Overcoming Childhood Abuse

1. What is Childhood Abuse?
   • Childhood abuse can be of three types: Emotional, physical and sexual abuse.
   • All three sorts of abuse can result in psychological problems in adulthood.
   • Many survivors of abuse will have suffered a mixture of emotional, physical and/or sexual abuse.
   • Definitions of abuse vary and few account for emotional, physical and/or sexual neglect.
   • If you were abused as a child you need to be aware that you are not alone.
   • It is more important for you to come to an understanding of the effects of your experiences than to try and define the abuse. Write these down.

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2. What Problems Are Associated With Childhood Abuse?
   • Problems occur with or without the presence of childhood abuse but abuse do make a person more vulnerable to developing difficulties.
   • Survivors of childhood abuse are likely to suffer from negative beliefs which make them see themselves and the world negatively. This affects their feelings for themselves and others and can impact on their relationships.
   • An abusive history can lead to an altered thinking process. Survivors are more likely to dissociate - (‘detach’ from reality) and may be more easily hurt or offended by abuse related issues.
   • Write down if and when you detach and the problems this causes. Note the issues you are very sensitive to and any problems this causes.
   • Survivors of abuse may suffer from intrusive memories/nightmares and flashbacks.
   • Our memories are generally accurate but can be misrepresented or have detail added to it.

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3. Recovering From Childhood Abuse.
   • It is possible to recover from childhood abuse but you need to undertake any changes at a time which is right for you. This may require waiting until the appropriate moment.
   • Change usually occurs in stages. Proceed in steps – pace yourself and allow yourself to adapt to new conditions.
   • Be prepared for ‘ups’ and ‘downs’ since this is a common pattern in progress.

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4. The Development Of Problems
   • Our personalities/strengths and weaknesses are formed by our natural temperament and our experiences
   • Early experiences can give rise to beliefs about you, others, the world and the future. These core beliefs affect your thinking, feelings and your behaviour. They may be positive, negative, true or false.
   • Consider your early useful and useless experiences and relationships. What effect do they have on you now and how have they affected the way you see yourself, others, the world and the future?
   • Belief systems can be accurate or inaccurate and the latter can be upsetting.
   • To get a better understanding of how belief systems work think of someone who has a prejudice you disagree with - Do they ever question their prejudice and how do they react when something matches or is contradictory to their prejudice?
   • Your experiences have formed your beliefs and your belief systems affect your mood, relationships and behaviour making you more or less susceptible to problems in adulthood. Bear in mind that not all your adult problems arise from abusive experiences and not all experiences of abuse cause difficulties in later life.
   • Write down your good and bad memories. How have these influenced your view of yourself, others, the world and the future? How do these beliefs make you feel and how do they affect the manner in which you handle your life? Consider how your belief systems influence your mood, relationships and behaviour. How might this make you more or less susceptible to problems?
   • At this stage you need to ask yourself if your view is completely correct or is there a wrong interpretation that could be challenged.

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5. How A Problem Continues
   • Any particular experience is a reflection of five elements- our thoughts which are related to our belief systems, our feelings, our behaviour, our biology and our circumstances.
   • These five elements affect each other and it is this interaction which maintains a problem.
   • To deal with your problems you need to recognize the various elements and try to alter some feature of it.

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6. Viewing Your Problems In Context
   • Keep a diary for several days to recognize your five elements. Note both productive and unhelpful patterns in your response so that you can consolidate the former. With improved understanding of the various features of your problems you will be able to comprehend what causes them to continue.
   • Consider ‘Why me?’- Recognize your present problems in view of your past experiences.
   • 'Why aren’t matters improving?’- Write down your problems and what maintains them.
   • 'What are my needs now?’- Write down your needs for future use and review this list as your needs alter with time.

