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Childhood Sexual Abuse

By Edited Apr 25, 2016 1 0

Childhood Sexual Abuse



According to a prevalence study conducted by the Center for Disease Control (CDC), Childhood Sexual Abuse (CSA) estimated 1 in 4 girls and 1 in 6 boys have been sexually abused before the age of 18 (CDC study).  Family members account for 30-40 percent of the perpetrators.  Fifty percent of the abuse is by someone outside the family, but the child knows and trust (Frawley, 1990; Kilpatrick, Saunders & Smith, 2003).  This does not even take into account the others who were abused and not reported.  There are more than 80,000 reported cases each year with many more not reported (American Academy of Child and Adolescent Psychiatry).  In a study of adults who had reported being sexually abuse, 2 out of 3, said they never reported it to anyone (Lovett, 2004).

The National Center for PTSD estimated that women are the abuser in 14% of cases against boys and 6% against girls.  This would conclude that men are the abusers, in most cases, against both boys and girls  (Department of Veteran’s Affairs).

Child Sexual Abuse

Children of all ages, races, ethnicities, and economic backgrounds are vulnerable to sexual abuse. Child sexual abuse affects both girls and boys in all kinds of neighborhoods and communities, and in countries around the world.  Sexual abuse is the forcing of unwanted or undesired sexual behaviors onto another person. Childhood sexual abuse is when a child is sexually abuse for the gratification of an older person.  This could be an adult or an older adolescent.  Most states have laws that define what age difference there must be before the incident is counted as sexual abuse.  In addition, most states have a law defining what the age of consent for sex is.  However, even with this law that does not mean that sexual abuse did not occur. 

In this paper there will be discussion of what sexual abuse is, how a perpetrator may conduct the process leading to sexual abuse (grooming), and the effects of sexual abuse on children and later when the abuse children become adults.  Statistics are provided about who is a victim and who is a perpetrator.  Some common myths will be discussed and debunked.  Treatment considerations are provided.  The paper will end with what victims, parents, teachers, caregivers, and mental health professionals should do when victimization occurs or is reported.  Together, hopefully, we can reduce the sexual victimization our most valuable nonrenewable resources, our children. 

Who are the Victims?

As reported above, 1 in 4 girls and 1 in 6 boys will be victims of sexual abuse by the time they are 18.  These statistics could be skewed.  Girls are more likely to report sexual abuse than boys are.  Men are less likely to report sexual abuse as a child because it will make them look weak.  Some men even find that society looks upon them favorably for having an early sexual experience, even if it was unwanted.  With this being said, the boys and later men are less likely to call their sexual encounter, a sexual assault or a molestation.  According to a study, completed by the National Center on Child Abuse and Neglect, girls are sexually abuse three times more than boys, but boys are more likely to die or be seriously injured by the abuse (Sedlak and Broadhurst, 1996). 

The incidences of child sexual abuse was 1.8 times higher among children with disability compared to the incidence among children without disability. The most common disabilities noted included emotional disturbance, learning disability, physical health problems, and speech or language delay or impairment (Barnett et al., 1997, p. 49). As stated in the introduction, 50-80 percent of perpetrators are trusted family or friends that the victim knows well.  The perpetrator knows the deficits the victim has and can exploit it to gain their objectives of sexual abuse. 

Child sexual abuse

Studies have found no difference in the prevalence rates of children sexually abuse in regards to race, ethnicities, or social classes.  However, poor parenting skills, unavailable parents, conflict, and poor child-parent relationships are significant risk factors to a child being sexually abused (Finkelhor, 1994).  There does seem to be an age when victimization is more likely to occur.  Both boys and girls are more likely to be sexually abused between the ages of 7 and 13 (Finkelhor, 1994). 

Stages of Process of Sexual Victimization

It is important for parents, teachers, caregivers, and mental health professionals to be aware of and understand the process of how a perpetrator will victimize a child.  The pattern is important when working with the victim and the families.  Delaplane, D. and A. Delaplane (2008) have a stage process and I have described those stages as I see it.

1.  The Approach
The act of molestation is an intentional act.  The first need is the perpetrator has to be alone with the potential victim.  This can be achieved by asking the child to play a game or to come and see what they offender has in another room, house, vehicle, etc.  This can be easily achieved, because remember 50-80% of the time the offender is someone the victim knows and trust.  Even strangers will try to develop some relationship with the caregiver or the victim to lead them to these activities or places. 

