Counseling Today, Knowledge Share

Counseling survivors of sexual assault

By Brooke Bagley and Joel Diambra August 26, 2016

My journey (Brooke Bagley) of developing a five-phase model of counseling began in 2013 as I was completing my master’s-level graduate program and transitioning into a therapy position at a local area sexual assault center where I had worked since 2010. For the past three-plus years, I have listened to horrific stories, learned to establish rapport, identified helpful strategies, Bagley_Diambraempowered my clients, observed healing, prompted restoration and marveled at my clients’ resilience. All the while, I was unintentionally and unknowingly developing an effective counseling model.

During the past two years, I’ve also been receiving supervision toward licensure from Joel Diambra, the secondary author of this article. I discovered (or uncovered) “my” model of counseling when he recognized that I had a sequential pattern to my counseling and asked me to begin identifying what I was doing and the reasons I was doing it. Thus, I began to reflect on my counseling practice and, over the course of several weekly licensure supervision meetings, we crafted a five-phase model — my way of counseling survivors of sexual assault toward healing and restoration.

Just the thought of counseling someone who has been sexually assaulted may be daunting for many counselors. I think it’s fairly natural for most counselors to feel professionally inadequate when they knowingly encounter their first client who has been sexually assaulted. Although my five-phase model is based in foundational counseling theories and skills, I offer it here as one guide for counseling clients who have experienced sexual assault. Perhaps it will provide a road map for other counselors serving similar clients.


Phase 1: Assessment and education 

Phase 1 primarily consists of effective assessment skills, identification of presenting problems and initiating the first steps toward building rapport and developing language (matching age-appropriate terms, paralleling word usage, avoiding trigger words, etc.) that is most effective for the client. The amount of time spent in this phase typically ranges from one to three sessions depending on the client’s trauma history, presentation and comfort with therapy, and assessment of the client’s basic needs.

During this phase, it is imperative for counselors to maintain a high level of empathy to create an environment of acceptance and comfort. Many survivors of sexual assault struggle with feelings of shame, guilt, embarrassment and defectiveness, and have a decreased level of trust in others who are outside their identified support systems. To facilitate an environment that feels supportive and safe, I use the client’s own language, focus on appropriate and accurate reflections, and allow the client to emote without much intervention on my part.

The psychosocial assessment covers basic client-related information familiar to most mental health providers. This assessment provides insights regarding a client’s familial, medical and work-related history, in addition to current issues and past functionality. I complete the assessment to focus more on trauma-related history, both specific to sexual trauma and complex trauma (any previous trauma-related incidences a client identifies as having experienced). This focus is helpful in gauging client resilience, gaining insight into a client’s threshold for stress and obtaining increased awareness of potential maladaptive cognitive patterns the client might possess related to any current situations or traumas. At this point, the initial narrative (the client’s first retelling of the traumatic experience) is established, and I am able to incorporate the client’s language into future interactions to help in developing rapport and trust.

Phase 1 also consists of a psychoeducational focus that is helpful in increasing the client’s confidence in pursuing and maintaining therapy services. After completing the psychosocial assessment, I file the assessment in the client’s chart to review later in the therapeutic process and provide the client with trauma-related materials on normative responses that may be experienced in all facets of the client’s functioning (cognitive, emotional, physical, mental, social, etc.) At this time, I walk the client through a trauma symptoms checklist that includes emotion-, behavior- and cognitive-related questions. These questions and the corresponding answers offer insights into the client’s level of affectedness, while simultaneously educating the client on how and why certain symptoms have manifested.

Phase 2: Rapport and strengths

Building rapport and identifying strengths are major components of allowing successful trauma processing and resolution to occur. In phase 2, I encourage clients to take a break from our immediate focus on the sexual trauma and to instead explore their perceived strengths. This action facilitates the instillation of hope. This phase deviates slightly from other trauma-focused therapies by offering clients allotted time to engage in intrapersonal exploration that is separate from their trauma. This approach is geared toward a focus on what they still have versus what they feel they have lost.

