Building trust with survivors of child sexual abuse

It’s universally acknowledged that trust is important, probably essential when working with traumatised people.

I have just completed a PhD at the University of Essex, and I am a Mindfulness Based Stress Reduction (MBSR) trainer, and a yoga teacher. I am also a survivor of child sexual abuse.

My PHD research explores the role of trust in recovery from (and living well with) developmental trauma from child sexual abuse; and what services can do to build trust. I used a qualitative methodology to interview 17 survivors of child sexual abuse. 

This blog outlines my key findings about how entrusting unfolds and the central importance of trustworthiness on the part of professionals.

Trauma and the impact on trust

The nature of developmental trauma caused by child sexual abuse stems directly from a breach of trust. When an adult sexually abuses a child or younger person in their care this is clearly an abuse of trust. However, it is challenging for the child to comprehend because they know instinctively that their survival and safety depends on adults.

Breaching trust at this formative age shapes the way trust is navigated in later life. As one of my participants, says:

This is recognised in academic research, and clinical practice. Diagnostic manuals such as the DSM-V and ICD-11 include difficulties with trust in criteria of mental health diagnoses some survivors receive such as Complex Post-Traumatic Stress Disorder (CPTSD), Post-Traumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD). However these manuals place all of the onus on the survivor to trust and make no mention of the need for, and provision of, a trustworthy relationship.

Learning from my PhD study

My research indicates that it is not just the initial sexual abuse suffered in childhood that shapes the carefulness survivors use in professional relationships.

Most of the people I interviewed felt their caution resulted from difficult, oftentimes (re)traumatising interactions trying to disclose their abuse to professionals, family and friends and being met with disbelief, silence, disgust, shock, rejection, and denial. Difficult experiences disclosing had made survivors in this study increasingly careful and more circumspect when needing to trust again.

When such earlier disclosures had been made the survivors had trusted their listener enough to break the silence. Silence is a well-documented aspect of survivor experience and is often the result of abuser grooming which utilises fear and shame to ensure the child keeps the abuse secret and the abuser safe.

If survivors are not believed when they disclose abuse, which may have taken years to feel safe enough to do, they may re-calibrate their parameters of who to trust, and what trustworthiness looks like in a professional.

If professionals then perceive survivors’ difficulties in trusting as arising from experiences of abuse, we can easily fail to pay attention to the importance of being a trustworthy person offering care ourselves.  

The importance of building transactional trust

The building of ‘transactional trust’ (Reina and Reina, 2009) is a first step towards building a full relational trust. Transactional trust refers to the trustor evaluating the trustee as a capable and reliable person in the context of a specific objective that the pair have come together to attain.

My research showed that from the first interaction onwards the survivor and their trustee are engaged together in ‘relational entrusting’, and this is entirely dependent on the behaviours of both parties in the relationship.

Furthermore, survivors most definitely could trust when certain requirements were fulfilled. In fact, they shared stories of many relationships where this had been possible and trauma healing ensued. One survivor said: 

Ahead of establishing ‘full’ trust all participants in the research study had numerous examples of establishing enough trust to access the service or care needed. This 'transactional trust' means there is sufficient trust to accomplish the task the relationship was formed to achieve.

The Crime Survey for England and Wales estimated in 2019 that 7.5% of adults aged 18 to 74 – about 3.1 million people – experienced child sexual abuse before the age of 16. In the same year this cost the UK economy £10.1 billion. This figure includes the costs of caring for survivors, lost output costs, and police, court, prison and safeguarding costs.

Given the scale of these figures we can safely say that practitioners will be working with child sexual abuse survivors, whether or not, they disclose their history. Therefore, it is important to know the centrality of building trust.