Working creatively with survivors of childhood sexual abuse

The NSPCC report: how safe are our children (2015) highlights something of the prevalence and incidence of childhood sexual abuse. The report suggests in 2013/14 there were 22,754 recorded sexual offences against children in England, Wales, Northern Ireland and Scotland. This figure is considered to be less as CSA often goes unreported. However the report outlines a sharp increase in the incidence of CSA and this has been suggested it may be because there is now more of a willingness to report abuse.The NSPCC (2015) define abuse as 'persuading or forcing a child to take part in sexual activities or encouraging a child to behave in sexually inappropriate ways'.

Abuse is a misuse of power, invading an individual's sense of self, psychological safety and the very fundamental integrity of their being. Thus having far reaching ramifications on an individual's life trajectory. I highlighted in a previous article: counselling survivors of childhood sexual abuse (Slaughter, 2016). How the development and maintenance of trust is essential with survivors of CSA. I also outlined the benefits of offering empathy and a non-judgemental, client centred space in which the client sets the pace of their therapy. This way of working can be extremely beneficial in working with CSA. However there may be times when words may not encapsulate a survivor's experience/s. There may be a need for a survivor to express and explore their issue outside of themselves, to externalise what's happened.

Survivors of CSA may experience mental health problems later in life. Which include PTSD, depression, anxiety and suicide. Survivors may have difficulty in coping and managing with everyday struggles, they may also find usual adult sexual intimacy difficult. As well as their own personal relationships with self and others. Survivors may develop non helpful ways of expressing their emotions through aggression or other self-destructive ways, such as addictive behaviours. Working through, articulating and exploring the powerful emotions and experiences of abuse are crucial aspects of the work and there are a variety of creative approaches which can be utilised.

How can a creative approach help?

Working creatively with survivors of CSA has many benefits. It can help individuals to gain a sense of autonomy over what happened, helping individuals to symbolise and objectify their experience. In objectifying or externalising one's experience, individuals are able to discover and explore their sense of personal power. Enhancing their self definition and a positive self view. Interventions are aimed at being supportive and empowering, helping individuals move from victim to survivor status. I outline below just a few examples of working creatively: letter writing, sand tray work and the use of art. 

One approach that helps clients to externalise their problems is through the medium of letter writing from a future self. This can help individuals to create new realities and identify new solutions, strengthening resiliency and self agency. Kress, Hoffman and Thomas (2008) list a number of ways in which letter writing can be used, such as letter writing from an older, wiser self. What would your future (older, wiser) self say to who you are now? How would you comfort yourself? How would your older, wiser self suggest you get through your current obstacles? It is suggested this exercise can help clients move beyond their present state and imagine a place where they have a sense of control and wisdom.

Another exercise may include writing a self accomplishment letter. What have you accomplished thus far? Identify a personal goal, write a letter to yourself as if you'd completed that goal, notice what thoughts, attitudes and behaviours you needed to attain that goal? These exercises are empowering and work towards a positive self view, whilst building upon known and unknown resources.

Inviting individuals to use a sand tray can be another beneficial way of working. Using a box covered in a layer of sand and with the use of objects or various figurines. Clients are invited to express their experiences using the safe container of the sand tray. This is an explorative opportunity. The therapist acts as a witness, is nonintrusive, empathic and accepting of the clients experiences. This is another way of communicating, exploring and accessing powerful emotions related to the abuse.

The use of art, drawings, paintings and collage. It may be that some feelings, ideas, experiences seem too complicated to put into words. Here the use of art may provide a platform for their expression. Drawing may be used to increase self understanding and create insights. Drawing can help clients to gain a sense of accomplishment and empowerment. In enabling individuals to express and explore their thoughts and feelings that otherwise may have stayed inside of themselves. Art work when used in this way may also create an appropriate marker for measuring therapeutic change.

There are many exercises using art just a few of these may be: drawing yourself, drawing the issue, drawing the future. With the therapist acting as a witness, offering a safe and supportive environment and a trusting and empathic relationship In order to explore the artwork.

In short

These approaches have many crossovers, in that they enable survivors to externalise some of their experiences, to objectify what's happened or happening. Developing self exploration, a sense of control over what's happened, building upon resources old and new. They all assist survivors to better articulate their experience, to make sense of them and to work through painful and often conflicting emotions of anger, guilt, shame and responsibility. Working through powerful emotions in a creative and resourceful way. Essential to this work are a respect for individuality and diversity, acceptance and a non-judgemental attitude, empathy and the development and maintenance of trust in the therapeutic relationship.


Brooke, S,L. (1995) Art therapy: an approach to working with sexual abuse survivors. The arts in psychotherapy. 22 (5), 447-466.

Johnston, S, M. (1997) The use of art and play therapy with victims of sexual abuse: a review of the literature. 24, (2), 101-113. Family Therapy: the journal of the California school of family psychology.

Kross, V. Hoffman, R. Thomas, A. (2008). Letters from the Future: the use of letter writing in counselling sexual abuse survivors. Journal of creativity in mental health. 3, (2), 105-118.

Jutte, S. Et al (2015) How safe are our children? The most comprehensive overview of child protection in the UK. London: NSPCC.

Slaughter, L, J. (2016) Counselling survivors of childhood sexual abuse (CSA). [online]

Counselling Directory is not responsible for the articles published by members. The views expressed are those of the member who wrote the article.

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