Jean never told anybody what had happened when she was growing up. She hoped if she never talked about it, it would go away. After all, it only happened once. She never told her parents because she didn’t think they would believe her. She had avoided her uncle as often as she could after it happened. She really didn’t think it made sense to talk about it now.
Growing up, Ryan’s parents were rarely ever home. When they were, they would tell Ryan, “I wish you were never born,” or “You were an accident!” Now, at 26, Ryan lives alone and experiences extreme stress anytime he receives the slightest social rejection. For example, today one of Ryan’s friends “took a rain check” for dinner because she had to work. Though Ryan rationally tells himself that his friend cares about him, and is not rejecting him, he feels extreme rejection. Memories of Ryan’s childhood flash in his mind, and he quickly pushes them away.
Definitions and Key Thoughts
Abused children are found at all socioeconomic levels. Abuse is a profoundly destructive experience for children. Symptoms such as irritability, oppositional defiance, poor educational performance, health complaints, sexual promiscuity, drug use, and running away from home are common with victimized children. Depression, panic disorders, dissociative disorders, and suicide attempts can also result from abuse.
Research expert John Briere categorizes child trauma as either abuse by omission or commission.[i]
Omission. According to Briere, omission involves the neglect of a child through parent unresponsiveness, and psychological or physical unavailability. Described as “the great unrecognized trauma,” with omission a child does not receive normal social stimulation, soothing, or support from a parent. Also with omission, there are no parent-child interactions that promote self-awareness, security, and positive views of others.[ii] Lastly, research by attachment expert John Bowlby shows that neglect is a severe traumatic experience, depriving a child of his/her innate needs for nurturance and love.[iii]
Commission. The sibling of abuse by omission, act of commission, is abusive behavior—psychological, physical, or sexual—directed toward the child. Such abuse is the single most powerful risk factor for developing a mental disorder of any kind for it creates longstanding attachment issues that distort one’s core perceptions of self, others, and the world.[iv]
Another form of abuse occurs when children live in homes where domestic violence occurs. The child may not be a direct victim of physical contact but is traumatized by s seeing family suffer at the hands of an abuser. These children suffer similar consequences to the ones listed above.
Child Sexual Abuse
Sexual abuse occurs when a person exploits another to satisfy the abuser’s desires. It consists of any sexual activity—verbal, visual, or physical. Sexual abuse is most often perpetrated by an adult who has access to another by virtue of real or imagined authority or kinship. Because the child often knows and even loves the abuser, the emotional confusion and damage can be intense. Statistics say that by age 18, 1 in 3 girls and 1 in 6 boys will be sexually abused by someone they love or should be able to trust.
The consequences of child sexual abuse are staggering:
Many long-lasting physical symptoms and illnesses have been associated with sexual victimization including chronic pelvic pain, premenstrual syndrome, gastrointestinal disorders, and a variety of chronic pain disorders, including headache, back pain, and facial pain. Between 4 and 30 percent of rape victims contract sexually transmitted diseases, including HIV. A longitudinal study in the United States estimated that over 32,000 pregnancies result each year from rape.
Immediate reactions to rape include…
Victims may experience emotional detachment, sleep disturbances, and flashbacks. Approximately one-third of rape victims have symptoms that become chronic. Rape victims often experience anxiety, guilt, nervousness, phobias, substance abuse, sleep disturbances, depression, alienation, suicidal behavior, and sexual dysfunction. They often distrust others, replay the assault in their minds, and are at increased risk of revictimization.
Rape can strain relationships because of its negative effect on the victim’s family, friends, and intimate partners. Victims of sexual violence are more likely than non-victims to engage in risky sexual behavior including having unprotected sex, having sex at an early age, having multiple sex partners, teen pregnancy, and trading sex for food, money, or other items.
Rape victims are more likely than non-victims to smoke cigarettes, overeat, drink alcohol, and are less likely to use seat belts. As you counsel a person who has been sexually abused, you must know the limits of confidentiality:
Sexual abuse is illegal and must be reported if the person is a minor. You must report it to the appropriate agencies, such as local law enforcement, the Department of Social and Health Services, or Child Protective Services. You must report it within a period of time, usually between twenty-four hours and seven days. Even if the client does not admit to abuse but you highly suspect it, you should report your suspicions.
Boston Therapy Assessment Interview
Rule out any suicidal risk, depression, or medical concerns (especially if the abuse was recent). Assess for the type of abuse perpetrated—its degree and its history. Sometimes the person is seeking help for other problems that actually stem back to an earlier abuse.
You need to get him/her to talk about that core issue. Be careful, however, not to re-traumatize the person with your questions. Trust and safety are of vital importance. The following questions are most appropriate for a victim of child abuse or neglect who is now either an adolescent or adult. Of course, these questions will change depending on who you are interviewing, and what that person’s age is:
Q1 What has happened that has brought you here today?
Q2 Is this the first time you’ve sought help?
Q3 Tell me about your family. How are things going at home?
Q4 Tell me about your past. Have you had any painful or unusual things happen—even a long time ago?
Q5 How long did that go on?