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7. What Stands In The Way Of Recovery?
   • You need to ask yourself if you are ready for the important alterations involved in recovery. Can you handle the potential stress of changing? How far can you proceed and will you have the help of those in your life?
   • The process of recovery can bring to the surface strong emotions and horrifying discoveries. You need to give yourself the opportunity to adapt to this.
   • Consider what stresses you and those in your life may experience if you change your lifestyle.
   • Do you partake in emotional numbing? What thoughts or feelings do you refrain from by doing this and how?
   • Recognize and write down your fears, noting any possible solutions.
   • Write down both what you will achieve and lose by recovering, to clarify your reasons for opting to recover and the things that stand in your way. Think about what support you have to assist you to cope with the losses and alterations e.g. good friends who will stand by you.

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8. What Do You Want?
   • Your goals need to be in line with reality, specific and within your capacity.
   • Break down your goal into steps you can manage.
   • Consider what you want and identify the realistic goals and the ones that need to be made less demanding.
   • In what way precisely do you wish to alter at the end of this process? Identify what will be the distinguishing features of this change.
   • List your goals and note those you will need to attempt in steps and try to clarify what steps will be necessary.

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9. Coping Skills
   • Observe and record long-term (e.g. talking to a friend about the problem) and short-term (e.g. displacing your bad feelings) helpful coping skills and those which are detrimental to your well-being. What was occurring at the time and how did you respond to the feelings? Note how your coping skill/response reduced your distress by rating your distress level before and after the response on a scale of 0-10 with 10 for extremely distressed.
   • Use the records made above to examine how you look after yourself at the moment. Write down your behaviour when distressed (e.g. indulge in food and alcohol) and mark out the short-term coping strategies and note the long-term ones.
   • Try to increase your coping skills so that you do not need to rely so much on the harmful strategies.
   • Practice breathing exercises several times a day so that you can control your breathing when you feel tense. (Breathe in deeply until your lungs are full then breathe out. Repeat this about 12 times in a minute).
   • If you can, use a simple relaxation exercise daily on a regular basis.
   • Try to become aware of when you dissociate/detach from reality, as in this way you can gain control.
   • Social support is crucial to the recovery process and you need to endeavour to consolidate your social network.

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10. Stress Awareness Training
    • You need to monitor your stress and become familiar with what sets it off and the feelings, thinking and actions associated with the anxiety. You can do this by keeping a diary. When you feel anxious note the date and time. What was the event? Rate your distress 1-10 (1 is no distress and 10 is extreme panic). What caused your anxiety? What was your response to cope with the problem? Re-rate your distress.
    • After two weeks of monitoring your stress levels you should become aware of what triggers your distress, your bodily feelings and thoughts when distressed, how your distress levels vary with different situations, what you tend to do when distressed and what is the best way for you to cope with your distress.
    • Make two lists – one of short-term only coping strategies and the other of long-term coping strategies. You can refer to these when you feel stressed. Try to incorporate more of the long-term strategies into your set of coping techniques and attempt to gradually abandon your short-term methods.
    • Avoid turning to stimulants such as alcohol, caffeine and nicotine as coping methods. These have unpleasant effects in the long-term.
    • Study your diary to determine what drives your cycles of distress. Is it bodily, psychological, behavioural or social?

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11. Dealing With Bodily Experiences: Controlling Your Breathing
    • Hyperventilation – faster breathing occurs in response to exertion and stress. In the long-term this can be uncomfortable and cause unpleasant physical symptoms which trigger more anxiety and more hyperventilation. Another cycle of stress is set up and can result in a panic attack.
    • You can rectify hyperventilation by learning to control your breathing.
    • First practice lying down and later sitting or standing. Place one hand on your stomach and the other on your chest. Breathe in slowly through your nose until your lungs are full then exhale slowly through your nose. Breathing in and out counts as one breath – aim to take 8-12 breaths a minute.
    • In order to be effective you need to practice this exercise repeatedly.

