‘Stay with the body’: facilitating integrative silence in community-based sexual trauma care

ABSTRACT

Background: Research has demonstrated that the verbal disclosure for adult victims of childhood sexual trauma (CST) presents significant challenges and seldom provides comprehensive trauma integration. Limited psychosocial support and specialist trauma care particularly in marginalised communities, can further exacerbate the non-disclosure of CST. Although various intervention models for adult victims of CST exist, the potential of facilitating integrative silence as part of community centred integrative trauma informed care (ITIC), remains under-explored.

Objective: The objective of this article, is to document how facilitating spaces of integrative silence in a therapeutic context, shifts embodied trauma awareness, comprehensive trauma realisation and trauma integration for adult victims of CST from intergenerational marginalised contexts.

Methods: Through participatory action research (PAR), framed in de-colonial feminist community praxis with 13 women aged 21-62, the first author as therapist-researcher facilitated audio-visual recorded semi-structured interviews (n = 13) and integrative trauma informed care (ITIC) follow-up sessions (n = 60) to assess the value of the spoken, unspoken and silence in trauma care. Inductive reflexive thematic analysis and a multistage recursive coding process of verbatim transcriptions, were used to identify embodied trauma awareness before, during, and after periods of silence.

Results: The de-colonial, feminist framing for community centred ITIC enhanced participant-specific embodied awareness, establishing a safe space for self-reflection. Contextual sensitivity and careful attention to the therapeutic environment were paramount. The facilitation of non-verbal expression empowered participants to explore alternatives to normative, essentialist and religious narratives that often stigmatise trauma responses. This approach enabled participants to reclaim a sense of agency, improving self-regulation and self-care.

Conclusion: This study highlights the potential of integrative silence in community based therapeutic contexts. Future research could explore the role of integrative silence in treating various forms of trauma in different cultural and geographic settings and its integration with other therapeutic modalities to enhance culturally sensitive mental health care.

Highlights

• The study affirms the importance of feminist psychotherapeutic praxis and community based ITIC.

• Addressing systemic power imbalances which includes the way the therapeutic relationship is navigated, showed the therapeutic value of integrative silence and non-verbal disclosure for historically racially marginalised adult survivors of childhood sexual trauma.

• Emphasising integrative silence and non-verbal disclosure offered valuable therapeutic pathways and meaningful alternatives to the conventional reliance on verbal trauma disclosure. This approach provided a more justice-based framework for trauma processing and recovery, which is often overlooked in traditional therapeutic models.

1. Introduction

Over thirty years into democracy, South Africa continues to grapple with the lingering effects of centuries of entrenched colonialism, and the recent apartheid dispensation that marginalised ‘Coloured’ communities in almost every aspect of their lives, from education to living conditions and healthcare. While general and basic healthcare were often unavailable to these communities, mental healthcare was even more inaccessible and often seen as a luxury. The societal scars of South Africa's racialised past underscore the critical need for adequate access to culturally responsive mental health care resources and specialist interventions at primary care level (Sorsdahl et al., 2023). Consequently, recommendations for the scaling up and decentralising of mental healthcare services have been extensive, including the World Health Organisation (WHO) mental health Gap Action Program (mhGAP) and the Mental Health and Poverty Project (MHaPP) implemented in South Africa, Ghana, Zambia and Uganda (Lund et al., 2010, 2012; Myers et al., 2018; Sorsdahl et al., 2023). Against this backdrop, there is a growing interest to address the pervasive issue of systemic injustice and mobilising research for social change (Bullock, 2013). A decolonial feminist discourse in critical psychology, that is reflexive and representative of marginalised communities, highlights the disproportionate incidences of sexual victimisation often coupled with socioeconomic marginalisation and poverty. Situated within this paradigm, the decolonisation of trauma research (Bryant, 2024) offers a critical reconceptualisation of knowledge production in health discourse, psychosocial trauma care, and intervention praxes (Gibbs et al., 2024). This reframing necessitates a multifaceted approach in the implementation of trauma-informed practices and as Egan (2020) suggests, an alternative on how the medicalised, western-centred diagnostic categorisation and pathologising of trauma can be re-envisioned. Such an integrative approach positions trauma realisation – as a process of recognising and integrating traumatic experiences – as a critical step toward effective and comprehensive treatment and recovery. However, for adult survivors of childhood sexual trauma (CST) from marginalised contexts, the process of trauma realisation is shaped by layers of intergenerational psychosocial adversity, systemic neglect and non-disclosure. Acknowledging and addressing this multifaceted complexity in trauma recovery, requires culturally sensitive psychotherapeutic care and community accessible supportive spaces offering comprehensive, tailored ITIC. Central to ITIC is the emphasis on safety, trustworthiness and collaboration which has specific implications for assessing trauma intervention praxes through participatory and collaborative research methodologies. Consequently, within a decolonial feminist framework that centres the autonomy, dignity, and agency of marginalised sexual trauma survivors (Gerbarg & Brown, 2011; Han et al., 2021), the concepts of ‘embodiment’ and ‘embodied trauma recovery’ offer an alternative to Western-centred notions of subjectivity and mind–body dualisms. Including these concepts in ITIC, provides a nuanced, relational, and context-dependent understanding of how bodies are shaped by – and respond to – specific power dynamics and social structures, including within therapeutic settings. Rooted in the critique of conventional trauma practices, this study turned to the body as a site of lived experience and meaning-making. Therefore, for South African marginalised adult victim-survivors of CST the enduring trauma of apartheid – that lead to and sustain marginalisation – highlight the interconnectedness of the body with social, historical, and cultural realities. This necessitates a shift away from disembodied, purely cognitive or memory-based approaches to trauma recovery (Denzin et al., 2014; Jordan et al., 2017). As Olff et al. (2019, p. 14) suggest in their decennial review of psycho-traumatology, feminist and integrative trauma-informed care requires ‘cross-cultural and gender-sensitive research on micro-, meso-, and macro-levels’. Given the aforementioned considerations in South African marginalised contexts, the disclosing of sexual victimisation can be challenging when perpetrators are often known in family and community contexts. Extensive research indicates that the complexity of suppressing embodied trauma from repeated CST, is often sustained by nondisclosure and a reduced ability to provide comprehensive verbal narratives as adults (Wagenmans et al., 2018). This non-disclosure creates additional barriers and reinforces isolation, stigma and shame (Johnson, 2022). The literature further highlights the need to consider how enforced silencing can lead to dissociation and the disintegration of consciousness, memory, emotion and somatic awareness (Koehler, 2016; Lanius et al., 2011; Lehmann, 2014). While ‘breaking the silence’ is a crucial step in bringing survivors into therapy, it is equally important to recognise that within a safe therapeutic environment, spaces of integrative silence and other non-verbal forms of expression can be vital. These methods allow victims to share their stories and reclaim their narratives in ways that transcend traditional verbal disclosure and is foundational to ethical, culturally sensitive, therapeutic praxes (Fricker, 2007). Silence in therapy can function as a form of communication that expresses emotional and relational needs, with its careful use by therapists facilitating safety, understanding, and containment (Sorsoli, 2004). As noted by Dragojlovic and Samuels (2023), integrative silence also enables engagement with the unspoken aspects of trauma and the unspeakable nature of certain lived experiences. While silence is often implicitly present in various therapeutic approaches, its intentional use as an integrative modality within community-based ITIC interventions remains under-theorised and largely overlooked. This study positions integrative silence as a compassionate alternative to cognitively driven, memory-recall-based practices that can unintentionally re-traumatise survivors, particularly within marginalised communities. Grounded in feminist and decolonial frameworks, the study views embodiment as the physiological awareness of the body in a present moment (Barrett et al., 2005; Craig, 2002). Drawing on Barrett's (2017) theory of constructed emotion, the study explores how silence supports affective regulation across a continuum of embodied and interoceptive awareness (Barrett & Simmons, 2015). By combining person-centred interviewing, interoceptive focus, and the therapeutic use of silence, this integrative, trauma-informed approach uniquely addresses the emotional and somatic dimensions of sexual trauma recovery within a marginalised South African context.