Q6 Can you tell me who was doing that to you? (If the person seems reticent,
explain that you need to know in order to help him, others who might be
abused, and the abuser himself. In addition, if your client is a minor and still
in contact with the abuser, immediate action must be taken.)
Q7 Do you know if others are being abused?
Q8 What problems are you currently having as a result of what has happened?
(Listen to how the abuse affected him. No two people are alike in the story
or the consequences of abuse. Be aware that victims tend to minimize the
impact of the abuse.)
Q9 Tell me how you feel about what has happened to you. (The client needs to
have permission to feel his true emotions.)
Q10 Do you feel responsible for the abuse? (Reassure him that he is not alone,
and that he is not responsible for the abuse.)
Q11 What do you believe about yourself? (Dig down for unhealthy beliefs that
have developed as a result of abuse. For example, what does he think about
himself that he would allow this abuse to continue?)
Q12 What do you believe about the person who is abusing you? (Listen for rationalizations.
“He couldn’t help it; he was drunk.” These defenses have helped
the client cope but have also made him less capable of seeing himself as a true
victim of abuse.)
Q13 Have you ever tried to stop the abuse? What happened?
Q14 What would you like to have happen as a result of our meeting today?
Q15 What kinds of boundaries do you think need to be set up to protect you?
Q16 Who else have you told about this?
Q17 How did that person respond?
Q18 Who can help you maintain the boundaries that you set? Who will be your
Q19 Where do you think God has been in all of this?
Q20 What do you as a person need in order to heal from this?
Counseling Therapy Insights
People who have been abused have had their boundaries violated in a horrible way. Healing from abuse involves restoration of healthy boundaries and of trust. The counseling process must be gentle and not contribute to an unintentional rewounding or shaming of the person. Follow the client’s lead in the telling of his story. Reassure him that the abuse was not his fault.
One of the questions often asked by someone who has been sexually abused is “Why me?” Sometimes feelings of worthlessness result from sexual abuse. As the counselor, you need to keep your own anger in check to provide a safe environment for the client to truly share.
Boston Therapy Tips and Action Steps
Treatment is crucial for abused children. The majority will need some type of medical and/or psychological help. However, the first step is to stop the violence. This may involve legal procedures to remove a perpetrator. Note: Counselors who suspect a child has been abused must report this information to Child Protective Services.
Assume three things in the process of treatment:
- The problem is treatable and the abused person will overcome the abuse.
- The person is not responsible for the abuse; he/she is only responsible for his/her recovery.
- The person needs to express, accept, and be prepared to deal with his feelings in order to heal.
1. Be Patient
Healing from sexual abuse is a process and people will vary in the amount of time required for their healing. It takes courage to seek help for healing, to talk about your experience, and to bring what was once in darkness into the light.
2. Grieve Your Loss
Much has been taken from you, so you are allowed to feel the pain and grieve the loss. Allowing yourself to feel the feelings will help you regain some of the power you need.
3. Regain Control
Being believed and being able to say what happened have been the first steps. You have permission to stand strong, to say no, to be empowered over the one who has exerted power over you.
4. Find Support
Attending a group for survivors of abuse/neglect can be an excellent next step.
5. Establish Boundaries
You now need to learn how to take care of yourself and re-establish healthy boundaries. What are the healthy boundaries you need to establish? Be sure trusted people are aware of those boundaries. That’s why others will need to be let in on what is happening—no matter how painful. You may need their help in dealing with the abuser. This will take the form of (1) speaking the truth to the abuser, (2) having the support of others in the Christian community, and/or (3) informed withdrawal from the abuser. If the abuser will not honor the boundaries, then other strategies may need to be put in place.
6. Know that You Will Heal
You do have a bright future. You’re not a victim, but a survivor. You may have lost a lot, but you are not “ruined” for the future. God can heal you.
7. Get More Intense Guidance
The person may need some professional guidance in order to truly deal with the depth of pain that abuse/neglect causes.
[i] Atia Daud, Skoglund, E., and Rydelius, P., “Children in Families of Torture Victims: Transgenerational Transmission of Parents’ Traumatic Experiences to Their Children,” International Journal of Social Welfare, 14(1), (January 2005), 23-33; John Briere, “Treating Adult Survivors of Severe Childhood Abuse and Neglect: Further Development of an Integrative Model,” in The APSAC Handbook on Child Maltreatment, 2nd Edition, (Newbury Park, CA: Sage Publications, 1996).
[ii] Gary Sibcy, “Lecture: Advanced Psychopathology,” Liberty University, (June 2005);
John Briere, “Treating Adult Survivors of Severe Childhood Abuse and Neglect: Further Development of an Integrative Model,” in The APSAC Handbook on Child Maltreatment, 2nd Edition, (Newbury Park, CA: Sage Publications, 1996).
[iii] John Bowlby, A Secure Base: Parent-Child Attachment and Healthy Human Development, (New York: Basic Books, 1988).
[iv] John Briere, “Treating Adult Survivors of Severe Childhood Abuse and Neglect: Further Development of an Integrative Model,” in The APSAC Handbook on Child Maltreatment, 2nd Edition, (Newbury Park, CA: Sage Publications, 1996); John Bowlby, A Secure Base: Parent-Child Attachment and healthy human Development, (New York: Basic Books, 1988).