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12. Dealing With Bodily Experiences: Relaxation
    • You need to develop relaxation into a skill you can use when you feel muscular tension due to stress.
    • Try to develop a routine and practice your relaxation exercises. Start by lying down and later you can try sitting or standing. Control your breathing.
    • Record your experiences noting the date and time. Rate your distress before the relaxation exercise, 1-10 (1 is tense and 10 is very relaxed). Which exercise did you use? Rate your distress afterwards. Make notes of the sort of day it was, your preoccupations etc.
    • Below are three exercises – only move to the next one when you are fully relaxed after a routine.
      1. Progressive Muscular Relaxation (PMR) – Breathe slowly and regularly as you focus on different parts of the body: feet – tense your feet then relax and repeat; legs – straighten your legs then relax and repeat; abdomen – tense your abdomen then relax and repeat; back – arc your back then relax and repeat; shoulders/neck – bring your shoulders up and in and press your head back. Relax and repeat; arms – stretch out your arms and hands. Relax and repeat; face – tense your face and bite hard then relax and repeat; whole body – tense your whole body then relax and repeat.
         
         After the routine if you still feel tense then repeat it then when you are relaxed think of something calming to relax your mind. Get up slowly and gently.
         
         You should practice PMR twice a day until you feel relaxed after the exercise.
      2. Shortened PMR – You can miss out the tensing and go straight to relaxing the different muscles. When you have achieved this you can progress to using the routine at other times and places.
      3. Simple Relaxation Routine – Identify a word, object or scene you find calming. Sit comfortably and close your eyes. Be aware of your breathing as you inhale through your nose. As you exhale, think about your calming mental image. Continue this until you feel relaxed. You should practice this exercise frequently.
    • When you have learned to relax using the three exercises you can start to use the skills throughout the day. Use something to remind you regularly to relax. Apply your relaxation skills whenever you need to use them in response to physical tension.

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13. Dealing With Psychological Aspects: Distraction
    • A cycle of mounting anxiety is set off by alarming thoughts and images. You can break this cycle by distracting yourself.
    • Physical Exercise – If you keep active you are less likely to be preoccupied by worrying thoughts.
    • Refocusing – Distract yourself by focusing on things around you e.g. listening to others’ conversations or studying how someone is dressed.
    • Mental Exercise – Formulate a phrase, picture or mental exercise that distracts you e.g. redesign your home, imagine your dream home in detail or recite poetry.
    • Develop a set of distraction techniques for different occasions that are suited to your needs e.g. If you get stressed at interviews then physical distraction will not be helpful.
    • Make two columns – in one write down the situation causing anxiety and in the other your chosen distraction method.
    • Practice your distraction techniques when you are not anxious and try to catch your anxiety at an early stage.

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14. Managing Your Time
    • Good time management requires being aware of:
      1. Your needs and strengths – list these opposite each other.
      2. Your standard procedure – find out how you use your time at present by keeping a record of how you spend your time. From the record you will be able to work out the best way of working. Try to get a balance of work tasks and include breaks.
      3. Your priorities – identify and rank in order of priority the different areas of your life. Consider the time you allocate to each and what is realistic and necessary. Perhaps others are making demands of you that you need to be more assertive about?
      4. Setting reasonable goals – keep in mind the important areas of your life when pursuing goals. Clearly define your goals so you know when you have achieved them. Some goals will need to be broken down into more manageable steps.
    • Once you know the above you can draw up a new more efficient schedule. Use an organizer and list long-term (within six months), medium-term (within a month) and short-term (within a week) goals. Set aside time each day to organize. Try to do a ‘To do’ list of prioritized tasks every day. Plan flexibly and review every month.
    • Delegating – giving over responsibility with authority, to others for appropriate tasks, is part of good time management.

