[Trigger Warning] Child Sexual Abuse

This is the–rather long–report I have written regarding what we studied about child sexual abuse on my course. It contains things that are likely to be triggering for some people even though I do not mention any specific cases, and I would caution anyone who may be affected by the topic to perhaps skip on this.

large (2)Some of the most difficult cases therapists can face are the ones of sexual abuse that happened when the patient was a child, whether it was done by a family member, someone in the family unit, or by a stranger; whether it happened once or carried on for years; whether it was unwanted nudity and touching or full on penetration. There is something truly frightening about imagining vulnerable children being taken advantage of by the adults that hold all the power and should know better than to use it in such ways. But what makes these cases particularly difficult isn’t so much the fact that it is a difficult thing to image and think about, but the fact that it may well illicit very strong emotional reactions within ourselves. We might be outraged, shocked, angered, worry about our patient with renewed vigour and feel upset now by the events of the past. We are, after all, only human and these reactions are understandable on every level, but within the confines of our role those are not the appropriate reactions for us to have when facing our client: we must learn to face the survivor with calm, supportive understanding, and not with a flurry of emotion that might frighten them away.

Regarding the above point, it was something that I was personally worried about: I get particularly affected by the stories of abused children (no matter the type of abuse) and it is something that gives birth to strong feelings of upset and anger within me. I always worried this might make me an unsuitable therapist but I have discovered that once I slip in that chair, in that place, my emotions seem to be filtered off somewhere else for as long as required. I have also found reading Toxic Parents by Susan Forward particularly helpful as it helped to desensitise me on the surface to the cases of abuse, allowing me to look at them with the eye of a counsellor instead of looking as them through my own emotions.

The other thing that can make these cases extremely hard to deal with is the attitude and behaviour of the client. They may find it extremely hard to talk about what happened and as such it might take us a very long time and a lot of trust building to get them to open up to us. What we must also understand is that they are never fully in control of their behaviour and that they will most likely attempt to repeatedly test us with unreasonable behaviour. It is easy for the counsellor to become frustrated, but we must remain calm and patient and learn to set limits without ever rejecting the patient: they are only acting as they are because of their childhood experience and it is, more than anything, a cry for help, a desperate need to find someone to trust and be loved by. The process of therapy with someone who has suffered from sexual abuse can take a very long time and progress might be so slow we might start to doubt ourselves and wonder if we might be making things worse instead of better. In these times our self-doubt is our greatest enemy and might stop us from properly helping our client: we must remember that we are not alone and that we have a supervisor and peers to turn to when we are in need of advice. However long the therapy takes, a lot of love and skill will be required, as well as never forgetting that no matter how bad things have been for the person, things can always get better and there is always hope for the survivors.

What is probably even scarier when it comes to sexual abuse in children is the statistics that come with research that has been done in this field. With, in the UK, an average of one child per classroom having reported abuse, and for each one of them the belief that there probably are another seven that will never speak up about what is happening to them, child sexual abuse is not something that is rare or only happens in sociology-economic background. Race, gender, wealth are not things that protect children from abusers and the horrible years they will put them through. When two thirds of the abusers come from the family, or family friends circle, it is not difficult to understand how survivors struggle to trust in their adult lives. In what is almost the most disturbing statistic of all, three quarter of cases lead to no convictions as no proof can be found: most abusers are very good at hiding what they do and so even children who have spoken up about their abuse might still be at risk of it carrying on because of an insufficient system in place to help them.

Most children will carry the secret of their abuse into their adult life, with varying reasons as to why they did not speak up at the time (fear of the abuser, fear of being weak, protecting another family member, etc…) but the main thing to remember is that most of these children will assume that the abuse is normal as they have never known anything else. This thought will only be reinforced if they have tried to speak up to a parent and been dismissed or ignored.

Most abusers are male although mothers (and women in general) can either be coerced into abuse or be the primary abuser themselves. Most abuser do not have a particular preference for a child’s gender and both boys and girls are as likely to be victim of child abuse. Some abusers will be under 18 themselves (siblings and/or peers). The abuse will be counted as paedophilia if the child is under 13 and incest (or just child abuse if the abuse is not coming from a family member) for children up to 16.