Parents tell their children not to talk to strangers or take things from strangers, but when the parent gives approval to do something with a stranger; this negates the verbal warnings given before. 

The approach act may be seen to the child as a game.  This is how a majority of the offenders operates.  This is sometimes called grooming.  Grooming is preparing the victim by gaining their trust or favor to try with further expectations.  The offender may entice the child to first play a “normal” game and then lead the child to more and more provocative activities such as looking at the genitals, touching the genitals, and etc.  The offender will reassure the victim that this is fun or “alright” to do. 

The approach can also be forced upon the victim.  This is obtained by the offender by telling the victim they are going to hurt them or their family.  The offender can tell the child, that the parents approved of it or they would not have let the child be in this situation.  This can play upon the emotions of the child and put them in fear of the offender and his/her parents. 

2.  Sexual Interaction
In the mind of the perpetrator the offense is an addictive process. It is not the end game that counts. It is the process that is addictive.  Like other addiction process, the beginning of sexual abuse could be less harmful activities, (looking, touching, fondling).  However, it progresses to oral, vaginal, anal, or all of the above. 

3.  Secrecy
Secrecy is very important to the offender so that he/she may continue to sexually victimize the child.  The offender knows the act he or she is doing is against the law and to not receive consequences for their actions they must make the victim maintain secrecy.

Secrecy is also important in the process, in that, the child continues to feel victimized even when not being physically assaulted.   Some children will keep the secret until the emotional or physical pain become too much to bear.  Some incidents will accidentally come out without the child intentionally trying to give up “the secret.”    The emotional and psychological strain can continue for years, even into adulthood.  Some people will block the thoughts of the victimization out until particularly stressful times and the “truth” may come out.  Other people may never reveal the secret and keep all the emotional turmoil pent-up and just suffer. 

4.  Disclosure
Revealing what happened and naming the offender is disclosing.  This is usually and a particularly hard thing to do, but necessary step for the victim to find peace and carry on with a productive life. 

The disclosure can be accidental.  The child could be playing with a parent, daycare provider, or mental health professional and show, on accident, what happened.  The disclosure may come during the course of play.  Mental health professionals make use of toys, games, and books to elicit emotions, thoughts, and feelings to come out.  The child could be playing with a particular toy in a way that the trained professional notices something is “just not right.”  The mental health therapist may then probe with questions or continued observations until verbal disclosure happens. 

The child victim may show the information thinking it is no big deal.  This is especially true for repeated victims.  This may be “the norm” for them.  It would be as normal to them as someone reporting they ate dinner last night.  If there is continued victimization, the child may believe this happens to everyone and does not think it is abnormal. 

The victim may verbally disclose the information because the perpetrator is unable to follow through with threats of harm.  In these cases, the offender may be incarcerated, dead, or moved far away at that time. 

The victim may verbally disclose on accident.  This occurs because the child cannot effectively use the defense mechanisms that protect the human psyche.  The victim may “accidently on purpose” reveal the secret.  The child may pretend this victimization is occurring to a friend and upon questioning will release the information that is needed to identify the offender and come to the conclusion the victim is the one telling the incident.  I say “accidently on purpose” to say the victim wants the person to probe more so they can justify the third-party person “pulled” the information out of them. 

When the disclosure occurs the offender will usually react negatively.  The reaction is most likely one of denial and hostility.  The offender will deny the allegations because it will cause a loss of reputation in the community, family problems, relationship problems, and legal consequences.  There is a lot for the offender to lose.  On occasions the offender will express his or her desires to get help and get protection.  This usually only occurs when the offender comes to the conclusion there is no way denial or hostility will work or when the evidence is so overwhelmingly against the offender.  This usually occurs when the offender is caught in the act with the victim. 

The people in charge of the welfare and being of the child may have denial in the situation as well.  They may feel guilt about not protecting the child from the victimization.  They may be a victim of abuse at the hands of the offender as well and does not feel they can help the other victim because of their own situation.  The person may also deny the charges because they are fearful of the repercussion to their own well-being of may fear retaliation from the offender.  Being in the situation brings attention to other aspects of the person’s life.  I have seen sexual abuse be covered up because of fear that the authorities would investigate and find other illegal activities taking place in the house (i.e. drug possession, drug manufacturing, prostitution, etc.). 

