Interpersonal Dependency Among Adult Survivors of Childhood Sexual Abuse in Therapy

ABSTRACT

This study investigated dependency in survivors of childhood sexual abuse (CSA). The Interpersonal Dependency Inventory (IDI) was administered at intake to 24 men and 85 women seen in therapy at a university-based community mental health clinic. In contrast to findings from earlier studies, no significant gender differences were obtained for IDI whole-scale or subscale scores. Analyses comparing CSA IDI scores with the IDI scores of previously studied groups indicated that among women, CSA survivors obtained higher dependency scores than non-CSA psychiatric patients, community adults, and college students. Findings for men were less consistent. Follow-up analyses revealed that commonly investigated CSA characteristics were unrelated to survivors' dependency scores. Implications of these findings for future research and clinical practice are explored.     

“I Am Not A Victim. I Am A Survivor”: Resilience as a Journey for Female Survivors of Child Sexual Abuse

ABSTRACT

This study was designed to expand our understanding of the positive aspects of coping and resilience in female survivors of child sexual abuse. Research questions focused on women’s lived experiences of being survivors of child sexual abuse and how they have experienced resilience, developed healthy intimate relationships, and viewed themselves as sexual beings. Using a qualitative research lens of phenomenology, we captured the essence of survivors’ experiences of resilience. Although each woman’s experience was unique, similar patterns of processes and outcomes emerged as meaningful in their development of resilient and healthy sexuality and relationship functioning. However, participants emphasized resilience as a process or journey—recovery from trauma, reconceptualization of self, and development of healthy sexuality included deliberate efforts occurring over time. Implications for future research and practice using a positive lens of resilience are provided.     

Introduction: Queering Later Life

Summary

The field of sexual trauma developed from the sociopolitical movements of the feminist, rape, and child protection movements. As thinking in the field developed, however, it has been difficult to integrate the perspective of the male survivor of sexual trauma into these perspectives. Gay men, in particular, have been notably absent from the literature, except when their abuse history is discussed as an etiology for their sexuality. It is clear that gay men suffer violence and oppression in the form of homophobia—an abuse with a sexual focus. Integrating the experience of gay men who have suffered trauma into perspectives regarding sexual trauma offers a possibility to enhance understanding about, as well as prevention efforts against, the sexual abuse of children. This includes expanding definitions and vocabulary regarding sexual trauma, as well as recognizing the impact on mental health professionals of working with survivors of sexual trauma.     

“From that Moment on My Life Changed”: Turning Points in the Healing Process for Men Recovering from Child Sexual Abuse

Recent research indicates that child sexual abuse often undermines the health of boys and men across the lifespan. However, some male survivors experience a turning point marking a positive change in their health trajectories and healing process. Although frequently discussed in reference to physical health problems or addictions, very little is known about turning points with respect to child sexual abuse for men. The purpose of this secondary qualitative analysis was to describe the different types of turning points experienced by male survivors who completed the 2010 Health and Well-Being Survey (N = 250). Using conventional content analysis, researchers identified seven types of turning points that were classified into three broad categories: influential relationships (professional and group support, personal relationships), insights and new meanings (cognitive realizations, necessity to change, spiritual transformation), and action-oriented communication (disclosure of CSA, pursuit of justice). Implications for clinical practice and future research are discussed.     

Healing from Childhood Sexual Abuse: A Meta-Synthesis of Qualitative Studies

ABSTRACT

Although the global prevalence of childhood sexual abuse (CSA) is very high, the experience of healing after such abuse has not been well documented. The goal of this study was to characterize the healing experience among CSA survivors presented in the literature. Metaethnography was used to synthesize an integrative literature review. The CINAHL, PubMed, PsycINFO, and Web of Science databases were used as data sources. Eight articles that explored healing experiences from CSA, published between 2007 and 2017, were included in the analysis. After performing a quality assessment, line-of-argument synthesis was used to construct the integrating scheme of healing experiences from CSA. CSA healing experiences included dissociating oneself from the memories of CSA, finding peace by creating a comfort zone, disclosure as the start of healing, attempting to establish identity through ongoing self-reflective activities, feeling comfort by sharing experiences and connecting with CSA survivors, and accepting CSA as part of the life history and stepping forward. Healing experiences from CSA synthesized from the analysis focused on personal growth, supporting previous theory on CSA health in the broader literature. A tailored care plan could be developed for CSA survivors who are at varying stages of healing.     

