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The “Wall of Fear”: The Bridge Between the Traumatic Event and Trauma
Resolution Therapy for Childhood Sexual Abuse Survivors

Article in Journal of Child Sexual Abuse · February 2005

DOI: 10.1300/J070v14n03_02 · Source: PubMed

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 The “Wall of Fear”:
The Bridge Between the Traumatic Event
and Trauma Resolution Therapy
for Childhood Sexual Abuse Survivors
Sheri Oz

ABSTRACT. A multitude of published books and papers on child sex-

ual abuse (CSA) describe symptoms, long-term effects, and therapy for
survivors of abuse. However, the parallels between the nature of the sex-
ual trauma event(s) as originally experienced by the victim and the ther-
apeutic process into which the survivor later becomes engaged have not
been reported. This paper attempts to fill that gap and proposes that the
concept of a “Wall of Fear” is the bridge connecting the two. In the first
part of the paper, a model of the CSA experience based upon Furniss
(1991) will be explained in order to point out the basis for the dissocia-
tion and other symptomology demonstrated by the CSA victim. Follow-
ing that, the stages of therapy will be mapped out, with special attention
to the concept of the Wall of Fear (Oz, 1999) and traumatic memory res-

Sheri Oz, MSc, is Director of Machon Eitan, a private clinic specializing in therapy
for child, adolescent and adult survivors of sexual trauma and their families, Kiryat
Motzkin, Israel. She provides consultation services for child protection teams and so-
cial services agencies. Her research interests include: family assessment tools for the
substantiation or mitigation of suspicions of child sexual abuse, international ap-
proaches to reporting and intervention in cases of child sexual abuse, and issues in dis-
sociation and trauma.
Address correspondence to: Sheri Oz, Machon Eitan, HaRav Kook 13, 26361,
Kiryat Motzkin, Israel (E-mail: sherioz@netvision.net.il).
Submitted for publication 9/19/03; revised 5/24/04; revised 10/22/04; accepted
11/19/04.
Journal of Child Sexual Abuse, Vol. 14(3) 2005
Available online at http://www.haworthpress.com/web/JCSA
© 2005 by The Haworth Press, Inc. All rights reserved.
doi:10.1300/J070v14n03_02 23
24 JOURNAL OF CHILD SEXUAL ABUSE

olution (abreactions) and with reference to the experience of the original

traumatic events. Therapist fear of decompensation will be addressed.
[Article copies available for a fee from The Haworth Document Delivery Service:
1-800-HAWORTH. E-mail address: <docdelivery@haworthpress.com> Website: <http://
www.HaworthPress.com> © 2005 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Abreaction, decompensation, sexual abuse, trauma ther-

apy, traumatic memories, dissociation

Child sexual abuse (CSA) is regarded as a special case of trauma in

that it usually comprises a series of traumatic events that occur within
the context of interpersonal relationships (Finkelhor, 1990; Freyd,
1996; Gold, 2000). For that reason, the recommended therapy includes
attention to family relationships, the context in which the abuse oc-
curred, and the attainment of life skills (Gold, 2000). The professional
literature is still ambivalent on the question of the degree of trauma res-
olution work necessary for CSA survivors.
Therapists entering the field of CSA therapy have been generally intro-
duced to a three-stage model that includes stabilization, trauma resolution,
and integration. Some clinicians (e.g., Gold, 2000) are suggesting, how-
ever, that it is possible to conduct a complete and effective therapy without
the formal stage of trauma work. According to the clinical experience of
the present author, while some clients do not proceed to the trauma work
and yet manage to reach a level of functioning which is sufficient for them,
recovery may not be complete without it. The CSA client will determine
the level of recovery to which he or she aspires; not to include the entire
range of therapeutic change possible into a map of goals is to aim lower
than many clients may eventually choose to go.
A model of the nature of the CSA trauma was first presented by
Furniss (1991) and a modified version is presented in this paper. This
understanding of the abuse trauma as experienced by the victim pro-
vides a basis upon which to understand the recovery process, the funda-
mental concept of which is the concept of a Wall of Fear (Oz, 1999).
The stages to recovery are an expansion of those of the three-stage
model:

1. Stabilization
a. the decision to embark upon therapy (Oz, 1995)
b. working toward client-therapist trust
 Sheri Oz 25

c. becoming familiar with the client’s environment and history

d. teaching the client about the therapy process and tools for deal-
ing with the emotional burden of trauma and trauma resolution
2. Trauma Resolution
e. approaching the Wall of Fear (Oz, 1999)
f. dealing with the Wall of Fear (Oz, 1999)
3. Integration
g. the world on the other side of the Wall (Oz, 1999)
h. re-evaluating decisions made earlier in life in view of a new per-
spective resulting from therapy
i. leaving therapy

WHY SEXUAL ABUSE IS SO TRAUMATIZING

In order to understand the experience of the child, we need to look at

what happens during a single CSA incident. Figure 1 graphically illus-
trates that experience and introduces us to two notions: the Shared Real-
ity and the World of Trauma (Furniss, 1991). Members of a family live
in what can be referred to as a commonly shared world of experience.
That means that family interactions are generally known and can be
talked about openly. Even when family members are not together physi-
cally, there can be a sense of togetherness or Shared Reality; for exam-
ple, a mother can look at her watch at 10:00 and, recalling that her son is
in the midst of taking a math exam, wonder how he is doing as she fears
he did not study enough. Or a husband can feel like he is “accompany-
ing” his wife into a very important meeting she has that morning, hop-
ing that by thinking about her he gives her moral support.
There are, however, two dramatic situations in which members of the
family do not all operate within the Shared Reality. The first scenario is
when a husband or wife has an affair, thereby creating a secret. There is
an investment in keeping the secret from other family members in order
to maintain the status quo. When the secret becomes known, the family
is thrown into open crisis, and the marital couple must make decisions
which will determine the future of the family. The second scenario in-
volves when sexual abuse occurs and a child is removed from the fam-
ily’s Shared Reality and is taken very cruelly into a World of Trauma (a
term referring to the “space” in which the abuse occurs, described more
fully below) about which either no one in the family is aware, or, if
aware, no one comments. This leaves the child isolated and in constant
danger. Imposition of the World of Trauma into the Shared Reality, ei-
26 JOURNAL OF CHILD SEXUAL ABUSE

