AAMFT Consumer Update

Childhood Sexual Abuse

Sexual abuse in the family is one of the most perplexing and confusing problems facing our families. While it is difficult to fully assess the extent of the problem, the number of families affected by this phenomenon are staggering. It is estimated that 1 out of 4 girls and 1 out of 5 boys are sexually abused by the time they reach the age of 18. The overwhelming majority of these children are abused by someone they know, perhaps a family member, a close family friend, a member of clergy, or a youth leader. Child sexual abuse is a painful traumatic family secret that has rippling effects upon the entire family. However, the therapy for families who are impacted by sexual abuse can help families heal from the abuse, and create tools to assure no further abuse will happen in their family, and hopefully for generations to come.

What exactly defines Child Sexual Abuse?

Child Sexual Abuse is:
1. Any sexual contact between an adult and child, defined as:
a. touching, with the intention of sexually arousing the child or providing sexual arousal for the offending party.
b. kissing, by one whose purpose is similar to touching
c. fondling of genitals or other parts of the body in a sexual or prolonged manner
d. overt sexual contact, such as oral-genital contact, such as oral-genital contact manual stimulation of genitals or intercourse.

2. Any behavior that is intended to stimulate the child sexually, or to sexually stimulate the abusing person through the use of the child, including showing the child erotic materials, photographing the child in a sexual manner or talking sexually to the child.

3. Sexual contact by a person that is in an older developmental stage than the child. Even children in the same developmental stage can experience the act as abusive if physical, emotional, harm is inflicted or used as coercion.

What are the long-term effects of Childhood Sexual Abuse?

There are indisputable long-term negative effects to child sexual abuse for many, if not most, victims. Such problems as eating disorders, substances abuse disorders sexual dysfunction and the most common consequences: guilt, shame, revictimization, diminished self-esteem, depression, relationship difficulties, and/or other types of dissociative disorders. This does not mean every child who has experienced abuse will necessarily present with symptoms. However, there is ample evidence that sexual abuse is damaging and warrants intensive and specialized intervention to stop the abuse and prevent generations of future victims.

What is the Treatment for Childhood Sexual Abuse?

Historically, there have been two broad approaches to the treatment of child sexual abuse: a victim advocacy/child welfare approach and a family-systems model. However, over the last two decades there have been a number of clinicians and researchers who have determined that a comprehensive treatment model that utilizes elements from both the child advocacy and family system approach can be the most effective. A comprehensive program will treat all members of the family and include the larger legal and social justice systems as well. There is no one cause of sexual abuse in the family, and good treatment should address all levels of vulnerabilities to abuse.

How Do You Find Treatment?

When looking for treatment for childhood sexual abuse, whether the abuse is currently happening or has happened in the past, there are a few important elements to look for in a program. A successful treatment program that is systemic and contextual in its approach to child sexual abuse will share similar philosophies and therapeutic goals.

What are the Treatment Goals?

The essential goal of any family sex abuse treatment program has to be the immediate cessation of all forms of abuse within the family. This goal will take precedence over all others and may determine the structure of therapy and the timing of interventions. For example, if the child is at risk for further abuse because the abusing family member denies the abuse, then removal of the abusive family member would be in order.

Another over-arching goal is that the family’s vulnerabilities to abuse must be reduced so that there is little if any likelihood of future abuse in the family. These vulnerability factors exist in all the contexts where the family exists.

Who is Involved in a Treatment Plan?

Many treatment plans include a therapeutic team that includes the family and all professionals involved with their case. Building this team with the family offers them a sense of power and control. The team meets regularly to discuss treatment planning, progress and, eventually, termination. Having everyone “on the same page” throughout treatment eases the entire therapeutic experience.

Creating and Maintaining Hope

There are few problems that can leave a family feeling more hopeless than sexual. Hope emerges from the basic belief in the goodness of people, and their ability to change. Most treatment programs have as their foundation a belief that families can and, with help and hard work, eradicate sexual abuse from their family.

Stages of Treatment

Most family therapy programs which treat sexual abuse are offered in the following stages:

Stage 1: Creating a Context for Change

In Stage 1, a context of safety and hopefulness is created. The family members commit to work toward change. A collaborative relationship between client and professionals is built to assess the problem and determine the therapeutic goals. A detailed treatment plan is determined between professionals and consumers.

Stage 2: Challenging Old Patterns and Expanding New Alternatives

The family is encouraged to creatively challenge problematic thoughts, feelings, and behaviors which are no longer useful, giving way to more adaptive healthier alternatives. Therapeutic interventions are designed based on the family’s strengths. During Stage 2, family members may actively participate in group, individual, family, or couple sessions

Stage 3: Consolidation

In this stage, the family consolidates the positive, adaptive new behaviors they have made so that they will sustain. The family prepares for future situations and plans how to continue to make adaptive choices to insure that no further abuse takes place in their life or future generations of their family.

Restoration versus Retribution

One of the most controversial differences between the traditional child advocacy and systemic approaches to treating child sexual abuse is the role of family intervention and whether or not a family can be reunited. Retribution in therapy means designing treatment to punish the behavior. This may include forbidding contact among some family members during therapy, threatening the removal of children for excessively long periods of time, and operating under the belief that sexually abusive behavior is impossible to eradicate. Restorative therapy is geared to create change within the family, by encouraging healthy, non-abusive family systems. The underlying view is that people are basically good, and that this goodness can be restored to encourage strong, positive-valued, abuse-free interactions. This restoration does not necessarily mean reunification; rather it means the restoring of some type of safe, non-abusive relationships.

These contexts include larger systemic vulnerability factors, such as a family living in a cultural system that may offer tacit approval of sexuality within the family; family system vulnerabilities, such as extreme enmeshment leading to social isolation; and individual vulnerability factors, such as specific paraphilias on the part of the abusing family member.

Utilization of Cognitive-Behavioral and Psycho-Educational Strategies

The family learns to recognize the repetitive and dysfunctional patterns that might characterize their family and which may make them more vulnerable to abuse. Once these are recognized, the family learns ways to disrupt these patterns and establish new, healthier interactions.

Strength-Based and Solution-Focused Interventions

Families and their members are seen as competent, complex, human beings rather than as mere “labels,” such as “offender” or “victim.” Most interventions are framed in a strength-based, resiliency manner. Family members are encouraged to engage in behaviors which build on their strengths and interests, and at the same time preclude abuse.

Safe Therapeutic Environment

A consistent and specific focus on safety is maintained. There is a strong emphasis for the establishment of strong and appropriate boundaries, which in turn will provide a sense of safety for the child victim and family.