This dissertation explores how adult survivors of child sexual abuse experience the early stages of psychotherapy. A hermeneutic methodology is used to illuminate therapy processes and outcomes, including attrition, from a survivor’s perspective. First-person accounts found in the research literature assist in illuminating an understanding of what these clients may encounter in this crucial first phase of the therapeutic process. This research proposes that survivors’ voices are essential to understanding the diverse experiences of sexual abuse survivors. However, the paucity of first-person accounts of the survivor’s initial therapy phase in the academic literature presented a difficulty for this study and points to a gap in existing research. Given the prevalence of child sexual abuse in the Western world, this hermeneutic literature review seeks to contribute toward a better understanding of the therapeutic needs of this growing client group, particularly at the beginning of their journey. This study’s findings have implications for the training and clinical practice of frontline health and education workers, including beginning and experienced counsellors and psychotherapists in Aotearoa New Zealand.