The Kepner Model of Working with Adult Survivors of Childhood Sexual Abuse. September 2014

Why a Trauma Model-1 Trauma specialist (Curtois:1999) re-assessed the methods of working with adult survivors of child sexual abuse due to the fact too many were feeling suicidal, attempting suicide or committing suicide. They decided that the focus of recovery required looking at more of the complexities on the impact of child sexual abuse on adult survivors rather than the content of what had happened.

Trauma Model – 2 Firstly, they acknowledged the survivors fragile sense of self was a priority. That it was necessary to explore how the person was coping with life at the moment. That they needed help to stabilise any present symptoms. Incorporating into recovery that relapse is to be anticipated and planned for. Acknowledgement of the impact on a therapist working with trauma

Educational Programme In the US they offer an educational programme prior to any trauma therapy and here is why. Clients are educated about how a person responds to trauma, the impact on themselves to trauma, how to understand their own coping mechanisms / creative adjustments, how to handle any flashbacks and how the impact of any shame may affect them personally. They also address and learn how to master the 4 post trauma abuse / shame issues such as; dissociation, sudden regression, the disorganised thought processes and sensory impairment. They are in the programme until they have mastered these issues so they know they have the control for recovery. This may last for months and only then do they look at any traumatic material. In turn these skills give them confidence and empowerment to know they will recover.

Kepner (1999) defines Child Sexual Abuse from a Developmental Point of View Child Sexual Abuse has caused an interruption and affected the natural cycle of emotional growth and development because it has had to alter in order for the child to survive and keep some dignity. As a result the natural processes of: Attachment Accomplishment Differentiation Assimilation …have been reshaped to accommodate the trauma. Therefore Recovery is about re-establishing the natural cycle of emotional growth and development.

Kepner Model (Healing Tasks) Using this model the therapist can better understand that: Healing is the establishment of natural processes of growth and development rather than the abreaction of memories. Different phases in healing require different orientation and emphasis from the therapist to the client. Eg. Initial phase requires education and development of awareness skills. Therapy is growth full when the survivor can experience bringing new skills and capacities to problems of childhood and of the present. Work with memories of abuse will have different emphasis and approach depending on the phase of healing. Therapy can be re-traumatising when the survivor is asked to face memories and experiences with inadequate resources and capacities for coping. For some it is too painful to look at memories but the Kepner Model enables a survivor to enhance their quality of life a considerable amount without that having to occur.

The Kepner Model has four stages: Developing Support which in itself is a healing process. (interpersonal) Developing Self Functions which is about learning to care for yourself. Undoing, Redoing and Mourning which involves restoring the proper relationship of the client to their environment. Grieving for the lost childhood and the struggle to survive and the loss of safety. Reconsolidation and developing an identity as a survivor and not a victim.

Developing Support: Helping the survivor to improve and develop their own support system is the basis of therapy. Learning how to trust and ask for help. The support comes from the environment through human and physical means and gives us all something we are not sufficiently able to give ourselves. Support gives us all a basic / foundation to enable us to experiment and grow. It is as necessary for adult as it is for children. One area that this initially develops is in the therapeutic relationship.

The Healing Relationship Many therapists suggest: That the development of the relationship between you and your client is going to be the therapy for a survivor who has been abused and traumatised. The person to person (Hycner: 1993) relationship is the: Foundation Process Goal …for healing

Working Phenomenologically: Means you approach the therapy believing that ‘All of the client’s history and what troubles him or her is being played out in the session’. Addressing the client’s issues in this manner means you are only working with what the client gives you and this is a safe and structured way to pace the therapy. The focus of this approach means you are only working with what surfaces for the client.

The Four Post Abuse are: Dissociation Survivors describe this experience as being disconnected from the here and now or going off, drifting into space. Partners describe their observations of dissociation as ‘light on no one home’ or ‘spaced out ’. Sudden Regression Survivors describe this experience as; ‘they no longer able to feel their age but actually feel much younger and quite vulnerable’. Their partners share that when the survivors is in this state they do not appear to be able to view things in an a adult ego state but rather only in a child ego state. Dis-organised Thought Processes Survivors describe that this experience occurs when their level of stress is high affects they way they think. They share they can no longer think straight or they know what to say but can go blank and not able to speak. Sensory Impairment This impairment is noticed when a survivor either reacts in an ‘over the top’ manner or under reacting’ to an event. This means that their response is not the normal one to the event.

How to Handle a Flashback: You do not have to take every invitation to go off. Triggers occur from the 5 senses You cannot go into a flashback without dissociating or regressing. You can stop the flashback at any level. Ask the client what they want to do when they are going into a flashback. E.g. do they want to go into a flashback to learn more about their history or go in to be able to learn how to stop and come back out in the ‘here and now’ or learn they have control. Keep eyes open, walk around the room and talk through what is happening. Be aware that flashbacks can be addictive. They can also mean for some that they opt out of the therapy work.

Resistance: Resistance is seen as a creative adjustment in therapy by being both creative and an adjustment to the situation set before a client. Another name used for creative adjustment is ‘coping mechanism’. One reason for this maybe that as a therapist you have gone too deep too fast with your client and their material. Inform the client that resistance is a positive form of self support. Ask the client what may not be in place for them to feel safe to continue. Also, shame may be the reason for the resistance.

Developing Self Functions: The developing of our self function (our inner resources) are the abilities we have to manage our on going experiences at the boundary of the meeting of others / environment / and our own disconnected parts. Eg. How we tolerate and manage our feelings, deal with conflicts, learn to be being assertive, asking and having our needs met, developing skills to manage flashbacks.

Undoing, Redoing and Mourning: The survivor being a child when the abuse occurred had little choice to keep and control the feelings and / or thoughts surrounding the abuse they suffered from being internalised. This may lead to the survivor re-enacting some of the abusive behaviours in current relationships. Undoing and redoing may then involve confronting these issues and bringing about change. With the support in place these feelings and thoughts can be looked at and have time to grieve and mourning for the child.

Reconsolidating: There is a feeling now developing that there is more to life than being abused. This process may include spiritual beliefs or other meaningful views coming into every day life and thoughts. When reconsolidation occurs at different times on the healing journey we are changed from being disorientated about the past to being orientated to the present and from this to a positive sense of the future.

Caring for Self: Vicarious traumatisation is the name given to the impact on therapist when they work with this traumatic material. It is not an event but a process. In some ways it is a drip, drip effect. We cannot work with this material and stay the same, we are changed for ever. We experience our own existential journey / crisis and we also journey and hold our client’s as they experience theirs. Developing a clinical framework to work with this client group is an important way of caring for ourselves.

Conclusion: This is a complex problem. Sitting with a client as they find their dignity and empowerment is rewarding. What we require is support as we support them. Gaining a theoretical understanding of Trauma and Sexual Abuse provides a cognitive support for ourselves and our clients. A Kepner Model approach is one way of dealing with this.