FIGURE 1. Nature of the Trauma (modified from Furniss, 1991)

World of Trauma

Darkness, threats, eye contact

Monster

Fear, anger, pain, helplessness

Entrance Ritual Exit Ritual

Shared Time

ther by discovery of the abuse by one of the family members or by open-

ing up of the secret by someone from outside the home, also throws the
family into crisis and forces each member of the family to take a posi-
tion with respect to the abuse. Often, the entire family, and not just the
perpetrator, have an interest in maintaining the status quo; that is, they
all have an interest in keeping the World of Trauma disconnected from
the Shared Reality.
The means by which the perpetrator selects and grooms the victim
are geared toward ensuring that the victim will not be able to connect the
World of Trauma with the Shared Reality. During the process of groom-
ing, the victim becomes indoctrinated to the abuser’s signals (Conte,
Wolf & Smith, 1989; Rogers & Renshaw, 1993) and over time, these
signals come to trigger in the victim a somewhat altered or dissociated
state, thereby comprising the entrance ritual into the World of Trauma.
For example, when her abuser would wink at her, one four-year-old
would stop whatever she was doing and go robotically to “their special
place.” In another case, a 12-year-old would lie awake in bed until she
could hear her father’s footsteps that accompanied his going to bed–if
the steps went in the direction of her parents’ bedroom, she would relax
and fall asleep. However, if the steps came in the direction of her bed-
room, she would be thrust into the World of Trauma; the sound of his
footsteps comprised the entrance ritual for her. A seven-year-old boy
was abused by his uncle, who would take him on hikes. When the uncle
would say, “Let’s play hide-and-seek,” the boy would freeze, knowing
that his uncle would then tickle him and touch him sexually.
 Sheri Oz 27

For some children, the abuse is not traumatic at the time it occurs. It
may be presented to them as a game, and they regard it simply as that.
The trauma for children like this may come later as a result of the reac-
tions of other adults to discovery of the abuse or when the child is old
enough to understand what really happened and then to understand how
his/her innocence was exploited. One 17-year-old who was abused by
her grandfather from the age of six to eight told her parents that she had
been raped when she was 12, the age at which she understood what he
had done.
The World of Trauma, the “scene of the crime” so to speak, is charac-
terized by several features. The first of these is darkness. Even if the
abuse occurs in the light of day, it is as if a dark cloud descends and cov-
ers the entire world. The child is plunged into this darkness, which is re-
lated to the phenomenon of dissociation that will be discussed below.
Secondly, threats may be made that are intended to secure the child’s
obedience during the abuse itself and even afterwards in not telling any-
one. The child may be threatened with physical harm to him/herself or
to those the child loves. Young children may believe these threats liter-
ally, as they have not yet developed the ability to distinguish between
reality and fantasy. So when the teenage boy threatens the 6-year-old
girl he raped that if she tells he will kill her infant brother, she is sure he
will carry out his threat! When a father threatens to break his son’s legs
if he tells anyone about the abuse he perpetrates on him, the young boy
believes that this is what his father will do. Some abusers may warn a
child that if they tell, no one will believe them, and even if someone
does believe them, that the child him/herself will be blamed. Unfortu-
nately, this is, in fact, what sometimes happens. On the other hand, chil-
dren are often “rewarded” with gifts or special attention for their
“participation” in the abusive acts, and then they feel guilty and need no
threats to keep them quiet.
Another factor which increases the child’s fear and reinforces the
verbal or nonverbal threats is the nature of the eye contact that may be
present. In healthy adult lovemaking, the mutual “looking deeply into
each other’s eyes” enhances the lovemaking experience, adding another
element to the communication of one’s love to the partner. However,
sexual abuse is not love and it is not lovemaking–it is violence by way
of the sex organs. So eye contact is not a message of love, it is a tool for
inspiring yet greater fear. The eye contact is one-sided, from the abuser
to the victim, and it can be described by the saying, “If looks could kill.”
Even if the abuser feels he or she is looking at the child lovingly, the
sexuality of the “look” is confusing to the child and it does not register
28 JOURNAL OF CHILD SEXUAL ABUSE

as “lovingness.” The effect of eye contact during abuse, then, is to instill

fear into the child victim.
In situations in which there is no eye contact, this is reinforcement of
the “unreality” of what is happening. With no eye contact, the child is
totally alone. The abuser is not there with him/her. The child may feel,
“This is not happening” or “Don’t believe your senses.”
Perhaps the most dramatic phenomenon that happens in the World of
Trauma is that as a by-product of the entrance ritual; the loving individ-
ual who resides in the Shared Reality is transformed into a “monster,”
someone other than that loving individual, not him/her. The abuser usu-
ally triggers the entrance ritual and joins the victim some moments later.
The four-year-old described above went to the “special place” and
waited for the abuser to join her; the daughter was already in bed before
her father came; the uncle went behind a bush for a moment and when
he emerged, he was the “not-uncle.”
In this way, the father (or uncle, grandfather, aunt, teacher, etc.) who
loves his little girl so much, more than anyone else in the world, the fa-
ther who gives her presents, who spends time with her, who makes her
laugh–this father is not the abuser. The abuser is a monster, a dark side
of the father, a not-father.
And therefore, the little girl is in a bind. She wants the abuse to stop.
She wants to tell people about the monster. But, however young she is,
she seems to know that if she were to tell about the monster, she would
not be understood. They would think she was talking about her father.
They would take away her father together with the monster. That is not
what she wants. She wants them to take away the monster and leave her
father with her. Even if the father does not show love in the Shared Real-
ity, the child knows that his/her life depends on him.
One child, when he was eight years old, could not bear the abuse any-
more and decided to tell about it. He took the chance that the “monster
father” would break his legs as threatened. That was already a better op-
tion than the continuing pain and the humiliating encopresis he suf-
fered. But when his father was put in jail awaiting trial and was no
longer at home to do his homework with him or to take him bike riding,
the boy regretted having told. He became depressed. He refused to co-
operate with the investigation and told everyone he had lied because he
was angry at his father for something.
When the abuser is not a member of the nuclear family, it is possible
that the child was psychologically dependent upon him/her due to a de-
gree of parental emotional neglect, which left the child vulnerable to the
grooming of someone who promised to provide the missing nurturance.
 Sheri Oz 29