Consequently, the research objectives were first, to assess how the study participants experienced and responded to the implementation of a ITIC therapeutic intervention framework that included facilitating integrative silence; second, paced by the responses of the study participants, evaluating how the subjective and embodied responses pre-, during and post periods of silence contributed to affective, visceral and interoceptive subjective trauma awareness and integration and third, building on emerging but limited research that links non-verbal practices to trauma recovery, offering a more nuanced understanding of how integrative silence can act as a catalyst to explore culturally responsive, participatory, community-based trauma care praxes.

2. Methods

2.1. Research context

The research was conducted in the greater Cape Town metropole on the Cape Flats which is characterised by townships, ghettos, and shantytowns, all products of the Group Areas Act 1950 and apartheid-era social engineering. These areas face intergenerational psychosocial and socioeconomic marginalisation due to race-based forced relocations and historical migrant labour housing.

2.2. Ethics

All procedures were approved by [The Biomedical Ethics Committee of the University of the Western Cape, Cape Town, approved the research procedures (Reference: BM20/10/07)]. To ensure confidentiality and anonymity, pseudonyms are used to refer to the study participants.

2.3. Study design and participants

2.3.1. Participant screening

In line with the qualitative, participatory action research design, the primary researcher was introduced to Sarah, the first participant who is a survivor of repeated childhood sexual abuse in community contexts on the Cape Flats. Sarah, who is well acquainted with social activists and religious leaders, facilitated introductory presentations at community gatherings and church meetings, which led to an additional twelve women volunteering to become part of the study. These women (aged 21–63), experienced sexual violation at different developmental ages before the age of eighteen, ranging from sexual grooming to gangrape. As the research population was difficult to access due to many considerations including community violence, stigma and non-disclosure of sexual trauma, Debra (age 60) who was raped at age nineteen and was willing to become part of the research, was also included. Age differences among participants were particularly emphasised to assess the impact and duration of trauma suppression and non-disclosure. Accounting for developmental age, trauma onset and the severity of challenges experienced at the time of research participation, the role of personal agency was particularly significant in facilitating non-invasive safe, therapeutic spaces which included integrative silence.

In Table 1, the micro-, meso-, exo- and macro-socio-ecological participants’ status are summarised. It includes age (21–63y), children (0–4), relationship status (single, divorced, remarried), education (uneducated, primary, secondary, tertiary), employment level, religion, and the type of healthcare access (public/private). Additionally, access to healthcare was an important clinical trauma assessment factor as 4 out of 13 participants had private healthcare access, which included dialectic behavioural therapy (DBT).

Table 1.

Participants’ micro-, meso-, exo- and macro-socio-ecological status.

Pseudonym	Age	Children	Relationship status	Education	Employment level	Religion	Healthcare access
Sarah	42	2	Divorced	University	Formal	Ca	Private
Mia	26	1	Single	University	Formal	Ca	Public
Ava	61	3	Divorced	Tertiary	Retired	Ca	Public
Charlotte	45	3	Divorced	University	Entrepreneur	Ca	Private
Joan	49	0	Single	Secondary	Informal	Ca	Public
Lydia	63	4	Divorced	Not Educated	Unemployed	Ca	Public
Evelyn	57	2	Second marriage	Tertiary	Unemployed	Ca	Public
Aisha	47	2	Second marriage	University	Formal	Me	Private
Amber	53	3	Second marriage	Secondary	Disability Pension	Cb	Public
Mandy	54	1	Separated	Secondary	Unemployed	Ca	Public
Debra	60	2	Married	Secondary	Parttime	Cc	Public
Zara	21	0	Single	University	Student	Me	Private
Violet	49	2	Married	Tertiary	Unemployed	Cd	Public

^aChristian Pentecostal. ^bC Christian Apostolic. ^cC Christian New Apostolic. ^dC Christian African Methodist Episcopal. ^eMuslim Sunni.

2.3.2. Data collection

From March to November 2022, the primary researcher – a clinical psychologist – conducted 13 semi-structured interviews and 60 follow-up ITIC sessions in accessible community faith spaces, including a church office and a home-based madrassa. Informed process consent and community accessibility shaped the intervention timelines and number of sessions. Initial interviews assessed participants’ clinical histories, including the nature and frequency of childhood sexual victimisation and overall mental and physical health. Early sessions prioritised trust, safety, acceptance, and non-judgement. A flexible, responsive approach enabled rich descriptions of lived trauma. Participants were informed that sessions might include silence, allowing spontaneous engagement with their embodied experiences.

The therapeutic sessions were conducted in Afrikaaps, English, and Afrikaans, allowing participants to express their experiences in their preferred language. Afrikaaps, a venacular spoken in Cape Town that predates Afrikaans, reflects the complex history of nationalism, race, and cultural restoration, and is defined by Toyer and Peck (2023, p. 1) as a form of ‘translinguism and linguistic citizenship'. As part of feminist decolonial praxis, acknowledging Afrikaaps as a language in its own right and not merely Afrikaans slang, challenges linguistic hierarchies in both knowledge production and data collection.

2.4. Measures

2.4.1. Intervention timeline

A qualitative research design allowed flexibility in the length of participation which varied between 4 and 22 weeks.

2.4.2. Clinical assessment and intervention planning

The study participants’ mental and physical well-being was assessed guided by the Interview Assessment Information and Practice Intake Form (Annex 1).

