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

Healing and Recovery
Karen A. Duncan, M.A., LMFT, LSW

The Forgotten Victims: Women, Trauma and the Criminal Justice System

(Please note: this article's discussion does not include female sex offenders or women who otherwise commit the crime of abuse toward children and teens.)

"I used drugs so often that I no longer remember several years of my life. My eight-year-old son, who now lives with my mother, has never known me without my being high. I hope to never go back to committing crimes to buy the drugs I used. I also want to stop the cycle of violence that has been in my life since I was a young girl. Maybe then I can keep my son safe and he will finally get to know his mother."
Quote from an inmate at the Indiana Women's Prison.

An Overview of Female Offenders: The Gender Difference

Women offenders present a unique population within the criminal justice system. The history and the crimes of women offenders are different from male offenders. Women are most often incarcerated for crimes against property and when they commit property crimes their criminal activity is often related to substance abuse. When women commit violent crimes it is often against a partner or other family member who has a history of violence against them. Mothers who are incarcerated are frequently the sole support of their children. During a mother's incarceration custody of her children is often jeopardized and visitation is problematic since most prison facilities are not conducive to an atmosphere of child visitation; depending on the crime committed, women may be denied visitation. Women who give birth while in prison face their children being placed into foster care or with family members who may live out of town or who are not willing to bring children for visitation. These families are often the same families where a woman's own maltreatment took place. A nationwide profile of the of the typical female offender would include serious substance abuse, chronic low self-esteem, childhood trauma and other types of victimization across her lifespan.

Over the past decade, the number of women within the criminal justice system has grown dramatically. From 1990 through 2002, the number of women in state and federal prisons grew 121 percent. A total of 97, 491 women were incarcerated as of 2002. While the rate of incarceration for women continues to be far lower than the rate for men (51 of every 100,000 women versus 819 of every 100,000 men) the number of women incarcerated has almost doubled the rate of men - more women are going to prison than ever before. Women are also placed under community supervision - probation, parole, and work release.

While the number of women sentenced for crimes has increased, the number of women convicted for violent crimes continues to decrease. When women commit violence crimes their victim is often a spouse, ex-spouse or partner and women often report being physically and/or sexually abused by the person they assaulted. Women offenders seems to typify the increase in aggressive behavior by females in response to a history of interpersonal and family violence perpetrated against them.

Over the past several years specific attitudes within our society have also influenced the increase in the number of women incarcerated. Government approaches to crime are oversimplified emphasizing punitive consequences rather than rehabilitation in response to complex and long-standing social problems. Mandatory sentencing laws such as California's "three strike law" that mandates imprisonment upon a third convicted offense along with the public's growing fear of crime and their demand that more enforcement against criminal behavior occur have created circumstances that have contributed more women within the criminal justice arena. Our society has also developed an attitude that crime represents individual pathology while often discounting the social structures and contextual aspects of crime and this is especially true when it comes to the criminal behavior of women.

Women are primarily arrested, incarcerated and detained for crimes related to property and drug offenses. In 1999, 1 in 3 women were serving a sentence for a drug related conviction. The Bureau of Justice Statistics (BJS) reports that drug offenses represent the greatest number of convictions for female offenders. The BJS report indicates that more than half the women in prison report committing their offense under the influence of drugs or alcohol which links women's use of drugs and the crimes they commit together. Women commit crimes to support their addictive behavior; however, their illegal activity also needs to be understood within a gender perspective of interpersonal trauma and victimization. Studies of women within the prison system indicate that eighty to ninety percent of the women incarcerated report a history of childhood sexual abuse often by multiple perpetrators who are in the family or close to the family. Childhood physical abuse is significant for women offenders as well and often co-occurs with other forms of childhood maltreatment. The trauma of childhood sexual abuse in particular is known to create a traumatic pathway to other types of interpersonal violence that includes rape, sexual assault and domestic violence.

