Child Sexual Abuse Workers’ Emotional Experiences of Working Therapeutically in the Western Cape, South Africa

South African child sexual abuse workers active in low-income communities bear witness to stories of sexual and physical abuse, neglect, pervasive deprivation, and violence. North American, British, and European workers’ emotional experiences have been captured in the literature, and a gap remains to be filled by those of their South African colleagues. This research aims to focus on the emotional experiences of social workers who engage therapeutically with sexually abused children in the Helderberg basin of the Western Cape, and resonate in some way with readers working in situations of poverty and trauma in other parts of the world. This study employed an explorative inductive research method, and followed a critical realist and contextual constructionist approach. Multiple-case study data collection took place by means of semi-structured interviews with social workers who engage therapeutically with sexually abused children. Data were examined by means of thematic analysis, and psychoanalytic theory was employed to analyse defences that surfaced during interviews. There were similarities in emotional experiences between South African participants and their abovementioned counterparts. The research also identified salient features of working with child sexual abuse in South Africa. The emotional experiences of doing such work, coupled with participants’ ways of managing sexually abused children’s material, gave rise to possible vicarious traumatisation symptoms and allowed for a psychoanalytic understanding to be put forward. The research also reports on useful measures that might enable individuals to continue interventions. To enable ongoing effective therapeutic engagement, social workers should have access to opportunities for acknowledging countertransferences and processing dynamic material defended against. The research contributes to knowledge of working in South Africa by exploring the emotional experiences of those who help sexually abused children daily, and by investigating the psychological impact prolonged therapeutic engagement has on workers active in Western Cape low-income communities.     

The gender neglect and textual abuse of children in the print media

In recent years the relationship between the media and child abuse has been subjected to closer scrutiny. Research at Monash University into the media portrayal of child abuse has led the researchers to examine the language used by the print media to represent both children who have been abused or neglected and the offences committed against them. This paper presents two findings from this research. The analysis firstly found that a child who has been abused or neglected may be objectified in print media language even when the child’s gender is previously identified. Secondly, the analysis found that the language used to describe the sexual abuse of children may serve to reduce the seriousness of offences. These phenomena, termed ‘gender neglect’ and ‘textual abuse’, are highlighted by examples from UK and Australian print media. The authors argue that ‘critical language awareness’ is important for children, just as it has been identified in research that examines the representation of women in print media. Copyright 2000 John Wiley & Sons, Ltd.     

An individual treatment programme for sexually abused adult males: description and preliminary findings

Growing recognition of male sexual abuse and its potentially debilitating effects has underscored the need to develop effective treatment interventions for this population. The present study describes an individual treatment programme that was developed for adult males who have experienced childhood sexual abuse. The treatment programme focused on three areas related to sexual abuse, specifically feelings of self‐blame, anger and anxiety. The study also presents preliminary findings on treatment effects, using self‐report measures that five participants completed prior to treatment and at various assessments following treatment termination. Overall findings indicated improvements in behavioural self‐blame, anger, state anxiety and trait anxiety. Treatment did not appear to have an effect on characterological self‐blame over the long term. The study's findings are limited by the reliance on self‐report data and the absence of a comparison group. As such, our findings should be viewed as an initial contribution to the currently limited empirical data on treatment effects for sexually abused adult males. Copyright © 2005 John Wiley & Sons, Ltd.     

Child sexual abuse and HIV transmission in sub‐Saharan Africa

The purpose of this paper is to examine the risks of HIV transmission to children through sexual abuse and exploitation in sub‐Saharan Africa. The paper is based on a review of pertinent literature. Child sexual abuse in this region must be defined broadly enough to encompass widespread coercion or violence in early sexual relations in some regions, the practice of ‘transactional sex’ and constructions of masculinity, emphasising multiple sexual partners and power over women and girls. The high HIV prevalence in sub‐Saharan Africa is briefly described. Research evidence showing the link between child sexual abuse and HIV transmission is reviewed, although this is a topic where very little direct empirical work has been conducted. Particular methodological and ethical difficulties have been encountered by researchers. Future research directions are indicated. Copyright © 2008 John Wiley & Sons, Ltd.     