During the day we went through a list of statements that we had to rate that were attached to tackling the myths surrounding child sexual abuse. Unfortunately, these myths are some of the reason why it has been so hard to put measures to protect children more efficiently and they are also things that are widely believed even by people who would never want children to come to harm and would be more active in trying to protect them if their judgement was not clouded by myths that help to make this issue somehow more bearable for those that cannot face the facts. Most common of those myths may be that child sexual abuse is rare: as we have seen above it is everything but. People are also inclined to believe that poorer families are more at risk of being affected, or that certain ethnicities are most likely to have it happen in their midst. Again, as discussed above, this isn’t true and as difficult as it may be to imagine that an apparently normal, average seeming man could go home to abuse his daughter or son, it is something important to remember as believing the opposite is likely to lead to people not believing children when they speak about what is happening to them.

Amongst other common myths that people are far too willing to believe is the fact that only girls suffer from sexual abuse, which is ridiculous when we know that, although not as widespread, boys are also sexually abused (in the same vein people also believe that abusers are all male). The myths would have you believe that sometimes children can have ‘brought it upon themselves’ by acting seductively or overly affectionately: this is not the case. The child is never responsible for the abuse: the adult is the party who holds the power in this equation and it is up to them to decide what to do with the child. If they chose to take their affection as a sexual invitation, then it is not the child’s fault but the fault of the adult who is willing to twist the reality in front of them to get what they want.

Let’s take a moment to take a look at the abuser: the power-holder in the relationship. There are four pre-conditions to sex offending: the need for the person to be attracted to children, the capacity to overcome one’s internal large (3)inhibitors (the fear of being discovered, the knowledge that this is morally wrong), the capacity to overcome external inhibitor (the other–or both–parents, supervisors, other children), and finally the capacity to overcome the victim’s resistance (which in children is often done through the use of grooming). Abusers are usually people who have poor self-image and low self-esteem despite how they might look to those around them (many would often describe them as confident and charismatic even though their self-image is very negative). These people expect rejection and have escaped to fantasising about children who cannot so easily reject them for one reason or another. They will take their time grooming both the children (and sometimes even the people around them) and the environment they’re in so that they have the perfect set up to carry out the abuse in. This is all part of the cycle of abuse, and after the abuse has been carried out there will be a period of guilt (at least at first) wherein the abuser is fully aware of the wrongness of what he/she has done. Eventually they will push that guilt away, pull themselves together in preparation to start the cycle again. The longer an abuser has been carrying out the abuse for, the shorter the guilt period will be allowing for more frequent and repeated abuse (some will even begin to skip the guilt phase altogether).

There was a facility in England at one point that attempted to treat abusers, looking at what they did as a disorder that they could be treated and trained out of: after all, abuse becomes a form of addiction and is born from a complete lack of inhibition. As such, it was believed that there would be ways for these men to return to society without pausing a risk to children. Unfortunately, the Gracewell facility did not last long enough for many of the results of its research to be fully visible, and it is therefore difficult to judge if child molesters could be rehabilitated within society without the risk of them hurting another child.

Now we turn to the child, the victim of the abuse, and the adult survivor that they will become. Most of the focus will be on this as it is very unlikely we will work with an abuser, and although it is important to understand them for the sake of our work and being able to work more efficiently with the victims of abuse, it is the victims themselves that we must acquire the skills to help.

It is important at this stage to mention that if we, as therapists, are dealing with anyone we think are/were abused, we must never ask directly “Are/were you abused?”. It is a leading question and could create a situation where the idea of abuse could be implanted in the client’s thoughts. I find it is important to mention here that people do not dream up sexual abuse, but the idea can be implanted especially by the therapist if the above mentioned leading questions are used.

There are many reasons why children suffering from abuse do not speak up about what is happening to them: first of all, we must remember that children think the abuse is normal when it is all they have known, especially if it started at a young age. Children are also afraid of not being believed: from a young age children are taught to be obedient and that the word of adults will always weigh more than theirs which makes speaking out against any adult difficult, especially when the adult is a frightening abuser. Alongside this, children will very often be terrified to break up the family unit: not only do they not want to be rejected, abandoned, or isolated, neither do they want to find themselves in a broken up household which they may be made to think society as lesser and wrong. There is also a lot of fear attached to speaking up: fear of what the abuser may do to them (or their siblings or mother/father) if they find out but also the fear of their own feelings of guilt, shame, and the belief that it is their fault.

large (4)This reluctance and difficulty to talk about sexual abuse follows the victims into adulthood and it is never an easy topic for a person to speak about at the beginning of their therapy when they are still heavily enmeshed with the feelings and emotions of their inner child. The conditioning they received as children is still at work, and so is the fear of not being believed. The low self-esteem created by the abuse will only make it more difficult, especially if they have built themselves a strong image on top to disguise it and revealing the abuse would require to bring the façade down. There is also the fact that they will have to bypass whatever coping mechanism they have in place: for example they could be using minimalisation to deal with the abuse but in turn that would make talking about what happened candidly very difficult.