Illusions of Intimacy

Summary

Gay men share the common human need for meaningful intimate contact in which the connection is genuine, open and honest. This need can be frustrated, complicated and undermined by a sexual trauma history. The child's sense of personal boundaries, of sexual integrity and of affectional relationships is deeply impacted by a sexual trauma. The child learns that his needs become secondary to the offender's and as a result the victim learns to barter with his sexuality to get those needs met. The offender may foster a sense of isolation in the child, creating a perspective of the world that is harsh and dangerous, so that the child becomes terrified of abandonment. Homophobia is understood to be a “sexuality abuse” and as a result gay men often come in contact with other survivors. As a result, distinguishing between sex and love and recognizing genuine intimacy become difficult. This creates a spiral of difficulties whereby gay men may take enormous risks to “belong” or to avoid abandonment, often with profound consequences in terms of health and self-esteem.     

Prevalence of Sexual Trauma History Using Behaviorally Specific Methods of Assessment in First Year College Students

There are several challenges associated with evaluating the prevalence of sexual trauma, including child sexual abuse and adult sexual assault. The aim of this study was to assess sexual trauma prevalence rates among first year college students (N = 954) using behaviorally specific questions and a more representative recruitment sample that did not rely on self-selection. Participants completed a list of sexual trauma questions, including general questions containing labels such as “rape” or “abuse” as well as behaviorally specific questions that describe specific behaviors that qualify as sexual trauma without labels. Results indicated that 6.7% of the sample reported at least one incident of child sexual abuse, with similar rates for men and women. Women were more likely to report a history of adult sexual assault, which was reported by 12.4% of the total sample. Participants were also more likely to endorse a history of sexual trauma when answering behaviorally specific rather than general “label” questions. Women survivors in particular were more likely than men to identify their experiences as abuse/assault (66.7% versus 21.1% for child sexual abuse), which may help explain prevalence differences between men and women in prior research. Men may be less likely than women to label their experiences as abuse and may be underidentified in sexual trauma research without the use of behaviorally specific questions. Overall, the results of this study suggest that the prevalence of sexual trauma is better assessed using behaviorally specific questions and that this is an important topic of study among both men and women.     

Chronic Avoidance Helps Explain the Relationship Between Severity of Childhood Sexual Abuse and Psychological Distress in Adulthood

ABSTRACT

Recent studies have found that chronic avoidance of unpleasant internal experiences (e.g., thoughts, emotions, memories) is a maladaptive means of affect regulation often adopted by women with a history of sexual victimization in childhood. The primary aim of this study was to replicate and extend previous findings suggesting that higher levels of experiential avoidance may account for the relationship between childhood sexual abuse (CSA) and psychological distress in adulthood. It was hypothesized that, in a sample of undergraduate females (n = 151), the relationship between severity of CSA (e.g., frequency, nature of victimization) and trauma-related psychological distress would be mediated by avoidance. Results supported this hypothesis. Findings are consistent with previous studies, and further suggest that the general tendency to avoid or escape from unpleasant internal experiences may be a specific factor that exacerbates psychological distress among women with a history of sexual victimization in childhood.     