Rapport building starts with intentional focus on empathy versus sympathy and the utilization of unconditional positive regard. This is accomplished by allowing clients to clarify their self-perceptions, identify as “survivors” or “victims,” and so on. This is the perfect time to incorporate the language or narrative the therapist has picked up from clients in the initial sessions. This conveys to clients that they were heard and listened to and, thus, are being cared for. I often explain the difference between empathy and sympathy during this phase to help clients identify which felt most supportive and when. This is also helpful to clients outside the counseling office because they are better able to identify those in their lives who provide this level of support and others who are less able to support them.

During the second phase, survivors of sexual abuse often report a reduced perception of control, diminished trust in others, a negative view of self and decreased feelings of worth related to being loved, cared for and valued. In this phase, I encourage clients toward increased positive views of self and self-confidence and the ability to seek support from individuals who can provide it. This skillset and a more positive perception of self are helpful over the course of the therapeutic journey.

Additionally, I explore clients’ past coping successes — activities they have previously engaged in that have been helpful in decreasing general stress — and work with clients towards creating a coping skills “kit” for emergency access. This provides go-to coping strategies when future trauma-related escalation occurs. When packing their kits, clients have included such items as adult coloring books, chocolate, scented oils, music playlists, the contact information of support people and so on.

Phase 3: Cognitive intervention

In phase 3, I explore clients’ cognitive processing. We work to identify thought patterns that lead to self-deprecating perceptions and triggering responses. I often alternate between the cognitive distortions focus of cognitive behavior therapy (CBT) and the emotion-incorporated theory of rational emotive behavior therapy (REBT).

During this phase, I recall the initial assessment (initial narrative of recent trauma) and work with clients to identify how they retell their history and describe their current functioning. Using a predeveloped checklist of common cognitive distortions, I work with clients in session to identify which distortions they are experiencing. Once clients are aware of these patterns, I encourage ongoing mindfulness activities to increase recognition of these cognitive distortions outside of therapy.

For example, I often give homework in the form of thought logs to help clients record triggering events, thought responses and actions taken. For clients who are less engaged in homework, a simple rubber band on the wrist is used to help clients heighten and maintain awareness. They do this by snapping the rubber band every time they experience a trigger. The hope is that if they find themselves snapping recurrently, they will in turn pay more attention to their maladaptive thoughts and can then better self-identify and later verbalize these patterns in therapy. Some of the cognitive distortions that clients commonly report to me include: “I am damaged”; “I will never be the same”; “I should have done something different”; “Nothing good ever happens to me.”

Once we identify negative thought patterns and triggers, we begin working toward positive and realistic reframes while continuing to focus on coping skills from the previous phase. I encourage clients to share their perceptions of their situations and, together, we begin to break down these thought patterns to help them process their experiences differently. For instance, a client might state, “My family seems uncomfortable when I bring up my assault. They must think I am overreacting.” In this case, we would work to create a healthier, more adaptive reframe such as, “My family may appear uncomfortable when I bring up my assault, but maybe it is because they are not sure how best to support me.”

This provides a reevaluation of the client’s perception. The hope is that clients will then recognize the potential in their support systems and, incorporating increased self-confidence from the previous phase, will feel comfortable conveying and eliciting more effective and efficient support from friends and family members.

Phase 4: Emotion focused

Phase 4 is primarily focused on emotion-based responses and interventions, along with the incorporation of mindfulness. I purposefully separate this from and have it follow the cognitive phase because I have found there are residual and intense emotional responses that often outweigh clients’ abilities to rationalize or self-soothe. Clients with complex trauma or a lack of effective coping skills often report numbness, a sense of disconnect from their bodies, intense and seemingly uncontrollable anxiety responses, and self-harming or self-medicating behaviors in various forms. In this phase, I primarily use Gestalt-based interventions to help clients better understand mind-body communication as it relates to emotional response.

The Gestalt interventions I use with clients are primarily focused on bodily sensations and reexperiencing physiological reactions. For this focus, I teach and encourage clients to practice body scanning on a regular basis but especially when experiencing more intense emotional reactions. The purpose is to have clients become better acquainted with specific aspects of their emotional functioning and the associated feelings linked to their bodies. This interventionBranding-Images_survivors allows in-the-moment understanding of how certain emotions manifest physiologically and encourages an increased awareness of clients’ specific responses to emotions in triggering conditions.