In this case, upon returning to the Shared Reality, the perpetrator may or
may not revert back to the loving individual he or she was before the
abuse began. The threats are what maintain the secrecy in this case.
Within the World of Trauma, the victim is wracked with pain, terror,
and rage. There may be no physical pain, but there certainly is emo-
tional pain and the pain of loneliness. During the abuse event, the loved
adult, having become a monster, is not an object to which the child can
remain attached, and there is no one else there to save him/her (Grand &
Alpert, 1993). So the child is alone. Additionally, there is a sense of
overwhelming helplessness of not being able to stop what is happening.
All of these feelings are too intense for a child or young adolescent to
bear, and the victim dissociates in order to survive (Loewenstein, 1993).
The dissociation can be in the form of depersonalization, or in more
extreme cases of trauma, to the extent of Dissociative Disorder Not Oth-
erwise Specified (DDNOS) or Dissociative Identity Disorder (DID;
Rothschild, 2000; Spiegel, 1993). Regardless of the degree of dissocia-
tion, the cloud of darkness which falls upon the World of Trauma, as
discussed earlier, remains with the child even after the traumatic event.
The child goes through daily life feeling cut off from the Shared Reality,
living life “in a fog” or “behind a glass wall” or as if “in a movie.” He or
she may experience colors as tones of gray–grayish green, grayish red,
etc.–and not as distinct colors; sounds may be muffled so that music and
birdsong may have lost their sharpness.
Perhaps the experience of being in the World of Trauma is similar to
being in an episode of the old television program, “The Twilight Zone”–
going into another dimension parallel to our known reality but not inhab-
ited by anyone else but the abuser and the victim. Momentarily, the vic-
tim ceases to live in the real world and even fears that he or she will not be
able to return to the real world.
When an abuse event ends, the victim and perpetrator must return to
the family’s Shared Reality. They do this by use of an exit ritual. A
word, a sentence, a gesture by the abuser signals to the victim that the
abuse event has come to an end, such as in the following examples: (1) Af-
ter reaching sexual satisfaction, one father would say to his daughter,
“After I leave, you go to pee and then clean yourself up. You’re such a
mess!” He would always use the same words, like a script. And know-
ing her part in the play, she would wait for him to leave the room and
would go to clean herself up. By the time she would leave the bath-
room, she would already feel that she had dreamed up the whole inci-
dent. (2) An 11-year-old boy was repeatedly fondled by an uncle who would
simultaneously bring himself to orgasm. During the entire incident, his
30 JOURNAL OF CHILD SEXUAL ABUSE

uncle never looked at him. The boy felt as if he didn’t really exist. And
when it was over, his uncle would wordlessly readjust his clothing and
just leave the scene. The boy would force himself to fall asleep, if only
for a few moments, and then he’d wake up as if it never happened.
Note how the abuser withdraws from the scene, leaving the child
alone to re-enter the Shared Reality by him/herself. This further en-
hances the sense of unreality of the abuse and of the World of Trauma
and consolidates the split between the “monster” and the loved person.
Knowing that he or she cannot tell others about the abuse experience, it
is in his/her interest to split it off from apparent awareness. This is part
of the mechanism behind the “forgetting” that many CSA survivors ex-
perience (Mollon, 1996). How else can we explain the ability of the
child to get up, get dressed, eat breakfast, and go to school as if nothing
had happened the night before? How else is it possible to understand
how a child goes to a family celebration in the presence of the abusing
family member without giving him/her away?
However, the dissociative split between the World of Trauma and the
Shared Reality is not hermetic. There is a slow leakage of the abuse ex-
perience into the daily life experience: the grey dissociative cloud that
hovers over the victim’s world, the feeling of being alone in the world,
undefined fear, shame, and worthlessness. Symptoms that others can
observe, such as acting out or acting in, are the expression in the Shared
Reality of the World of Trauma even though non-offending parents,
teachers, etc., may not interpret these signs correctly. They are not al-
ways a call for help, but represent the inability of the child to contain the
intense emotional burden of the trauma. (In some cases, because of the
threats made by the abuser, the child feels he or she is in some way pro-
tecting the family by keeping the secret and does not want the secret to
be discovered.)
What develops for the child is a sense of living in the two worlds si-
multaneously, so that even after the abuse in fact ends, the World of
Trauma is experienced as “living on alongside present time”–like walk-
ing with each foot on the parallel tracks of a railway line. At the same
time, the child also feels like he or she is walking a tightrope between
these two worlds. Just like light is both a particle and a wave, the child is
walking both on the railway tracks and on the tightrope. The child is in
both worlds at the same time and in neither World. This is what lies be-
hind his/her sense of being different, of being crazy and hiding it from
everyone. The child is afraid that one moment of not paying attention
and he/she will lose control and become insane. This is the experience
that many untreated survivors of CSA carry into adulthood.
 Sheri Oz 31