Women will often use substances to moderate the effects of trauma - increase arousal, dissociation and traumatic memories, sleep disruptions or re-experiencing the physical sensations of the trauma. Also, it is not uncommon that perpetrators introduce the use of drugs and alcohol during the original childhood trauma in order to gain better control over the child and to maintain complacency during the cycle of abuse. Childhood traumas often begin an early pattern of substance abuse for girls that continue when they become women. Women find themselves in destructive relationships with men who are trafficking in illegal substances. These family members and partners frequently threaten or commit violence toward women when they do not comply with their demands. Women go to prison because of the involvement of male relatives or partners in the buying and selling of drugs and because of their own use of substances.

A history of trauma combined with crimes related to substance abuse also has significant implications for the children of incarcerated mothers since most children are in the custody of their mothers who are the sole caregiver. These children are at a higher risk for abuse and other forms of maltreatment than children whose mothers have not been incarcerated or whose mothers are not using substances. They face multiple problems of foster care, abandonment, loss and separation, limited visitation, school disruptions and emotional and developmental issues related to attachment disorder. When states include the cost of foster care for children whose mothers are incarcerated it often adds thirty percent to the cost of imprisoning women over men and the emotional and social cost is even higher for children.

Women have primarily been incarcerated within a criminal justice system developed for men. This fact contributes to women being ignored, diminished and further marginalized within a punitive system that often re-traumatizes women. While some prisons are beginning to establish models of gender sensitivity few are readily available nationwide. Gender sensitive models of female incarceration still hold women accountable for their crimes, but take into account the victimization history of women.

As stated within the Indiana Women's Prison (IWP) annual report, "The mission of the Indiana Women's Prison is to effectively manage a diversified population in a safe, secure, healthy environment that encourages healing, change and family preservation through quality programming while ensuring the protection of the public, staff and offenders." The IWP mission statement is an example of how a criminal justice system can be sensitive to gender by responding affirmatively to women's history of trauma, substance abuse related crimes, community safety, the needs of children, and the restoration of women's lives through healing and recovery from trauma. Hopefully, as these programs gain credibility they will have a greater influence on how the crimes of women are viewed within a context of victimization that occurs to these women across their lifespan. In doing so, we would see an improvement in the ability to meet the needs of children whose mothers are imprisoned while developing and implementing justice programs that truly provide justice by helping women restore their lives within a community that is absent of violence and drugs.

Risk Factors From Victimization

Cathy Spatz Widom in her paper, "Childhood Victimization and the Derailment of Girls and Women to the Criminal Justice System" asserts that the problem of female criminality is substantially more complex than presented in the literature. The research Spatz presents suggests that girls who have been victimized are nearly twice as likely to be arrested as juveniles and as adults. Girls who experience sexual abuse are at an increase risk of entering prostitution and running away to escape abusive environments that are not resolved through legal channels. Living on the streets place girls in jeopardy for all types of risk behavior that will include crime. Girls who are sexually and physically abused can also experience difficulties in academic achievements that in turn reduce their ability to enter paths of higher education or being able to achieve higher paying stable jobs. The multiple health problems associated with sexual abuse can diminish a girl's ability to attend school or to do well at school especially while she is experiencing childhood trauma.

Adolescent offenders can escalate to more serious offenses. Spatz found a smaller "subset of female offenders who go on to become career criminals" that develop antisocial behavior and beliefs and delinquent lifestyles. Girls who experience abuse and neglect seldom grow up in homes that provide adequate nurturance, emotional support, positive socialization, and supervision or family structure. One or more parent might already be in the criminal justice system or parents and siblings associate with known criminals within their community. The opportunity to learn aggressive and antisocial behavior can occur within some families where abuse and neglect take place along with a family belief system sets destructive patterns in place.

Girls who are abused and neglected experience a sense of loss and control over their lives. This pattern can continue into adulthood where women enter relationships with partners who have similar characteristics to the perpetrator and believe they have the right to dominate and control their relationships with women and children. Children also directly blame themselves for abuse by believing they were somehow responsible for the perpetrator's behavior either due to their inability to stop the perpetrator because of their young age and lack of power or because appropriate intervention by other adults in the family did not take place. Girls will also indirectly blame themselves when they experience the effects of abuse such as diminished self-esteem and shame. Self-blame can be experienced in a girl's' self-perception of not being "good enough" or "not as good" as other people.

