Years ago I attained a certificate as a Counsellor for survivors of child sexual abuse. This helped me gain more knowledge on the subject and gave a deeper insight into my own childhood. I also understood the reason I was over-protective with my own children and the obsession to keep them safe during childhood.
I have also participated in campaiging work for a U.S. organization against abuse within religious cults. http://www.silentlambs.org
I hope the following information helps those of you that have experienced any of the issues raised in this post.
The words “child abuse” are likely to conjure up horror stories that appear from time to time – physical beatings, a child locked in a closet or tied up for long periods; or the unimaginable – like Ariel Castro’s imprisonment of young girls
In fact, abuse takes many forms, beyond the physical. Recent research finds that its impact is long-lasting. It extends far into adulthood, where it affects both physical and mental health.
As Faulkner wrote: “The past is never dead. It’s not even past.”
This same study, combined with the findings of some other recent research, contains hopeful signs for healing and healthy growth following early abuse.
First, consider some less visible forms of abuse, beyond the physical, that can create lasting consequences. For example, parental neglect; indifference to the child’s needs or temperament; outright humiliation; deliberate denigration. All may be fuelled by the parent’s own self-hatred, jealousy, or narcissism.
Examples range from the parent who leaves a child in the car or home alone for hours. Or the parent who rebuffs the child who excitedly says, “look at my new drawing!” or “see what I wrote for this school project!” and who receives a curt, “Don’t bother me now. I’ve got to finish up this report.”
Or the parent who consistently and vocally praises one child, while ignoring or criticizing the child’s sibling. And there’s the classic, “You’ll never amount to anything!” Or, why can’t you be more like your sister/brother?”
I’ve heard them all, and more. All take a toll, and this new research study
confirms that abuse has a long shelf life. It takes a continuing toll on both physical and mental health well into adulthood. The study, conducted by researchers at UCLA and published in the Proceedings of the National Academy of Sciences examined the effects of abuse and corresponding lack of parental affection across the body’s entire regulatory system. It found strong links between negative early life experiences and health, across the board. The effects permeate one’s entire mind-body system
This study of 756 subjects suggested that “biological embedding” occurs through programming brain circuitry in ways that shape response patterns to subsequent stress. That causes wear and tear extending across multiple mind-body systems, and creates adverse health outcomes decades later. The researchers suggest that toxic childhood stress alters neural responses to stress, boosting the emotional and physical arousal to threat, and making it more difficult for that reaction to be shut off.
Signs of Hope
Something encouraging also emerged from this study, and it joins with findings from two other studies about parents and children. The UCLA study found that the presence of a loving, parental figure can provide protection to the abused child. According to the study’s report, “It is well-recognized that providing children in adverse circumstances with a nurturing relationship is beneficial for their overall wellbeing. Our findings suggest that a loving relationship may also prevent the rise in biomarkers indicative of disease risk across numerous physiological systems.”
According to Judith E. Carroll, the study’s lead author, “If the child has love from parental figures they may be more protected from the impact of abuse on adult biological risk for health problems than those who don’t have that loving adult in their life.” That is, those who reported higher amounts of parental warmth and affection in their childhood had lower multisystem health risks. Moreover, the researchers found “a significant interaction of abuse and warmth, so that individuals reporting low levels of love and affection and high levels of abuse in childhood had the highest multisystem risk in adulthood.”
Their findings suggest that “parental warmth and affection protect one against the harmful effects of toxic childhood stress.” That’s good news, and it links with another recent finding that touching and stroking contribute to a healthy sense of self.
That is, according to this study, affectionate physical contact, “…characterized by a slow caress or stroke — often an instinctive gesture from a mother to a child or between partners in romantic relationships — may increase the brain’s ability to construct a sense of body ownership and, in turn, play a part in creating and sustaining a healthy sense of self.”
Such touching seems to play a role in how the brain learns to construct a mental picture and an understanding of the body, which ultimately helps to create a coherent sense of self, according to a summary of the findings
On the negative side, the absence of such experiences are linked with various physical and emotional disorders. “As affective touch is typically received from a loved one, these findings further highlight how close relationships…play a crucial role in the construction of a sense of self,” said Laura Crucianelli, the lead researcher.