5.  Suppression
The last considerations in disclosure are reasons some people will suppress the victimization and try to “move on” like the sexual assault never occurred.  The victim or family will adopt an attitude of “It is not that big of a deal.  He/She will soon get over it.”  They may also think the consequence of revealing the incident is more harmful than the suppression.  They are so much wrong.  The suppression of the sexual victimization is long-term and can affect every aspect of the victim’s life.  Whereas, the consequences of revealing would be, in most cases, shorter term. 

6.  Repression or Recovery
Some adjustments will have to be made when the sexual assault is revealed but life will go on.  Treatment of the child sexual victim and of the offender will need to take place. 

The victim will need to work through the severe psychological damage and regain trust and hope in other people to continue to have a healthy lifestyle.  The offender, who has deep-seated psychological issues will need to have therapy to find the etiology of his/her own disturbances and learn corrective measures when dealing with those emotions and possible future behaviors. 

When the victim learns that this situation is not normal in their life and can effectively move on to a better life and provide for themselves and the ones they care for, the situation is in recovery.  When they learn to be resilient and the others around them are able to get back to “normal” relationships of trust and love, the recovery has succeeded. 

When the offender does not only avoid the sexual victimization of others for fear of legal or social consequences, but truly understands that this is wrong for a person to effect others in this way, then his/her treatment is considered a success. 

What is Trauma?

According to the American Psychological Association (APA), trauma is “an emotional response to a terrible event like an accident, rape, or natural disaster” (APA, 2012).  The trauma can also cause horror, terror, helplessness, and fear for the future.  It is common for children to experience at least one traumatic event in their lifetime.  These events can, and likely do, have a psychological impact on the person.  However, more pervasive and chronic traumatic events can cause more psychological distress and long-term consequences to the person.  One type of pervasive traumatic event is the childhood sexual abuse.  The sexual assault, with only a one time occurrence, is powerful and can cause severe psychological problem that can adversely effect the person, but the repeated sexual assaults can created the feelings of hopelessness, that the events will end; helplessness, that the events cannot be changed by the victims or those responsible for their welfare; and the victim does not feel the ability to be happy again. 

Post traumatic Stress Disorder

Witnessing or experiencing a traumatic event, such as sexual abuse can lead to a psychiatric disorder known as Post traumatic Stress Disorder (PTSD).  The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) defines PTSD as “the development of characteristic symptoms following exposure to an extreme traumatic event stressors involving direct personal experience of an event that involves real or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person…” (American Psychiatric Association, 2000).  This definition could include sexual abuse if the criteria for that disorder is met.  The diagnostic criteria for PTSD (American Psychiatric Association, 2000, pp 467-468) are as follows:

A. The person has been exposed to a traumatic even in which both of the following were present:
(1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
(2) The person’s response involved intense fear, helplessness, or horror.  Note:  in children, this may be expressed instead by disorganized or agitated behavior

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
(1) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.  Note:  in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) Recurrent distressing dreams of the event.  Note:  in children, there may be frightening dreams without recognizable content.
(3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experiences, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).  Note:  in young children, trauma-specific reenactment may occur.
(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) Efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) Inability to recall an important aspect of the trauma
(4) Markedly diminished interest or participation in significant activities
(5) Feeling of detachment or estrangement from others
(6) Restricted range of affect (e.g., unable to have loving feelings)
(7) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptom of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) Difficulty falling or staying asleep
(2) Irritability or outburst of anger
(3) Difficulty concentrating
(4) Hyper vigilance
(5) Exaggerated startle response
E. Duration of the disturbance (symptoms from Criteria B, C, and D,) is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

When the criteria is met, the diagnosis will also indicate if the symptoms are acute, if the duration of symptoms is less than 3 months; or chronic if the duration of symptoms is 3 months or more.  There is a type of PTSD specifier called “with delayed onset.”  This is when the onset of the symptoms is at least 6 months after the stressors.

Before Criteria E is met the symptoms are reported as Acute Stress Disorder.  The symptoms are the same.  The duration of symptoms is the only factor that separates the diagnosis of PTSD and Acute Stress Disorder.