Childhood victimization and its effects prevent girls from completing their age-appropriate development. Childhood sexual abuse in particular causes disruption in developing emotional, social and psychological skills essential to adult development by interfering with building positive friendships and partner relationships as well as the establishment of a positive female identity. The effects of abuse can transfer to their adult lives and continue to disrupt the development of a positive sense of well-being and belief of deserving the good life has to offer. As women become mothers, the traumatic effects of childhood victimization can transfer to their children and impact their emotional, physical and psychological development. As with other women who have experienced the trauma of sexual abuse and other forms of childhood traumas, women offenders also search for a spiritual meaning to their lives and history often seeking to fill the personal void of loneliness, emptiness and isolation they have experienced for many years.

Counseling Women Offenders: Trauma Education and Prevention Recovery

Women offenders present a growing population for counseling and social services. At the present time I am developing a Trauma Education and Prevention Recovery Group for women at the Indiana Women's Prison and plan to provide training for staff at the prison as well. This group program is considered a first stage of treatment for this population of women. It is also an approach I would recommend for substance abuse counselors working with women who are not incarcerated but where a history of trauma exist for women with a history of substance abuse since co-morbidity of female trauma and addiction has been well documented over the past several years. While I encourage counselors to consider working with this population of women as they can inspire admiration as their strengths become known, I also recommend a thorough understanding of sexual and physical trauma that is gender based and at least several years of experience. Counselors need to understand the importance of a gender sensitive perspective for female offenders since a history of trauma and victimization are often linked to women's offending behaviors. The women I am working with have extensive histories of multiple traumas, substance abuse and criminal activity. The following table highlights the profile of this group of women.

Table One

• Age range of women: 20 to 30 years of age
• Crimes Committed:
  • Forgery - 2
  • Murder - 3
  • Drug Possession - 2
  • Theft - 2
• Time of Incarceration: 4 months to 30 years
• Number of women reporting sexual abuse:
  • 6 out of 8
  • Age when sexual abuse occurred: 2 years of age to 6 years of age
  • Average length of time the sexual abuse occurred: 8 years
• Relationship of perpetrator: Brother, friends of brother, father, step-father, family friend, ex-husband.
• Number of women reporting physical abuse: 2 women
  (all but one woman experienced physical abuse by a male family member; the one woman who did not was physically abused by her mother)
• Co-traumas of abuse: 8 out of 8 have experienced sexual, physical or emotional abuse in combination as well as sexual assault and domestic violence in their adult years.
• Co-morbidity of other problems: Substance abuse, anxiety, depression, self-injury, eating disorders, posttraumatic symptoms, and unresolved issues of loss, grief, rage and conflictual family relationships.

When working with this population of women it is also critical to incorporate a plan of preventing future interpersonal violence and victimization. By including prevention education, real support is given to women in the creation and establishment of a new life once released. Prevention of future violence means that the traumatic pathway created by childhood or adolescent victimization and occurring over a woman's lifespan is disrupted and prevented from reoccurring to women once they are released. If violence is prevented and recovery from past traumas occurs then women are less likely to relapse into destructive relationships, substance abuse and crime.

The Group Process: Focus and Boundaries.

Due to limitations of funding and staff resources, the therapeutic approach most often provided to women who are incarcerated is a recovery process that focuses on education about victimization, the effects and impact of trauma to women's lives and recovery and prevention of future traumas. Therefore, when working with women who are incarcerated it is important to remember that a recovery group focused on education and prevention needs to identify and maintain specific boundaries and in particular around the nondisclosure of specific aspects of sexual, emotional and physical trauma that can cause re-traumatization to occur. Establishing boundaries within the therapeutic process is a first step with any therapeutic intervention, but it becomes especially important for women within a prison setting. The therapist must have control within the group while having an attitude of equality, compassion and respect. It is also important to remember that most women within the prison system have more than likely not participated in previous recovery programs and when they have few actually completed and experienced a sense of healing. While a group approach has its limitations it can be beneficial to support the restoration of women's lives and the prevention of victimization into the future.