The ITIC sessions explored trauma awareness, shifts and transitions in trauma awareness and embodied, affective trauma integration. Silence was intentionally used to facilitate awareness of affective and physical discomfort linked to recalled experiences of sexual violation. This included trauma related altered states of consciousness, physical and affective changes, images, thoughts, flashbacks, memories and affective and physical relief in applying the methodological diagram (Figure 1). The therapeutic space was co-constructed, mindful of long-term trauma suppression and coping styles including avoidance, control and isolation and aimed to prevent re-traumatisation. To create a supportive therapeutic environment, long and intensive sessions were avoided. Potential triggers were identified during the intake interview, and active listening was practised by refraining from unnecessary verbal interruptions, particularly during moments of silence. Process consent was prioritised throughout, and participants were given the option to use the therapeutic space to rest or sleep after each session. At the end of each session, participants could discuss their experiences and how they found the sessions conducive or not. Online support was made available between sessions to provide consistency in therapeutic support and detailed process notes and post-session reflection notes assisted in planning follow-up sessions. Audio-visual recordings of the sessions made in-depth, detailed, procedural qualitative analysis possible.

Figure 1.

Methodological diagram outlining Phases 1–8.

Figure 1 is a visual representation of the ITIC process. The diagram illustrates the flexible progression through eight phases, guiding therapeutic engagement while allowing for participant-led pacing and thematic exploration. During the periods of integrative silence, participants were not instructed to focus on any single specific sensation. Instead, they were gently encouraged to attend to any emerging bodily sensations, feelings, or internal states without judgment. This open-ended focus allowed for a broad range of affective and sensory experiences – including pain, numbness, tingling, trembling, warmth, and others – to arise and be acknowledged. The aim was to facilitate interoceptive awareness and embodied presence, creating a safe space for participants to reconnect with their bodies, which are sites of trauma and dissociation.

The number of sessions varied across participants, reflecting the person-centred and responsive nature of the intervention. Some participants attended between 2 and 11 sessions depending on their individual needs, comfort levels, and availability. The therapist’s interventions were similarly flexible and guided by each participant’s responses to the method. While Figure 1 presents a methodological diagram that outlines a general framework (phases 1–8), this structure functioned more as a flexible guide than a rigid framework. Clinical judgment was used to adapt the sequence and emphasis of each phase based on the participant’s readiness and emergent themes during each session. The points listed in the boxes in Figure 1 were not rigidly or systematically applied in every session, rather, they served as guiding themes that could be explored in depth or bypassed, depending on the participant’s responses. For instance, while the body-based themes such as pain and numbness were often addressed, participants were also encouraged to notice other sensations like trembling, heat, cold, or pressure if those were more relevant to their experience. The purpose was to promote self-regulation, reconnection with the body, and the integration of fragmented or suppressed trauma responses within a safe therapeutic relationship.

2.5. Data analysis

2.5.1. Reflexivity

This study was shaped by the critical reflexivity of its research team, whose diverse backgrounds and positionalities deeply informed the research process and its ethical commitments. The study participants self-identified as ‘Coloured’ – an apartheid-era racial classification. The first author, a white South African clinical psychologist with extensive experience in trauma care, critically reflected on her own upbringing during apartheid as someone who was socioeconomically privileged. This awareness informed her commitment to conducting socially just research by actively engaging with issues of systemic inequality, health equity, and the power dynamics inherent in trauma recovery work. SN, a decolonial feminist scholar of religion and CST survivor of Indian indentured labour descent, contributed expertise in theorising gender, power, and systemic inequality. IK, with global expertise in trauma-sensitive care and systemic health disparities, brought an interdisciplinary approach to designing inclusive care pathways, further grounding the study in a commitment to restorative, community-based healing practices. Collectively, the authors’ positionalities reflect their shared commitment to addressing systemic inequality and violence and not further marginalise communities impacted by the injustices of apartheid. Their diverse perspectives informed the development of tailored, embodied trauma interventions thereby contributing to inclusive, trauma-sensitive data analysis.

2.5.2. Qualitative, thematic analysis

A systematic, nuanced and manual inductive reflexive thematic analysis of the transcripts was conducted (Braun & Clarke, 2018). As the primary researcher/therapist, LM sought immersion in the data by reading and re-reading the transcripts, validated by referring to the audio-visual recorded data when needed, writing reflective notes and referring to the clinical process notes taken during the interviews and ITIC sessions. Potential themes and the coding frame were revised in supervisory discussions with SN and IK. The coding process was inductive which involved comparing, contrasting and interpreting patterns and themes. Identifying patterns as a phase-oriented analysis of the dataset, included identifying themes and subthemes described in Table 2.

Table 2.

Themes and subthemes identified from the reflexive, inductive analysis.

Theme	Subtheme(s)
Trauma response patterns (TR)	Trauma avoidance
	Trauma expression
	Trauma release
	Trauma integration
Affective awareness and responses	Affective states (AS)
	Contextual emotional expressions (TR/AS)
	Arousal
Somatic and experiential responses	Physical sensations (PN) (RP)
	Metaphoric descriptions or symbols of inner states (I)
Cognitive and interpretational responses	Memories (M)
	Coping styles

TR = Trauma response; AS = Affective state; PN = Pins and needles; RP = Reproductive parts; I = Images; M = Memory.

The coding process proceeded in three primary ways: first, by identifying multiple trauma-related categories; second, through time-coded observations; and third, by examining affective and physical valence and arousal. In a subsequent coding phase, we aligned the coding framework and analysis with the structure and flow of the trauma-informed therapeutic sessions, capturing the nuanced, embodied processes of trauma realisation and integration. Organising the trauma integrative process into distinct phases provided a structured analytical framework for trauma categorising and time-coding, first by analysing the average length of and when silences occurred and second, the criteria defining trauma awareness phases included the study participants’ experiences across three phases – pre-silence (Phase 1), during silence (Phase 2), and post-silence (Phase 3). Pre-silence (Phase 1): The facilitating of periods of silence were preceded by discussions of trauma responses and coping styles, identifying emotional dysregulation, interpersonal difficulties, an awareness of identity, trauma suppression, selective or total amnesia, self-concepts, negative beliefs and expectations, dissociation, detachment from a sense of self, somatisation, and alterations in attention and consciousness. The articulation and categorising of interoceptive awareness, affective states and emotional experiences were co-constructed, relying on each participant’s unique way to embody their experiences, the primary researcher/therapist’s verbatim introductions to facilitate periods of silence included the following:‪

I want you to just connect with your body and as you start to become aware of yourself, I want you to briefly share anything that you experience with me. This can be anything you experience in your body including discomfort or pain, sensory awareness, emotions, a memory or an image. Just try to be as flexible as possible and not to judge what you experience before sharing it. In this space nothing is wrong or just your imagination, including anything you think or what you can share with me. You need to take your time and don’t think anything isn’t important. I’m going to give you some time, once you are ready, you can share and we’ll take it from there.

‪‪During silence (Phase 2): During Phase 2, the focus was on transitions and shifts in trauma awareness unique to each participant’s process. Drawing on Barrett’s (2017) theory of constructed emotion, silence was utilised to facilitate affective states with or without visceral and interoceptive embodied awareness. Although there is a lack of consensus among scholars regarding interoception, this study explored it as a ‘physiological sense of the condition of the body at a given moment’ (Craig 2002, p. 655), considering it a basic feature of consciousness which is not unique to instances of emotion. Affective states such as sadness, anger and fear were described not as ‘homogeneous states’, but as context specific with affective valence and arousal on a continuum of awareness (Barrett & Simmons, 2015). The facilitation of the trauma awareness and integration processes, is illustrated in Table 5 in the result section below, which illustrates the participant specific processes, sessions and intervention timelines.

