Grieving sexual abuse: The therapist's process

Clinicians working in the area of sexual abuse often experience grief as a direct result of the trauma they encounter in their therapeutic endeavors. This article explores the stages of grief that transpire in reaction to treating sexual victimization and examines the behavioral indicators which surface during each phase of the therapist's process. The author's personal account is included as a means of chronicling this experience and offering suggestions as to more effective resolution. As a final note, certain preventative measures which are aimed at diminishing the potential for negative countertransference and personal conflict are presented for consideration.     

The process of coping with domestic violence in adult survivors of childhood sexual abuse

Research suggests that the use of disengaged or avoidant strategies to cope with interpersonal violence contributes to the development of depressive symptoms and other psychological difficulties. Survivors of childhood sexual abuse (CSA) who are exposed to subsequent episodes of abuse may be more likely to rely on disengaged coping strategies, placing them at elevated risk of psychological symptomatology. In this study, we explored the interrelationships between coping, depression, and self-esteem in an ethnically diverse sample of domestic violence survivors (N = 219) with and without a history of CSA. As predicted, CSA survivors (n = 86) reported significantly greater use of disengaged coping strategies (wishful thinking, self-criticism, and social withdrawal) than non-CSA survivors (n = 133). As hypothesized, both a CSA history and the use of disengaged coping significantly predicted higher levels of depression and lower self- esteem. Clinical implications of the findings are discussed.     

How children tell: the process of disclosure in child sexual abuse

In an analysis of the disclosure by a large number of children from three to 17 years of age of having been sexually abused, and who were eventually confirmed as credible victims, the large majority at first denied the abuse. The authors describe disclosure as a process with definable phases and characteristics--seldom the single entity that typical investigations consider disclosure to be, thereby setting the stage for ensuring injustices and harm to the children.     

Ritual,and child sexual abuse,but not ritual child sexual abuse

Central to the controversy over ritual (satanic) child sexual abuse have been claims concerning agency ‘diagnoses’ of cases. Specifically, it has been alleged that agency findings of ritual abuse have been erroneous and are the product of poor practice. There is, though, little systematic information regarding agency assessment of suspected ritual abuse cases. This paper presents two cases where there was evidence both of child sexual abuse and ‘ritual’ but where agencies adjudged that these aspects occurred independently of one another and were not indicative of ritual child sexual abuse. The existence of these cases underlines the need for a broader and more balanced debate in respect of ritual abuse in general and the agency handling of these cases in particular. Copyright © 2000 John Wiley & Sons, Ltd.     

Holocaust child survivors and child sexual abuse

This study utilized a qualitative analysis of child survivors of the Holocaust who were sexually abused during World War II. The research study aimed to give this specific group of survivors a voice and to explore the impact of multiple extreme traumas, the Holocaust and childhood sexual abuse, on the survivors. Twenty-two child survivors of the Holocaust who were sexually abused during the war completed open-ended interviews. The data was qualitatively analyzed according to Tutty, Rothery, and Grinnell's (1996) guidelines. Three major themes were found: issues relating to the sexual abuse trauma, survivors' perceptions of the abuse, and survivors' general perspectives towards life. The identity of the offenders, Jewish or non-Jewish, determined the survivors' feelings towards themselves, the perpetrators, and about the worth of life.     

The association of maternal depressive symptoms with child externalizing problems: the role of maternal support following child sexual abuse

This study examines the role of abuse-specific maternal support in the association between parent depressive symptoms and child externalizing problems in a sample of children with a history of sexual abuse. In total, 106 mother-child dyads were studied. The association between maternal depressive symptoms and child delinquency behaviors was found to partially operate through abuse-specific maternal support, which was assessed via parent report. Implications of the findings for parenting programs are discussed, and future research directions are considered.     

The child as active participant in sexual abuse

This article reviews the spectrum of positions with regard to sexual activity in the home involving adults and children. It explores the motivational aspects that promote incestuous behavior and particularly highlights the enticing rewards available to children to engage in sexual behavior with adults. Treatment implications are suggested that avoid parental blaming and direct treatment for children, except when children specifically reach out for help. Parent education and marital therapy are recommended as treatments of choice.     

Male victims of child sexual abuse

Despite the increased attention the subject of child sexual abuse has received in recent years, rarely has much consideration been given to the boys and adolescent males who are the victims of such abuse. That young girls are consistently the clear majority of sexual abuse victims is not disputed, however the extent to which they are the majority is in question. A review of existing literature has indicated that one of the leading factors for this inadvertent negligence in presenting a truer picture of the magnitude of the problem for male victims concerns the area of under-reporting of the incidence of abuse of young males. Under-reporting has served to give a false sense of the scope of child sexual abuse, particularly for male children. Many societal and methodological factors contribute to under-reporting. Reasons for the discrepancy in reporting abuse will be presented and implications for practice will be discussed.     

