Working with Adult Survivors of Childhood Sexual Abuse

Liezel Anguelova

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351810173
• Edition: 1
• Topic: Psychologie
• Subtopic: Trouble de stress post-traumatique (TSPT)

This book provides a framework for addressing the extended treatment needs of adult survivors of child sexual abuse. It is based on a therapeutic intervention model that provides flexibility for therapists to work according to their training and skills set while incorporating practical techniques structured around the needs of survivors. The book begins by providing therapists with crucial information about sex abuse survivors—such as ethical considerations, types of abuse, the stages of abuse, and the effects of the abuse on the child—as well as a method useful in the putting together of an abuse profile which ultimately assists in identifying treatment needs. The second part of the book provides client homework exercises for treatment and covers working with memories; denial; problematic emotions such as guilt, self-blame, and shame; depression and anxiety; sexuality; as well as parents, partners, and more. This accessible yet comprehensive guide will be of utmost use to mental health professionals who work with adult survivors of childhood sexual abuse.

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PART I

CONTEXTUALIZATION

Defining Child Sexual Abuse, Developing the Therapeutic Intervention, Assessing Treatment Needs

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1

CHILD SEXUAL ABUSE

1.1 INTRODUCTION

Child sexual abuse (CSA) has been extensively researched and written about. It remains, unfortunately, to be a continuing reality, taking many victims, with devastating and often life-long debilitating consequences. Therefore continual progressive research on CSA is vital. Ongoing research plays an important role in assisting professionals working with victims and survivors of CSA to advance their therapeutic practice. Professionals should be knowledgeable about the complexity and controversy surrounding CSA. Knowledge about types of sexual abuse, including different definitions, the impact on the developing child, the effect on adult functioning and different therapeutic approaches effective in the healing process of the victims of sexual abuse should be continuously updated by topic specific research. For the purpose of creating a holistic picture of CSA, research from as far as two decades ago and current research will be integrated.

In this chapter the different definitions of CSA and a formulation of an operational definition used for the purpose of this book will be addressed. Types of abuse, the effects on the child victim and consequences on adult functioning are discussed. The information provided should be sufficient in providing a basis for understanding CSA. Additional information on different aspects related to CSA could be obtained from the list of numerous references provided. Explication of terms relevant to the concise understanding of this book is included in the final section of this chapter.

1.2 DEFINING CHILD SEXUAL ABUSE

CSA has been a subject of controversy and often coloured by many different myths and assumptions. The subjects of controversy in research centre mainly on defining CSA and variability in the prevalence rates of CSA.

Countless definitions have seen the light, not only in the domain of social sciences, with specific reference to psychology and social work, but in other fields where interventions were done with victims and survivors, such as the judicial system (Afifi, 2012). Pereda, Guilera, Forns and Gomez-Benito (2009) reflect on the difficulty in attaining consensus when defining CSA. Researchers’ definitions of CSA diverge considerably according to the research methods used for their specific studies (Browning & Laumann, 1997). Other methodological factors such as data collection methods, sampling methods, rates of response and types of assessment questions used to measure sexual abuse may contribute to the variance in the prevalence rates (Vogeltanz, Wilsnack, Harris, Wilsnack, Wonderlich & Kristjanson, 1999).

Bolen (2001) indicates that the prevalence rate of CSA ranges from 12% to 18% for females and 2% to 12% for males (Bolen, 2001). Pereda, Guilera, Forns and Gomez-Benito (2009) did a comparative study on prevalence rates as reported by Finkelhor in 1994. They found a general pattern that remained more or less consistent over the years from 1994 to 2009. New data for countries other than the US and Europe were included in their study. They found a global prevalence of 19.7% for females and 7.9% for males. In this analysis, Africa had the highest prevalence rate of CSA (34.4%), primarily because of elevated rates in South Africa. Statistics for Europe indicated the lowest prevalence rate (9.2%) and America and Asia had prevalence rates between 10.1% and 23.9%. Stoltenborgh, van IJzendoorn, Euser and Bakermans-Kranenburg (2011) based prevalence on the meta-analysis of a self-disclosure study. They reported estimated data of global prevalence of 12.7%—18% for girls and 7.6% for boys. Their rates for the specific continents are listed in Table 1.1.

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Table 1.1

Prevalence rates of CSA

Source: Adopted from Stoltenborgh et al. (2011).

In constructing an operational definition for the purpose of clarity of perspective for this book, the definitions of CSA as obtained from the literature review is discussed.

1.2.1 Definitions Derived from Child Sexual Abuse Literature

There seems to be no universally accepted definition for the phenomenon of CSA (Glazer & Frosh, 1993). Different researchers within the field of psychology (Lalor & McElvaney, 2010; Runyan, 2000; Widom, 1988) and researchers in other social sciences (Spies, 2006), touching on the subject of CSA, subscribe to variously formulated definitions (Dixon, 1998; Giardino, 2001).

