Contextualising therapeutic care for child survivors of sexual violence in situations of war : a reflection on theory, context and practice

In this article, the author sought to raise awareness of and discuss ways to effectively address contextual challenges faced by mental health workers who provide therapeutic services to child rape survivors in war-affected regions, in general, and in the cultural context of the eastern region of the Democratic Republic of Congo, in particular, where rape is considered a sexual taboo, causing or amplifying attachment issues for survivors. A qualitative analysis of current literature review and therapeutic practice has been conducted in this article. Two cases are presented to illustrate contextual challenges. The analysis of case one focuses on ethical dilemmas between asserting professional boundaries and addressing clients’ needs in situations wherein there are no alternative resources beyond the therapist’s scope of practice, whereas the analysis of case two focuses on relationship and attachment challenges for survivors because of the interpretation of rape as sexual taboo. It was observed that, given extraordinary contextual challenges, therapists who assist child survivors in war-affected zones interact with their clients beyond their offices. Connecting at an empathy level alone is not enough. It also takes the therapists’ ability to demonstrate compassion and creativity in their effort to facilitate the healing journey of their clients.

Key implications for practice

• This article draws attention to wartime child rape and its context-specific consequences on the survivors' attachment security.
• Awareness is raised of the cultural context and ethical challenges surrounding the practice of therapeutic care for child survivors in war-affected regions.
• Observed limitations are reported to the Western model of therapeutic relationship and the requirement of compassion and solution-driven creativity by therapists beyond empathy for a more contextualised and effective support of their clients.