THERAPY

Survivors of childhood sexual abuse seek therapy under a variety of

guises. Some start therapy with clear memories of the abuse and the de-
termination to get help in overcoming the ravages of the phenomenon.
Others may not remember having been abused, or they may be too
scared or humiliated to discuss it in a straightforward manner. They
may report that they need help with relationship problems, psychoso-
matic ailments, or parenting. Alternatively, they may be unable to point
to anything more than a general sense of dissatisfaction with life. Some
survivors request therapy for serious problems, such as addictions, im-
pulsive behaviors, depression, suicidality, or phobias. Regardless of the
manner of presentation, therapy will follow a similar path for most cli-
ents (see Figure 2), the ultimate purpose of which is the convergence of
the World of Trauma within the Shared Reality, such that the survivor
no longer lives between the two worlds as described in the previous
section, and events of the past feel like they really are in the past.
All therapists have their own unique way of beginning therapy, a
stage which involves a process of familiarization for both client and
therapist. However, one of the errors a therapist can make at the outset is
to assume that a client who has made a first appointment has decided to
be a therapy client. The decision to embark upon a program of therapy
for CSA is a brave decision and one that should be explored in sessions
(Oz, 1995). Trauma therapy is a frightening prospect, and it is possible
that the client has not decided to resolve their issues but just to have an
anchor that helps them survive from week to week. It is frustrating for
the clinician to be in this role, and in such cases, the therapist may be
tempted to see the client as resistant. If the therapist can provide a
good-enough holding environment, the client may develop sufficient
ego strength, and the trauma therapist can then fall into his/her more fa-
miliar role of more active interventions. This may, in some cases, take
years.
The first task of therapy is to establish the groundwork for building a
relationship of trust between the client and the therapist. This is done
during the initial stages of the therapy process in which clients share
their life story: family background and current life situation, including
employment, couple relationships, children (if any), friendships, symp-
toms, and clients’ understanding of the problem. Clients note, some
consciously and some only unconsciously, how the therapist relates to
them and to the information that is unfolding before them. Does the
32 JOURNAL OF CHILD SEXUAL ABUSE

FIGURE 2. The Stages of Therapy in the Treatment of CSA Survivors

W
A
Decision to be L
in Therapy
L

TRUST O
F
Family of Origin
Current Life Situation
Symptoms F
E
A
R

therapist listen respectfully? Is the therapist judgmental? Is the therapist

cold or empathic? How do I feel in the room together with the therapist?
However, abuse survivors have difficulty assessing how they feel with
a therapist. After all, as children they were led to believe that they could
not trust their own senses: the abuser may have told them that what was
happening was love and, therefore, not wrong. The non-abusing parent
may have said: “Your uncle would not do such a thing! You must have
misunderstood.” The resolution of this dilemma is either to decide that it
is not safe to trust anyone and to become prematurely self-sufficient, or to
continue to hope that the abusive or neglectful adult(s) will “come to their
senses” and to cling to them until that happens. Whichever solution a par-
ticular individual finds, this will then be repeated throughout life with
other adults in the family, with teachers, with friends, with therapists, etc.
So clients who gave up trusting and decided that nobody is worthy of
their trust expect to be disappointed again and again. Yet they crave the
experience of being able to relax and rely on another human being to take
care of them. And clients who trust blindly need to learn to withhold ab-
solute trust, and test trustworthiness instead. It is important to recognize
these polarized positions of the CSA survivor and to encourage clients to
challenge their own approaches to trust issues. It is important for the ther-
apist to expect to be tested.
At an early stage of therapy, clients can be asked if there was some-
one they knew during their childhood who valued them. Most of them
can confirm that there was at least one such individual. In this case, it is
possible to suppose that this client knows how it feels to be positively
regarded and knows how it feels to trust, and that can serve as a founda-
tion upon which to build the therapeutic relationship. While many cli-
 Sheri Oz 33

ents have had the good fortune of finding at least one trustworthy
individual with whom they were able to feel trusted and cared for, there
are those for whom the world contains only hurtful, exploitive, or uncar-
ing people, both in the past and in the present. For these clients, the ther-
apist knows that he/she will have to single-handedly fulfill a role that is
better shared among several individuals within the client’s own social
environment.
It can be anticipated that most clients will feel stuck at various points
along the path to recovery and they won’t believe that they are making
any progress at all. One way to prepare for that is to set up a baseline
against which the client can compare his/her psychological state at later
stages of the therapy. For example, after the first or second session, a ki-
netic HTP (a house, a tree, and a person, with movement in the drawing
[Burns, 1987]) can be requested. At later stages of therapy, they can be
asked to repeat the kinetic HTP and by viewing the series of drawings,
they can see for themselves that there has been movement and that the
process is dynamic.
H’s first drawing is shown in Figure 3. When H (age 50) entered ther-
apy, she was aware of her father’s physical abusiveness and described
being overwhelmed by her uncontrollable rage. At the beginning, she
had no memories of sexual abuse.
In H’s first kinetic HTP, we see the figure running toward the house
with arms outstretched. It is not clear if the arms are showing anticipa-
tion about arriving home or a need for self-defense. It is clear, however,
that the figure, lightly drawn and hollow, is the least emphasized ele-
ment in the drawing. The house, on the other hand, is heavily shaded
and outlined. In the windows are curved lines implying unrest within
the home. The door is emphasized in such a way that it appears to be in-
viting, but at the same time is barred, indicating that it is not necessarily
true that one can enter the house or that what happens in the house can
be shared with others. The tree overhanging the house appears to have
legs but it is not clear in which direction it is running–toward or away
from the house. The overall impression of the drawing is one of anxiety,
insecurity, and invisibility.
While the client and therapist are getting to know each other and
growing used to working together, the client usually feels an initial
sense of relief; starting therapy raises hopes that life can be better, that
problems can be solved. Now that there is a place to talk about what is
distressing and difficult, the loneliness that the child abuse survivor
feels is relieved somewhat. There is someone who cares, someone who
understands. They usually feel better after the session than they did be-
34 JOURNAL OF CHILD SEXUAL ABUSE