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15. Sleep Management
    • The length of sleep necessary varies from person to person.
    • Worrying will prevent you from sleeping.
    • You need less sleep as you get older.
    • Sleep is affected by mood, stress, food, alcohol, exercise and medicines.
    • In the long-term, sleeping tablets are not helpful and can be addictive.
    • You can manage your sleep problems by changing your behaviour rather than resorting to medication.
    • Keep a sleep diary for several nights to ascertain if you have a problem. Note the date and anything that might affect your ability to sleep e.g. your activity before retiring. If you have waking episodes, note your activity to restore sleep. Was it helpful? Next day note the number of hours of sleep you managed to get and rate how alert you feel 1-10 (1 is dull and sleepy and 10 is very alert). Rate your performance that day 1-10 (1 is poor performance and 10 is performed well). If you do have a problem the following suggestions might be helpful:
      1. Analyze your sleep diary to see if poor sleep is due to stress and is likely to get better as this eases; are there behaviours which result in poor sleep that you could change?; identify helpful and unhelpful ways of coping and avoid the latter.
      2. Introduce pleasant smells into your sleeping environment to help you relax e.g. potpourri or lavender oil.
      3. Try to relax an hour or two before you go to bed. Keep your daily stress low and seek counselling or the support of friends if you feel the need. Exercise during the day. Avoid caffeine, nicotine and alcohol and try a warm milk drink before bed. Make sure you are not hungry before retiring as this will keep you awake. · Ensure you have a quiet bedroom and a comfortable bed and have emptied your bladder before trying to sleep. Use your bed only for sleeping and set an alarm so you wake regularly each day. Avoid naps during the day.
      4. If you sleepwalk you are advised to discuss this with your doctor as it can be dangerous.
    • To cope with disturbing dreams you could try:
      1. Constructing a positive ending to your disturbing dream and mentally practicing this alternative ending several times before sleeping;
      2. Practicing beforehand what you might say if the dream occurs;
      3. Keep water and a towel by your bedside to wash your face with if you wake up sweating - this will help you re-orientate;
      4. Keep a notepad and pencil within reach so you can record your dreams but beware of reading too much into their interpretation.
    • Relaxed Breathing Method:
      You could try the following method of relaxed breathing to ease tension and promote sleep:
      1. Ensure you have some time to yourself and push your worries to one side;
      2. Sit or lie comfortably and close your eyes with your arms by your side;
      3. Concentrate on breathing naturally;
      4. Place your hands on your stomach and breathe in deeply and hold for a few seconds feeling your stomach rise. Breathe out and feel your stomach contract. Repeat and as you breathe out think of a relaxing image or sound. Continue doing this until you feel thoroughly relaxed;
      5. Count back from 10 then open your eyes and feel how relaxed you are now. Slowly get up and resume normal activities.

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16. Problem-Solving
    • Problems of any sort can be distressful.
    • The problem-solving approach can be useful in these cases. You learn to focus your thinking and find solutions to your problem instead of panicking. There are six steps in problem-solving:
      1. Define the Problem – Be specific and try to break the problem into more manageable tasks. Do one task at a time. Choose your task and specify your goal.
      2. List Solutions – Try to write down as many ideas, to solve your problem, as you can.
      3. Evaluate the Pros and Cons of Each Solution – Consider your solutions and reject the unsuitable ones. List the remaining solutions in order of usefulness.
      4. Selecting a Solution and Planning Action - Choose your first solution and decide how you will put it into action. Rehearse your task and make sure you have a back-up plan in case your task does not go as planned.
      5. Do it - Attempt your solution.
      6. Review the Result of the Solution – If your solution is successful try to understand why it was so. If your solution is unsuccessful try to comprehend why it did not work. Praise yourself for having tried and choose your next solution from your list.

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17. Handling Distressful Memories
    • Distressful memories are of two types: flashbacks and intrusive memories. Ways of dealing with these are given below.
    • You could try avoiding the trigger to these memories e.g. certain situations or specific people.
    • Distract yourself from these memories by focusing on things around you. Try to become skilled at refocusing by practicing even when you do not suffer these bad memories.
    • You can try distracting yourself with an object you carry around with you or a visual picture that can calm and distract you.
    • Try to develop a few words or a phrase to remind you that you are coping at the moment. Write out the phrase and leave reminders where you can see them so that you can bring it to mind when you need it.
    • Find a position that makes you feel safe, strong or comfortable and practice adopting it so that you can use it easily to fight your distress.
    • Occasionally it is necessary to confront these memories so that you can assign them to the past.
    • Only when you feel ready to face the past should you try to write down your experiences. You are advised to have an adequate mastery of coping skills and perhaps someone available to support you.
    • First write down brief details then rewrite to include as much detail as possible. What happened? What did you feel? What went through your mind?
    • Do not pressure yourself to remember things – just note what you can recall.
    • Take a break when you need to but continue later.
    • Read the completed account with compassion for yourself and try to figure out the specified importance of your experience.

