For the butterflies i never chased, i grieve: Incorporating grief and loss issues in treatment with survivors of childhood sexual abuse

Abstract As treatment for survivors of childhood sexual abuse receives increased attention, the need for therapist sensitivity to related issues of grief and loss becomes important. In addition to grieving the loss of a normal, innocent childhood, adult survivors may experience emotional pain due to subsequent losses in adulthood precipitated by the consequences of abuse (i.e., difficulty in developing and maintaining healthy intimate relationships, loss of mental health). The death of one's abuser may produce a conflicted grief reaction resulting from intense feelings of anger or ambivalence, particularly in the case of incest. This report discusses the dynamics of grief and loss central to childhood sexual abuse. Assessment strategies are presented, and therapeutic interventions, including the use of ritual, creative writing, and art, are described through the use of case studies. Also termination issues and implications for clinicians working with survivors are discussed.