A compassionate approach to healing childhood sexual abuse
by Karen A. Duncan, M.A.

Treatment for the Trauma of Child Sexual Abuse:
An Overview of Premises for Women

The traumatic crime of child sexual abuse is epidemic in the United States. According to The National Center of Child Abuse and Neglect (1996) children under the age of eight accounts for 39% of the substantiated cases of sexual abuse reported to police and child protective services. Along with these staggering statistics is the fact that this specific childhood trauma has been and continues to be the most underreported form of child abuse, which makes any estimate of its prevalence greater than what is actually reported. According to the Rape and Incest National Network (www.RAINN.org) one in four girls and one in six boys will experience sexual abuse before reaching the age of seventeen and this abuse will be perpetrated most often by a family member or someone close to the family.

Among the factors that help explain the epidemic of child sexual abuse are the pervasiveness of family perpetrators and their lack of stopping their own behavior and seeking help, the long-term secrecy that surrounds sexual abuse as a family trauma, the shame and confusion children and teens experience when it does occur, the silence within our society in discussing the sexual abuse of children and the intergenerational family aspect of this particular trauma. These same factors also help account for the significant number of women who historically experienced this trauma when they were children along with the reports that women and children are frequently the target of sexual abuse and other forms of interpersonal violence that intimate partners, family members or someone close to the family account for the majority of perpetrators.

Child sexual abuse carries with it a certain stigma that while being dispelled still permeates our society. Along with the stigma are the prolonged problems associated with sexual abuse experienced in childhood. A 1995 study by Polusny reported that child sexual abuse was a primary reason that brought women to mental health services and substance abuse programs. Studies also substantiate that women experience Posttraumatic Stress Disorder at a higher rate than men and that they are at-risk of continued victimization throughout their lives from the traumatic pathway that child sexual abuse creates. Sexual abuse trauma is also associated with physical health problems for women that often include irritable bowel syndrome, migraines, non-specific muscle pain and uterine pain during sexual intercourse. Among the problems that women experience associated with the trauma of sexual abuse are a repeated pattern of damaging and violent relationships, depression, anxiety, suicidal thoughts, intrusive thoughts of the abusive, nightmares and flashbacks, intense rage, criminal activity, negative self-image, self-jury and eating disorders. Along with the emotional, physical and substance abuse problems that women can experience is the traumatic pathway that sexual abuse creates - a pathway that leads women to revictimization when they are adults. Rape, sexual assault and domestic violence are known outcomes of this traumatic pathway. A recent study published in the Journal of Traumatic Stress identified this traumatic pathway as one of the risk factors for adult sexual assault. In this recent study, sexual abuse in childhood was identified by twenty-two percent of the women in their study who experienced sexual assault and violence as adults.

The prevalence of sexual abuse requires that mental health professionals have the most up-to-date information on the treatment protocols that are finding success with women for this particular childhood trauma. Gender sensitivity, information on the family belief system where sexual abuse occurs, known risk factors for revictimization, associated problems, disruption in the mother/child relationship, interventions with self-injury, the role of dissociation, group therapy, resolution for couples, and the experience of chronic shock symptoms are among the knowledge areas required by mental health and social work professionals who offer therapeutic intervention with women for sexual abuse trauma in childhood. It is also important to recognize that not all traumas are the same nor are the people who experience them. Therefore, an integrated and individualized approach to therapeutic intervention is often the most successful when working with women to restore their lives and facilitate the holistic healing of the diversity of problems associated with sexual abuse trauma.