FIGURE 3. Kinetic HTP Drawn by H at the Outset of Therapy

fore. After a short while, the week begins to revolve around the day of
the appointment. No longer is the week from Sunday to Sunday, but if
the therapy session is on Tuesdays, then the week is from Tuesday to
Tuesday. The client says: “I’ll wait and tell that to my therapist on Tues-
day.” Dreams seem to be dreamed on the night before therapy. Even for
the client who dreads therapy because it is painful, the week is still orga-
nized around the day of the sessions. These are signs that a relationship
is forming, a relationship in which the client depends upon the therapist.
That dependence means that the relationship with the therapist has
become important to the client. Yet, clients can experience this as dan-
gerous. They can feel they are losing control and giving it up to the ther-
apist, and since the abuser had control and maliciously exploited it, this
can be particularly frightening for the client. Some clients do not man-
age to deal with this fear and pull away from therapy again and again,
therapist after therapist, despairing of their ability to ever heal.
Most clients, however, do manage to cope with this growing depend-
ence and accept it as part of the therapeutic process. At this time, the
therapist helps the client find ways to handle overwhelming emotion,
teaching self-soothing procedures which the client can apply when be-
 Sheri Oz 35

ginning to feel loss of control out of session. Depending upon the clini-
cian’s training, guided fantasy, body-oriented therapies, or EMDR (see
Appendix) may be used for this. However, not all clients find self-
soothing methods useful, and some may balk when the therapist sug-
gests learning them, regarding such an approach as foolishness or not
serious. In some cases, therefore, the self-soothing tools can be intro-
duced only in-session when the client actually feels overwhelmed as op-
posed to something to be applied at some undefined later time. Moreover,
previously practiced self-soothing techniques may suddenly be found to
be ineffective as the therapy proceeds and the most intense emotional ma-
terial arises.
As therapy progresses beyond the initial period in which clients feel
hopeful about resolving their trauma history and relief at having a place to
talk about distressing issues, they notice that pressures build up once
more. They often start to fear coming to therapy without understanding
why. Clients also notice that during the week or on the way to the clinic,
they may be very clear about what they want to talk about, but as soon as
the clinic door shuts behind them, their minds often go blank. This seems
similar to the phenomenon of speechlessness at the time of the traumatic
event itself, apparently caused by the shutting down of Broca’s area
(Hull, 2002; van der Kolk, McFarland, & Weisaeth, 1996). In other
words, the therapy room itself seems to be a recreation of the World of
Trauma. There are other parallels–the client is alone in a closed room
with one other person; what happens in this room is painful and arouses
overwhelming emotions; there are entrance and exit rituals to the therapy
hour.
Some clients do significant work on themselves before coming to
therapy. In such a case, or when they have been to other therapists in the
past, they may already be standing close to the Wall of Fear at the start
of this new therapeutic process. For others, it may take many months or
years to reach this point.

THE WALL OF FEAR

The experience of approaching the Wall of Fear involves increasing

intensity of the symptoms which originally plagued the client when be-
ginning therapy. Depression becomes deeper, suicidal thoughts may be
dangerously frequent, dominating thoughts and fantasies, anxiety at-
tacks grow more serious, obsessions become more pervasive, and
self-injurious and other compulsive behaviors seem even more difficult
36 JOURNAL OF CHILD SEXUAL ABUSE

to control. Those with eating, substance abuse, and obsessive-compul-

sive disorders find that, while they may have gained some control of
their impulses in the initial stages of therapy, the battle may become
more difficult as they approach the Wall of Fear. Both the containment
provided by the therapeutic relationship and the self-soothing tech-
niques the client may already have learned paradoxically allow the
client to become more distressed.
It is important for the therapist to distinguish between increasing dis-
tress which is part of an increased ability to tolerate overwhelming affect,
and increasing distress which is a sign that the client is decompensating.
In any case, the client may not let the therapist steer him/her away from
the direct trauma work. Different options for dealing with traumatic
memories (EMDR, TIR, SE, narrative or arts-based techniques) and the
option of not directly processing the trauma should be discussed with the
client openly and a joint decision made regarding how to proceed. Not
proceeding with the trauma work at this time may just mean that it is de-
layed, rather than not necessary.
Generally, the most intense and distressing part of therapy is around
the issue of crossing the Wall of Fear, and the greatest amount of time
and energy in therapy is spent standing in front of the Wall. Clients
know that they have to cross over to the other side of the Wall even
though the thought is terrifying. Some clients describe it, not as a wall,
but as a cliff from which they know they have to jump. The client feels
him/herself approaching the Wall of Fear and bouncing back from it in
panic. This happens over and over again. Clients often feel that they will
never be able to get beyond this point, and many despair of ever getting
control of their lives.
The frightening aspect for the client is that he/she does not know
what lies on the other side of the wall or at the bottom of the cliff. And,
while staying in place is more and more unbearable, at least the pain and
other emotions involved are familiar. It is interesting, at this stage, to
have clients redraw the kinetic HTP that they did at the outset of ther-
apy. H’s drawing is shown in Figure 4. We can see many interesting ele-
ments in this drawing compared with the first one: the heaviness of the
lines and shading show a great deal of anxiety, much more than was
present at the start of therapy. Yet, at the same time, the figure has more
“presence”; it is no longer hollow, has been clothed, and has hair and
some sign of facial features. The figure remains in the same pose as be-
fore. Now there is an additional figure in the doorway; is this the client’s
mother? Or perhaps it represents the therapist. The house has changed
and seems to be the client’s current home, one built alongside the origi-
 Sheri Oz 37