Trauma shifts: Trauma shifts were based on participants’ experiences of trauma awareness during periods of silence, encompassing memories of violation, affective states, interoceptive awareness and/or physical discomfort. Participants’ trauma responses and coping styles were diverse and included exhaustion, confusion, sadness, agitation, avoidance, numbness, physical arousal, blunted affect, traumatic memories and images

Trauma transitions: Trauma transitions explored changes in states of awareness experienced during trauma shifts. The therapeutic approach maintain space for participant self-awareness through non-verbal, non-invasive therapeutic responses and minimal verbal affirmations.

Post-silence (Phase 3): The third phase describes the outcome of facilitating silence and exploring ways to intentionally engage with avoidant and repetitive trauma responses, coping-styles and self-harm tendencies. Specifically, this phase described how shifts and transitions in trauma awareness could lead to active acceptance, trauma integration and embodied self-regulation.

3. ‪‪‪Results

A summary of the clinical assessment and intervention timeline is provided in Table 3, including the trauma age (preverbal to nineteen), trauma type (rape, gangrape, sexual grooming, digital rape), physical health, mental well-being, coping skills (isolation, substance abuse, co-dependency), total sessions conducted, total intervention time (h), intervention timeline (weeks) and follow-up assessments (months). Pentecostal, African evangelical Christian, and Sunni Muslim religious affiliations played a significant role in coping with the effect of the experienced trauma, though these settings lacked psychosocial interventions tailored to sexual trauma. The study found that participants shared intergenerational histories of CST. The lived experiences of sexual violence and the resulted trauma, varied in terms of onset and severity. Attending to the participants’ age, the length of trauma suppression, the intervention timelines were carefully considered throughout the intervention process.

Table 3.

Participants’ physical and mental well-being and intervention timelines.

Pseudonym	Trauma age	Trauma type	Physical health	Mental well-being	Coping skills	Total sessions	Total time (h)	Intervention timeline (weeks)	Follow-up (months)
Sarah	5–18	SG/R	HBP/W	SH	Isolation	6	5:43:16	8	16
Mia	3–21	R	STD	DS	Substances/A	8	5:05:11	20	11
Ava	8–40	SG/R/GR	Chol+	DS	Isolation	8	3:25:58	22	13
Charlotte	15	SG/DR	Good	IF	Co-dependent	2	1:35:58	4	NA
Joan	9–18	SG/DR	Psoriasis	IF	Co-dependent	4	2:20:59	8	NA
Lydia	7–18	SG/R	Good	DS	Isolation	5	1:59:57	16	5
Evelyn	6–18	SG/DR	Good	DS	Co-dependent	5	5:22:42	12	9
Aisha	5–14	SG/GR	Good	IA	Performance	11	8:54:47	20	12
Amber	7–17	SG/GR	Str/As/W	DS	Isolation	6	4:23:42	9	10
Mandy	5–18	SG/R	MS	DS	Isolation	4	2:57:16	5	7
Debra	19	R	Allergies	DS	Isolation	4	3:23:32	9	7
Zara	8–10	SG/DR	Good	IA	Co-dependent	4	4:10:58	12	NA
Violet	5–18	SG/DR	FM	DS	Isolation	6	6:26:30	8	7

SG = Sexual Grooming; R = Rape; GR = Gang Rape; DR = Digital Rape; HBP = High Blood Pressure; WF = Weight Fluctuations; STD = Sexually Transmitted Disease; Str = Stroke; As = Asthma; FM = Fibromyalgia; Chol+ = High Cholesterol; DS = Deep Sadness; IA = Intense Anger; IF = Intense Fear; SH = Self Harm; A = Alcohol/Substance Abuse; NA = Not Applicable.

All the participants experienced significant mental health distress, manifesting as suicidality, fear, anxiety and acute and chronic depressive episodes, evident in the clinical history assessment shown in Table 3. Details of the collateral abuse, trauma responses and coping styles with quotes of the lived experience and current life experiences of each study participant, are provided to evidence, enrich and substantiate analytic findings in Table 4.

Table 4.

Participants’ clinical history assessment and narratives of lived and current life experiences.

