Article Strengthening Vicarious Resilience in Adult Survivors of Childhood Sexual Abuse: A Narrative Approach to Couples Therapy Charity Francis Laughlin1 The Family Journal: Counseling and Therapy for Couples and Families 2020, Vol. 28(1) 15-24 ª The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1066480719894938 journals.sagepub.com/home/tfj and Kaitlyn A. Rusca1 Abstract Childhood sexual abuse (CSA) is correlated with numerous adverse effects, both intrapersonal and interpersonal. Couples where one or more partners is a CSA survivor often report problems in social/relational adjustment, emotional expressiveness, revictimization, low relationship satisfaction and stability, and sexual dysfunction. Despite the adverse effects of CSA, some individuals with a history of CSA retain typical levels of functioning, and data from studies of resilience in CSA survivors suggest the importance of social and relational support for favorable outcomes. Resilience is not only an individual factor but also a social, ecological process, and research on vicarious resilience in therapist–client relationships suggests that resilience can be transmitted across relationship systems through a combination of witnessing resilience stories and beliefs about the possibility of resilience and its transmission. We suggest that in romantic partnerships (including nonheteronormative configurations) where one or more partners has a history of CSA, narrative couples therapy is well suited to address the systemic impacts of trauma and resilience by facilitating the transmission of each partner’s resilience to the other. Two narrative interventions, mapping and definitional ceremonies, are suggested to facilitate the transmission of resilience within the couple system through the sharing and witnessing of each other’s subjugated resilience narratives, thereby promoting a re-authored preferred identity based on acceptance, strength, and agency rather than shame, avoidance, and interpersonal difficulty. Keywords childhood sexual abuse, narrative couples therapy, vicarious resilience, definitional ceremony, mapping Childhood sexual abuse (CSA) is an interpersonal trauma defined by the American Medical Association (1992) as “the engagement of a child in sexual activities for which the child is developmentally unprepared and cannot give informed consent” (p. 5). Townsend and Rheingold (2013) report a CSA prevalence of 10.7–11.4% for females and 3.8–4.6% for males across six studies of adolescent populations in the United States. Similarly, data pooled from several U.S. telephone surveys of 17 year olds (n ¼ 708) suggest a combined CSA/sexual assault prevalence of 11.9% for females and 1.9% of males by an adult perpetrator; when perpetrators under age 18 are included in the data, the rate increases to 26.6% for females and 5.1% for males (Finkelhor, Shattuck, Turner, & Hamby, 2014). These studies suggest that CSA is a significant social issue that impacts females much more often than males (to date, CSA prevalence data do not distinguish gender identities other than male and female). Incidence is likely higher, however, due to lack of disclosure; in particular, males are less likely to report abuse or take much longer to report abuse than females (O’Leary & Barber, 2008). CSA is a particularly complex type of interpersonal trauma because love and exploitation are often commingled, and the abused individual may be silenced, shamed, blamed, or met with disbelief when she or he discloses the abuse (Nasim & Nadan, 2013). Documented correlates of impaired functioning with CSA history across child, adolescent, and adult populations include “depression, post-traumatic stress disorder (PTSD), substance abuse, impaired academic/occupational functioning, and inappropriate sexual behavior” (McClure, Chavez, Agars, Peacock, & Matosian, 2008, p. 81), and CSA survivors often experience low self-esteem and views of the self as bad or worthless (Saha, Chung, & Thorne, 2011). Correlates common to males with CSA history include conduct disorders, personality disorders, suicidal ideation, depression, anxiety, PTSD, shame, difficulty expressing emotions, relationship challenges, trauma reenactments, identity confusion, intrusive memories, and sexual dysfunction (Crete & Singh, 2015). A qualitative study of adult women with active memories of CSA found that these women 1 Couples and Family Therapy Program, School of Theology and Ministry, Seattle University, WA, USA Corresponding Author: Charity Francis Laughlin, Couples and Family Therapy Program, School of Theology and Ministry, Seattle University, 901 12th Ave., Seattle, WA 98122, USA. Email: laughli5@seattleu.edu 16 The Family Journal: Counseling and Therapy for Couples and Families 28(1) invest energy into “uncoordinated alliance protection” (Kochka & Carolan, 2002, p. 65), tending the relationship at the expense of self and ignoring their own needs. Another study found that adult female survivors of CSA are less empathically accurate than nonabused controls; the researchers hypothesized that empathic inaccuracy may be a coping mechanism to manage the anxiety of a potential relationship rupture (Millwood, 2011). CSA history also impacts interpersonal relationships; relationship distress, low satisfaction, low relationship stability, and sexual problems are common correlates (Nasim & Nadan, 2013). Couples where one partner is a CSA survivor often report problems in social/relational adjustment, emotional expressiveness, revictimization, and sexual dysfunction (Rasmussen Hall & Follette, 2004). In addition, CSA survivors report perceiving their relationships as lower quality and more isolating than controls and report