nal house in the farming community in which she grew up. The win-
dows still show evidence of a storm inside the house, and there is great
attention to detail. So, the client is becoming more aware of her inner
life and more in touch with her feelings, which necessarily corresponds
with an increase in anxiety.
This is also the most difficult stage of therapy for therapists. It is ex-
cruciating to watch the pain and despair experienced by clients, in addi-
tion to the fear that clients may commit suicide. This is also a precarious
point in that clients are tempted to leave therapy, feeling there is no help
for them. The client’s trust in the therapist is crucial at this point to en-
able therapist and client to work together in dealing with the Wall of
Fear. Clients may test the therapist’s trustworthiness in some “very cre-
ative” ways at this point. For example, H left the country for a month to
visit her daughter, calling me from the airport on the morning of our
scheduled EMDR session.
Clients can be helped to explore the issue of leaving therapy when the
subject arises. Using a cost-cost analysis (Oz, 1995), the salient aspects
of the dilemma are listed. We can look at the list of costs B (age 37)
drew up regarding this issue:
Costs of leaving therapy Costs of continuing therapy
- continue to suffer same pain and fear - won't be able to stand the growing pain
- remain alone with the secret - have to tell husband I can't stand to have
- no hope of change sex with him anymore
- continue to have problems at work - money, energy, and time spent on therapy
- will keep waiting just to die - won't be able to function well at work
- won't be able to deny what happened and
will have to decide what to do with family
relationships
- his threats of what would happen if I tell
will come true

From this table, B saw the difference in the nature of the costs of leav-
ing and continuing therapy: the costs of leaving therapy were known and
continuing therapy entailed taking a chance with the unknown. To stop
the sessions would mean continuing life in the same degree of suffering
that originally brought her into therapy. She found that unbearable before
and there was no reason to think that she would not eventually either re-
turn to therapy or commit suicide. Most significant for her was that the
38 JOURNAL OF CHILD SEXUAL ABUSE

FIGURE 4. Kinetic HTP Drawn by H During Stage of Dealing with the Wall of
Fear (10 Months After Start of Therapy).

thought of continuing our work brought her up against the threats her
abuser made. While as an adult she recognized the irrationality of this, at
an emotional level she felt paralyzed with fear. She further recognized
that leaving therapy meant keeping the secret and maintaining the status
quo at great cost to her; continuing therapy would involve breaking the
secret, thereby involving others and affecting relationships with the fam-
ily. Therefore, her decision was also a choice between continuing to pay a
personal price and possibly paying the price of relationships. Thus, she
was faced with choosing what she valued most–a chance for either im-
proving her own mental health or protecting relationships and not upset-
ting others. Clients sometimes choose one and sometimes the other. It is
important that we accept even the decision to leave therapy at this junc-
ture. When we respect their decision to “take a break” from therapy, they
find it easier to return later, usually with renewed strength and determina-
tion.
As clients deal with the Wall, they can be shown a drawing of the
map of recovery (Figure 2), and the stages up to the Wall of Fear can be
explained. When asked what they anticipate lies on the other side of the
 Sheri Oz 39

Wall, they invariably reply with one or more of the following: death, in-
sanity, or emptiness. It is not surprising, then, that in order to continue
through the Wall they must fight hard against all their most basic sur-
vival instincts. They can be reassured that there will be no death and no
insanity. But there will be emptiness.
The figure illustrating the nature of the trauma (Figure 1) can be re-
drawn for the client in order to demonstrate that the Wall of Fear is actu-
ally the boundary around the World of Trauma. Remember that the
child at some point dissociated out of the World of Trauma in order to
survive: the child felt that if the abuse lasted one more second, he/she
would either die or go insane and dissociation was the best strategy
available. Now, as the client progresses in therapy, he/she comes closer
to the World of Trauma. In other words, the client must reconnect with
the experience of the abuse in order to survive the experience without
dissociating from it. This means that moving along the map of therapy
brings the client backwards in time through the dissociative state to the
moment of splitting. The client must reconnect with the moment before
dissociating out of the horrors of the abuse; for some this is connected
with the abusive acts themselves and for others, such as B above, it is
telling in spite of the threats the abuser made. This empowers the client
who learns that he/she can live through the intense emotional experi-
ence without either dying or going insane. He/she can feel all the terror,
rage, pain, and helplessness and not fall apart.
Clients have been reported to find themselves in a hospital emer-
gency ward after a therapy session with either a dissociative or psy-
chotic breakdown or with somatic complaints caused by severe anxiety
(see Gold, 2000; Herman, 1992). This is the reason trauma memory
work is so controversial. However, several questions need to be asked
here: who got more scared by the apparent impending collapse of the
client–the client or the therapist? Has the therapist enough experience
working with survivors of trauma to withstand the intensity of the emo-
tional release of the abreaction? By being hesitant regarding trauma
work, is the therapist conveying his/her own fear of the work to the cli-
ent and setting the client up for possible decompensation? By not hav-
ing enough respect for the potential power of the abreaction, is the
therapist leaving the client open to an “unpleasant surprise?” A case
example may prove instructive:
Y (age 28) had been in psychodynamic therapy for over a year with
another therapist, having embarked upon therapy with vague feelings of
dissatisfaction. Over the year, her distress grew and she began to have
anxiety attacks characterized by stomach pains and nausea. By the time
40 JOURNAL OF CHILD SEXUAL ABUSE

