Sexual abuse has been a growing concern in our society. The statistics on sexual abuse in America are alarming. According to Finkelhor (1994) “approximately 150,000 confirmed cases of child sexual abuse were reported to child welfare authorities in the United States during 1993” (p.31). Lucinda stated, “I have worked with children who have been sexually abused and it is a devastating experience for the individual”.
Working with an individual who has a history of sexual abuse would be very difficult. The individual will likely be guarded and possibly closed off from the surrounding environment. He or she may not want to talk about what happened in their past, and want to shut it away so they never have to relive the horror that happened to them. Since this abuse is not as visible as physical abuse, it is harder for people outside the abuse to recognize it. The individual in the abuse may feel that it is their fault, or they are inviting the abuser into the relationship. The abused individual may also feel that when speaking about the abuse to another person, that person will judge them think it is the fault of the abused.
Some of the core issues in treatment while working with someone diagnosed with a history of sexual abuse is gaining the clients trust so that they may disclose their history of being sexually abused and feeling safe and not being judged. Lucinda stated, “For me, the most important factor for the clinician is to gain the trust of the individual first before the client feels safe enough to share such an experience with a total stranger”. Sexual abuse is a touchy subject to some and some individuals do not disclose having been sexually abused because they feel ashamed or guilty or they fear being judge has damaged goods. According to Lev’s post, “88% of cases of sexual abuse are never disclosed by the child.” In agreement, Alaggia (2005) states, “50% to 80% of victims do not purposefully disclose childhood sexual abuse before adulthood” (p.454).
Another core issue is the ability to gain that initial trust between the client and the clinician. For someone that has had a history of sexual abuse this can be a hard aspect to have happen. This is understandable because at some point in that person’s life they lost the ability to trust when someone took that opportunity away from them. It’s like that individual had their bond of trust violated and that may carry over as an adult for the ability to trust their own feelings and judgment. Additional core issues noticed with those sexually abused would be placing the blame on themselves or taking the responsibility for what has occurred to that individual. Also, having a constant fear instilled in them that something is wrong with them. Perhaps even issues with power and control because one may feel that was stripped away from them. An abused child will not open up unless they can trust again (trust is obviously something that is tarnished and even lost through the abuse).
Another core issue in treatment while working with someone diagnosed with a history of sexual abuse is using memory to work through the trauma. As Courtois (1992) points out, “Therapy is geared not only to the retrieval of autobiographical memory, but towards the integration of affect with recall to achieve resolution of the trauma.” Because so many feelings, emotions of the memories are difficult to deal with on a day to day basis, many victims of sexual abuse tend to dissociate and therefore can suffer from dissociative disorder and PTSD. I think it is extremely important to address sexual assault of males. So often is hard to come forward about the assault but as Hopper (2010) addresses, “Approximately one in six boys is sexually abused before age 16.” He goes on to talk about the long lasting affect’s of sexual abuse and how it can become a perpetuated cycle of being hurt: “Avoiding getting close to people and trying to hide all of one’s pain and vulnerabilities may creating a sense of safety. But this approach to relationships leads to a great deal of loneliness, prevents experiences and learning about developing true intimacy and trust, and makes one vulnerable to desperately and naively putting trust in the wrong people and being betrayed again.” A core factor for many that are abused is that they are not alone. Many times knowing that others are dealing with a similar situation can make a huge difference.
The types of therapeutic modality that works best for someone who has been abused should be determined based on the individual and the therapist preference. In the article by Courtois (1999) discusses that the resolution of sexual abuse trauma requiring retrieval of memory and the working through of the associated affect. This is important so the individual can heal by having fully acknowledged what has occurred to them in the past. The article further states, memory retrieval is an important component of the therapeutic process. As a therapist, an essential task when working with the client, would be having them acknowledge the abuse that has happened to them and be able to retrieve the full memory to proceed in the healing process. Courtois (1999) notes how memory deficits “are quite characteristic of trauma response and are utilized in the interest of defense and protection. This is an essential point for the clinician to understand in working on trauma resolution in general and memory retrieval in particular”. The strengths perspective acknowledges the client as the expert, which allows the memory retrieval to be a lot easier, and to be more accurate from the client.