Another illustration of the interconnections between the mind, body, and the network of relationships of which one is a part, is a study finding
that a positive, mutually supportive and sensitive love relationship was associated with positive, supportive and nurturing behaviour towards one’s children.
The study’s lead author, Abigail Millings of the University of Bristol, commented in a research summary that researchers sought to examine how caregiving plays out in families: “…how one relationship affects another relationship. We wanted to see how romantic relationships between parents might be associated with what kind of parents they are. Our work is the first to look at romantic caregiving and parenting styles at the same time.”
The research found – no surprise – that “a common skill set underpins caregiving across different types of relationships, and for both mothers and fathers. If you can do responsive caregiving, it seems that you can do it across different relationships.”
Millings added, ”It might be the case that practicing being sensitive and responsive — for example, by really listening and by really thinking about the other person’s perspective — to our partners will also help us to improve these skills with our kids.”
I think the upshot of this and other findings is that they provide more empirical confirmation that everything is connected in our lives. How we think, feel, relate, and behave are all part of an interconnected whole. To that point, evidence continues to mount that humans are hardwired for empathy and connection. It’s our natural state, but its expression may become stunted or deformed by our life experiences. One example is a recent University of Virginia study, published in the journal Social Cognitive and Affective Neuroscience.
Using functional magnetic resonance imaging brain scans (fMRIs), if found that we experience people who we become close to as though they are our own selves. “It’s essentially a breakdown of self and other; our self comes to include the people we become close to,” said lead research James Coan.
The problem is that our life experiences often generate diminished self-worth, fragmentation, isolation, or retreat into ego attachments that disconnect us from ourselves, within; and from others. Despite our surface differences and conflicts we are one, beneath those differences, like organs of the same body. That reality – if we practice it – has the power not only to heal damage to young lives, but also to enhance greater health and wellbeing for all lives, young and old.
The Long-Term Effects of Childhood Sexual Abuse: Counseling Implications
Melissa Hall and Joshua Hall
Hall, Melissa E., is a Counsellor Education Doctoral Student at the University of Arkansas. She has experience working with at-risk children, adolescents, and their families. Her research interests include marital satisfaction, the role of family in child and adolescent behaviour, and foster care. Hall, Joshua R., is a Licensed Social Worker. He has clinical experience working with at-risk populations including foster youth. His research interests include foster care, social welfare policy, and child and adolescent behaviour.
Childhood sexual abuse is a subject that has received much attention in recent years. Twenty-eight to 33% of women and 12 to 18% of men were victims of childhood or adolescent sexual abuse (Roland, 2002, as cited in Long, Burnett, & Thomas, 2006). Sexual abuse that does not include touch and other types of sexual abuse are reported less often, which means this number of individuals who have been sexually abused in their childhood may actually be greater (Maltz, 2002). With such a high percentage of people having experienced childhood sexual abuse, it is likely that many people seeking therapy will have histories that include sexual abuse. It is imperative that counsellors are aware of and familiar with the symptoms and long-term effects associated with childhood sexual abuse to help gain a deeper understanding of what is needed in counselling. This paper will define childhood sexual abuse and review the impact it can have, explore the long-term effects and symptoms associated with childhood sexual abuse, and discuss counselling implications.
Childhood Sexual Abuse
There are many forms of childhood sexual abuse. The sexual abuse can involve seduction by a beloved relative or it can be a violent act committed by a stranger. Sexual abuse can be hard to define because of the many different forms it can take on, the different levels of frequency, the variation of circumstances it can occur within, and the different relationships that it may be associated with. Maltz (2002) gives the following definition: “sexual abuse occurs whenever one person dominates and exploits another by means of sexual activity or suggestion” (Maltz, 2001a, as cited in Maltz, 2002, p. 321). Ratican (1992) defines childhood sexual abuse as: any sexual act, overt or covert, between a child and an adult (or older child, where the younger child’s participation is obtained through seduction or coercion). Irrespective of how childhood sexual abuse is defined it generally has significant negative and pervasive psychological impact on its victims. (p. 33) The majority of sexual abuse happens in childhood, with incest being the most common form (Courtois, 1996, as cited in Maltz, 2002). The impact of childhood sexual abuse varies from person to person and from case to case.