Barriers to Utilization of Mental Health Services amongst Male Child Sexual Abuse Survivors: Service Providers’ Perspective

ABSTRACT

Most research on child sexual abuse has been on survivors to the exclusion of service providers. This paper focuses on one group of findings from a larger qualitative study. The aim of the paper is to identify existing services and highlight the gaps in the current programs available for male CSA survivors from the perspective of service providers. Semi-structured interviews were conducted with 11 mental health service providers, recruited from two Southern and Central Ontario cities. Findings presented here report service providers’ perspective of gaps in services for male CSA survivors. “Limited Male CSA Programs”, “Institutional Barriers”, “Attitudinal Barriers”, and “Systemic Gaps” emerged as four major themes from the data analysis. Findings demonstrate the need to re-evaluate currently available service and highlights gaps in mental health service available for male CSA survivors. Implications for policy, practice, and research are discussed.     

The “Wall of Fear”: The Bridge Between the Traumatic Event and Trauma Resolution Therapy for Childhood Sexual Abuse Survivors

ABSTRACT

A multitude of published books and papers on child sexual abuse (CSA) describe symptoms, long-term effects, and therapy for survivors of abuse. However, the parallels between the nature of the sexual trauma event(s) as originally experienced by the victim and the therapeutic process into which the survivor later becomes engaged have not been reported. This paper attempts to fill that gap and proposes that the concept of a “Wall of Fear” is the bridge connecting the two. In the first part of the paper, a model of the CSA experience based upon Furniss (1991) will be explained in order to point out the basis for the dissociation and other symptomology demonstrated by the CSA victim. Following that, the stages of therapy will be mapped out, with special attention to the concept of the Wall of Fear (Oz, 1999) and traumatic memory resolution (abreactions) and with reference to the experience of the original traumatic events. Therapist fear of decompensation will be addressed.     

Psychologists' Attitudes Toward Adult Male Survivors of Sexual Abuse

ABSTRACT

Psychologists' attitudes toward adult male sexual abuse survivors were explored. Psychologists (n = 154) read vignettes describing the sexual abuse of a male victim, then completed the Male Role Norm Scale, the Jackson Incest Blame Scale, a vignette response sheet, and a personal data sheet. Stepwise regression was used to analyze the data. Variables included characteristics of the psychologists, the perpetrator, and the victim. The psychologists' attitudes toward men, rather than the sex of the psychologists, predicted blaming attitudes. Victim responses, sexual abuse treatment experience, and the severity of abuse were also predictors. Practical suggestions for treatment are noted.     

Attributions of Blame among Victims of Child Sexual Abuse: Findings from a Community Sample

ABSTRACT

According to the attribution theory, negative outcomes of child sexual abuse (CSA) are thought to vary depending on whether CSA victims attribute the abuse to internal or external factors, respectively, self-blame and perpetrator-blame. Therefore, the purpose of this study was to identify abuse characteristics and attitudes that influence blame attributions among CSA victims from a community sample. Data from respondents with a history of CSA (N = 1,496) have been used in predicting blame attributions; perpetrator-blame, self-blame, or both. Results from a multinomial logistic regression analysis showed that attitudes toward gender roles had a significant effect on blame: victims were more likely to blame themselves when they endorsed more conservative gender attitudes than victims with more liberal attitudes. Implications for this finding are discussed.     

The Place of Culture and Religion in Patterns of Disclosure and Reporting Sexual Abuse of Males: A Case Study of Ultra Orthodox Male Victims

ABSTRACT

This article deals with reporting patterns of sexual abuse in males in a religious-cultural context through a case study of ultra-Orthodox Jewish (Haredi) men who were young victims of sexual abuse. The study is based on in-depth interviews with 40 Haredi men. The results indicate that sexual abuse involving ultra-Orthodox boys was and is underreported. Moreover, the results indicate that even when such incidents were reported, the avenues for disclosure were parents, educational-religious figures, and friends. It was also found that silencing in matters related to sexuality, viewing sexual abuse in boys as a serious sin and taboo, and encouraging blind obedience—all of which characterize Haredi society—were factors in the underreporting. The results also show a strong tendency to cover up incidents of sexual abuse on an individual level, on a family level, and at the community level. The findings indicate a linkage between the religious and cultural background of male victims of sexual abuse and their reporting patterns.     