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18. Improving Your Self-Image And Combating Self-Harm.
    • Work on your self-image by making pleasurable activities a priority. Mix with people you like that value and make you feel good. Make the effort to nourish yourself – do something nice for yourself everyday.
    • Try to identify your good qualities. List the qualities you value in others then note the ones that apply to yourself or a friend might say you possess.
    • Keep a record of the positive things in your life. Note as many positive events, compliments, achievements and qualities as you can and reread the entries every week and summarize to build your self-image and challenge negative beliefs.
    • If you feel suicidal or have the urge to harm yourself, identify these feelings try to understand why you feel this way e.g. It may be the result of very low self-esteem or distress.
    • Recognize what triggers these feelings so that you can avoid them.
    • Consider what coping strategies you have to restrain your urges e.g. relaxation techniques or distraction.
    • Make a contract, not to harm or kill yourself, with someone close to you.
    • When you feel the urge to harm yourself phone for help instead of following these feelings. Keep a list of important telephone numbers of friends and professionals close at hand.
    • Do not keep anything you could kill or harm yourself with near you.
    • Keep a written reminder with you close at hand of why you should live and not harm yourself.

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19. Achieving a Balanced Viewpoint
    • Problems arise when we misjudge too often.
    • Common misjudgments include:
      1. all-or-nothing thinking (black and white thinking);
      2. catastrophization (predicting the very worst);
      3. overgeneralization (you notice something that is true and make generalizations about it);
      4. using a ‘mental filter’ (focusing on a negative feature and disregarding the good aspects);
      5. disqualifying the positives (dismissing the good things about yourself or your life);
      6. magnification/minimization (exaggerating and under valuing the meaning of negative and positive events respectively);
      7. jumping to conclusions (interpreting things without evidence);
      8. emotional reasoning (an over reliance on feelings to guide judgments);
      9. taking thing personally (assuming that anything bad is directed at you);
      10. self-blame or criticism (blaming or criticizing yourself needlessly);
      11. labeling (calling yourself names);
      12. unrealistic expectations of yourself or others.
    • Learn to identify misjudgments you are prone to so that you are aware of the biases in your thinking. Correct your misjudgments by asking: What are your distressing thoughts or images? Is your view biased? Consider the evidence that supports your thoughts or images and that which does not do so. What is the worst thing that could occur and how would you cope?

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20. Dealing With Blame.
    • Letting go of self-blame is not an easy step forward and you need to allow yourself time to adapt to the changes.
    • How will you feel about yourself, others and your future when you let go of self-blame?
    • What stresses might occur from the change?
    • To understand how abuse occurs consider why your abuser wanted to abuse; how s/he overcame her/his inhibitions; how s/he was able to get the chance to abuse. Keep in mind that the abuser chose to abuse.
    • Why do you think you may have been susceptible to abuse?
    • Assign responsibility for the blame where it belongs. Say out loud: I was not responsible for ------.
    • ------ was responsible for -----
    • List all the people involved in your abuse and rank them from the most to the least responsible then see if it is reasonable for you to feel responsible and add yourself to the list.
    • Get in touch with the child in you by writing a letter to an imaginary child who is the age you were when abused. Comfort the child by explaining why it is the abuser who is to blame. You could address the letter to the child in you if you feel you are able to do so.
    • Write down reasons why you feel you were to blame and then challenge these with reasons why you were not to blame.
    • Write letters, which you may or may not wish to send, to: the aggressor/s; to other parent or parents; to the damaged child from the adult self; a fairy tale about your life in the third person with a happy ending to give you hope; to a partner/lover or ex-partner/lover; to each of your children or the child you would like to have. Repeat these letters when you reach the conclusion of all this advice to see how you have changed with therapy.
    • Survivors of childhood abuse often have the additional burden of being abusers themselves.
    • If you feel you have abused others try writing a letter to the person/s you have abused and you may or may not choose to send this letter.