A study compared the experiences of women who experienced familial sexual abuse with women who experienced non-familial abuse. They found that women who experienced familial abuse reported higher current levels of depression and anxiety when thinking about the abuse. Other variables they found to increase the levels of reported distress were abuse experiences that involved more extensive sexual abuse, a higher number of sexual abuse experiences, and a younger age during the first sexual abuse experience (Hartman, Finn, & Leon, 1987). While the nature and severity of the sexual act may cause more serious impact, many other factors may influence the degree of damage the victim experiences. Other factors may include the perspective of the individual, the individual’s internal resources, and the individual’s level of support (Courtois, 1988, as cited in Ratican, 1992). Although not all forms of childhood sexual abuse include direct touch, it is important for therapists to understand that childhood sexual abuse can take on many different forms that still exploit the victim sexually and cause harm. The perpetrator may exploit the child by introducing them to pornography prematurely, assaulting them through the internet, or manipulating them into taking pornographic photos. Childhood sexual abuse infringes on the basic rights of human beings. Children should be able to have sexual experiences at the appropriate developmental time and within their control and choice. The nature and dynamics of sexual abuse and sexually abusive relationships are often traumatic. When sexual abuse occurs in childhood it can hinder normal social growth and be a cause of many different psychosocial problems (Maltz, 2002). The next section of this paper will review literature and research concerning these long-term effects of childhood sexual abuse.
The Long-Term Effects of Childhood Sexual Abuse
Childhood sexual abuse has been correlated with higher levels of depression, guilt, shame, self-blame, eating disorders, somatic concerns, anxiety, dissociative patterns, repression, denial, sexual problems, and relationship problems. Depression has been found to be the most common long-term symptom among survivors. Survivors may have difficulty in externalizing the abuse, thus thinking negatively about themselves (Hartman et al., 1987). After years of negative self- thoughts, survivors have feelings of worthlessness and avoid others because they believe they have nothing to offer (Long et al., 2006). Ratican (1992) describes the symptoms of child sexual abuse survivors’ depression to be feeling down much of the time, having suicidal ideation, having disturbed sleeping patterns, and having disturbed eating patterns Survivors often experience guilt, shame, and self-blame. It has been shown that survivors frequently take personal responsibility for the abuse. When the sexual abuse is done by an esteemed trusted adult it may be hard for the children to view the perpetrator in a negative light, thus leaving them incapable of seeing what happened as not their fault. Survivors often blame themselves and internalize negative messages about themselves. Survivors tend to display more self-destructive behaviours and experience more suicidal ideation than those who have not been abused (Browne & Finkelhor, 1986). Body issues and eating disorders have also been cited as a long-term effect of childhood sexual abuse. Ratican (1992) describes the symptoms of child sexual abuse survivors’ body image problems to be related to feeling dirty or ugly, dissatisfaction with body or appearance, eating disorders, and obesity. Survivors’ distress may also result in somatic concerns. A study found that women survivors reported significantly more medical concerns than did people who have not experienced sexual abuse. The most frequent medial complaint was pelvic pain (Cunningham, Pearce, & Pearce, 1988). Somatization symptoms among survivors are often related to pelvic pain, gastrointestinal problems, headaches, and difficulty swallowing (Ratican, 1992). Stress and anxiety are often long-term effects of childhood sexual abuse. Childhood sexual abuse can be frightening and cause stress long after the experience or experiences have ceased. Many times survivors experience chronic anxiety, tension, anxiety attacks, and phobias (Briere & Runtz, 1988, as cited in Ratican, 1992).