Clinical history assessment	Narratives of lived and current life experiences
Sarah: Collateral abuse: Family of origin context was characterised by maternal neglect, physical and emotional abuse. Various suicidal attempts and a tendency to social isolation and affective dissociation, has been prevalent and was persisting since her conversion to and practice of Pentecostal Christianity. Trauma responses and coping styles: Blunted affect, religious bypassing, isolation, self-harm, suicidal tendency, inappropriate interpersonal boundaries, co-dependency, fear of intimacy and vulnerability.‪	Lived experience of rape: ‪‘The perpetrator stayed at our house he slept in the lounge. One evening he pulled me in his bed, letting me know how much he loves me and I’m like 5 years old. He obviously knew how my mommy treated me so he used that to silence me’. Current life experience, Session 1: ‘Emotionally I snap out of situations just like that (snaps fingers). I never really allowed myself to feel pain, even any emotion. It’s difficult for me to articulate it. There is that hurt that I tried to shove somewhere down there, you know’.
Mia: Collateral abuse: She was living at home with her 6-year daughter and parents and family members who are verbally and emotionally abusive, with little or no personal space. Trauma responses and coping styles: Non-disclosure, dissociation, blunted affects, risk taking sexual relationships, religious bypassing,	Lived experience of rape: ‘My options were, I walk home through the townships where I don’t know what can happen to me that time of night, or I stay with him, and I know he is going to rape me. I pretended it didn’t happen to me even while it was happening That night my little girl was conceived’. Current life experience, Session 2: ‘I’m trying to think that it is not real what happened to me’.
Ava: Collateral abuse: Ava experiences incest at a very young age with various family members including her father. After being gangrape in a public space, she got up went home and did not share what happened to her with anyone due to a fear of judgement. Her family context was characterised by severe intergenerational physical violence and emotional abuse. Trauma responses and coping styles: Blunted affect, isolation, physical exhaustion, lack of selfcare‪	Lived experience: ‪First incident: ‘My brother raped me, I was 8 years old. I didn’t tell my mom otherwise my dad will beat my brother severely. So, I just got nothing from her … nothing.’ Gangrape: ‘My heart is pounding, they are right on front of me, the three men. It is too severe they hate me very much’. Current life experience, Session 2: ‘Everything is still so fresh in my memory but I put it behind my head, I just leave it there. Everything is dead, I’ve been in this place for a long time’
Charlotte: Collateral abuse: Charlotte has a generational history of emotion, physical and paternal incestual sexual abuse. She was financially independent and in process of divorce form an abusive partner and had experienced paternal incest. She has spent 8 years in DBT therapy and on her own account has become dependent on her therapist. She however voiced that she still experienced chronic severe, anger. Trauma responses and coping styles: Cognitive trauma bypassing, blunted affect, co-dependency‪	Lived experience: ‘I woke up with him in my bed, all over me, putting his tongue in my mouth’. Current life experience, Session 2: ‪’You see you have to understand the history with my dad, my dad was feared by all of my family. He used to hit my mom. I am so angry all the time, I can’t get rid of the anger’.
Joan: Collateral abuse: Emotional abuse, neglect encouraging non-disclosure, judgement from parental and close family members. Joan has not had any partnerships and relied on her faith to cope with maternal neglect and abuse from care givers, including being sexually abused by a close family member. She did disclose this as a child to a maternal grandmother who discouraged her to speak about it out of fear of disrupting family relations. Trauma responses and coping styles: Religious bypassing, interpersonal isolation, fear of intimacy	Lived experience: ‘He touched my private parts, washing me. He said he will hurt me if I tell anyone’. (Crying uncontrollably) Current life experience, Session 1: ‘It feels like there is this stumbling block in life. I have never been intimate with anyone, I’m too scared’.
Evelyn: Collateral abuse: Paternal neglect, alcoholism, emotional abuse, co-dependency, lack of income and autonomy, violent community. Her Christian belief has not brought consistent relief from chronic, debilitating fear. First disclosure of victimisation was during the sessions. Trauma responses and coping styles: Non-disclosure, guilt, isolation, blunted affect‪	Lived experience: ‪’He took me to the kitchen I had to clean the house, I was 8, he forced his penis into me’. Current life experience, Session 1: ‘There is always a barrier there and constant fear. It’s been 57 years it seems like this fear has been so deeply rooted in me. I was just a little child, why did this happen to me?’
Aisha: Collateral abuse: Aisha’s childhood experiences of abuse and incest in various contexts in community were non-disclosed and she chose to follow various religious programmes and relying on her faith. Though she has tried to overcome the memories of abuse and not living in the community context anymore, she still experienced no closure related to the trauma. Trauma responses and coping styles: Religious bypassing, blunted affect‪	Lived experience: ‪ ‘I was 5/6y old there was a group of boys and we had to suck their dicks. I thought it was normal after all of that.’ Current life experience, Session 3: ‘I’m so tired of always being the good girl and trying to cope with everything’.
Amber: Collateral abuse: Amber’s health complaints were varied including high blood pressure, a stroke that compromise her mobility, morbidly obese, high cholesterol and is socially isolated due to physical challenges and lack of mobility. Trauma include gangrape by a boyfriend and gangsters at the age of 14 years and a boyfriend at knifepoint at age 16. Trauma responses and coping styles: Non-disclosure, co-dependency‪	Lived experience: ‪’My new boyfriend also forced me, I was 17 and didn’t understand, two of his friends came after, part of gangsters, he raped me on the ground, one held my feet … then I fell pregnant, I didn’t know who the dad was.’ Current life experience, Session 1: ‘I am always sad, I can remember everything that had happened to me but I try not to think about it that often, I just block it out ‘.
Mandy: Collateral abuse: Mandy was repeatedly sexually assaulted and raped by her stepfather and as a result she fell pregnant and had to disclose the details to her mother. She chose to raise the baby and during the time of the sessions she had left her partner who has been emotionally abusive and tends to isolate herself. Trauma responses and coping styles: Non-disclosure, isolation, blunted affect‪	Lived experience: ‘He tied me up in the back room and raped me, repeatedly. I had to stand in front of the bed’. Current life experience, Session 2: ‪’Sometimes I ask what is wrong with me, is it because I never could speak about what happened. I like to help others, want to make others happy despite my own sadness’.
Debra: Collateral abuse: Debra was raped at gunpoint the age of 19 It A court case led to non-conviction of the perpetrator and she was left with no choice but to have to see him at family meetings where he was usually inappropriate and often mocking her. She received no counselling for what happened to her and there was also a culture of silence and judgement in the family. Trauma responses and coping styles: Isolation, physical exhaustion, non-disclosure‪	Lived experience: ‘‪He raped me the whole night The next morning he put me on the bus back home. I told my parents but my dad blamed me. That was how my dad was. His say was always the last and we always had to do what he said. I was blamed, there was a court case but nothing came of that, he said stuff, there was no women’s rights then so everything just was ignored and pushed to the side’. Current life experience, Session 2: ‪’This keeps me back from healing, I am very emotional, I don’t want to feel like this anymore’.
Zara: Collateral abuse: Intergenerational abuse by paternal grandfather from preverbal – age 9, who also abused her mother and aunt. The criminal court case lasting several years, she had to part of court proceedings from 16 −18 testifying on a testimony she wrote at 9. The alleged perpetrator was not convicted and is still living in the community. Trauma responses and coping styles: Religious bypassing, cognitive trauma bypassing‪	Lived experience: ‪’Sunday mornings, I remember because it used to be this show on TV, it would play when everything would be happening, so that’s specifically how I knew it was a weekend, and I knew it was a Sunday, uhm also my granny would be like in the kitchen, but for me, parts of me felt like she knew what was happening.’ Current life experience, Session 1: ‘In the family we never speak about this … it was much worse than the court case, the silence. My mom and aunt went through the same’.
Violet: Collateral abuse: Violet was sexually abused by family members and never disclosed it. Her sister shared the same experiences but didn’t speak about is. She was diagnosed with acute fibromyalgia, back spasms and depression taking constant mediation and experiencing repeated memories and flashbacks of the abuse. Trauma responses and coping styles: Religious bypassing, blunted affect, physical exhaustion, non-disclosure‪	Lived experience: ‪’I was about 5y, more or less. It was my daddy’s youngest brother. A few after that, I was about 9y or 10y. It was my daddy’s other brother. He is dead now, can’t talk to him now. Not long after that, it was my daddy’s best friend. I thought it must be my fault.’ Current life experience, Session 1: ‘It is just getting worse. I can’t control the flash backs it pops into my head every day. I have prayed about it. Ask God to forgive them, I forgive them, but lately I’m not sure if I have forgiven them, because I’m having weird thoughts of wanting to harm them’. Session 2: ‘I felt so relieved just to share what happened to me, I haven’t slept so well in years’.
Lydia: Collateral abuse: Lydia as a child of a domestic worker did not have access to good education and resources. It is in this context that she experienced sexual trauma from the sons and father who was her mother’s employer. This included indecent exposure, rape and sexual grooming. The first disclosure of what happened to her was during the sessions. Trauma responses and coping styles: Non-disclosure, religious bypassing	Lived experience: ‘I lived in fear, I don’t know what to make. I can’t tell the wife of the employer, and my mother is not near when it happens. My mom would discipline me for other stuff, beating me’. Current life experience, Session 1: ‘That hurt has always been in me when I think of it now.’