more relationship problems, whereas partners of CSA survivors report relationship concerns including pain, anger, isolation, frustration, and communication problems (MacIntosh & Johnson, 2008). Despite this bleak picture, a significant percentage of CSA survivors display remarkable resilience and retain adaptive levels of functioning (Domhardt, Münzer, Fegert, & Goldbeck, 2015). In a literature review of 37 studies of CSA survivors and resilience, Domhardt and colleagues defined resilience as “a dynamic developmental process encompassing the attainment of positive adaptation within the context of significant adversity” (p. 476) and found that the rate of resilience in adult samples ranged from 15% to 47% (resilience was considered present if it was displayed in at least one domain that theoretically or empirically should have been adversely impacted by CSA). Ungar (2013) has emphasized the importance of a facilitative environment and contextually relevant protective factors to resilience in his social–ecological definition of resilience as “the capacity of both individuals and their environments to interact in ways that optimize developmental processes” (p. 256). Findings from research examining protective factors associated with resilient outcomes in CSA history support this notion, revealing the presence of both individual and contextual protective factors. Social and familial support, both overall and after the disclosure, significantly correlate with resilient outcomes (Domhardt et al., 2015; Dufour, Nadeau, & Bertrand, 2000; McClure et al., 2008). Domhardt and colleagues identified the following individual and contextual protective factors that correlate with resilience in individuals with CSA history: optimism, internal locus of control, active coping, externalizing blame and trauma-related cognitions, ability to understand and regulate emotions, interpersonal competence and trust, secure attachment (for females), self-esteem, spirituality/religiosity, law-abiding behavior, leisure activities, high socioeconomic factors in self and/or family, family stability and support, relationship satisfaction, higher level of caregiver education, community social support, and education. Interestingly, in a quantitative study of 177 females with CSA history, details such as age at time of abuse, relationship to perpetrator, and severity of the abuse accounted for only 3% of the variance in well-being outcomes, whereas systemic and social factors accounted for 13–22% of the variance (McClure et al., 2008). These findings suggest the importance of positive systemic and relational factors for accessing resilience in conjunction with CSA, factors which could be amplified through systemic therapy. Although CSA history often correlates with relational distress and interpersonal impairments, those same relationships may also be the means of healing. Indeed, CSA survivors display longing for stable attachments and connection with others, and relationships can provide healing in the present for past wounds (MacIntosh & Johnson, 2008; Nasim & Nadan, 2013). Vicarious Resilience In 2007, Hernández, Gangsei, and Engstrom proposed the new concept of vicarious resilience based on a qualitative study of how client stories of resilience positively impacted therapists who worked with trauma survivors. Research on vicarious resilience, like Ungar’s (2013) conception of resilience as a social, ecological process, suggests that resilience is a process that can be transmitted across interpersonal relationships. Vicarious resilience is theoretically linked to the phenomenon of vicarious trauma, which involves changes to the therapist’s inner world—schemas, feelings, worldview, sense of safety, and the like—as a result of interacting with clients’ trauma stories (Hernandez-Wolfe, Killian, Engstrom, & Gangsei, 2015). In contrast, Hernández and colleagues (2007) define the process of vicarious resilience as “a unique and positive effect that transforms therapists in response to client trauma survivors’ own resiliency” (p. 237). To our knowledge to date, the concept of vicarious resilience has only been researched in the therapist–client relationship in cases of political violence and kidnapping (Hernández, Gangsei, & Engstrom, 2007), torture (Edelkott, Engstrom, Hernandez-Wolfe, & Gangsei, 2016; Hernandez-Wolfe et al., 2015), and natural disasters (Nuttman-Schwartz, 2015). Although vicarious resilience has not been studied in couples and families, the process whereby resilience is transmitted appears to involve witnessing resilience in narratives, belief that individuals have the capacity for resilience, and belief that vicarious resilience is possible (Edelkott et al., 2016). We hypothesize that, in couples where one or more partners has a history of CSA, narrative couples therapy that facilitates bidirectional vicarious resilience through the sharing and witnessing of each partner’s subjugated resilience narratives may serve to increase positive connection while amplifying systemic resilience. In the context of couples therapy, vicarious resilience is envisioned not as a linear process but rather as a positive feedback loop where each partner’s resilience narrative will inspire and engender vicarious resilience in the other. Narrative therapy’s client-centered, nonpathologizing stance, its focus on shared/witnessed story to make sense of experience and create preferred identities, and its emphasis on subjugated narratives and unique outcomes will provide a therapeutic healing context for the circular process of vicarious resilience to occur. Francis Laughlin and Rusca 17 Narrative Therapy therapy, seven exhibited clinically significant decreases