If you read the symptoms of PTSD, you can see where childhood sexual abuse can be a traumatic event than can lead to the clinical diagnosis of PTSD.  Theoretically, a person can, at times, not meet enough symptoms to carry the PTSD diagnosis, but my experience does not lead me to believe it is in actuality possible. The person may be coping well with the sexual abuse and not having enough symptoms, but the victimization is causing a lot of problems in life's areas.

In younger children, dreams of the event can turn into nightmares of monsters and threats to self or others.  During the daytime the child may have repetitive play where the child is “acting out” the events.  Whereas, in adults and older children, with better communication skills, these “flashbacks” or reliving the events can be communicated verbally.  Parents, teachers, and other caregivers should be interviewed to get their impression of the child’s diminished activities.  Children will experience more somatic symptoms in response to the trauma.  Adults may have this as well, but again, adults are more able to verbally communicate. 

Lenore Terr (1994) did longitudinal studies of children who survived traumatic events.  Terr found all victims of trauma had symptoms of body memories, repetitive reenactments, specific fears related to the trauma, and a change in attitudes.  Terr described two types of survivors, Type I and Type II.

Type I survivors have not blocked out memories of the traumatic event.  They do still have some misperceptions or “omens” of the intentions of others, with whom, they come in contact with.  They are pessimistic or mistrusting of other individual and may interpret relatively innocuous events by others as a threat of harm to them. 

Type II survivors do not have full memory of the trauma.  They may be in denial about what happened to them.  They may interpret the abuse or trauma as not harmful to their well-being.  The survivor may develop psychological coping mechanisms, such as depersonalization, dissociation, and “numbing” that may work at a conscious level but may be interfering with maturation and psychological growth. 

Identification of Childhood Sexual Abuse

The easiest and obviously the best way is for the victim to revel the secret and start the appropriate healing process with a trained mental health profession.  I said this was obvious but it may be the hardest step for the victim to do.  The victim may first resort to “self-treatment.”  Self-treatment can include emotions, attitudes, and behaviors that can temporarily alleviate the symptoms.  A victim may turn to “self medicating” with illicit drugs or “doctor shop” to get medication that may help alleviate short term symptoms but may prolong the actual healing process from occurring.  Some symptoms of childhood sexual abuse may manifest itself in other problematic behaviors and emotions.  These symptoms may relieve some immediate psychological stress related to the victimization.  However, they do not work in the long term and can cause added problematic issues that the victim will have to deal with.

Child sexual abuse

Some of the problematic emotions and fears can lead to symptoms that will help others identify PTSD in the victim.  They are as follows:
• The victim may develop new fears.  The victim may become distrustful of other people and new situations, in which they feel uncomfortable in.  Other anxiety disorders such as Generalized Anxiety Disorder, Specific phobias, Social anxiety, and Agoraphobia could occur. 
• Especially in young children, separation anxiety could occur.  The separation anxiety may even occur with the offender. 
• Sleep problems and Nightmares.  This is one of the criteria for PTSD.  The victim may only present with sleep problems to obtain medication to help with the dyssomnias.  The person may not consciously know the sleep problems are related to the traumatic events. 
• Depression is very common in people who have been a victim of childhood sexual abuse.  They may feel responsible for not being strong enough to stop the abuse.  They may feel they should have reported it sooner or even at all.  The victim may feel hopeless about the situation and their future.  They may feel that no one can help them and the world is unjust.  They may feel they are not worthy of love and happiness.  The feelings associated with this are called the cognitive triad of depression described by Aaron Beck (1976). 
• The person may experience a loss of interest in daily activities.  This may be a symptom of the depression, but it could also be a symptom of the anxiety they are experiencing, or both. 
• The victim may have a reduced ability to concentrate.  They may be having reoccurring thoughts about the traumatic event(s) and unable to concentrate of the “here and now.”  They may feel their “here and now” is hopeless so they do not think about that.  They may be daydreaming about a time when life was more simple and “good.”  The victim could be plotting revenge against the offender.  Another psychological occurrence that may be occurring is dissociation.  Dissociation, in relations to psychology, is the altered state of consciousness characterized by partial or complex disruption of the normal integration of a person’s normal conscious or psychological functioning.  Some people call this an “out of body experience.”  Some victims report they dissociated during the victimization in order to not feel the pain associated with the event.  They report they are “out of their body” and watching the event from somewhere else in the room.  Others will report the “out of body” experience as taking them to another place to mentally escape. 
• In school children, symptoms may present themselves in the classroom.  The dramatic change in school performance could be a tell-tale sign of the victimization of the child.  This is not always a good indicator and this symptom should be guarded in making an interpretation.  The child may be struggling for other reasons.   However, this in addition to other symptoms that may be present is a strong indicator that something is wrong in the child’s life.  It may not be sexual abuse, but then none of the symptoms are “stand alone.”  That means the holistic approach to symptomatology should be present. 
• Anger and irritability.  An increase “lashing out” or temper tantrums could be a symptom of the child trying to psychologically deal with a traumatic event.  Anger is rooted in depression and anxiety and PTSD is an anxiety disorder.  Irritability and anger could be a way to keep people at a “psychological arms length” away from them.  In the subconscious of the victim, this could a way to protect themselves from further victimization at the hands of the perpetrator or other potential perpetrators.  Remember the symptom of PTSD where the victim will become pessimistic and untrusting of other people. 
• Somatic complaints can lead to somatoform disorders.  A somatoform disorder is when the person is present biological problems without a medical cause or reason.  They are not feigned or faked.  In contrast hypochondrias, fictitious disorders, and malingering may be first to come to mind, when thinking about victims.   Hypochondrias is when the person is preoccupied bodily ailments, but no supportive medical information is available.  Fictitious disorder is when symptoms are feigned to assume the role of a patient.  With Hypochondrias and Fictitious Disorder the objective is not secondary gain.  Malingering is different from the two aforementioned disorders.  Malingering is done to receive some secondary gain, such as money, disability check, or attention.  Somatization Disorder is not often wanted by the victim.  They actually experience the uncomfortable pain.  In the case of sexual abuse, the pain may be in the genital region and cause displeasure with sex.  You can assume this may cause future relationship problems. 