By identifying specific behavioural and emotional reactions – such as ‘Pressure chest’, ‘Blunted affect’, and ‘Tearful’ (AS), the variability and progression of trauma realisation and integration were assessed. The analysis categorised trauma responses into three distinct phases: Trauma shift (initial realisation) Trauma transition (deepened trauma engagement), and Trauma awareness/realisation (acceptance and emotional release, such as anger or fear). Time-coded observations (e.g. 2’00” for Trauma avoidance) captured changes in affective arousal and somatic indicators, indicating how the participants moved from avoidance and physical reactivity to deeper processing. This transition was inferred through the sequencing of affective and embodied states, such as moving from ‘Trauma avoidance’ to ‘Trauma release’, with embodied cues like tearfulness and anxiety marking thresholds between phases. Overall, the method combined timestamped coding with thematic analysis of physical and emotional responses to map the evolving internal experience of trauma from suppression to integration.

In summary, the transition between phases described in Table 5 is not marked by a single event but rather by a change in the identified trauma response patterns and themes. As illustrated, the detailed disclosure and validating emotional valence led to visceral awareness and vulnerability, enhancing self-regulation. The trauma integrative process often began with subtle visceral signals, such as chest pressure, progressing through heightened affective states and context specific emotional experiences such as fear, tearfulness and anxiety. Each response served as a critical indicator to pace the depth of each participant’s engagement with their trauma.

Table 5.

Phases 1–3: Trauma shifts, trauma transition, trauma awareness.