in PTSD symptoms; of these seven, three no longer met criteria for PTSD; and participants reported high levels of satisfaction. The treatment was guided by the following core principles of trauma-informed narrative therapy manualized by Stillman (2010): identifying aspects of one’s story outside the effects of the trauma, developing personal values and initiatives, claiming identity apart from the trauma, positioning client as the expert and therapist as collaborator, highlighting the client’s personal agency, externalizing problems, examining contexts for decisions and events, highlighting metaphors and narrative arcs, and deconstructing the problem story. Although research examining the effectiveness of systemic, narrative therapy for treatment of CSA survivors is limited, several theoreticians have made a case for a systemic lens using narrative therapy in CSA treatment (D. Johnson, Holyoak, & Cravens Pickens, 2019; B. J. Miller, Cardona, & Hardin, 2006). Miller and colleagues propose systemically oriented individual therapy with adult CSA survivors using a creative integration of narrative and internal family systems theories to augment a more empowered, less oppressed identity. Johnson and colleagues seek to address the long-term relational impacts of CSA for adult survivors using a systemic, narrative couples therapy approach that utilizes the partner as outsider witness in the cocreation of a preferred, powerful, and agentic identity for the CSA survivor. Narrative therapy views identity as an amalgamation of significant voices in the person’s life, and a goal of narrative therapy is re-authoring a preferred identity through empowerment to choose which voices are allowed to contribute to the identity construction process (White, 2007). In creating this preferred, agentic identity, externalization of the problem is a core aspect of narrative-informed trauma treatment (B. J. Miller et al., 2006). Several studies have highlighted the impact of CSA to identity. In one qualitative retrospective study of four women who had undergone therapy to resolve CSA impacts, data showed that participants progressed from a view of the self as flawed, shameful, insignificant, and undeserving to a more positive view of self characterized by greater selfconfidence and self-acceptance; interventions that focused on sharing their stories and externalizing the abuse were particularly helpful in facilitating this shift (Saha et al., 2011). Another qualitative study of the impact of CSA on identity with 30 adults with a history of CSA traced the transformation of self and highlighted the importance of meaning-making and integration of the abuse into the survivor’s life story (Krayer, Seddon, Robinson, & Gwilym, 2015). Data from a retrospective qualitative study of 74 adults with a history of CSA exploring the role and process of story in abuse recovery (Draucker & Martsolf, 2008) also support the theoretical effectiveness of treating CSA through narrative couples therapy. Narrative therapy focuses on story and witnessing of stories as a means of healing, and data from this study showed that survivors who were able to tell their abuse stories had more positive outcomes. Study results showed a natural progression in storytelling moving from secrecy and shielding Narrative therapy grew out of social constructionist philosophy, which acknowledges multiple realities and views reality as a subjective social construct shaped by the language used to describe it (Mills & Sprenkle, 1995). Narrative therapists believe that stories organize experience, form identity, and shape behavior. Often, the stories people tell themselves are influenced by sociocultural and familial messages. Through dialogue, clients and therapists together open space for possibility and re-author stories depicting a preferred, resilient, and agentic identity (White & Epston, 1990). In narrative therapy, the therapist is no longer the expert but takes a curious, not-knowing stance, considering clients the experts on their experiences and learning the meaning of clients’ stories for them (Freedman & Combs, 1996). Rather than pathologizing or thinking about clients in terms of deficits, narrative therapists take a collaborative, strength-based approach, believing that people already have the skills and knowledge necessary to handle and resolve their problems. Narrative therapists assume that clients come to therapy because they are caught in a dominant problem-saturated story which is no longer helpful or satisfactory (White & Epston, 1990). As the problem is externalized, viewed as separate from the client’s identity, clients begin to “unravel some of the negative conclusions they have usually reached about their identity under the influence of the problem” (White, 2007, p. 26) and re-author problem-saturated stories into a more positive identity story. Rather than the problem defining the client, the client then can take responsibility for how she or he interacts with it (Freedman & Combs, 1996). Narrative therapists use deconstructive listening to evoke the re-authoring of problem stories into alternative, more empowered identity stories. Relative influence questioning invites clients to map the influence of the problem in their lives and relationships and their influence on the problem, opening space for clients to identify moments when the problem was less powerful or absent and highlighting these easily overlooked unique outcomes (Freedman & Combs, 1996). The client then begins to experience and embrace alternative or subjugated stories separate from the dominant problemsaturated story, and this preferred story is reinforced through the witnessing by important