Treatment of Childhood Sexual Abuse
Mental Health Professionals (MHP) can help identify and provide appropriate information and support.  The mental health profession can direct victims, parents, and caregivers to books, organizations, and internet sites that will help them understand the process.  There are many good ones out there.  Some will be more appropriate for specific victims than others.  The following information is derived from the American Psychological Associations’ website Children and Trauma: Tips for Mental Health Professional (2012).

Mental Health Professionals can help families and victims to make connections and maintain necessary interventions. The MHP should keep the therapeutic process going and keep the family engaged until symptom relief is manageable.  Follow up on missed appointments and “homework assignments” to show the victim and family you are there for them.  The MHP may not be able to provide treatment for the victim and family for personal or other reasons.  The MHP should direct the family to someone who has training and can provide the treatment. 

The Mental Health Professional may choose to receive specialized training and be a part of a program that will provide seminars or panel discussions on the topics of childhood sexual abuse.  These MHPs will be a great asset to other MHPs who may not have the specialized training.  These MHP can be a valuable resource for community organizations and schools looking to provide training in recognizing and referring victims of sexual abuse. 

The Mental Health Professional may be available to provide specific consultation to schools, other professionals, and organizations to promote advocacy for the victims. 

When working specifically with the victim the Mental Health Professional should convey an expectation of full recovery.  This will help the victim regain some hope that the professional has confidence in their training and the victim that recovery is possible.  Remember the victim may have developed the cognitive triad of depression symptoms of hopelessness, helplessness, and haplessness (lack of happiness). 

Help the victim and family understand the expected and normal reactions to the trauma associated with childhood sexual abuse.  Help them to identify and use their existing coping skills in an appropriate manner.  The MHP must know when to ask for help and not be afraid to seek consultation. 

The Mental Health Profession must match the appropriate care to the victim’s needs and phase of recovery.

Immediately after the trauma occurs the Mental Health Professional should attend to the basic needs of the victims.  This includes safety, shelter, and reuniting family members, excluding the offender if that is the case.  Next, the MHP should assess initial responses from the victim and family and arrange to follow up over time with either that MHP or another qualified MHP.  The MHP should provide information about support of parents, family, and community efforts.  This can be done in the following ways:
• Provide safe, developmentally appropriate, culturally responsive, recovery environment.
• Reduce ongoing exposure to stressors/secondary traumas.
• Reestablish normal roles and routines.
• Activate support with relatives, spiritual, and community systems of the victim. 