A General Assessment:

As with other women who have experienced interpersonal violence it is important to assess the impact of the various traumas committed against women. An individual one-to-one assessment is seldom possible so it useful to initiate an assessment in the form of a written history where women answer pre-determined questions in writing. This type of assessment process helps women to gradually begin to acknowledge and share their trauma history, family and individual history and the crimes that led to their incarceration. Please remember that assessment does not force disclosure of the specific aspects of interpersonal traumas especially sexual trauma. Disclosure that takes place before a woman is ready, willing, prepared and where adequate trust and safety is not established will lead to a woman being retraumatized within a therapeutic process.

The focus of this type of assessment identifies and acknowledges in a general way the specific traumas that have been experienced (sexual, physical, emotional), the age and stage of development that the trauma occurred, what current symptoms of trauma are being experienced that disrupt daily life, the relationship of the perpetrator when the traumas occurred and the relationship with the perpetrator today and the health related problems that are frequently associated with interpersonal violence and trauma. A substance abuse history would also take place at this time and a determination of the relationship to a woman's current incarceration. This general approach to assessment maintains the therapeutic boundary for the group as it allows for disclosure outside of the group (in writing) so that the group can focus on education and prevention and disclosure within the group do not cause further trauma to women.

The Size and Time Limit of the Group:

Whenever possible the group size should be kept small to allow for safety, trust and time for discussion. I recommend no more than five women be involved in the recovery group. However, an upper limit of ten women is acceptable depending on the experience, training, skill level and education of the therapist with regard to childhood trauma recovery and working with women. A once a week group that is held for two hours can support women while recognizing the limits on their time. It is also important to remember that women are often at different stages of release and sentencing when entering an education and prevention recovery group. The selection of women into a trauma education and prevention recovery group is primarily made based on a history of trauma not on the crime they committed or the sentence they received.

Education:

Education is a key component in a first stage of Trauma Education and Prevention (TEP) recovery group. The focus of trauma education is to provide information that allows women to make insightful connections between current or past problems and the victimization they have experienced. TEP also helps women to understand the impact that interpersonal violence has had upon their patterns of relationships and it can be especially helpful with the relationship to their children when discussing maternal attachment disorder occurring from trauma. How a woman's self-concept and female identity has been distorted or harmed is helpful to enable women to identify core issues that contribute to sustaining damaging relationships, identifies how different decisions today can restore their self-esteem and create a positive life-sustaining female identity and work towards developing a prevention plan that includes distancing from abusive and violent relationships.

Basic components of TEP includes three areas 1) A definition and discussion of trauma--the types of trauma that women experience, how childhood traumas create a traumatic pathway to other types of violence across a woman's lifespan, how often trauma occurs to women, and the relationship between trauma and substance, 2) The impact of trauma--the prolonged problems and symptoms associated with trauma, how to recognize and self-manage specific trauma effects that are healing in their approach, trauma's impact on memory and the neuro-biological aspects of trauma and how trauma is stored in the body and experienced physically as well as emotionally. Prolonged problems associated with sexual trauma and victimization while similar can vary among individual women. The specific problems associated with trauma would be presented based on the assessment process and the information women provided from their trauma histories. This allows for an individualized focus for each group along with relevant and meaningful discussion within this type of therapeutic process. 3) The prevention of future victimization by identifying the traumatic pathways that lead to future violence, how to identify and establish needed boundaries within relationships, the redefining of family and partner relationships, what safety means and how to establish and maintain personal safety and self-care.

A first stage education and prevention recovery program for women also includes information on what recovery entails, methods for self-soothing, relaxation and self-nurturance, identifying the family context of abuse, emotional healing and expression, healthy family characteristics, and preventing victimization in the lives of children.

In summary, a Trauma Education and Prevention Recovery Group for incarcerated women is a positive first stage of introducing the healing process. The primary outcome is to assist women to understand that healing from trauma is possible and to redirect their lives away from trauma, substance abuse and illegal behavior. The three areas provided to women in this first stage of recovery include assessment, education and prevention. A once a week group held for two hours over a five-month period allows for women to attend twenty sessions. This first stage begins the process of healing from multiple interpersonal violent traumas by acknowledging the reason for women's incarceration and introducing a sustaining concept of accountability for change in order to end the traumatic pathway that begins from childhood abuse and victimization and spans a woman's life history.