The admissibility of evidence in child sexual abuse cases

Testimony in court by child victims of sexual abuse results in further trauma, frequently inconsistent or retracted accusations, and, in incest cases, exacerbation of family difficulties. A number of states have liberalized rules of evidence in such instances to spare the child; some states have enacted legislation simplifying introduction of the child's out-of-court statements, although the constitutionality of these statutes has yet to be tested.     

The pattern of child sexual abuse in northern ireland

A team from the Departments of Child Psychiatry, Royal Belfast Hospital for Sick Children, and of Epidemiology and Public Health, Queens University Belfast, conducted a study in 1987 of the reported incidence of child sexual abuse in Northern Ireland. The incidence rate of established cases of child sexual abuse was 0.9 per 1000 children under the age of 17 years. Further analysis of all the cases of sexual abuse (suspected, alleged and established) and an estimation of the potential under-ascertainment indicated that the actual rate was between 0.9 per 1000 and 1.85 per 1000 children. Data obtained from a detailed structured questionnaire on each sexually abused child was analysed. The results are presented in relation to the child, age and sex; the abuse, type and duration; the abuser, sex, age and relationship to the child; and outcome factors, initial psychological sequelae, physical signs and symptoms, and social sequelae.     

Parental functioning and child sexual abuse

Eighty-two mothers and 46 fathers of emotionally disturbed youth in a day treatment program completed the Family Assessment Device (FAD) at time of intake. Interviews with therapists enabled classification of families into three groups: those whose client (the youth) had been sexually abused, those where sexual abuse was suspected but not confirmed, and those without a sexual abuse history. All cases of abuse were non-incestuous. Comparisons of the confirmed abuse and non-abuse groups were made, using three types of analyses. ANOVA of parental responses to the FAD by group yielded significance for mothers but not for fathers, with mothers of abused children reporting more family dysfunction in problem-solving and roles than mothers of non-abused children. Second, significant differences between parents according to group were found in the abused sample in problem-solving, communication, and general functioning, but not in the non-abused sample; mothers reported significantly greater pathology in their families than did fathers. Third, comparison of differences between mothers and their children within families yielded a greater number of differences in the non-abused group. Significance was obtained in affective responsivity and behavior control in both samples. Additionally, however, significant differences in communication and roles were obtained in the non-abused group. Caution in differentiating between incestuous and non-incestuous families is suggested. Implications of this research for family interventions, especially with regard to mother/child perceptual congruence, are discussed.     

Medical advances in child sexual abuse

This volume is the first of a two-part special issue detailing state of the art practice in medical issues around child sexual abuse. The six articles in this issue explore methods for medical history evaluation, the rationale for when sexual examinations should take place, specific hymenal findings that suggest a child has been sexually abused, the healing of genital injuries, approaches to interpretation of medical findings, and the neurological harm of sexual abuse. From the initial history to the process of the medical examination, the mechanics of what a genital examination might show, and the neurobiological consequences, it is demonstrated that the harm of sexual abuse is has more effect on the brain than the genital area.     

A comparison of two programmes for victims of child sexual abuse: a treatment outcome study

This study aimed to evaluate the comparative effectiveness of individual therapy and combined individual and group therapy in the treatment of the psychological sequelae of child sexual abuse. The Child Behaviour Checklist (CBCL), the Youth Self Report form (YSR), the Children's Depression Inventory (CDI) and the Trauma Symptom Checklist for Children (TSCC) were administered before treatment and 6 months later to a group of 20 young people who participated in individual therapy (IT) programmes and to a group of 18 young people who participated in programmes that involved combined individual and group therapy (IGT). For both types of programmes, statistically significant improvement occurred on the following scales: the total problems, internalizing problems, externalizing problems, withdrawn, somatic complaints, anxious/depressed, social problems, attention problems and aggressive behaviour problems CBCL scales; the total depression, interpersonal problems and anhedonia CDI scales; and the depression and anger TSCC scales. The only scale for which one therapy programme led to greater improvement than another was the CDI ineffectiveness scale. The IGT programme led to a reduction in the mean CDI ineffectiveness score, whereas a slight increase in the mean ineffectiveness score occurred in the IT group. There were no significant differences in the rates of clinically significant improvement associated with the two treatments and no major differences between cases who improved and those that did not improve over the course of therapy. From this study, it may be concluded that after 6 months, individual therapy and combined individual and group therapy were equally effective in the treatment of the psychological sequelae of child sexual abuse. Copyright © 2002 John Wiley & Sons, Ltd.     

Stockholm syndrome and child sexual abuse

This article, based on an analysis of unstructured interviews, identifies that the emotional bond between survivors of child sexual abuse and the people who perpetrated the abuse against them is similar to that of the powerful bi-directional relationship central to Stockholm Syndrome as described by Graham (1994). Aspects of Stockholm Syndrome could be identified in the responses of adult survivors of child sexual abuse, which appeared to impact on their ability to criminally report offenders. An emotional bond, which has enabled the sexual abuse of children, has served to protect the offender long after the abuse has ceased. The implications of Stockholm Syndrome could offer valuable insights to those working in the field of child sexual abuse.