others. Narrative Couples Therapy and Treatment of CSA To date, limited empirical data exist supporting the use of narrative therapy with trauma. Hedtke (2014) has explored the use of narrative interventions such as externalizing, listening for unique outcomes, re-membering, and opening space for new identity stories of agency, resilience, and hope in families facing loss. Results were promising in a pilot investigation using narrative therapy with 14 veterans with a diagnosis of PTSD (Erbes, Stillman, Wieling, Bera, & Leskela, 2014). Of the 11 participants who completed 11–12 sessions of narrative 18 The Family Journal: Counseling and Therapy for Couples and Families 28(1) the story to creating a revised narrative that viewed the abuse with more complexity, incorporated listener perspectives, and helped the survivor to integrate the experience into their life story. Some survivors found meaning through telling their story in a way that would help others. MacIntosh and Johnson (2008) state that partners of CSA survivors often feel left out of the therapy process and suggest that couples therapy may create a safe space for the sharing of stories in addition to mitigating the interpersonal distress that is often present when there is a history of CSA. Nasim and Nadan (2013) propose that couples therapy can be a context where the traumatized partner’s story can be witnessed, not only by the therapist but perhaps more importantly by the partner. Nasim and Nadan (2013) draw on narrative theory to identify two levels of witnessing: the therapist’s witnessing and externalization of the couple’s trauma relational pattern and the survivor partner’s witnessing of and reflecting on an interview between the therapist and the traumatized partner in a structured way. This process elicits a preferred narrative and identity of “resistance, survival, and strength” (p. 371). Given that positive systemic factors significantly mediate resilient outcomes in CSA survivors (Domhardt et al., 2015; Dufour et al., 2000; McClure et al., 2008), strengthening a CSA survivor(s)’ primary relationship through couples therapy will theoretically enhance resilient outcomes, and couples therapy that increases resilience for both partners by supporting the process of vicarious resilience within the system may further bolster adaptation and thriving despite adversity. Due to its focus on uncovering unique outcomes, eliciting alternative narratives, and cocreating a preferred identity with important others, narrative therapy is particularly poised for strengthening subjugated resilience narratives and facilitating the process of vicarious resilience. Two narrative interventions, mapping and definitional ceremonies, are proposed to facilitate the process of vicarious resilience in a couple where at least one partner has a history of CSA. Through these systemic, narrative interventions, the sharing of resilience narratives within the couple system will transform the storyteller by contributing to a cocreated identity of competence and agency and transform the witnesser by inspiring connection to their own resilient identity as they witness their partner’s resilience. It is important to note that narrative couples therapy may not always be indicated for couples with a CSA history. Revictimization is a real risk for CSA survivors (Rasmussen Hall & Follette, 2004); since females are more likely than males to be a CSA survivor (Finkelhor et al., 2014; Townsend & Rheingold, 2013) and females are also more likely than males to be the victim of intimate partner violence (M. Johnson, 2006; E. Miller & McCaw, 2019), female CSA survivors will statistically be at higher risk of victimization than males in intimate relationships. However, the intersection of intimate partner violence and gender is far from simple; data show that males are also victims of intimate partner violence in no small numbers, though not as often as females (M. Johnson, 2006; E. Miller & McCaw, 2019). Keeping in mind these risks of revictimization as well as intimate partner violence in general, therapists working with couples with CSA history should assess for safety in the relationship prior to facilitating couples therapy interventions that, by inviting emotional openness, could place an already vulnerable partner at additional risk. These interventions should be utilized during middle to later stages of couples therapy, once the therapist has ruled out safety concerns, established the clients as experts of their story, opened space for each partner’s voice, and allowed exploration of the problem story. B. J. Miller, Cardona, and Hardin (2006) also suggest an important distinction when using the narrative intervention of externalization in work with CSA survivors: Externalizing what happened and its attenuating impacts is beneficial, whereas externalizing the part of the self that holds the pain could exacerbate a tendency toward denial, avoidance, and disconnection from the self. These narrative interventions are envisioned for use whether one or both partners have a history of CSA (or other trauma), provided that some trauma processing has already occurred, either in individual therapy or in earlier couples therapy sessions. The therapist should remain trauma informed in her or his approach, going slowly as appropriate and taking a break if either partner begins to feel unsafe during the experience. In setting the stage for systemic, narrative interventions, the therapist should provide guidelines for each partner’s role beforehand, emphasizing that the observing/witnessing role is not meant for advice-giving or constructive criticism but rather for amplification of their partner’s resilience