she started to see me, she had dreams of having been raped in early
childhood and she was “visiting” emergency rooms on a regular basis.
She was seeing a psychiatrist for psychomedication.
The night after her first session with me, in which we discussed her
previous therapy and her current life situation (her mother had moved in
with her and her husband), she suffered a breakdown. Her husband
called to tell me she was lying on the floor with her thumb in her mouth
muttering incomprehensibly and oblivious to all around her. Before
suggesting taking her to Emergency, I decided to try to help her with
Traumatic Incident Reduction (TIR–see Appendix). My reasoning was
that if it didn’t work, we could always take her to the hospital later. I did
not want to enhance her already present sense of fragility and depend-
ence upon medical interventions. Given her history of emergency “vis-
its,” it is possible that this time she may have been hospitalized and that
could have had serious impact on her sense of self and on her career.
Furthermore, dissociative fugues such as this are generally time-limited
and self-extinguishing (Reshef, 2003).
Limp and held up on either side by her mother and her husband, I
worked with her using TIR. At first there was not much response from
her, but gradually she began to talk in a child’s voice about what she was
experiencing in her body. After almost two hours, she opened her eyes,
looked around, and asked in her adult voice if there was anything in the
house to eat. She knew she had suffered a breakdown but had no mem-
ory of any content. There were two more instances like this one that
summer and then work proceeded as per the section on “after the Wall
of Fear,” during which time memories of the rape became available to
her in her adult state.
The best tools for working on moving through to the other side of the
Wall of Fear are EMDR, TIR, or some forms of body-oriented ap-
proaches. While these clinical tools do not help everyone, when they do,
they significantly shorten the length of time it takes to deal with the
Wall of Fear phenomena.
Some clients experience crossing the Wall of Fear as a one-time
event that puts the fear, suicidal thoughts, and depression behind them;
other clients experience the Wall of Fear as a series of walls, some
higher, thicker, and harder than others. In this case, they flip back and
forth between “before-the-wall” feelings and “after-the-wall” feelings.
Getting through the Wall of Fear initially brings a form of relief, and cli-
ents are glad to see that neither death nor insanity waits for them on the
other side.
 Sheri Oz 41

THE OTHER SIDE OF THE WALL

Shortly after having crossed the Wall of Fear, whether this is one wall
or a series of walls, clients are overwhelmed by deep sadness. This is no
longer depression, but sadness. The crying now is not merely tearing up
but deep sobs which come up both from the abused inner child part that
is finally able to release the pain and from the adult ego state that
mourns the losses associated with having been abused: the loss of inno-
cence, of the ideal family s/he was supposed to have had, of the ability
to have fun, the ability to concentrate, to have intimate relationships,
etc. The crying brings a sense of relief, yet at the same time, the empti-
ness they anticipated feeling does, in fact, overtake them. This is the
emptiness of not having had anyone to take care of them as a child. For
even if the abuse occurred outside the family, the child who felt he/she
could not talk about what was happening was a very lonely child who
lived in a world that did not take care of him/her. It is also the emptiness
of the objectless state within the World of Trauma.
Depression, which leads to self-injury and suicidal thoughts, can be
thought of as a form of self-anger, perhaps resulting from the guilt children
feel, thinking they were responsible for their own abuse. After crossing
over to the other side of the Wall of Fear, the self-directed anger changes
into anger toward the perpetrator(s) and to an even greater degree toward
other adults who were supposed to have protected them and did not. This is
different from the diffuse rage felt before the Wall. Thoughts of revenge
may come up, and “murder fantasies” replace suicidal ideation. Managing
the anger and desires for revenge is easier than dealing with the depression
and suicidality for the therapist, if not for the client.
The grey clouds that hung over their lives start to lift. One day a client
will notice that s/he sees colors or hears sounds more clearly than ever
before because s/he is no longer walking around in a fog or behind a
glass screen.
It can take months for the sadness, pain, and anger to begin to sub-
side. During this time, clients also deal with the sense of not knowing
who they are. There is the recognition that, until now, their identity con-
sisted of having been a victim and that that is no longer appropriate; but
they do not yet have an alternative identity. They feel that they were not
allowed to develop into the individual they were born to be. Therefore, a
great deal of energy is invested in discovering a new identity based upon
survival and strength.
The World of Trauma becomes integrated within the Shared Reality,
such that the events of the World of Trauma are no longer secret and can
42 JOURNAL OF CHILD SEXUAL ABUSE

be discussed with others. In addition, events belonging to the World of

Trauma become memories of the past and are no longer experienced as
something that is still happening in current day-to-day life.
As the client starts to emerge from the sense of emptiness, this is the
time to begin assertiveness training and to begin making decisions for
the future. This may include re-examining decisions made in the past.
Some clients decide to change careers; others wonder if their marriages
are still tenable (Oz, 2001). They decide whether or not to confront their
families and/or the abuser, and what kind of relationships they want to
maintain with the family of origin and extended family.
H’s kinetic HTP from this time is shown in Figure 5. Here we can see
that the anxiety has lifted. Surprisingly, there is no tree at all. The house
seems to have lost its powerful impact–there are now no windows and
so no storm is apparent. Interestingly, the door resembles either a bed or
a grave. Perhaps one can say that the abuse has been “put to rest” or bur-
ied. Attention has shifted from the house to the self, the “person” being
much fuller than ever before with clear facial features and a smile. How-
ever, it is clear that a new identity has not yet been solidified. In spite of
that, H felt that she had gotten what she could from therapy. She had no
more interest in coming in for sessions, feeling she had the tools she
needed for tackling life’s problems.
One year later, H sent me a letter and a new drawing. The drawing is
illustrated in Figure 6. Now we see lines that are clear and not overly
shaded or emphasized. The figure walks nonchalantly in a stance that is
relaxed and assured. The house is decorated with flowers and the win-
dows no longer show signs of any storminess within. The tree is clearly
alive and youthful in appearance. Her letter describes how at the end of
therapy she was still tense and would explode in anger at members of
her family. However, gradually she felt herself strengthening from
within, growing calmer. Her compulsive housekeeping gradually disap-
peared, and she developed a stronger relationship with her husband and
children. Finally, the raging disappeared. This emphasizes the fact that
there is a kind of inertia to the therapeutic process by which change
continues even after the formal clinical work has ended.