Assessing the Long-Term Effects of EMDR: Results from an 18-Month Follow-Up Study with Adult Female Survivors of CSA

ABSTRACT

This 18-month follow-up study builds on the findings of a randomized experimental evaluation that found qualified support for the short-term effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in reducing trauma symptoms among adult female survivors of childhood sexual abuse (CSA). The current study provides preliminary evidence that the therapeutic benefits of EMDR for adult female survivors of CSA can be maintained over an 18-month period. Furthermore, there is some support for the suggestion that EMDR did so more efficiently and provided a greater sense of trauma resolution than did routine individual therapy.     

Training Mental Health Professionals in Child Sexual Abuse: Curricular Guidelines

This study explored whether counseling practices with women survivors of child sexual abuse reflect the belief that women do not sexually abuse children. Canadian therapists (n?=?164) who work with women survivors of child sexual abuse were surveyed about their beliefs about what constitutes child sexual abuse, who commits child sexual abuse, and their practices regarding inquiries about abusive behavior. A majority self-reported that they ask women and think it is important to ask but most believe that clients will not spontaneously self-disclose inappropriate sexual thoughts or behaviors. How broadly or narrowly therapists defined child sexual abuse was not related to self-reported therapeutic discussion. Therapists demonstrated differential gender beliefs about child sexual abuse perpetration, but this did not relate to self-reported counseling practices. Implications for therapist education are discussed.     

Facial emotion identification and sexual assault risk detection among college student sexual assault victims and nonvictims

Objective: High rates of sexual victimization among college students necessitate further study of factors associated with sexual assault risk detection. The present study examined how social information processing relates to sexual assault risk detection as a function of sexual assault victimization history. Participants: 225 undergraduates (M_age = 19.12, SD = 1.44; 66% women). Methods: Participants completed an online questionnaire assessing victimization history, an emotion identification task, and a sexual assault risk detection task between June 2013 and May 2014. Results: Emotion identification moderated the association between victimization history and risk detection such that sexual assault survivors with lower emotion identification accuracy also reported the least risk in a sexual assault vignette. Conclusions: Findings suggest that differences in social information processing, specifically recognition of others' emotions, are associated with sexual assault risk detection. College prevention programs could incorporate emotional awareness strategies, particularly for men and women who are sexual assault survivors.     

Perceived Loss of Social Contact and Trauma Symptoms among Adolescents Who Have Experienced Sexual Abuse

ABSTRACT

Child sexual abuse (CSA) is a robust predictor of trauma symptoms. Past research has identified many correlates of trauma symptoms following disclosure of CSA. Theory suggests that loss of social contact may be another important contributor to adolescents’ trauma symptoms following CSA. A clinical sample of 166 adolescents (95% female) between 11 and 19 years (M = 13.80, SD = 1.87) reported on perceived loss of social contact, the extent to which the CSA was coercive, appraisals of self-blame for the abuse, supportiveness of a primary non-abusing caregiver, and trauma symptoms. The adolescent’s relationship to the abuser, abuse severity and duration were coded from forensic interviews. Results indicated that greater perceived loss of social contact was associated with higher levels of trauma symptoms, even after controlling for other correlates of trauma symptoms and demographic variables. These findings suggest that perceived loss of social contact may be an important variable to consider in assessing and intervening with adolescents who have been sexually abused.     

The Economic Consequences of Child Sexual Abuse for Adult Lesbian Women

This study is designed to extend the investigation of the long‐term consequences of child sexual abuse (CSA) into the workplace and to consider the effects on the economic welfare of 1,925 lesbian women from the National Lesbian Health Care Survey. It seeks to develop a two‐stage, least‐squares model that considers simultaneously the effects of child sexual abuse on four spheres of a woman's life—her physical health, mental health, educational attainment, and economic welfare; and to investigate the differential impacts of diverse forms of child sexual abuse on the adult woman's functioning. The CSA survivors experienced adverse health and mental health consequences. The type of CSA experienced was also a significant predictor of a woman's educational attainment and annual earnings.