PHASE 1	PHASE 2		PHASE 3
Pre-silence	During silence		Post silence
Trauma response patterns	Trauma shift	Trauma transition	Realisation/ Awareness	Valence	Arousal
Sarah
Session 2
Trauma avoidance	2’00” Tornado (I)	0’20” Pressure chest	Visceral	Embodied	↑Arousal
Blunted affect	1’32” Fear (TR/AS)	1’42” Tearful (AS)	Trauma release	Affective	↑Arousal
Religious bypassing	2’12” Dark hole(I)	0’15” Anxious (TR)	Loss control	Affective	↑Arousal
Trauma avoidance	0’10” Light pole(I)	0’13” Ball energy(I)	Gain control	Affective	↓Arousal
Session 3
Mistrust	1’00” Control (TR)	0’17” Pressure chest	Visceral	Embodied	↓Arousal
Fear of vulnerability	1’35” Anger (AS)	5’50” Self-harm	Maternal abuse	Affective	↑Arousal
Session 4
Express emotions	4’30” Sadness (AS)	0’50” Fear intimacy	Self-blame	Affective	↑Arousal
Feels empowered	2”30” Waterfall (I)	1’10” Less guilt	Vulnerability	Affective	↓Arousal
Session 5
Family stressors	5’20” Tornado(I)	02’45” Pain chest	Visceral	Embodied	↑Arousal
Isolation/Silenced	3’10”Anxious (AS)	4’00” Pain throat	Voicing needs	Embodied	↑Arousal
Feels calm/at peace	1’13”Light ring (I)	0’13” In water (I)	No need for control	Affective	↓Arousal
Mia
Session 2
Non-disclosure	3’20” Abuse (M)	3’00” Nausea	Visceral	Embodied	↑Arousal
Dissociation	5’10” Anxious (AS)	1’30” Abd* pain	Trauma/Visceral	Embodied	↑Arousal
Session 5
Intimate relationship	2’00” Exhausted	3’00” Fear (AS)	Avoidance	Affective	↑Arousal
Family violence	2’30” Suffocation	3’00” Fear (AS)	Avoidance	Embodied	↑Arousal
Parental abuse	2’20” Anxious (AS)	1’23” Anger (AS)	Voicing needs	Affective	↑Arousal
Session 7
Maternal abuse	0’45” Sadness (AS)	0’35” Crying	Vulnerability	Affective	↓Arousal
Parental rejection	0’32” Fear (AS)	4’35” Abd* pain	Abuse/Visceral	Embodied	↑Arousal
Dissociation	2’23” Fear (AS)	3’32” Abd* pain	Abuse/Visceral	Embodied	↑Arousal
Family violence	0’16” Anger (AS)	0’19” Pain release	Voicing neglect	Embodied	↓Arousal
Ava
Session 1
Gangrape	0’20” Overwhelmed	0’10” Gangrape (M)	Trauma awareness	Embodied	↑Arousal
Blunted affect	0’08” Fear (AS)	0’09” Pressure heart	Abuse/Visceral	Embodied	↑Arousal
Physical exhaustion	0’17” Fear (AS)	0’08” Pressure heart	Abuse(M)/Visceral	Embodied	↑Arousal
Session 2
Gangrape	0’03” Heart, lungs	0’25” Gangrape (M)	Visceral	Embodied	↑Arousal
Dissociation	0’10” Body floating	0’08” Tearful (AS)	Voice victimisation	Affective	↓Arousal
Maternal abuse	0’45” Abuse (M)	0’55” Nausea	Abuse(M)/Visceral	Embodied	↑Arousal
Physical abuse	0’25” Abuse (M)	0’28” Fear (AS)	Self-neglect	Affective	↑Arousal
Session 3
Gangrape	0’10” Numbness	0’12” Body feet	Victimization (M)	Embodied	↑Arousal
Session 4
Physical abuse	0’20” Abuse (M)	0’12” Chest pressure	Abuse(M)/Visceral	Embodied	↑Arousal
Maternal neglect	0’15” Abuse (M)	0’17” Feet (PN)	Visceral	Embodied	↓Arousal
Session 6
Physical abuse	0’15” Dead inside	0’23” Morgue (I)	Self-aware	Embodied	↓Arousal
Incest	0’12” Abuse (M)	0’11” Suffocating	Visceral (smell)	Embodied	↑Arousal
Trauma release	0’10” Natural light (I)	0’09” Express hope	Self-aware	Embodied	↓Arousal
Session 7
Selfcare	0’35” Empty inside	0’40’ Flowers (I)	Voicing needs	Embodied	↓Arousal
Self-regulation	0’41” Flowers (I)	2’23” Ocean (I)	Self-aware	Embodied	↓Arousal
Charlotte
Session 2
Paternal incest	0’06” Abuse (M)	0’13” Fear (AS)	Victimization (M)	Affective	↑Arousal
Anger	0’07” Anxious	0’22” Tearful	Trauma awareness	Affective	↑Arousal
Trauma avoidance	0’15” Overwhelmed	0’19” Exhaustion	Trauma awareness	Embodied	↓Arousal
Joan
Session 2
Non-disclosure	0’20” Abuse (M)	0’11” Fear (AS)	victimisation (M)	Affective	↑Arousal
Religious bypassing	0’07” Angels (I)	0’11” Dissociation	Gain control	Affective	↓Arousal
Session 3
Physical abuse	0’12” Fear (AS)	0’19” Shaking	Visceral	Embodied	↑Arousal
Maternal neglect	3’11” Sadness	4’15” Crying	Trauma awareness	Affective	↑Arousal
Self-regulation	2’10” At peace	2’05” Sense relief	Vulnerable	Affective	↓Arousal
Evelyn
Session 2
Non-disclosure	0’18” Sadness	0’09” Crying	Trauma awareness	Affective	↓Arousal
Fear	0’50’ Abuse	1”12” Abd* pain	Visceral	Embodied	↑Arousal
Trauma avoidance	0’12” Abuse (M)	0’19” Shaking	Visceral	Embodied	↑Arousal
Session 5
Trauma avoidance	8’12” Crying	5’12” Abd* pain	Visceral	Embodied	↓Arousal
Trauma avoidance	7’10” Abuse (M)	4’09” Abd* pain	Visceral	Embodied	↑Arousal
Trauma avoidance	2’12” Abuse (M)	3’12” Nausea	Visceral	Embodied	↓Arousal
Non-disclosure	1’13” Anger (AS)	4’13” Abd* pain	Visceral	Embodied	↓Arousal
Aisha
Session 4
Parental neglect	1’20” Little girl(I)	0’45” Pressure chest	Visceral	Embodied	↑Arousal
Paternal abuse	0’21” Abuse (M)	0’09” Cold	Visceral	Embodied	↓Arousal
Incest  Self-regulation	0’11” Abuse (M) 0’12” Sadness	0’07” Cold 0’08” At peace	Visceral Vulnerable	Embodied Affective	↓Arousal ↓Arousal
Session 5
Sexual grooming	0’07” Abuse (M)	0’06” Fear (AS)	Trauma awareness	Affective	↑Arousal
Session 7 Hopelessness	1’23” Abuse (M)	0’12” No protection	Victimization	Affective	↑Arousal
Session 9
Selfcare	2’12” Sadness	0’13” Crying	Self-acceptance	Affective	↓Arousal
Amber
Session 1
Family stressors	5’12” Sadness	1’21” Pressure chest	Visceral	Embodied	↑Arousal
Non-disclosure	3’15” Sadness	2’13” Heart	Visceral	Embodied	↑Arousal
Session 2
Partner abuse	0’45” Crying	0’12” Pressure head	Visceral	Embodied	↑Arousal
Family stressors	11’12” Sadness	2’21” Stroke (M)	Trauma awareness	Embodied	↑Arousal
Session 3
Family stressors	5’15” Exhaustion	4’15” Chest tight	Visceral	Embodied	↑Arousal
Self-regulation	4’25” Sadness	2’01” At peace	Vulnerable	Affective	↓Arousal
Session 4
Family stressors	3’18” Exhaustion	2’16” Chest tight	Visceral	Embodied	↓Arousal
Session 5
Family stressors	2’17” Exhaustion	3’16” Chest release	Visceral	Embodied	↓Arousal
Session 6
Family boundaries	0’17” Self-acceptance	2”25 At peace	Self-aware	Affective	↑Arousal
Mandy
Session 2
Non-disclosure	1’15” Sadness	2’19” Crying	Trauma awareness	Affective	↑Arousal
Maternal neglect	2’30” Sadness	3’15” Crying	Trauma awareness	Affective	↑Arousal
Paternal absence	1’17” Crying	2’19” Need for safety	Trauma awareness	Affective	↑Arousal
Session 4
Trauma avoidance	6’15” Fear (AS)	2’16” Crying	Trauma awareness	Affective	↑Arousal
Debra Session 1 Non-disclosure	0’50” Fear (AS)	0’15” Abuse (M)	Trauma awareness	Affective	↑Arousal
Trauma avoidance	0’18” Fear (AS)	0’20” Legs	Visceral	Embodied	↑Arousal
Session 2
Family stressors	3’19” Sadness	4’19” Whole body	Visceral	Embodied	↑Arousal
Paternal abuse	5’22” Sadness	3’19” Whole body	Trauma awareness	Embodied	↑Arousal
Session 3
Partner neglect	3’18” Fear	2’20” Chest	Trauma awareness	Embodied	↑Arousal
Rejection	4’12” Sadness	3’19” Crying	Trauma awareness	Affective	↑Arousal
Session 4
Victimization	2’13” Abuse (M)	1’13” Crying	Trauma awareness	Embodied	↑Arousal
Stress response	5’19” Anxious (AS)	2’19” Allergy skin	Visceral	Embodied	↑Arousal
Stress release	4’02” Sadness	3’22” At peace	Visceral	Embodied	↓Arousal
Zara Session 2
Trauma avoidance	0’15” Crying	0’12” Disclosure	Trauma awareness	Affective	↑Arousal
Lack of support	0’18” Crying	0’10” Chest	Vulnerability	Affective	↑Arousal
Session 4
Dissociation	1’18” Numbness	2’33” Shoulders	Daily stressors	Embodied	↑Arousal
Disclosure	2’13” Sadness	1’13” Sense release	Vulnerability	Affective	↓Arousal
Violet
Session 1
Non-disclosure	2’30” Crying	3’12” Abuse (M)	Trauma awareness	Affective	↑Arousal
Disclosure	3’19” Abuse (M)	2’33” Whole body	Trauma awareness	Embodied	↑Arousal
Victimization	2’20” Abuse (M)	1’22” Crying	Trauma awareness	Affective	↑Arousal
Religious bypassing	0’23” Abuse (M)	0’12” Forgiveness	Trauma avoidance	Affective	↑Arousal
Session 3
Stress response	1’29” Dizziness	2’23” Crying	Trauma awareness	Embodied	↑Arousal
Victimization	2’34” Sadness	2’30”Chest pressure	Trauma awareness	Embodied	↑Arousal
Paternal neglect	3’23” Sadness	1’27” RP* pain	Visceral	Embodied	↑Arousal
Session 5
Feel calm/at peace	6’23”Naturallight(I)	3’23” Heavy body	Vulnerability	Embodied	↓Arousal
Intimacy partner	2’23” + Memory	1’23” Acceptance	Vulnerability	Affective	↓Arousal
Victimization	5’23” Anger (AS)	2’23” Nausea	Trauma awareness	Embodied	↑Arousal
Session 6
Victimization	4’23” Sadness	1’23”Reprod*pressure	Vulnerability	Embodied	↑Arousal
Feels at peace	2’23”Naturallight(I)	0’23”Feet (PN)	Vulnerability	Embodied	↑Arousal
Self-regulation	1’45” Self as child(I)	2’06” Body (PN)	Trauma awareness	Embodied	↓Arousal
Lydia
Session 1
Non-disclosure	0’12” Sadness	1’15” Sense release	Trauma awareness	Affective	↑Arousal
Religious bypassing	1’23” Guilt	0’23” Shame	Trauma awareness	Affective	↑Arousal
Session 2
Religious bypassing	2’12” Self-blame	0’12” Guilt (AS)	Dissociation	Affective	↓Arousal
Disclosure	1’23” Mountain (I)	2’12” Sense of release	Trauma awareness	Affective	↓Arousal
Session 3
Family stressors	0’23” Anxious (AS)	0’23” Guilt (AS)	Trauma awareness	Affective	↑Arousal
Self-regulation	1’35’ Mountain (I)	0’15” At peace	Integration	Affective	↓Arousal

Time sequence for silence – bold.

