Embodied Care Pathways: Feminist Restorative Therapeutic Approaches for Adult Women Survivors of Childhood Sexual Abuse in Marginalised Contexts

This PhD study explores the therapeutic co-development of a trauma-informed, embodied care model for adult survivors of childhood sexual abuse (CSA) in the under-resourced Cape Flats region of South Africa. This thesis follows the PhD by publication route and is based on four peer-reviewed journal articles that collectively develop, apply and critically evaluate the Integrative Trauma-Informed Care (ITIC) model. The four published papers examine: (1) embodied silence as integrative healing, (2) religious coping and spiritual complexity in trauma recovery, (3) feminist restorative praxis in community psychology, and (4) the ethical application of the ITIC model in under-resourced contexts. Grounded in decolonial feminist ethics and critical community psychology, the study addresses a significant epistemic and ethical gap in mainstream trauma care, which often neglects the sociopolitical, geographic and embodied realities of victim-survivors in marginalised settings. Using a qualitative community based research framework that includes participatory research principles and the Integrative Trauma-Informed Care (ITIC) model, this study engaged thirteen adult women who identify as ‘coloured’, a historically racialised and systemically excluded group. The research was embedded in therapeutic processes, using recorded sessions, in-depth interviews and therapeutic co-designed care pathways to explore how trauma is expressed, processed and integrated across verbal and non-verbal dimensions. Original contributions include the intentional use of integrative silence and the creation of therapeutic spaces that prioritise relational trust, cultural sensitivity and spiritual complexity. Findings indicate the necessity of addressing intergenerational trauma, systemic violence and institutionalised religion’s dual role in both supporting and suppressing trauma integration and recovery. The study presents a multicomponent, survivor-led ITIC model that is adaptable across diverse community needs and emphasises embodied, temporal and culturally embedded trauma recovery. The findings contribute original knowledge to global health psychology, feminist mental health praxis and decolonial research methods. Theoretical insight for clinicians, researchers and policymakers is provided for the ethical design and practical delivery of ITIC interventions in marginalized contexts. The study advances a transformative paradigm of trauma care that foregrounds equity, survivor agency and relational healing in settings marked by structural violence. In doing so, it expands the possibilities of trauma-informed practice by demonstrating how person-centred, feminist and decolonial methodologies can generate contextually grounded therapeutic pathways of recovery.