CONCLUSION

This paper presents the concept of a Wall of Fear as a focal point of

therapy for survivors of childhood sexual abuse (CSA). It is proposed
here that the Wall of Fear is a phenomenon which is present to some de-
 Sheri Oz 43

FIGURE 5. Kinetic HTP Drawn by H at Termination of Therapy

gree in all work with survivors regardless of the clinician’s theoretical

orientation because of the observation that the therapy room itself takes
on the qualities of the World of Trauma, the metaphorical “crime scene”
of the original abuse events.
Because of the very real fear of retraumatization, professionals have
been searching for ways to resolve the sexual trauma that would be less
brutal than abreactions have been found to be. This has led to the approach
according to which much of the early stage of therapy is invested in devel-
oping self-soothing techniques that would promote gentler and more con-
trolled resolution of traumatic memories. However, self-soothing is not
effective for all clients, and even when the client was able to modulate in-
tense emotion earlier in therapy, they may not be able to maintain this abil-
ity when moving closer to traumatic memories. It is important, therefore,
that the concept of the Wall of Fear is understood so that neither therapists
nor their clients feel like failures.
Recent approaches suggest that teaching self-soothing techniques and
life skills may constitute an end in itself, even eliminating the need for ab-
reaction of the traumatic events (e.g., Gold, 2000). This observation does
44 JOURNAL OF CHILD SEXUAL ABUSE

FIGURE 6. Kinetic HTP Drawn by H One Year After Termination of Therapy

not take into account: (1) the fact that therapy clients often engage in a se-
ries of therapies; and (2) the fact that clients enter therapy with a variety
of initial levels of functioning, ranging from nonfunctioning to high
achievers. Reaching a level of functioning previously unknown is cer-
tainly a legitimate goal of therapy; however, if therapists somehow lead
their clients to believe that this is the best they can hope for, without pre-
paring them for the possibility that after “this round” of therapy they may
proceed toward the Wall of Fear on their own and require further help,
clients may feel shamed by their seeming inability to maintain the thera-
peutic gains.
For the client who was highly functional before therapy began, both
the client and the therapist need to be prepared for the likelihood that
there will be a period of time during which functioning decreases signif-
icantly. In this case, it is important to ensure that significant others are
aware of the therapy map in order to provide effective support for the
client (Oz, 2001) and attempting to time the work around the Wall of
Fear to periods in which decreased performance is less detrimental,
such as during holidays. (Of course, this is not always possible.)
 Sheri Oz 45

The increased symptomology experienced by many clients when

working with the Wall of Fear brings therapists in touch with their own
countertransferential fears (Reshef, 2003). The therapist who can remain
a calm presence will help the trauma survivor “ ‘ride out’ the anxiety in a
safe environment,” thereby reducing the sense of danger inherent to the
memories until then (Rothbaum & Schwartz, 2002, p. 65). Experience,
good supervision, and an inner understanding that crossing the Wall is an
inevitable part of the therapy process for many clients gives the therapist
the confidence to do this.
In conclusion, it is suggested here that CSA therapy has a natural life
span and that following it through means dealing with the Wall of Fear
and traumatic memory resolution as an inevitable part of that process.
Just like some people are content with a high school education while
others go on to a PhD, and some couples are happy if their lives run
smoothly with minimal communication while others work hard to
achieve a deep level of emotional intimacy, some CSA survivors con-
sider themselves lucky to be able to get up in the morning, go to work,
and come home to a spouse and/or children whereas for others this is
their starting point for therapy. In other words, some clients come to
therapy to learn the tools for avoiding approaching the Wall of Fear
(self-soothing) that other clients have been able to apply since child-
hood (functioning as a form of avoidance) and no longer find helpful to
their sense of self. For all clients, the Wall of Fear is a defining feature,
whether as something to be avoided or something to be crossed. Clini-
cians provide the opportunity for clients to do whatever is right for them
by virtue of the fact that the therapy room, itself, takes on the qualities of
the World of Trauma.

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 Sheri Oz 47

APPENDIX

Body Oriented Treatment. There are several approaches to working

through trauma through the body. These include, but are not restricted to:
Somatic Experiencing (Levine, 1997), Safe Body Therapy (Rothschild,
2000), and Sensorimotor Psychotherapy (Ogden & Minton, 2000). The
rationale for these approaches is that the traumatic memories remain
locked within the brain and the body, and working somatically helps
safely release the individual from the traumatic triggers (Websites:
www.traumahealing.com, www.trauma.cc, www.sensorimotorpsycho
therapy.org).
EMDR–Eye Movement Desensitization and Reprogramming. A
method developed by Francine Shapiro (1995) to promote desensitiza-
tion of triggers of trauma or phobic responses and cognitive restructur-
ing for cognitive errors. Once based upon eye movements, it now
comprises a variety of bilateral stimuli (auditory, tactile) applied while
working through well-defined protocols. The international EMDR as-
sociation provides training worldwide for licensed mental health pro-
fessionals (Website: www.emdrportal.com).
Guided Fantasy–also called Guided Imagery (e.g., Esplen, Gallop, &
Garfinkel, 1999). This is a form of relaxation, which allows for in-
creased concentration and ability to notice feelings or sensations that
are otherwise not attended to. Resolution of memories and cognitive er-
rors is possible (Dolan, 1991). It is related to hypnosis but without the
formal hypnotic induction process. While self-help books abound that
give instruction in guided fantasy to the professional and layman alike,
this is a powerful tool and should not be attempted without attending a
course with a qualified instructor.
TIR–Traumatic Incidence Reduction. TIR (French & Harris, 1999) is
a form of exposure therapy that consists of having the client repeatedly
review the traumatic event that the client him/herself has selected for
working on. Sessions are time-unlimited and proceed until the client
reaches a point of resolution marked by three criteria: the event is expe-
rienced as having happened in the past, the client is obviously relaxed
and relieved of the emotional charge of the memory, and the client has
reached a new cognitive understanding of the event or its context. The
therapist, who provides a safe milieu within which to process traumatic
memories, offers no interpretation and all insights originate with the cli-
ent him/herself. Trainings for professionals are offered around the
world (Website: www.tirtraining.com).

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