A study compared the post traumatic stress symptoms in Vietnam veterans and adult survivors of childhood sexual abuse. The study revealed that childhood sexual abuse is traumatizing and can result in symptoms comparable to symptoms from war-related trauma (McNew & Abell, 1995). Some survivors may have dissociated to protect themselves from experiencing the sexual abuse. As adults they may still use this coping mechanism when they feel unsafe or threatened (King, 2009). Dissociation for survivors of childhood sexual abuse may include feelings of confusion, feelings of disorientation, nightmares, flashbacks, and difficulty experiencing feelings. Denial and repression of sexual abuse is believed by some to be a long-term effect of childhood sexual abuse. Symptoms may include experiencing amnesia concerning parts of their childhood, negating the effects and impact of sexual abuse, and feeling that they should forget about the abuse (Ratican, 1992). Whether or not survivors can forget past childhood sexual abuse experiences and later recover those memories is a controversial topic. Some therapists believe that sexual abuse can cause enough trauma that the victim forgets or represses the experience as a coping mechanism. Others believe that recovered memories are false or that the client is led to create them (King, 2009)
Survivors of sexual abuse may experience difficulty in establishing interpersonal relationships. Symptoms correlated with childhood sexual abuse may hinder the development and growth of relationships. Common relationship difficulties that survivors may experience are difficulties with trust, fear of intimacy, fear of being different or weird, difficulty establishing interpersonal boundaries, passive behaviours, and getting involved in abusive relationships (Ratican, 1992). Feinauer, Callahan, and Hilton (1996) examined the relationship between a person’s ability to adjust to an intimate relationship, depression, and level of severity of childhood abuse. Their study revealed that as the severity of abuse increased, the scores measuring the ability to adjust to intimate relationships decreased.
Sexual abuse often is initiated by someone the child loves and trusts, which breaks trust and may result in the child believing that people they love will hurt them (Strean, 1988 as cited in Pearson, 1994). Kessler and Bieschke (1999) found a significant relationship between women who were sexually abused in childhood and adult victimization. Many survivors experience sexual difficulties. The long-term effects of the abuse that the survivor experiences, such as, depression and dissociative patterns, affect the survivors sexual functioning. Maltz (2001a, as cited in Maltz, 2002) gives a list of the top ten sexual symptoms that often result from experiences of sexual abuse: “avoiding, fearing, or lacking interest in sex; approaching sex as an obligation; experiencing negative feelings such as anger, disgust, or guilt with touch; having difficulty becoming aroused or feeling sensation; feeling emotionally distant or not present during sex; experiencing intrusive or disturbing sexual thoughts and images; engaging in compulsive or inappropriate sexual behaviours; experiencing difficulty establishing or maintaining an intimate relationship; experiencing vaginal pain or orgasmic difficulties (women); and experiencing erectile, ejaculatory, or orgasmic difficulties (men; p. 323).
A study done on the prevalence and predictors of sexual dysfunction in the Untied States revealed that victims of sexual abuse experience sexual problems more than the general population. They found that male victims of childhood sexual abuse were more likely to experience erectile dysfunction, premature ejaculation, and low sexual desire, and they found that women were more likely to have arousal disorders (Laumann, Piel, & Rosen, 1999). It is important to point out that although research has shown there to be significant relationships between long-term effect variables and childhood sexual abuse, each victim’s responses and experiences will not be the same. Although it is often viewed as a traumatic experience, there is no single symptom among all survivors and it is important for clinicians to focus on the individual needs of the client.
There are many important things for a counsellor to consider when helping a survivor overcome long-term effects or symptoms of sexual abuse. The literature regarding the therapeutic process after disclosure has been made is limited and no specific treatment model is suggested (Kessler, Nelson, Jurich, & White, 2004). Although no specific treatment model is used for counselling survivors, researchers and clinicians have provided suggestions and important implications for counsellors to consider. This section of the paper will explore these counselling implications. Kessler et al. (2004) identified common treatment decision-making practices of therapists treating adult survivors of childhood sexual abuse. Their study revealed that regardless of the treatment mode, the therapists found it important to assess the client presenting problems, the effects the abuse has on their current functioning, and how the client currently copes. Because clients often have trouble externalizing the abuse, therapists may need to work with client to increase their ability to accurately attribute responsibility. To help decrease levels of depression and anxiety, helpful goals for the survivor may be to increase their sense of control and increase their ability to accurately attribute responsibility (Hartman et al., 1987). The therapeutic alliance is imperative to help counselling survivors feel safe. Childhood sexual abuse survivors often present with symptomatic problems, feelings, and behaviours that result from the abuse, rather than for the sexual abuse itself (Courtois 1988, as cited in Ratican, 1992). Feelings of fear or vulnerability may hinder the client from disclosing their childhood sexual abuse. Relationship building techniques such as using encouragement, validation, self-disclosure, and boundary setting are encouraged to help build the therapeutic alliance. Accepting the survivor’s version of their sexual abuse experience is often therapeutic and helps strengthen the alliance (Pearson, 1994). It is important for the counsellor to allow the client time to build feelings of trust, safety, and openness. Because sexual abuse is abusive in power by nature egalitarianism is stressed as an important factor. Allowing the client to have control in both the pace and direction of the therapeutic process is important (Ratican, 1992). Client empowerment is a technique used with survivors. Van Velsor and Cox (2001) suggest it is vital to help survivors process, uncover, and express anger because anger can be used to help a client feel empowered, appropriately attribute responsibility, establish boundaries, and promote self-efficacy and power.