I ask clients to walk me through a recent trauma-related episode, having them focus on what they felt bodily versus emotionally or cognitively. Many clients report feeling like anxiety manifests in their digestive tract (stomach, bowels) in the form of cramps and intense aching or, alternatively, in the form of pressure in the temples of the head or behind the eyes.

Some clients will report a complete disconnect when they experience intense emotional reactions. They become physically numb and feel no sensation — much like physical denial. Clients who disconnect are more prone to self-harm. They tend to revisit this unhealthy form of coping even if it has not been in active state for them for some time.

A common practice I use for working with this trauma response is based in mindfulness. I encourage clients to engage all five of their physiological senses by directing them to pick different therapeutic items up in my office (essential oils, stones, stuffed animals, mints, wall art, etc.) to smell, touch, taste, listen to and focus on visually. Once this senses-based intervention has been practiced within the therapeutic office, I encourage clients to continue using this intervention at home. A more severe tactic of grasping ice has been found to be helpful for clients who have tendencies toward self-harm. The ice allows for a physiological stimuli or shock to the body that engages sensation centers in the brain similar to those engaged in cutting, burning, etc. The hope is that these clients will choose items that are pleasing to them over items that are unpleasant, thus creating more positive experiences that involve bodily sensations.

Phase 5: Trauma narrative

The final phase in this model is focused on the trauma narrative. It is at this point in the therapeutic process that clients are displaying and self-reporting more stable emotional and cognitive-related responses to stress and more effective use of healthy coping skills.

I encourage survivors of sexual assault to begin writing out their trauma narratives, which occurs in session. Retelling their stories has been empirically proved to decrease the severity of the trauma response. It also allows clients to apply new meaning to their experiences and incorporate new and positive self-views and language. I do not recommend writing trauma narratives outside of the therapy session, however, because clients with a recent trauma can still be easily triggered. This is especially true when the narrative directly engages their previous trauma.

Once an initial narrative is written, I have the client read it out loud two separate times within the same session, or sometimes over the course of two sessions depending on the client’s responses to the narrative work. The first time, clients read their accounts of their trauma verbatim. From there, we are able to explore and process their reactions to the narrative and gauge their level of trauma response. I then ask clients to reread their narratives in the third person, as though they are telling someone else’s story. This allows them to take a bird’s-eye view of their trauma experience and perceive it differently, which often results in clients permitting more empathy and understanding for themselves.

Implications and model tenets 

My experience with this model in treating survivors of sexual assault has been favorable. Using this five-phase model, I have maintained a high client retention rate of 70 percent and a low cancellation rate of approximately 25 percent (compared with a typical rate of 40 percent within our center) over the past 18 months. Most clients report an overall increase in functionality after three sessions. These same clients have engaged in trauma work sooner in the therapeutic process than have our clients treated without the five-phase model.

Tenets of this model include effective assessment skills, a focus on client history and complex trauma, empowerment and encouragement of clients, an empathic strength-based approach and the incorporation of CBT/REBT and Gestalt-based interventions.




Brooke Bagley, a national certified counselor, is a therapy team leader/supervisor and clinical mental health therapist at the Sexual Assault Center of East Tennessee. Contact her at

Joel Diambra is an associate professor of counselor education, associate department head and director of graduate studies in the Educational Psychology and Counseling Department in the College of Education, Health and Human Services at the University of Tennessee in Knoxville. He is a licensed professional counselor-mental health service provider. Contact him at

Letters to the editor:




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.


  1. Sarah Smith

    My cousin recently got sexually abused and needs to get some help. Thanks for the advice about how there are several phases including emotion focused. It would also be smart to get a counselor that you like and get along with.

  2. Marcus Groen

    Brook & Joel,
    I am a student specializing in adult survivors of childhood abuse. Unfortunately the term “abuse” incorporates a myriad of maltreatment and commissions including sexual assault. Thank you for providing a framework as a starting point for handling this sensitive but necessary issue. Your research provided a wealth of much needed stepping stones: Using age appropriate language and encouraging clients to break from the immediate trauma, instead focusing on strengths; among others excellent observations.
    Thank You both from an aspiring psychologist.