through reflection on how their partner’s resilience has positively impacted them. Mapping Resilience: The Resilience Time Line Mapping resilience through the creation of a resilience time line is an intervention adapted from a classic mapping intervention utilized in narrative therapy to amplify a subjugated narrative of resilience, strength, and hope (White, 2007). This intervention fits well with the middle stage of narrative couples therapy, when the focus of therapy moves to shifting the problem-saturated narrative, finding unique outcomes, and co-constructing an identity capable of agency over the problem. Mapping resilience is an interpersonal approach that will shift the problem-saturated story by focusing on the unique outcome (resilience), while at the same time increasing vicarious resilience in the couple system as each partner witnesses and affirms each other’s resilience narrative. Mapping resilience is envisioned as a 2-hr activity where a three-dimensional time line will be created and traversed by the couple in order to engage not only the cognitive domain but also the physical domain in the telling, witnessing, and vicarious experiencing of each other’s resilience narratives, as one’s story is often connected to one’s body (Rothschild, 2000). Supplies needed are yarn or ribbon, markers, a variety of small toys or figurines, and several colors of post-it notes or index cards. (This intervention may also be adapted to a two-dimensional approach as time and space allows by drawing the time line on a whiteboard or a large sheet of butcher paper.) To facilitate this intervention, the therapist will give each partner a piece of 19 Francis Laughlin and Rusca event and externalizing the problem in order to define one’s identity separate from the event (White, 2007). Subsequently, each partner will be given 20 min to create two different colored sets of post-it notes: one that identifies internal and external supports at difficult points in their life and another set that identifies resilience-depicting actions or aspects of identity that emerged in relation to their difficulties. Table 1 lists questions that could be used as prompts to thicken this resilience narrative. Once both have completed their post-it notes, partners will be directed to place these at appropriate intervals along their time line. Then, each partner will be invited to walk their time line in turn from remote history to imagined future, reflecting on what is written on each post-it note as they wish, while their partner accompanies them. The couple may be invited to hold hands or maintain a physical connection throughout this process. (Figure 1 provides a diagram of this intervention.) The couple is the expert of their story, but the following guidelines may be helpful in guiding the process in a way that highlights the subjugated resilience narrative and facilitates vicarious resilience: (a) if a partner chooses to elaborate on the toy or figurine that was placed on the time line to depict a traumatic event, reflect on how that particular item symbolizes the event and (b) speak about identified supports and strengths Table 1. Deconstructing Questions to Thicken Resilience Narrative. 1. 2. When this happened, what inner qualities helped you get through? When this happened, who was there for you? What thoughts or activities made life bearable? 3. What could you imagine this support person saying to you today about your resilience? 4. When this happened, where, and how did you find peace? 5. What do you imagine resilience will look like in your couple relationship in the near future? yarn or ribbon approximately three yards in length and ask them to use the yarn to create the shape or line on the floor that depicts the time line trajectory of their lives. Partners should position their time lines in relation to their partners’ time line to depict the advent of the relationship and a transition from an individual to a shared time line. The therapist will then invite the couple to place labels at appropriate intervals along the time line premarked with the following categories that White (2007) suggests for mapping landscape of action and landscape of identity: remote history, distant history, recent history, present, and near future. Next, the couple will be invited to choose several toys or figurines to place along the time line to depict events that were traumatic or overwhelming; this serves both the purpose of assigning a metaphor to the Support Available Support S Available Partner 1’s Timeline Partner 1: Traumatic Event Partner 2’s Timeline Remote History Emergent resilient identity Emergent resilient identity Distant History Recent History Present Near Future Partner 2: Traumatic Event Support Available Support Available Emergent resilient identity Emergent resilient identity Figure 1. Mapping resilience intervention for couples. Each partner is invited to place on their time line (1) one or more objects to depict an overwhelming/traumatic event, (2) internal and external supports that were available, and (3) aspects of resilient identity that emerged. Each partner then walks their time line in turn, accompanied by their partner. 