Sometimes the victim may not be identified immediately after sexual abuse.  Mental Health Professionals may have already completed the steps in the phase listed above.  There are things to do anytime after the trauma occurs.  They are as follows:
• Allow the victims to express their feelings if they want to.  Do not pressure them.  This may cause them to retreat for psychological protection.
• Help parents and other key adults to be aware of their own reactions and to listen and understand the child’s reactions.

The Mental Health Professional must be aware of and conduct an evaluation for other persistent adverse reactions from the victim.  This could include suicidal ideation and plans.  Drug use or “self-medicating” could occur.  Along the course of treatment, anger, depression, anxiety, etc may occur and those symptoms must be addressed and related to the traumatic event.  The normal process of recovery should be explained.  Psychological numbing, impairments and persistent, adverse reactions may warrant the need for treatment. Interventions that may be needed are more attention to trauma-focused treatment.  The therapy may have wandered off into other problems areas.  Refocus will be needed.  The MHP however, should respect the child and family’s readiness for treatment.  The family and child may not be able to do treatment at this time.  Provide support and let them know you will be available.  Leave the door open for treatment to resume, when they are ready. 

The Mental Health Professional should understand the child, family, and cultural perspectives.  Listen carefully to the child and family.  They might be telling you something using their own cultural experiences.  Respect, gain information and ask questions about specific aspects of their culture.  Do not openly question if their culture is “holding” them back from recovery.  This may be they recovery they need and you may be trying to impose your culture on them.  Your cultural ideas might not be right in this specific case.  Their cultural might not be right either, but it is theirs and they will hold on to it and possibly take it away with them leaving them without your help.  One last thing to help with this is to involve relatives and other kinship groups in the process if the victim and family will allow it. 

Working with these cases can cause some issues to be stirred up in the Mental Health Professional.  Take care of yourself, physically, emotionally, and spiritually to ensure that you are there to help the victim at the appropriate time when needed.  Know your limits and seek consultation or supervision if needed.  Don’t be afraid to ask for help.  Remember you are trying to be a model and set an example for the victim to ask for and receive help when needed. 

Another thing you as the Mental Health Professional should be aware of is when you are becoming overly involved with this patient.  You could be setting yourself up for burnout, exhaustion, numbing, distancing, or psychological disturbances yourself. 

Lastly, the American Psychological Association, warns the Mental Health Professional to be aware of some potential pitfalls when working with childhood sexual abuse.  I would extend this to Mental Health Professionals working with any clients.  They are as follows:
• Assuming that all children/clients will respond to the problems or trauma in the same manner.
• Pathologizing early distress or reactions to the traumatic or problematic event.
• Conveying the message that trauma exposure or issues inevitably results in long term psychological damage.
• Assuming that all clients will have long term damage requiring long term treatment.
• Creating situations in which clients have little choice or control
• Forcing children or parents to tell their story.  Remember to listen carefully when they do. 
• Ignoring your own stress from your work with the clients.

Summary of Core Issues

Evans and Sullivan (1995) outlined the core issues for survivors of sexual abuse.  The therapist should train the client to be aware of these core issues, and relate them over the course of treatment.  Have the client verbally communicate which core issue they are identifying with when the issue comes up in therapy. 

• Strong need to be in control.
• Tendency to be overly sensitive and to take things personally.
• Difficulty trusting others
• Distorted sense of responsibility
• Trouble being appropriately assertive and dealing with anger
• Tendency to reenact or repeat self-defeating behaviors
• Sexual and somatic problems
• Alienation from self and others
• Frequent use of denial or dissociation to deal with problems
• In some, repression—pushing out of awareness of painful memories and feelings. 

Childhood sexual abuse is a traumatic experience that has ranging and lasting effects.  With the prevalence of childhood sexual abuse and increased ability of victims to come forth and revel the “secret,” clinicians will encounter more and more sexual victims.  It is important for the fields of psychology, educations, religion, and medical to be able to identify and adequately perform appropriate treatment.  To do this the professional must be aware of culturally sensitive experience and guide the victim and family to recovery.  It is important to understand and address childhood sexual abuse to help prevent, identify, and treat victims, potential victims, and families.  Helping these people address these issues will enable them to lead fuller and more functional lives. 



Please Tell: A Child's Story About Sexual Abuse (Early Steps)
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