taking a one-down position, as well as, a quiet tone and eye contact to assist you in building rapport in potentially volatile sessions. So why do you suppose I decided to include such basics skills in this CD section?

I find when a client is volatile, I sometimes over look the basics of my body language and voice tone. Think of the last volatile client you treated. Would it be a good idea to replay this section prior to your next session with that client to review some of these basics you may be overlooking?

As you know the volatile client is probably involved in transference. In the next section, we will look at transference as well as splitting.
Reviewed 2023

Peer-Reviewed Journal Article Reference:
Ensink, K., Borelli, J. L., Normandin, L., Target, M., & Fonagy, P. (2020). Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties. American Journal of Orthopsychiatry, 90(1), 115–124. 

Jones, T. M., Bottoms, B. L., & Stevenson, M. C. (2020). Child victim empathy mediates the influence of jurors’ sexual abuse experiences on child sexual abuse case judgments: Meta-analyses. Psychology, Public Policy, and Law. Advance online publication.

Schuler, M., Mohnke, S., Amelung, T., Dziobek, I., Lemme, B., Borchardt, V., Gerwinn, H., Kärgel, C., Kneer, J., Massau, C., Pohl, A., Tenbergen, G., Weiß, S., Wittfoth, M., Waller, L., Beier, K. M., Walter, M., Ponseti, J., Schiffer, B., . . . Walter, H. (2019). Empathy in pedophilia and sexual offending against children: A multifaceted approach. Journal of Abnormal Psychology, 128(5), 453–464.

QUESTION 8
What are three skills that de-escalate a volatile session? To select and enter your answer go to Test.

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