20 The Family Journal: Counseling and Therapy for Couples and Families 28(1) from the perspective of what these meant about one’s resilient identity. Once one partner is finished traversing their time line, the other partner will be invited to reflect on their partner’s resilience time line using the following prompts: What did I learn about your resilience and strength? How was I impacted by hearing this? How does hearing this impact our imagined resilient future? Watson and Neria (2013) suggest that, to build individual resilience following trauma, interventions should augment selfefficacy and build a renewed sense of hope in life and self. Yet, as vicarious resilience research has suggested, resilience is not only an individual phenomenon but may also be a shared quality in a relationship or context that is transmitted by the witnessing of resilience in each other. Mapping resilience focuses on a broader context to create a thickened description of both trauma and resilience rather than simply focusing on CSA history as an isolated phenomenon. The witnessing, re-authoring, and remembering enacted through the couple experience of traversing each other’s resilience time lines together will evoke the cocreation of a preferred resilient identity despite the trauma of CSA. Narrative Intervention: Definitional Ceremonies With Couples A definitional ceremony, with each partner acting as witness to the other’s resilience narrative, could be utilized during later stages of narrative couples therapy in order to further promote vicarious resilience; solidify new, strength-based identities; and establish each partner as witness of the other’s resilience. Myerhoff (1982), an anthropologist, initially developed definitional ceremonies in her work with a community of immigrants who had no natural audience or witness to their lives and culture. Myerhoff observed, in absence of natural occasions for witnessing, a need for performances proclaiming collective identity, and she called these performances “definitional ceremonies.” White (1995) then adapted definitional ceremonies to his therapeutic work to legitimize and strengthen clients’ preferred stories through the witnessing and response of a significant audience. In definitional ceremonies within narrative practice, clients are invited to tell and retell their preferred stories, while an outsider witness(es) (Carey & Russell, 2003) listens and then actively responds to the person’s story in particular ways. White (1995) quotes Myerhoff (1986) in explaining that “definitional ceremonies deal with the problems of invisibility and marginality; they are strategies that provide opportunities for being seen and in one’s own terms, garnering witnesses to one’s worth, vitality and being” (as cited, p. 4). In this way, definitional ceremonies can draw out subjugated narratives, thicken preferred stories, and provide opportunity for reflection, empowering people to see hopeful possibilities for greater personal agency in creating their lives. White (1995) emphasizes the role of the outsider witness in definitional ceremonies as vital to “the acknowledgement and the authentication of people’s claims about their histories and about their identities . . . giv[ing] greater public and factual character to these claims” (p. 4). In narrative practice with a couple in which one or more partners is a survivor of CSA, definitional ceremonies can be adapted to foster the transmission of resilience. The definitional ceremony entails some client preparation; the narrative therapist should take time, perhaps 30 min, to explain the process, preparing both partners to assume the outsider-witness role. The definitional ceremonies themselves entail at least two 2-hr sessions, one (or several) focused on each partner’s story of resilience, while the other partner acts as witness. White’s (2005) four-step process of “multi-layered tellings and re-tellings” (p. 15) has been adapted here to place each partner both in the role of focus person and outsider witness, in turn: (1) The partner who is the current focus (Partner A) tells the story. (2) Partner A’s story is retold by their partner (Partner B), who acts as an outsider witness. (3) Partner A retells the story, incorporating new meanings. (4) Partner B retells the story yet again, incorporating additional layers of awareness. The therapist guides these tellings, and the partner, when acting as witness, remains strictly in the audience position, avoiding advice and opinions about their partner’s story (White, 2005). In the first telling, the therapist interviews the CSA survivor about his or her story of sexual trauma and resilience using traditional narrative techniques such as deconstructive listening, deconstructive questioning, and drawing out unique outcomes and subjugated stories in order to illuminate and thicken preferred narratives of meaning, strength, and resilience. The therapist coparticipates in the process of re-authoring new stories and self-representations by asking questions that draw out greater detail (Wood & Roche, 2001). Table 1 offers suggestions for questions that could be utilized during the first telling to thicken the narrative. In Step 2, the witnessing partner is invited to reflect on what it meant to hear their partner’s story, speaking in dialogue with the therapist, while the storytelling partner listens. The therapist guides this dialogue according to the following categories of outsider witness response suggested by White (2005): expressions that caught the witnessing partner’s attention, images evoked by these expressions, what these expressions suggest about the storytelling partner’s values and identity, what aspect of the witnessing partner’s life accounted for them being drawn to these particular expressions and images, and how the witnessing partner was impacted in hearing the story. Table 2 provides specific questions, adapted from White’s (2005) suggested questions, that could be utilized to elicit reflections from the witnessing partner on how their partner’s story has impacted them, captured their imagination, and in some way evoked their own transformation. Carey and Russell (2003) claim that the most powerful