Impacts of childhood sexual abuse (CSA) are profound and long-lasting, often resulting in impairments to survivors’ mentalization and/or Theory of Mind (ToM) abilities. The current study aimed to enhance our understanding of these phenomena and explored potential for recovery via effective therapeutic interventions. The research sample consisted of 18 patients and 19 therapists residing or working in two types of facilities: live-in prisoner rehabilitation centers facilities for female parolees (PRA); and a psychiatric unit hospital ward specializing in sexual abuse survivors (PU). Data were based on semi-structured interviews analyzed using the qualitative thematic analysis approach. Findings demonstrate that survivors are vulnerable to fractured thought processes that reflect their early traumatic experience, impacting their present-day perspectives of themselves, others, and the world, and resultantly projected within the therapeutic relationship. Awareness and identification of these expressions within the therapeutic relationship can help promote mentalization-based healing for survivors.