Following are some of the therapeutic treatment premises found to be successful with women experiencing this particular sexual trauma (Duncan, 2005):

• An approach that is one of respect, consent, and mutuality exist between the therapist and the female client.
• A thorough social and family history, testing to obtain information on associated problems such as the experience of depression, anxiety, dissociation, eating disorders, substance abuse, and sexual comfort.
• Medical information to understand the efficacy of certain medications prescribed for symptoms of sexual abuse trauma and diagnostics that have occurred.
• Obtaining a trauma history with a woman while being sensitive to pacing disclosure over a period of time and throughout the stages of healing will provide a safeguard that the woman does not experience re-traumatization from the therapist.
• Assess for domestic violence and other personal safety risks that could be placing women in danger and the impact sexual abuse has had upon the mother/child relationship.
• An educational component early in treatment that provides information about child sexual abuse and how it impacts a woman's development, the experience of memory, associated problems and family risk factors for revictimization.
• Information about somatic illness and chronic pain and the somatosensory therapies that tend to alleviate the traumatic storage of the sexual abuse experience within the body. A specific protocol prior to using therapeutic touch would include explaining the types of touch that will occur associated with a specific problem a woman is experiencing, the location of the body to be touched that never includes agreed upon sexual places on the body, the reasons for therapeutic touch, the number of sessions where therapeutic touch will be integrated into a particular stage of healing, assess where on the body the sexual abuse impacted and consent from the women to participate in this type of therapeutic intervention. It is also recommended that a supervisor or co-therapist be present during these sessions and this person be introduced to the client at the beginning of the healing process and reintroduced prior to touch therapy beginning. Craniosacral therapies and body massage are adjunct therapies that are included in this protocol.
• Understanding and identifying the specific impact of sexual abuse for an individual woman is essential to establishing a written treatment plan that will be followed throughout the stages of healing and updated periodically to report on progress and direction for therapy. This treatment plan is shared and review with the female client for questions about recommendations and commitment to the recovery process.
• A coordination of care among healthcare providers can be especially relevant for women given the physical health problems that women experience from sexual abuse. Consent for exchanging information is provided at the beginning of the assessment stage.
• Identifying when a woman is ready and capable of participating in a recovery group without traumatizing other women is critical to preventing disruption to the healing process.

Therapeutic interventions with women for the trauma of sexual abuse is never complete until prevention education is integrated into the stages of healing in order to assure that women have the knowledge to prevent future victimization especially interpersonal trauma and that mothers in particular are able to apply this knowledge to the safety of their children as well. Therapeutic treatment for women without prevention education perpetuates sexual abuse and other forms of violence. Social work is a foundation for this dual and integrated approach to helping women restore their lives, protect themselves and assure the safety of their children. Healing from the trauma of child sexual abuse is possible but it is not a "quick fix" and it is seldom accomplished in less than one to three years. The context of the trauma has a direct impact on the amount of time that will be needed to heal - age at the time of the abuse, family environment and other traumas, relationship to the perpetrator, number of perpetrators, the period of time the abuse occurred, and success in previous treatment will all have a bearing on the amount of time needed by a woman to heal. This honest and open communication by professionals working with women will provide one of the foundations of establishing trust and respect with women whose lives have been disrupted by the trauma of childhood sexual abuse.

Article References:

1. Duncan K.A. (2004). Healing from the Trauma of Childhood Sexual Abuse: The Journey for Women. (Praeger Publishers: Connecticut).
2. Elliot, D.M., Mok, D.S., and Briere, J. (2004). Adult Sexual Assault: Prevalence, Symptomatology, and Sex Differences in the General Population. Journal of Traumatic Stress, 17, (3), 203-212.
3. Nash, M., Hulsey, T., Sexton, M., Harralson, T., and Lambert, W. (1993). Long-Term Sequelae of Childhood Sexual Abuse: Perceived Family Environment, Psychopathology, and Dissociation. Journal of Consulting and Clinical Psychology, 61, (2), 276-283.
4. Polusny, M., and Follette, V. (1995). Long-term correlates of child sexual abuse: Theory and review of the empirical literature. Applied and Preventive Psychology, 4, 143-166.
5. Saunders, S., Kilpatrick, D., Hanson, R., Resnick, H., and Walker, M. (1999). Prevalence, Case Characteristics, and Long-Term Psychological Correlates of Child Rape Among Women: A National Survey. Child Maltreatment, 4, (3), 187-200.
6. Schore, A. (2001). The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health. Infant Mental Health Journal, 22, 201-269.
7. U.S. Census Bureau. (Census 2000). "Female Populations by Age, Race and Hispanic or Latino Origin for the United States: 2000," Summary Table 1, October 3, 2001.