Discovering an integrated framework for practice: a qualitative investigation of theories used by social workers working as sexual abuse therapists

In this article, I explore the historical background and context to the theoretical eclecticism described by the participants interviewed for a research study. The initial aim was to test the relevance of the vicarious traumatisation (vt) or vt literature with a group of sexual abuse therapists. The participants interviewed were all working as sexual abuse therapists in group and individual practices, many of whom worked in the field before there were well articulated theories of trauma assessment and treatment in the 1970s and 1980s. With the available theory, they actively developed their own unique frameworks for practice and became pioneers in the field. The findings of this research suggest that the practitioners' reference to diverse sources of theory is both a resource and protective factor which, when synthesised, is drawn upon to support the day-to-day work of sexual abuse therapy.     

Attachment and the Repetition of Trauma: A Case Study of Attachment‐Based Crisis Intervention

This article explores the difficult case of a 16‐year‐old who was causing a great deal of anxiety by presenting with dramatic behaviour, such as leaping off buildings, swallowing needles and poisons, and jumping in front of cars. The case study explores a six‐month period of crisis intervention, which focused on the unique kind of attachment relationship that existed between the teenager and his mother. The mother had experienced recurrent traumatisation prior to his birth, and it was found that the aftereffects of this traumatisation must have influenced the teenager's early attachment experiences and subsequent development. The attachment‐based therapy treated the crises as primarily ‘relational crises’. The therapy involved investigating and sharing formulations about their attachment history, cultivating an insight into the relational or dynamic determinants of the teenager's crises. Broader suggestions are made concerning the application of attachment theory to different approaches in family therapy, as well as to our understanding of phenomena such as transgenerational traumatisation.     

Obfuscating Child Sexual Abuse II: Listening to Survivors

The reality of the extent and experience of child sexual abuse cannot be revealed while children are unable to ‘stand up and be counted’. Limited alternatives, lack of information and dependence on adults prevent the true scale of the problem being appreciated. Similarly, media and legal treatment of abused children also operate to suppress the truth. The expertise and knowledge of those who have suffered abuse need to be acknowledged and utilized in order that child sexual abuse can no longer be obfuscated. © 1997 John Wiley & Sons, Ltd.     

Brief Report: Attitudes About Responding to Survey Questions Concerning Childhood Sexual Abuse by Hispanic Female College Students

In no studies have research participants been asked how they feel about answering questions concerning childhood sexual abuse. We have performed searches from two different search engines again and have found nothing published which specifically addresses this question in the way we have. A questionnaire about childhood sexual abuse was administered to a sample of Mexican-American female college students. Over 32% reported positive histories of childhood sexual abuse before age 18. These subjects were more uncomfortable (37%) than those who did not experience childhood sexual abuse when answering questions about childhood sexual abuse (12%; p < 0.00001), but they were not more uncomfortable in answering questions about alcohol or drug use. Women who were sexually abused in childhood also readily disclosed childhood sexual abuse histories despite revealing discomfort about being asked questions concerning childhood sexual abuse. Our findings support concerns by researchers that childhood sexual abuse is neglected because researchers have an unwarranted perception about how fragile sexually abused subjects are as subjects.     

Are Children Protected in the Family Court? A Perspective from Western Australia

Despite a landmark High Court judgement in the area of child sexual abuse allegations (M and M, 1988), a major concern in such cases seems to be the fear that mothers use false accusations against fathers as ‘weapons’ in custody and contact cases. This paper seeks to examine the validity of such views as they apply to Western Australia. In particular, it examines the belief that false accusations are rampant; the questionable nature of ‘parental alienation syndrome’, the belief that young children's accounts of abuse lack credibility, and the ignoring of the effect of abuse itself on the nature of a child's testimony. The paper argues that the principle of ‘protection of the child's best interests’ should not necessarily be equated with the child having access, even supervised access, with a parent previously accused of having abused the child.     