They recommend that the counsellor help the client reframe their anger into an emotion they can use to help define their rights and needs, explore the covert norms for anger expression among women, and help survivors use their anger for productive action and behaviour. Assisting the client in gaining skills that will help them find and develop supportive relationships, especially with a partner, is also considered an important goal in helping a survivor overcome some of the long-term effects of childhood sexual abuse. Helping the client gain skills that will help them better adjust to, enhance, and develop intimate relationships may be an important step in counselling a survivor of childhood sexual abuse. In a study conducted by Feinauer et al. (1996), it was revealed that the better a survivor was able to adjust to intimate relationships, the lower their depression scores were despite the level of abuse they experienced. The authors suggest that positive intimate relationships may increase the survivors’ feelings of safety, help them gain interpersonal experience, and experience reconnection. If the survivor is in a committed, long-term relationship, it is important for the survivor’s partner to also become educated about the long-term effects of childhood sexual abuse and learn ways they can actively participate in the healing process. Counsellors can help couples learn to integrate communication, choice, trust, respect, and equality into their intimate relationship (Maltz, 2002). Feinauer et al. (1996) suggest that the therapeutic goals for a couple include a resolution of issues related to physical and emotional safety, resolution of distressing memories, increased trust between survivor and partner, understanding of survivors symptoms, and participation in appropriate social reconnection.
Therapists are recommended to address the more general psychosocial problems before treating the sexual problems of survivors. This is due to the sensitive and vulnerable nature of sex. Survivors are more likely to experience success in sex and relationship counselling after resolving feelings about the abuse and gaining skills in areas such as assertiveness and self-awareness (Maltz, 2002). Maltz (2001a, as cited in Maltz, 2002) suggests that a first step in sexual healing is to help the survivor connect their current sexual problems with their past sexual abuse. It may help for the survivor to see a list of the sexual symptoms that often are from past sexual abuse. Ratican (1992) describes the sexual symptoms of survivors to often include sexualizing relationships, inappropriate seduction, difficulties with affection and intimacy, compulsive sexual behaviour, promiscuity, problems concerning desire, arousal, and orgasm, flashbacks, difficulties with touch, and sadistic/masochistic tendencies.
A treatment designed for sexual healing often focuses on understanding how the sexual abuse influenced their sexuality, adjusting sexual attitudes, gaining a more positive sexual self-concept, decreasing negative sexual behaviours, learning how to cope with negative reactions to touch, and developing skills to positively experience touch and sexual intimacy (Maltz, 2002).
It is important that research continue on the topic of the long-term effects of childhood sexual abuse. The severity of this issue and the significant implications it has on the lives of survivors has been well established. With this knowledge it is imperative that counsellors continue to expand their knowledge of childhood sexual abuse. There is much to be learned on how counsellors and therapists can best help survivors of childhood sexual abuse overcome its long-term effects. Further research is needed to address best practice and treatment interventions for survivors. Childhood sexual abuse is obviously often a traumatic experience that has many consequences throughout the person’s life. The effects of childhood sexual abuse last into adulthood and counsellors need to be well-trained in order to provide the best services possible.