  3. Michelle Elliott

    I have these issues! Some I felt with at 18yrs. Mom made me start NA,and AA….
    I can say I had never heard of some of the drugs they talked about, but as for being raised like I was, by an addict and alcoholism and child abuse with some neglect….
    This program helped me go through my childhood and do the 12 steps….
    That helped me to be able to have any kind of relationship with my mom! She never sexually assaulted any of us!!! But from the time I was 9yrs, 15yrs,22yrs……I was sexually assaulted. I’ve not had any therapy for this, I use the tools that NA and AA taught me to get by this far! I’m 51yrs now!
    Do not have a drinking problem or drug problem!!! I want therapy for theses assaults that I have never felt safe enough to share with therapy! Now I need to let these go!! I don’t want to feel like these just happened, anymore!!! But don’t know where to go! My primary doctor sent me to a therapist that had no idea how to help!
    Sincerely Michelle Elliott

    1. Jade Lotus

      How to Recover from Sexual Trauma?

      • Open up to someone whom you trust. Or join a support group from where you get valuable information on how to cope with symptoms.
      • Prepare yourself to anticipate common triggers, and you will understand better of your situation.
      • Whenever you feel tensed, shortness of breath, just calm down and soothe your sexual panic with this simple breathing exercise.
      • Sit comfortably with your back straight. Take a deep breath for a minute and then slowly exhale. Repeat the cycle until you become relaxed and focused.
      • Be in touch with your body and mind. You will feel more confident and safe.
      • Don’t hesitate to make new friends, reconnect with old friends, and participate in social gatherings.

  4. Carley Marvin

    So I really like what this is saying and it is all really true. I am a victim of sexual assault and I have been working and healing and it is a really long process and I have been through all of those phase several times and they do help the cognitive therapy and the narrative helped me the most all the times I have done them but it is a really good idea to get a counselor bc it is better to have someone to talk to about it and not hold it in bc if you hold it is you will become a mess I promise ik I have here recently been through that I stopped talking about it and all the emotion I had built up made me have a emotional break down and it wasnt pretty so get a counselor or have someone you can talk to about it once a week but anyway I really do like this

  5. Elisha

    Thank you for sharing your experience! I’m currently in am MFT masters program and your phased approach seems like a great tool to use in the future.
    Have you ever treated couples with this approach or do you opt to working with the abused individual directly? Sometimes couples will come into counseling to seek help together for the negative impacts the trauma has had on both of them and their relationship.
    Additionally, would you be able and willing to share some of the checklists you talked about? Such as the trauma symptoms checklist or common cognitive distortions?
    Thanks again!

  6. Kelvin Chung

    Thank you for the article, Brooke and Joel.

    I feel amazing that you can write it in a accurate and clear manner. As sometimes the difficulty is not on the counselling process, but the challenging is to articulate what we are doing clearly.

    Reading this article, it inspired me on the knowledge of dealing with traumatic issue and facilitate me to have a clearer picture on my counselling styles.


  7. Joyce Donoven

    This was very interesting and informative. I was especially interested in the negative thoughts and triggers.

  8. Zodwa

    Id like to have conselling because im slow in everything i do. I was sexual abuse i thank you for motivation , i hope i will get some help without informing my family

  9. Melodie Sargent

    I thought your article was very well written. I especially like the idea of writing out the trauma and then reading it twice. Mindfulness and body scanning was also very interesting.

  10. Melodie Sargent

    Working with Indian students is difficult when there are so many missing people or so many deaths on the reservation. So much help is needed and it appears that the jurisdictional issue is a large issue. Who is in charge of finding the loved one when she disappears? Is it the tribe, the county, the state, or the federal government? It seems that they each do their own thing and most often nothing is solved. It is a long and drawn out process with no answers many times.
    So many of my students have vanished, have been killed, and are in prison. Yet, we are here to try to help make sense of it to the survivors. We can only be here for them and answers their questions to the best of our abilities.