For example, before the Sexual Offences Act of 2007 was implemented in South Africa, not even the judicial system concurred with one legal definition, and no statutory definition of CSA existed (Spies, 2006; Van Der Merwe, 2005). Although the following criteria were taken into consideration in a legal context: the age of the child, degrees of relatedness to the perpetrator, degrees of threat or violence and differences in perpetrators’ intentions, it was often only attempted sexual intercourse and sexual intercourse which was legally seen as sexual abuse or sexual violence (Spies, 2006). If this definition were to be used in research the extent of prevalence of CSA would be severely under-reported.

Levett (1988) comments on the restricted nature of such a definition, as many other sexual activities, in addition to sexual intercourse, have traumatic effects on the sexually abused child. Dale (1986) and Gainey and Payne (2002) addressed this restricted definition and formulated CSA as the sexual exploitation of a child under the age of 16 years, for the sexual pleasure and gratification of an older person and included acts such as indecent exposure, obscene telephone calls, pornography, child molestation (inappropriate fondling, oral genital contact, mutual masturbation), prostitution, attempted intercourse, incest and rape.

Kritsberg (2000) lists two categories of sexual abuse, namely emotional sexual abuse and physical sexual abuse. They may be happening in conjunction and may involve violence and seduction. Emotional sexual abuse refers to the perpetrator’s behaviour being directed to sexually shaming, ridiculing and harassing the victim without physical contact. Reference is also made to seductive emotional abuse where the perpetrator treats the child as a sexual equal and the child is expected to meet the perpetrator’s emotional need (Kritsberg, 2000). In situations of incestuous emotional sexual abuse Blume (1990) termed the phrase “quasi-spousal abuse”, where the parents share information which is deeply personal or sexual in nature with the child.

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As Barnett, Miller-Perrin and Perrin (1997), Gilgun (1994) and Levett (1988) emphasize the role of power in sexual abuse, Kamsler (1990) also incorporates the role of power and defines CSA as a relationship, sexual in nature, where the child is coerced into compliance by the dominant position of authority of an adult. The child is thus dependent and powerless in such a relationship.

The definition by Gilgun (1994) focuses on the sexual gratification gained by an older or more powerful person when taking advantage of a child. He thus defines CSA as an abuse of power. Levett (1988) defined sexual abuse from within a feminist perspective and proceeded to postulate a double power dynamic of exploitation, namely age and masculinity.

The National Centre on Child Abuse and Neglect (Barnett et al., 1997) approaches the subject of defining CSA in terms of adult–child sexual interaction. They postulate four essential key components for their definition:

1 it includes physical contact and non-contact activities;

2 it emphasizes the exploitation of adult authority and power to achieve the adult’s sexual ends;

3 it addresses the age or maturational advantage of the perpetrator over the child; and

4 it is broad enough to include intra-familial (i.e. incest) and extra-familial abuse.

Barnett et al. (1997) bring two important aspects pertaining to the controversy of definition into consideration. First, behaviours that are defined as sexual, and second the question of when sexual interactions become abusive. Allender (2008) describes these sexual behaviours and interactions referring to contact and interaction. CSA thus seems to encompass types of sexual behaviour with physical contact and acts without physical contact.

The severity of each type of sexual contact is also taken into consideration. The severity of the abuse, for example intercourse, correlated with graver long-term sequelae (Dube, Anda, Whitfield, Brown, Felitti, Dong & Giles, 2005) and would thus be important to be taken into consideration when treatment is planned (Gericke, 2014). The severity of the CSA is emphasized in multiple research results as playing a significant role in poorer interpersonal functioning and increased symptomatology in adult survivors (Callahan, Price & Hilsenroth, 2003). It thus implies that abuse severity should be assessed by professionals to identify survivors who are at higher risk of mental health symptoms so as to focus therapy on addressing possible increased symptomatology (O’Leary, Coohey & Easton, 2010; Gericke, 2014).

Table 1.2

Types and severity of CSA

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The definitions of CSA as described are tabularized under the headings CSA with physical contact and without physical and the severity levels are indicated. All contact can be made forcibly or non-forcibly, depending on the level of coercion that the perpetrator has established with the victim (Allender, 2008).

1.2.2 Operational Definition for This Book

According to Afifi (2012) and Runyan (2000) the use of broad-based definitions is a methodological limitation in the research of CSA, which in turn creates confusion about the definition. For purposes of clarity, the operational definition as compiled for this book incorporates the following specific criteria and includes:

• The perpetrat...