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21. Dealing With Anger
    • Anger is triggered by frustrations and you need to learn to manage your anger.
    • It is important not to deny your anger but express it at the cause and not displace it.
    • Monitor your anger: What was the situation? What did you feel? What thoughts did you have? What did you do? How helpful was this? What were your misjudgments e.g. jumping to conclusions? How do you see the event now? Consider more balanced responses.
    • You may feel anger towards your abuser. To get in touch with these feelings try imagining yourself as a child. Consider what was done to you and the consequences to your life – the struggle, the losses and the unhappiness. What are your feelings?
    • Think of ways now of dealing with your anger e.g. pounding pillows with fists or playing forceful sports then calming yourself by taking a bath. Keep the list close at hand.
    • You may indirectly express your anger by writing a letter to the person or an assertive telephone call or you may directly express your anger and confront the person. Try to engage in calming activity afterwards.
    • See ‘Overcoming Anger’ in the Forward Counselling Advice Service.

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22. Speaking Out
    • It is your decision as to whether you speak out or not, how much you disclose and to whom. Consider the pros and cons of speaking out.
    • Plan how you are going to disclose your abuse, to whom, at what time and place and in particular what you will say. What could go wrong and how would you handle this? Think about the worst-case scenario and have a back-up plan. Familiarize yourself with your task by rehearsing in your imagination.
    • It is your choice whether you confront or not. Think about the pros and cons of confronting and decide whether it is in your best interest.
    • Write down your hopes and distinguish between realistic, unpredictable – beyond your restraint and unrealistic hopes. Do not rush into confronting. It is better to wait, if most of your hopes are unpredictable or unrealistic, until the time is right.
    • Plan your confrontation – Whom are you going to confront and why? Where and when and will you need anyone for support? What are you going to say? What is the worst-case scenario and how would you cope? Rehearse your plan in your imagination to prepare yourself.
    • It is not essential that you forgive your abuser to find emotional release but you do need to forgive yourself for having been abused.
    • Allow yourself the time to really think about forgiveness by writing down your thoughts and discussing it with others.

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23. You And Your Family
    • You may want reconciliation and improved relationships with your family, or compromise or you may want to distance yourself from your family.
    • Record your feelings and the trigger for them, when you are with your family.
    • Establish ground rules for dealing with your family. List what you want or need from your family. How can you ensure you get what you need?
    • In order to understand the difficulties you face visualize an event where you state what you need. What feelings and associated thoughts do you have?
    • To be assertive you need to think about what you need or want; what is in accordance with reason and just? Make a reasonable proposal which is often a compromise; what would be the results of your proposal not being adequately thought about?
    • If assertiveness is a problem for you consider doing an assertiveness training course.

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24. Removing The Obstacles To Intimacy
    • If you have been abused you may feel confused in intimate relationships.
    • Record and examine closely the things that prevent you from achieving intimacy with someone. Note your thoughts and reactions when you distance yourself from a friend or end a relationship and make an analysis e.g. are you overgeneralising?
    • Social inadequacy can be an obstacle to intimacy. Apply your assertiveness skills to your social and work life and observe how socially skilled people handle situations in particular difficult ones. Rehearse your social behaviours so that you are comfortable with them.
    • Try to grasp your anxious thoughts, examine them closely and if required, challenge them. What are your anxious thoughts? Is your outlook biased – are there misjudgments? Consider the evidence to support and discount your thoughts.
    • See ‘Overcoming Social Phobia’ in the Forward Counselling Advice Service.
    • It is possible to become over-intimate and make ourselves vulnerable to exploitation. Trust can be given in a series of stages and you can fluctuate as to how much you trust someone.
    • Communication is necessary for all relationships. Record the feelings which threaten your relationship (e.g. jealousy) and grasp the automatic thoughts. Analyze them and find alternative ways of dealing with the situation.