The Relationship Between Child Sexual Abuse and Alexithymic Symptoms in a Population of Recovering Adult Substance Abusers

ABSTRACT

Recovering substance abusers with a history of childhood sexual abuse (n = 69) or no history of childhood sexual abuse (n = 68) completed the Toronto Alexithymia Scale (TAS) and a background survey assessing demographic data and (In the case of sexually abused respondents) parameters of the childhood abuse experienced. The sexually abused group scored significantly higher than the non-abused group on the TAS. Within the abused group, measured alexithymic symptomatology was found to be related positively to the duration of the abuse. Alexithymia was significantly higher when the sexual abuse first occurred after the victim had reached the age of 12, when a perpetrator of the sexual abuse was a father or stepfather, and when the abuse involved oral, vaginal, and/or anal penetration. Results were interpreted as indicating that the development of alexithymic symptoms may represent another defense victims may employ to insulate themselves from painful affect, along with dissociative symptoms and substance abuse, which have been shown previously to characterize adult survivors of child sexual abuse.     

Organized abuse: NSPCC experience

A survey of a national child protection agency's experience of organized abuse in 1990–1991 found awareness of incidents among 41% of the participants and direct involvement with children in 20%. The 19 cases where there was direct involvement with 61 children from 43 families were categorized by the workers as network (N = 10), ritual (N = 6) and child pornography (N = 3) and came from England, Wales and Northern Ireland. The children in the three types presented different profiles from each other and from that of the sexually abused children placed on child protection registers. The children in the network cases were more likely to be boys and abused by non-relatives, the majority of whom were charged and convicted. The children in the ritual cases were the youngest, more likely to be abused by extended family members and most often the subjects of legal protection. The inherent difficulties in fully describing an organized abuse ‘case’ are outlined.     

The Clinical Correlates of Reported Childhood Sexual Abuse: An Association Between Age at Trauma Onset and Severity of Depression and PTSD in Adults

This study investigated the relationship between the age of -self‐reported sexual abuse occurrence and the development of post-traumatic stress disorder and/or depressive symptoms in adulthood. Subjects were evaluated for the presence of post-traumatic stress disorder and/or depressive symptoms as well as for a self-reported history of sexual abuse before the age of 18. Results found that relative risk of having severe post-traumatic stress disorder symptoms was 10 times higher in patients reporting sexual abuse after age 12 than in those reporting sexual abuse before age 12. Relative risk of having severe depressive symptoms was higher for those abused before the age of 12 than for those abused after the age of 12. Findings suggest that the impact of reported sexual abuse at different stages of development may lead to distinct psychiatric symptoms in adulthood.     

Cognitive behavioural psychotherapy intervention in childhood sexual abuse: identifying new directions from the literature

The short‐ and long‐term consequences of childhood sexual abuse have been extensively reported. However, for many years there has been an absence of psychological conceptual frameworks for understanding and treating abuse trauma symptoms. This paper reviews a number of outcome studies for the treatment of child sexual abuse where a post‐traumatic stress disorder (PTSD) conceptualization was used to plan treatment interventions. The paper concludes that, contrary to some concerns expressed by clinicians, sexually abused children and their non‐abusing carers can signi?cantly bene?t from cognitive behavioural interventions which use reliving and confrontation of the abusive experience. Notwithstanding this, there is a need for further controlled outcome research of cognitive behavioural interventions using reliving techniques to explore how and why these interventions help in reducing abuse‐related PTSD symptoms. Copyright © 2004 John Wiley & Sons, Ltd.     

Perception of one’s own gender role and the role played by men in adolescent female victims of sexual abuse / Percepción del rol de género propio y del rol que desempeñan los hombres,en mujeres adolescentes víctimas de abuso sexual

In order to ascertain whether suffering sexual abuse affects the perception of adolescent females’ gender role and the perception of the gender role played by men, 71 victims and 76 adolescents who had not been abused were assessed. The findings indicate that sexual abuse victims minimize the positive characteristics of men and overestimate the negative ones, and they perceive themselves with few positive female features but with many negative ones. They are also dissatisfied with their own gender role, which produces maladjustments that increase the difficulty of establishing relationships with the opposite sex, which in turn might generate subsequent risky behaviours.     

