 Hello, this is Bob Cook from the Manchester Institute for Psychotherapy and this is a presentation concerning working with survivors of sexual abuse and I go through the presenting issues and also a treatment plan for working with sexual abuse. I've called this presentation those survivor to thriver because it's really a therapy of victory. Okay, so let's move on to the presenting issues. Clients from this population will present quite often an anxiety and panic attacks and palpitations, flashbacks, often of a cognitive nature as well as a feelings nature and sometimes they'll have cognition and no feelings and sometimes they'll have these feelings flashbacks and are concerned what they're about and they're often incapacitating with their functioning. They have problems with relationships usually around trust, they come usually with sexual problems and the sexual problems trigger off the flashbacks and the memories and with that comes splitting and dissociation, cutting off from their bodies, from their self, from their feelings, from their thinking and of course usually poor self-image because this is such an early invasion. Okay, let's go to the treatment plan. So the first stage is establishing a trusting alliance which actually may go on through most of the psychotherapy as don't trust is such a big injunction here. Secondly, once they've got to a stage where they can trust you more, they'll go into making connections with their past and often it's this is about retrieval of memory work either at a cognitive feeling level. Third stage which often goes with the connections to the past and the retrieval of memory work will be what I call anyway the emergency phase and this phase is usually characterised by the emergency of feelings so they get flooded with feelings at this stage. So this is a stage when therapists need to be more accessible for them. What I mean by that is to be arranging phone contact or maybe going to twice or even three times a week in terms of therapy sessions. So this emergency phase will carry on for a while as they deal with the feelings they've suppressed and they need to be able to integrate their feelings and their thinking. This will help them understand their behaviours and also help them connect with their spit off parts of their selves. Okay after that it's about grieving and letting go often dealing with the loss of their childhood, the loss of their early memories and feelings perhaps and also dealing with their loss of life which they've often suppressed until this point. After that comes the re-decision process where they can start making new re-decisions and new healthy decisions in their life today and then looking at new integration of putting these feelings into practice, these decisions into practice, these new ways of being and then finally saying well dealing with how those really from the endings. Okay this is my treatment plan and please remember it's not linear. You may go in and out of these different stages. In some ways if I could have done on this presentation I'd put circles rather than a linear list because as I said you'll go in and out of the different stages. This isn't about a logical one-step, two-step, three-step, four-step, five-step whatever treatment plan. This is much more holistic, fluid way of working with this population. Okay I hope this helped and please remember that this is a slow process. It's not about overwhelming them. That's of course what usually happened to this population, their history. So this is about going slowly, it's about doing the don't feel, don't close, don't trust injunctions and about being there for them and helping them trust somebody maybe for the first time. It's very rewarding work and that's why I call this presentation from survivors to thrivers because part of the process is helping them celebrate their victories and taking ownership of their new feelings, their integration, their split off parts of themselves and helping them move through so they're finding a new way of living with people today and how to be in relationships in a healthy way perhaps for the first time. So good luck with this work and I hope this presentation has been useful for you. Bye!