It is crucial that clinicians be educated when working with individuals who have a history of childhood sexual abuse. Stearn (1988) states, “to diagnostically assess and treat clients in the most effective manner, social workers need to discover how each sexual abused clients views himself or herself, significant others, and the world” (p.466). Jennings (1994) “examines ways of using a broad spectrum of creative approaches, such as art, play, dance, music and drama, and combinations of those, to work with people who have been traumatized by experiences of sexual abuse” (p.471). Lucinda stated, “In my opinion, the best therapeutic modality that would work best with clients who have a history of childhood sexual abuse is using the strengths perspective”. The client is the expert on his or her own experience because only they know how they felt and what actually occurred during those moments. Bell (2003) believes
“the strengths perspective involves turning away from rational, empirical models that order and codify reality, toward a constructivist view, which holds that the identification of human problems reflects not objective reality, but the perspective of the one doing the looking. With this constructivist understanding, three assumptions emerge from the strengths perspective. First, clients have personal and environmental strengths and are more likely to act on those strengths when they are affirmed and supported. Second, the strengths perspective views the client as the expert on his or her own experience. Third, the roles of the social workers shift from expert and “fixer” to collaborator who respects and fosters the strengths of the client” (p.513).
Lucinda stated, “I feel that being empathetic, understanding, and compassionate are important in working with these clients”. According to Calof (1993) “listening to their stories and helping them explore the truth of their experiences has enabled many to turn their lives around” (p.45).
Family therapy is also important. Acknowledging the important and loving family members and their role in the victim’s life can help. With their love and support, the abused can work with the family to form treatment plans and other means of support.
As social workers, we have to not only listen to what our clients are saying but also read their body language as well as anything else they give us as clues. They are children who have been violated and are reluctant to speak because in their minds they did something wrong. We have to work collaboratively with the non-offending family (if that is obvious), schools, doctors, and other professionals so that we can get a full picture of the child’s symptoms, behaviors, and problems. Once we establish there has been abuse and from whom, we must remove the abuser if that has not already been done. Only then will we be able to work with the child towards a state of healing. Healing cannot happen when someone is still being abused. However literature does state most do not disclose what has happened until they are adults. Sometimes, it is not possible to remove the abuser if nothing is said about the abuse. As social workers, we would have to take every incident as it comes and deal with it as soon as possible. Unfortunately and sadly, most sexual abusers get off with a slap in the hand while the children they abuse suffer for the rest of their lives.
Essential Task for Therapists
An essential task for the therapist is providing a safe environment. Ensuring that a victim of sexual abuse feels comfortable in their setting is a pertinent factor in providing treatment. Also, maybe the sex of the therapist will matter. If the victim is female and was sexually abuse by a male, she may only feel comfortable speaking with another female. Lana stated, “The women in my placement have expressed many times their fears and anxieties when in groups with men after sexual assaults that they faced both as children and adults”.
As therapist we should not only be treating for sexual abuse, we should also be doing more about prevention and education to all young children. It should not take years for a person to disclose that they were abused as child without having the ability to address the abuse. They should not have to go through the feelings that it was their fault or the one to blame. Laura stated, ” I think it is very important for children to understand that it is often an adult that they know who becomes an abuser. Schools teach stranger-danger, and to fear the stranger, when often the threat comes from an individual close to or seen by the child.” Children need to be aware that there are monsters who can appear as nice people, who are not only strangers, and the only way to make something bad go away they have to talk. Some ways to do this is by using examples of what is appropriate from different people is the best way to get things across. Also, using child-like language is very important as well. Using characters from TV and books can be used as examples of love and family as long as the child can relate and understand in a certain way.
A therapist of someone who has a history of sexual abuse would need to patient and empathetic, while urging the individual to share their story. The individual has likely lived many years of hiding the abuse and trying to act like it never happened, while trying to live a “normal” life. This is not possible, as the horrible history will present itself in varying disorders, such as borderline personality disorder, dissociative disorder, and posttraumatic stress disorder and create upset in their life. The therapist must create an era of trust and safety in which the individual can feel comfortable and able to speak about their past. I think the therapist needs to ease into the revelations in order to help the individual to feel more comfortable; with each small piece, followed by safety and reassurance, another may follow, allowing the individual to reveal their past. This is really the ideal, and the therapist will need to be able to help the person overcome the varying disorders and other issues in their life.
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