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25. Sexual Problems
    • Your sexual relationship will be affected by how good your relationship is with your sexual partner, how you feel about yourself and your body, your mental state and your understanding of sex.
    • Sexually abused children are often ashamed of asking about sex. Thus they have a very poor knowledge of sex.
    • Think about your needs and work out ground rules for your sexual relationship that will help you meet them. Share and discuss this with your partner.
    • Study your sex-related stresses by noting the feeling and grasping the thought then analyzing them and finding alternative ways of dealing with the situation.
    • Learn to develop more positive feelings about your body.
    • Visualize a child who has never experienced sexual abuse. How does it come to like its body? These are the things that will enable you to improve your relationship with your body. E.g. dressing up and accepting compliments.
    • Note how you could start to like your body e.g. treating yourself to perfume or lotions.
    • Try not to compare yourself to just the best looking people. This will only be discouraging.
    • Threat tends to trigger dissociation/detaching from reality. Try to grasp, examine closely and challenge your fears. You may be able to get rid of some of them and dissociate less.
    • It is necessary to attempt to maintain a good mood since this affects your sex drive.
    • Challenge myths about sex.
    • If you think physical damage is the cause of painful sex you should have a physical examination. Another reason may be muscular tension. The woman who experiences pain can use lubrication and insert one finger then two and even three into her vagina and masturbate if she wishes. As a couple, partners can avoid penetration and concentrate on pleasuring each other without genital contact. Next they can begin to touch each other sexually but avoid penetration. Finally when both are ready and relaxed they can attempt gentle and gradual penetrative intercourse.
    • You need to treat sex as being of most importance and make known your own needs with regard to sex.

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26. Dealing With Interpersonal Relationships
    • Interpersonal relationships may have causing you problems and may be preventing you from recovering – in any event interpersonal relationships will be affected by your abuse.
    • You need to understand your personal relationships and be able to deal with them effectively.
    • Draw interpersonal maps for:
      1. How your interpersonal relationships are at present;
      2. How your interpersonal relationships might be now if you did not suffer from your emotional problem;
      3. How your interpersonal relationships will be in 10 years if you continue to suffer from your emotional problem;
      4. How you would ideally like your interpersonal relationships to be.
    • These will summarize all your relationships and allow you to recognize any changes you may desire.
    • List all your important relationships and put yourself in the middle of the map in a circle.
    • Place each person's name in a circle on the map, around you in the middle - the closer the relationship to you, the closer the circle to you.
    • Join these circle's to you in the middle with an arrow outward if it is you mainly giving; an arrow inward if you are mainly receiving; a two-way arrow if giving and receiving is balanced; a question mark if you are unsure.
    • Examine these maps noting any differences and set yourself goals to make any desired changes to your relationships.
    • For each relationship ask yourself:
      • who initiates and terminates contact;
      • are you happy with how often you see this person? ;
      • who decides what to do or what to talk about? ;
      • is there a balance between giving and receiving? ;
      • do you want to alter the relationship in anyway?
    • Consider questions such as:
      • who could I confide in and get advice from? ;
      • who would be there for me if I fell ill? ;
      • who would lend me money at very short notice?
    • Next time you have contact with each person, examine the relationship - participate and observe. Were your predictions correct? - If not, what was different?
    • When you have a complete picture of your relationships, think about how you maintain them and in what way you want to change your relationships.
    • Two important reasons for making changes are:
      1. A balanced and supportive social network is necessary for your well-being;
      2. By altering your relationships but avoiding being controlling, you may increase your sense of control.
    • Start by making small changes and monitoring progress. You could also try discussing what you have learned about the relationship with the individual.

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27. The Grieving Process
    • Grieving involves many emotions from feeling numb to yearning for losses which may become a preoccupation. You may get very angry and experience guilt as a result or because you feel responsible for the loss.
    • Consider and list your past losses and the things you have to relinquish now to move on.
    • Write down your feelings and associated thoughts then explain them and formulate alternative action.
    • Examine your beliefs about crying. Do they apply to an adult? Will these beliefs hinder your recovery?
    • Do not be afraid to cry and let it happen naturally. Try not to bottle-up grief since when you do cry you may feel overwhelmed.
    • Be your own parent and learn to nurture yourself. Write down the losses you can now make up for and how you can do this. What was missing in your childhood that you can compensate for now?