*Embodied = General awareness * Visceral = Interoceptive awareness *Affective state (AS) * Trauma response (TR) *Image (I) *Memory (M) *Pins and needles (PN) *Reproductive parts (RP).

4. Discussion

In the absence of integrative trauma care at the community or primary care level, trauma disclosure became increasingly difficult for participants, leading to long-term suppression, maladaptive coping, and trauma avoidance. Assessing ITIC practices, including the facilitation of silence, had to be responsive to these dynamics. The study’s focus on subjective and embodied responses to silence offers unique insights into trauma realisation, processing, and integration.

4.1. Therapeutic implications of facilitating integrative silence

The study demonstrates that integrative silence within the ITIC model is particularly significant in the context of long-term trauma suppression, where behavioural self-blame, exacerbated by a sense of loss of control, often impedes recovery. By facilitating trauma processing at an safe, individually appropriate pace (Popay et al., 2021), therapeutic power dynamics were critically attended to. The study participants engaged with memories, emotions, and bodily awareness on their own terms, with careful attention to the duration of silence to prevent re-traumatisation or therapeutic coercion. Integrative silence thus served as a supportive space, enabling trauma integration while challenging dominant socio-spiritual narratives that tend to bypass the embodied impacts of CST. The study identified five specific areas that contributed to refining and advancing the ITIC therapeutic approach. First, a structured, phase-oriented framework supported nuanced trauma evaluation and intervention, second, maintaining silence by minimising interruptions created a safe therapeutic space, enabling deeper engagement with trauma, third, integrative silence helped participants confront and process their pain, particularly in the context of recurring violations, fourth, the approach offered non-pathologising alternatives to interpreting visceral discomfort, and a more holistic integration of traumatic experiences and finally, post-session reflections and participant feedback ensured experiential and analytical validity, guiding ongoing refinement of the therapeutic process.

4.2. Community centred ITIC

4.2.1. Cultural factors influencing the effectiveness of integrative silence

The study indicates that integrative silence as a therapeutic intervention is closely linked with culturally responsive and community-based participatory, trauma care practices. This approach builds on emerging research linking non-verbal practices to trauma recovery, and can play a significant role in helping trauma survivors connect with both their personal and communal experiences of trauma. This approach validates diverse cultural meanings attached to silence, further supporting its effectiveness as a therapeutic intervention.

4.2.2. Attending to the therapeutic space

The delivery of care extended beyond participant – therapist interactions by including community engagement as a precursor to this process. Facilitating silence within community based integrative trauma care, required an in-depth assessment of lived experiences, clinical histories and current biopsychosocial distress markers underscoring the complex and severely invasive nature of violation in already marginalised contexts.

4.2.3. Avoiding potential re-traumatisation

Creating spaces of silence involved carefully avoiding prolonged and unnecessary discomfort that could lead the participants to revert to maladaptive coping styles. It was essential to balance silence with an awareness of both past violation and present psychosocial stressors.

4.2.4. Active acceptance

The process emphasised the importance of agency in coming to memory and vocalisation, which was not just solely related to meaning-making and religious beliefs, but also highlighted the role of embodiment. Many women expressed that they still felt dirty and defiled despite previous religious interventions, pointing to the need for less reliance on performative religious trauma bypass mechanisms like forgiveness, guilt, shame and self-blame.

4.2.5. Self-regulation and selfcare

Participants’ experiences of affective and embodied self-awareness during moments of silence – including physical exhaustion and visceral reactions to recalled violations – highlighted the critical need for interpersonal and psychosocial care, particularly in relearning appropriate forms of self-regulation. Experiences of social isolation and disrupted interpersonal relationships illustrated the critical need to restore practices of self-care, particularly within a critical feminist community psychology framework that recognises the relational and socio-political dimensions of well-being.

5. Conclusion

This research situates ITIC within South Africa’s broader context of historical systemic injustice, highlighting the value of integrative silence as a trauma care approach that is person-centred and sensitive to cultural, social, and political realities. Grounded in a decolonial feminist framework, the study advocates for therapeutic approaches that honour non-verbal communication amid socio-political complexity. By moving beyond cognitively driven methods, community-centred ITIC prioritises agency, emotional regulation, and the integration of fragmented experiences rooted in marginalisation and systemic violence. The findings demonstrate how silence can serve diverse therapeutic functions:

Creating safety: Silence provides a non-threatening space where victims can feel in control, which is essential for those who have experienced profound violations of their autonomy.

Encouraging reflection: Silence allows for deep introspection, giving victims the time to process and articulate their thoughts and emotions.

Facilitating non-verbal expression: Given the somatic nature of sexual trauma, silence can help victims attune to their bodily sensations and memories, which are often beyond verbal articulation.

Empowering the victims: By not filling the silence, therapists empower victims to take the lead in their recovery journey with a sense of agency and autonomy.

Contextual sensitivity: On the Cape Flats, a historically marginalised community, silence in therapy respects the cultural and historical context of victims. It acknowledges the compounded trauma of sexual violence and systemic oppression.

Resistance to dominant narratives: Silence can be a form of resistance against dominant narratives, allowing for culturally resonant narratives to emerge.

Reclaiming voice: In line with decolonial feminist thought, silence is a means for the study participants to eventually reclaim their own voice and power, challenging apartheid legacies of silencing and marginalisation. By systematically examining these aspects presented in this paper, future research can build upon the current findings to enhance therapeutic practices and outcomes for adult survivors of sexual abuse from diverse and marginalised communities.

Annex 1.

1. Participant intake form

Your cooperation in completing this questionnaire will be helpful in planning services for you. Please answer all items carefully. If you do not understand an item, I am happy to provide you with clarification and assisting with completing the form. (Translation in Afrikaans and Kaaps if requested)

Previous interventions and psychotherapy

Please describe your reason/concern for seeking therapy:

Are you currently having any suicidal or homicidal thoughts? Yes No

If yes, please explain:

Have you received prior counselling? Yes No

Therapist’s name, address and dates of previous counselling:

May I contact your previous therapist? (with appropriate release) Yes No

Areas of concern

Please indicate any of the following problems or concerns, which pertain to you.

If you indicate more than three, kindly indicate your most urgent concerns:

In your own words, what is the nature of the concern you wish to address in therapy?

Feel free to describe this in as much or little detail as you wish. Use additional paper if you like.

• b.Assessment of acute and chronic medical conditions

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The authors affirm that the research participants provided written informed consent for the sharing of publication specific anonymised research data. The participants of this study did not give written consent for the original data set to be shared publicly and due to the sensitive nature of the research, supporting data is not available.

Consent to participate

All participants were required to provide written informed consent before starting the first in person interview.