comments for the individual at the center of the definitional ceremony are those where outsider witnesses reflect on being touched by hearing the story and discover connections to their own lives. This aspect of the definitional ceremony may be particularly healing in the couple relationship, creating connection, understanding, support, 21 Francis Laughlin and Rusca Table 2. Questions for the Witnessing Partner (Outsider Witness). Challenges and Future Directions 1. General contraindications to couples therapy should be taken into account in regard to couples therapy with CSA history, including lack of motivation on the part of one or both partners to change relational dynamics, imminent threat of divorce, significant untreated psychopathology in one or both partners, intimate partner violence, and ongoing nonconsensual extrarelational activity (Wolska, 2011). Due to risks of revictimization in CSA survivors, the therapist should particularly be aware of the possibility of victimization, violence, and abuse in the relationship. Furthermore, a focus on enhancing vicarious resilience could exacerbate polarized roles where one partner is always seen to be the resilient one providing support to the CSA survivor whose history might be (even benevolently) blamed for all the problems in the relationship (Rasmussen Hall & Follette, 2004). In this case, the therapist would be wise to exert great care to draw out the resilience of both partners in order to balance roles. The narrative interventions involving witnessing each other’s stories would be contraindicated when one partner is unable or unwilling to hear the CSA survivor’s story and acknowledge its impact on the survivor and the relationship and would thus be unable to provide a life-giving and therapeutic witness. Serious imbalances of power, violence in the relationship, and a severe lack of trust and/or emotional safety would preclude such vulnerable storytelling and invitation to witness. Because CSA data currently reflect gender-binary terminology, one must assume that individuals who identify as gender nonbinary are either collapsed into male/female categories or else not represented in the data on CSA and resilience. In addition, discussion and empirical data are lacking regarding CSA treatment in the context of nonheteronormative romantic partnerships. Thus, caution should be used in applying existing data regarding CSA prevalence, impacts, and resilience factors to LGBTQIA+ populations and relationships. In order to address these gaps in the data, researchers could begin by expanding their research questions to encompass identities that do not fit heterosexual norms, keeping in mind the following recommendations for including queer identities in qualitative research: comfort with fluidity, awareness of identity, openness to the unknown, willingness to answer questions from the broader culture, cultural sensitivity, and advocacy (Levy & Johnson, 2011). However, we suggest that themes of identity, story, and witness are applicable to CSA treatment regardless of gender identity or sexual orientation, and thus narrative couples therapy with CSA survivors would be fitting for both heterosexual and nonheteronormative relationship configurations, provided other contraindications to couples therapy, as previously discussed, are not present. Although vicarious resilience is a promising idea for use in couples therapy, it has only been researched in client–therapist relationships, and caution should be utilized when generalizing this data to other types of relationships such as couple relationships which involve more complex factors than the therapeutic alliance; for example, finances, housing, parenting, values, and sexuality as well as entrenched roles and communication patterns. We hope that What expressions in your partner’s telling particularly stood out for you? 2. What images or metaphors did these expressions evoke, related to either your partner or life in general? 3. What did these expressions say about your partner’s beliefs, identity, or hopes and dreams? 4. Can you share about what aspects of your own life might have accounted for these particular aspects of your partner’s story to stand out for you? 5. How has hearing this story impacted you? How are you different now? Where has the experience of hearing it taken you? affirmation, and movement not only in each individual but also, consequently, in the relationship. In Step 3, the CSA survivor becomes the focus again, while the witnessing partner listens. The therapist asks the CSA survivor about his or her experience of listening to the outsider witness/partner response to her or his story. In Step 4, the outsider witness/partner tells the CSA survivor’s story again, again guided by the questions in Table 2 and incorporating additional levels of awareness, and the couple and therapist then come together to discuss the experience (Carey & Russell, 2003). In a subsequent session, the roles switch, and the partner of the CSA survivor is asked to play the central role in the ceremony, sharing a story of resilience around a painful experience or trauma from her or his life. The CSA survivor partner then takes the role of the outsider witness, and the couple moves through the four steps of the definitional ceremony again. Data from studies of CSA survivors indicate that acknowledgment of the trauma rather than avoidance correlates with better outcomes (Draucker & Martsolf, 2008; Nasim & Nadan, 2013; Saha et al., 2011), that acceptance offered by one’s intimate partner helps to mitigate the shame that often accompanies CSA history (Crete & Singh, 2015; MacIntosh & Johnson, 2008), and that trauma-informed couples