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28. Assertiveness Training
    • The aim of assertive behaviour is to stand up for your legitimate rights and face others without putting yourself or them down.
    • Assertiveness training teaches you to increase the number and variety of situations in which you are assertive.
    • There are three types of interpersonal behaviour:
      1. Aggressive - you may be forceful in expressing your opinions, feelings and wants.
      2. Passive - your opinions, feelings and wants may be withheld completely or partly.
      3. Opinions, feelings and wants are stated with respect for the rights of others.
    • Make sure you are aware of your fundamental rights which include: asking for what you want; saying 'No' without guilt; not being perfect; being ignorant about something; being responsible for your actions; having your own perspective and emotions; being indecisive; choosing whether or not to deal with others' difficulties; expecting privacy, independence and success.
    • There are five steps to being assertive:
      1. What do you want? ;
      2. What is fair? ;
      3. Be clear in asking for it;
      4. Contemplate and be ready for the risks;
      5. Stay calm
    • Practice your arguments in advance and repeat yourself to get the message across. Be prepared to negotiate.
    • Think about situations in which you are not assertive and how you could change this and be assertive.
    • Write out a detailed description of problem scenes - note when and where the problem occurs; who is involved; what your difficulties are; how you handle it; your fear of what will happen if you are assertive; your goal.
    • To deal with a problem situation:
      1. Consider your rights and wants.
      2. Unless spontaneous action is required, arrange a mutually convenient time to discuss your problem with the other person.
      3. Define the problem as specifically as possible.
      4. Describe your feelings using 'I' messages, to give the other person an understanding of how important the issue is to you.
      5. Make your request in one or two simple but firm sentences.
      6. Give positive reinforcement to get what you want e.g. we'll be able to spend more time together. If this will be ineffective try negative reinforcement, describing the alternative way you will look after yourself if your wishes are not met.
    • You need to arrive at a workable compromise. Agree to review this after a specified length of time and if you are not both satisfied you can renegotiate.
    • Avoid being manipulated - techniques include:
      1. 'Broken Record' where you choose a concise assertive statement to say over and over to get your message across.
      2. Delay responding to a challenging statement until you are more prepared.
      3. Inviting criticism may reveal what is troubling the other person.
      4. When someone puts you down, acknowledge something you can agree with in their criticism and ignore the rest.
      5. You can change the focus, from discussing the topic to analyzing the interaction between the two of you.
    • In instances where you lack time you could use the short form assertiveness technique. Consider:
      1. Your thoughts - state the facts as: 'I think…'
      2. Your feelings - express as 'I' statements: 'I feel…'
      3. Your wants - specify behaviour change as: 'I want…'
    • You need to develop assertive body language. Practice the following basic rules in front of a mirror so that you learn how to apply them to problem situations:
      1. Maintain eye contact and an erect body posture.
      2. Speak clearly and firmly.
      3. Emphasize what you are saying with gestures and facial expressions.
    • Learn to listen assertively:
      1. Make sure you are both ready to listen.
      2. Listen giving the other person your full attention and ask them to clarify if necessary.
      3. Let the other person know you have heard what s/he has expressed to you.
    • Practice being more assertive in problem situations and consider how it makes you feel.
    • Role-playing is a good way to improve your assertiveness in a safe environment before trying it out in real life situations.

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29. Conclusion
    • You are bound to suffer from set backs and need to establish a relapse prevention plan.
    • Write down your high risk situations and related negative thoughts. Explain them and formulate alternative action. Then note the worst outcome and related negative thoughts. Explain them and formulate alternative action.
    • Keep your management strategy close at hand - in this way you will be prepared in times of crisis.
    • Your abuse will always be a part of your past but remember that it is in the past and focus on your future.

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