Redefining Justice for Women

As the knowledge base from research about women in the criminal justice system has increased there has been a call for equity justice. Equity justice proposed that sanctions ought to be tailored to the specific characteristics and circumstances of individual offenders. If this perspective gains attention then gender will become a special circumstance that would warrant differential treatment when a crime is committed by a woman or girl. Researchers, clinicians and criminal justice experts are now recognizing that women and girls are caught up in a system of justice that seldom delivers justice to girls and women. Experts recognize that females begin criminal activity and enter the criminal justice system as a result of circumstances and a history distinctly different from those of men, and that women and girls find themselves at a distinct disadvantage especially when it comes to sentencing.

Beth Richie, a sociologist, suggests that a key to understanding and responding to women as offenders is to understand their status as crime victims. Women are often the victims of crime before they become offenders. Richie proposes that preventing women from reoffending can be accomplished when "the link between gender abuse and women's involvement in illegal activity" is clearly understood. Patterns of violence exist among the various forms of violence that women experience. Richie cites a study indicating " 78 percent of rapes are committed by someone known to the victim. The extent to which being in an intimate relationship affects the nature of abuse was confirmed in a study that indicated 82 percent of women raped or sexually assaulted by a lone offender were victimized by a spouse, ex-spouse, partner, friend, acquaintance or relative".

A study by the Bureau of Justice Statistics revealed that nearly "70 percent of abused women serving time in correctional facilities said they used illegal drugs during the month before their current offense" and a study by the National Clearinghouse for the Defense of Battered Women, a national organizational that collects data on the relationship between violence against women and women's involvement in illegal activity, reports that "more than half of all women in detention had been battered or raped before being incarcerated."

As the criminal justice system broadens it perspective about the crimes that women commit and the factors that substantially contribute to women's illegal activities it has the opportunity to improve programs and support the reentry of women into safe communities that will decrease recidivism back into the criminal justice system. Applying this knowledge makes it possible to reduce the rates of violence against women and women's participation in crime.

Women have a vital role within communities and families. Women continue to be the primary caregivers of children. When society makes it possible for mothers to be safe, their children can be safe as well. The intergenerational and gender aspects of trauma, violence and victimization while well-known also needs to be well-recognized if counselors, advocates, prison-based programs and researchers are going to coordinate efforts to work with women who have both committed crimes and been the victims of crime. Currently, none of the women I am working with were ever provided justice or a legal remedy for the abuses committed against them as children. This is bitter pill to swallow for women who are serving time for their crimes while the perpetrators of the crimes against them go free - statute of limitations enable sexual abuse of the past to go unchallenged within a system of justice.

A more complete understanding of the relationship between gender based violence and women's criminal behavior will make it possible to address the needs of this special population in a humanistic manner by supporting women who have committed crimes to make life changes before they are released so they might re-enter their communities and families as women who have healed and who can live free of violence--no longer at-risk to become offenders or victims again.

The Gender Factor:

1. Nearly 8 in 10 women incarcerated report experiencing at least one incident of child sexual or physical abuse; most report multiple abuses by multiple family perpetrators.
2. Approximately 75 percent of incarcerated women are mothers; two thirds have children under the age of 18; Seventy two percent of women with children under the age of 18 lived with their mothers prior to her entering prison. These children are now in foster care or family placement, often within the same families where their mothers experienced sexual and physical abuse.
3. Nearly one half of women in prison report committing their offense under the influence of drugs or alcohol; one third report committing their offense to buy drugs.
4. According to the Bureau of Justice Statistics an estimated 1 million women in the U.S. are the victims of violence committed by an intimate partner.
5. The National Violence Against Women Survey revealed that more than 1.5 million women had been raped and/or physically assaulted in the year before the survey was conducted (1998).
6. Studies indicate that the incidence and types of domestic violence in same-sex relationships are comparable to those in heterosexual relationships.
7. In a 1994 study 34 percent of all women who sought medical care in an emergency room were the victims of domestic violence.
8. Prevalence studies for sexual abuse indicate that 24.5 million women between the ages of 20 to 54 have experienced child sexual abuse; an estimated 12.6 million girls 19 and younger have experienced sexual abuse.
9. A 1996 survey of incarcerated women found that "at least half of all female prisoners had experienced some form of sexual abuse before their imprisonment".