The above are but a few of the reasons why children and adults alike do not speak of the abuse they went through, but it is important to remember that each case is different and each person will have different reasons as to why they did, or did not speak up about what was happening to them. Let’s add to this that given that the greatest trauma of childhood sexual abuse is the betrayal of the adult, the capacity to trust of the victim has been shattered, making approaching anyone even more complicated.

But as much as children and adults alike are good at hiding the truth of what happened to them, there are many things that can give hints that something is wrong. There are signs in a child’s behaviour and health that something might be wrong, signs that will appear no matter how old they are. Although they might act as though the abuse is normal, children will always know that it is wrong, and they might start developing sleep disturbances, behavioural problems, or physical problems. Although those might differ depending on the age group of the child, they are all behaviours that are abnormal and unexplained and should be looked into instead of judged and condemned immediately.

When dealing with abused children, we must show that we believe them: children do not imagine sexual abuse. By telling them we believe them we are combating one of their greatest fear, that of not being believed. We have to emphasize confidentiality and what that entails and encourage them to talk to us. We must never suggest they tell someone else or give them advice, they need to feel like they are thoroughly in control of the situation as that is something that will help them feel safer and trust us. By giving them control we do the one thing the abuser never does. Once they are talking to us, we can discuss all the options available: from getting agencies involved so they can be taken away from the abuse, to the possible consequences of telling. We may need to give them a great deal of time and space to decide what they want to do but we must remember that if we think the child is in harm’s way we are duty bound to report it to a supervisor and the authorities as the priority in those cases is the physical safety of the child (which is something we also need to explain to them so they do not see our reaching out towards others as yet another betrayal).

A lot of the above will also be relevant when dealing with adults who have suffered abuse in their childhood. As I said above these adults will test our relationships with them at every turn, but we must be capable of remaining unflinchingly kind and accepting, building an atmosphere in which they can learn to both feel safe and trust again. Our empathy is our greatest tool to connect with them and the rapport they build with us will be the first step towards reconstructing the self-esteem they were robbed of at a young age. Most of all we must always remember, and remind them that there is hope: no matter how bleak everything in their lives has looked until now, there is potential for healing and a better life in the future.

One of the areas most affected by sexual abuse in childhood is that of relationships, especially intimate ones. Incapable of trusting, the victim of abuse will often find it very difficult to connect to anyone deeply and emotionally. They are more at risk of finding abusive partners as this would recreate the patterns they are used to and know how to live with, as well as being the only way they might know how to receive ‘love’. They might be completely avoiding getting close to others (physically and emotionally) or become extremely promiscuous. Overall they are plagued by fear of rejection, of not being loved, and their overwhelming guilt and shame for what happened will slowly erode at anything they try to build. In the same way they test their relationship with the therapist, adult victims of sexual abuse will also test their partner in the same way: making irrational demands, using shock tactics and anything they can do to prove that in the end they are unlovable and will eventually be abandoned.

There are several techniques that can be used to help the clients that come to us with issues rooted in childhood sexual abuse. Above all else we must give them the space and capacity to express themselves: through artwork or large (5)letter writing (Susan Forward in Toxic Parents describes the different types of letters she gets her clients to write and I have found myself particularly drawn to them as I could definitely see how the different stages of them could be beneficial!). Visualisation can help soothe and offer a safety net for the client to explore memories and may even allow for new ones to emerge (again we must be careful as a therapist not to implant such memories). There will, obviously, be other technique that might be helpful in the course of therapy but I believe the above will be a constant for most of our clients that have suffered from sexual abuse whereas the others may vary based on each individual’s experience and how much they are capable/willing to express what happened to them.

It is difficult to summarise all that is relevant to child sexual abuse in a report (or at least I have found it to be the case, although this may be due to me just having finished Toxic Parents and therefore having many thoughts on the subject), but I hope that what I have presented here covers the broadness and deepness of the topic. It was a difficult, emotionally taxing study day, but I think that a greater understanding of this subject is needed, not just within the counselling profession, but for everyone. So much hurt and pain might be able to be stopped if people only knew where and how to look.  Although there is something daunting about being faced with someone who has suffered from such tremendous pain, I am no longer afraid and I feel, if not entirely ready, at least as prepared as I can be for the day that I will need to help a victim of childhood sexual abuse.

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