Characteristics of Sexually Abused Children and Their Nonoffending Mothers Followed by Child Welfare Services: The Role of a Maternal History of Child Sexual Abuse

Considering the importance of mother’s support in the adaptation of a sexually abused child, it is relevant to determine if the mothers and children involved in an intergenerational cycle of child sexual victimization differ from dyads in which only the child has been abused. The purpose of this study was to compare mother–child dyads with sexually abused children according to whether the mother had herself been victim of child sexual abuse. The sample included 87 dyads with sexually abused children aged 3–18 years old and their mothers (44 reporting maternal and child abuse), followed by social welfare services of the province of Quebec (Canada). The two groups of mothers were compared on their past family abuse experiences and past family relations, their mental health history, their current psychological distress, their parenting behaviors, and their current levels of family functioning. Children were compared on their adaptation. Multivariate analyses indicated that mothers reporting child sexual abuse were more likely to report more other maltreatments in their childhood and greater prevalence of lifetime history of alcohol abuse disorders, dysthymia, and panic disorder compared with mothers who had not experienced CSA. Compared to children whose mothers had not experienced CSA, those whose mothers had experienced CSA showed higher rates of problems behaviors and were more likely to report having been sexually abused by a trusted person. These results highlight the specific clinical needs for the assessment and treatment for sexually abused children whose mothers experienced child sexual abuse.     

Remembering and forgetting childhood sexual abuse

Twelve white middle-class women who had been severely sexually abused as children by a family member were asked to provide a narrative of their abuse and discuss their subsequent remembering and forgetting of these experiences. Most claimed they had undergone periods during which they had not recalled their abuse, but also claimed that they had never forgotten their experiences at another point during the interview. Nine of the women had actively tried to forget the abusive experiences, although 8 still experienced recurrent and often relentless intrusive memories. Our findings suggest that women with continuous memories may have longer and more coherent narratives than women without continuous memories. Implications of these findings for understanding the phenomenology of memory experiences and the concept of "recovered" memories of childhood sexual abuse are discussed.     

Research With Adolescent Victims of Child Sexual Abuse: Evaluation of Emotional Impact on Participants

The aim of this study was to evaluate the emotional impact on adolescent victims of sexual abuse from participating in a study addressing the consequences of their abuse. A total of 114 adolescents between 12 and 17 years old participated (54 sexually abused adolescents and 60 nonabused students). Both groups responded to a battery of scales to determine their coping strategies and some psychological consequences linked to stressful experiences and two questions about the emotional impact of participating in the study. Sexually abused adolescents reported fewer unpleasant emotions after participating than did nonvictim students (mean difference = .45, t[109] = ?2.934; p < .01). Adolescents who had more symptoms reported more discomfort (r_S scores between .35 and .49; p < .01). These results suggest that when ethical guidelines are followed, it is possible to survey adolescent victims of sexual abuse on aspects related to their experience without causing them significant distress.     

Stop It Now! A Pilot Study Into the Limits and Benefits of a Free Helpline Preventing Child Sexual Abuse

Stop It Now! aims to prevent child sexual abuse using a free anonymous helpline. It provides information, advice, and guidance to anyone concerned about child sexual abuse. It targets people who have sexually abused children or who are worried that they might do so. This article presents findings from a pilot study on the operation and outcomes of the helplines in the United Kingdom and the Netherlands. The findings underline the strength of the public health approach to prevention efforts. More specifically, benefits reported by helpline users are shown to correspond with the aims of the helplines. A number of factors were reported by users that helped them modify their own or others’ actions to minimize risk of abuse. However, a challenge that remains is ensuring that helplines are accessible to those most in need. Recommendations are included to further expand the effect of Stop It Now! in reducing CSA.     

Shame and Guilt in Men Exposed to Childhood Sexual Abuse: A Qualitative Investigation

This study examined the experiences of shame and guilt in adult males sexually abused as children. Seven participants attending a service for male sexual abuse completed measures of shame, guilt, dissociation, and childhood trauma history and subsequently participated in a focus group. All participants experienced childhood sexual abuse in the “severe” range and showed elevated scores for shame, guilt, and dissociation. Four superordinate themes with associated subordinate themes emerged: (a) self-as-shame (foundations of self-as-shame, fear of exposure, temporary antidote: connection), (b) pervasiveness and power of doubt and denial (from others, from self, consequences of incredulity), (c) uncontrollability (of problems after disclosure, of rage, of intrusions and emotional pain), and (d) dissociation. Results are discussed with reference to the existing literature and the emerging “self-as-shame” construct, which appeared to encapsulate participants’ view of themselves.