  11. Ryan

    Not to blame the person above who mentioned NA and AA. However There are unhealthy archaic statements in the Big Book and basic Text. For example “whenever we are disturbed we will invariably find that [ we are at fault ]. If We arfe thurough in our inventory, will find that through a millions forms of delusional self centeredness that we had stepped on the toes of other fellows in the past and caused them to react against us.” Also telling people they are poweerless is often NOTthe healthiest thing to do. It may have helped Bill Wilson because he was suspect of being a narcicist always blaming his wife lois for his drinking. Billl Wilson and many people in the program tend to use extreme over simplifications that are written in the AA and NA books like absolute religious truths which of course are often blame vicrtims for not forgiving their abuser when its veery important to encourage and develope healthy strong respected feelings of anger as emotional boundary communication inwardly and outwardly to sxcociety to evoke respect and support and warn there is something wrong with emotion value rather the flat empty words. .

  12. Leslie

    I continue to be dismayed that this is still the major orientation of therapy, “correcting thought patterns.” No, if I’m a trauma victim, there is nothing distorted or unnatural about the common thoughts and feelings that flow from that. Trying to encourage a client to have a level head about what they’ve been through is a dressed-up way of saying “it really wasn’t that bad.” It is not always healthier to be more positive about things or give other people the benefit of the doubt, sometimes being given permission to say “it was awful”, “it was terrible”, “people acted or behaved badly” is exactly what you need to do, not turning every negative feeling around. That seems to have the end of making me less trouble for other people, not truly healing me. All that has done is prompted me to push my feelings out of my mind and tell myself I’m really okay when I’m not. Psychotherapy needs to be a lot more about the shared experience of active empathy, not behavior correction.

    1. Alison Moreton

      You are absolutely right about being able to say how awful your experience was and to have someone standing alongside you in your sadness and trauma. I also think that at some point later in the journey when we are finding who we really are, we can engage in negative thoughts about ourselves and get stuck in these eg. “No-one loves me” It can often help to ask ourselves what triggered those thoughts. Discovering the triggers can sometimes help us to see that we don’t need to stay stuck. I believe this model is not supposed to be used in isolation, but alongside emotional support and counselling with an empathic, warm person who can allow the time and space for you to talk about your experiences and feelings.

  13. Rebecca

    Thank you for publishing this very useful resource! As a beginner in the helping profession I found this easy to adopt and I have a clearer picture of what to do now.

    1. Charly

      Hi Brooke and Joel
      Thank you for sharing an informative article, I really enjoyed reading your process when supporting survivors of sexual assault. I am a relational counsellor, and work with both couples and individuals on their relationships. But i am aware of more disclosures being made to me, about rape and sexual assault, so your phased approach seems like a great tool to use, alongside my work.

      I can see how this approach could be employed with individuals but wonder if it could also be applied within the couple work therapy also?

      Can I also ask if you would be willing to share the materials of your 5 phase model, e.g. psychosocial checklist, your preferred Gestalt-based interventions?
      Much appreciated!

  14. Anne

    How do I move on that this doesn’t affect my current relationship, I was in a sexual harassment relationship when I was only 16 n have been traumatized since

    1. Counseling Today

      You can contact the NAMI Helpline for support in your local area: call 1-800-950-NAMI (6264) or text NAMI to 741-741 for 24/7 crisis support via text message.

  15. Ruthe

    I’m an 88 year woman who’s daughter was molested by her step father when she was a child! She refuses to get counciling and I have enabled her all these years because I can’t stand to see her hurting!

    She can’t afford to pay for counciling! What are her options? I’m concerned mostly because she acts out in tantrums!

    Any advise would ne greatly appreciated! Thank you. Ruthe

  16. Stephen MORASH

    My step daughter was raped as a teen ager and is now 25. She can’t move on from this. How can you help? We are in vanciuver canada though. Do you do zoom meetings one on one

    1. Counseling Today

      Please contact the NAMI helpline to find support in your local area: 1-800-950-NAMI (6264) or

  17. James Colgan

    My wife was sexually assaulted as a child , we had been awful verbal arguments until I found these articles which has helped myself I have learned thru talking with her in a calm manner that , that the choices in what I say can trigger emotions in her which causes arguments that should not have happened , I will continue to read these articles , they helped a lot , my wife has started seeing a counselor which has also helped a lot


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