therapy is often helpful to mitigate the intimate relationship distress that accompanies a history of CSA (MacIntosh & Johnson, 2008; Nasim & Nadan, 2013). Crete and Singh found that resilient outcomes in a history of CSA correlated not only with processing the abusive experiences and experiencing trust and connection with the partner but also with the CSA survivor’s reframed positive identity encompassing self-acceptance and a positive vision for the future; furthermore, resilience in the survivor correlated not only with their partner’s ability to express compassion and employ active listening but also with their partner’s focus on the positive rather than negative implications of the trauma experienced by their partners and affirmation of their partner’s courage, tenacity, and resilience. These data suggest that resilience-focused, relational narrative interventions, such as mapping resilience and definitional ceremonies, will promote healing and vicarious resilience through the process of telling one’s story, experiencing its witnessing by an important other, and cocreating a preferred resilient identity. 22 The Family Journal: Counseling and Therapy for Couples and Families 28(1) continued research regarding vicarious resilience will be applied to intimate and familial relationships as well as to a variety of presenting concerns. Because of our focus on engendering vicarious resilience in couples, we do not present a complete overview of narrative interventions that could be applied to CSA treatment with couples. For an exploration of early stage narrative couples therapy with CSA survivors, see D. Johnson, Holyoak, and Cravens Pickens (2019). Overall, empirical data are lacking on the use of systemic therapies, including narrative therapy, for use in the conjunction with CSA and other types of trauma, and we hope that this theoretical exploration will provoke additional empirical research regarding applications of systemic modalities to CSA treatment. Conclusion Although CSA correlates with adverse interpersonal and intrapersonal effects, a significant number of individuals with a history of CSA exhibit resilience, the ability to function well in life despite difficult or traumatic experiences. Resilience is both an individual construct based on internal factors such as personality, self-efficacy, interpersonal effectiveness, and cognitive flexibility (Domhardt et al., 2015) and an outcome of a supportive relationship between the individual and their environment (Ungar, 2013). The relationship with one’s partner is a crucial aspect of one’s environment, yet often individuals with a history of CSA report intimate relationship difficulties. Thus, couples therapy that fosters increased resilience despite a history of CSA could be uniquely poised not only to increase connection in the relationship but also to promote contextual resilience that would, in turn, enhance functioning for both partners in the engagement of their preferred identities with life itself. Narrative therapy’s strength-based, nonpathologizing, social constructionist approach may be particularly appropriate for CSA survivors who have experienced boundary violations and disempowerment and may carry a self-concept of shame and badness. Good outcomes with a CSA history generally correlate with sharing the story rather than avoiding it (Nasim & Nadan, 2013), and the focus on shared stories in narrative therapy provides an opportunity for the survivor’s trauma and resilience to be witnessed and for a preferred resilient identity to be created through the empowered telling, retelling, and reflecting of each other’s stories. The narrative interventions of mapping resilience by traversing one’s resilience time line with one’s partner and witnessing each other’s resilience through definitional ceremonies may be particularly useful for couples with a history of CSA for transmitting resilience and creating preferred resilient identities. The relatively new concept of vicarious resilience (Hernández et al., 2007) suggests that, much as trauma can be transmitted in relationships, resilience can also be transmitted through witnessing the resilience in another’s story, believing that individuals have the capability for resilience and believing that one’s own resilience can be built by witnessing another’s resilience (Edelkott et al., 2016). Therapy that facilitates the transmission of vicarious resilience across couple systems may provide a fresh approach when working with distressed couples with a history of CSA. The narrative interventions described for use with these couples are relational processes that engender relational, systemic results. As narrative therapists affirm, the creation of identity is relational and public, not individual and private (White, 2005). In the process of mapping resilience and the definitional ceremony, preferred stories are thickened, new identities and meanings are authored in relationship with the significant other and therapist, and space is opened for transformation to occur through the process of witnessing and being witnessed (Wood & Roche, 2001). Vicarious resilience is engendered and enhanced as each partner witnesses the other’s powerful narrative of resilience, and the partners’ stories become linked, connected, and interwoven in a shared story of resilience. As a result, the couple is “transported” (White, 2005, p. 16) to a preferred identity that facilitates new ways of being together in the world. Acknowledgments We would like to thank Rebecca A. Cobb for her inspiration and guidance in writing this article. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. 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