Psychological Treatment for Sexual Abuse
Psychological treatment of sexual abuse in children
Until recently, the problem of sexual violence remained closed in our country, and even more so it was not customary to discuss sexual abuse committed against children. Although, according to some reports, the most frequent victims of sexual violence are minors. Children and adolescents are at increased risk due to such age-related characteristics of the psyche as obedience, suggestibility, weak assessment and prognosis, immaturity, and lack of life experience. At the same time, children are the most vulnerable and sensitive, therefore, the experience of abuse leads to serious consequences that affect the mental state and further development of the child.
So, in incest families, early and intense sexual stimulation can lead to the formation of deviant sexual behavior in the child, and later – to prostitution or sexual abuse on his part. The psychological consequences vary depending on the age of the children.
There are several stages of a child’s experience of sexual abuse, which are psychological signs of sexual abuse committed against a child:
- Stage 1 – primary reaction: insomnia, loss of appetite, panic, nightmares, anxiety, impaired concentration, perception, memory lapses, depression, treating oneself as dirty, flawed, abrupt change in behavior;
- Stage 2 – accommodation: ensuring maximum safety (unwillingness to go to bed, being alone with the rapist), using a certain position of the body to reduce pain, fever, vomiting, various seizures and painful conditions (without confirmation of these conditions by clinical studies), inadequate reaction to gifts, sweets;
- Stage 3 – long-term consequences: emotional disorders, which include anxiety and fears, panic, nightmares, depressive states, uncontrollable outbursts of aggression and anger directed at the weaker ones, at animals, at oneself; post-traumatic stress disorder: nervousness, insomnia, poor concentration, various phobias, numbness, “blackouts”, spontaneous sensory sensations (visual, auditory, tactile) associated with sexual abuse (smell of cologne, music, cold wet fingers, wallpaper color, etc.), causing a picture of violence, nightmares, obsessive thoughts; cognitive disorders, expressed in low self-esteem, self-blame, perception of oneself as ugly, helpless, impaired interpersonal contacts, isolation, passivity, regression in development.
As a rule, victims of sexual violence develop a specific model of behavior – sexualized behavior. Conventionally, there are several stages of the severity of this behavioral model:
- the first stage – children demonstrate sexual cognition and sexual preoccupation not typical of age;
- the second stage – intense masturbation, demonstration of intimate parts of the body;
- the third stage – the involvement of other children or adults in sexual activity. At this stage, children can become aggressive, start using alcohol and drugs, leave home, and often commit suicide attempts. Adolescents develop protective mechanisms: promiscuous sexual intercourse (more often in girls), self-identification with the rapist (more often in boys).
Children who have been sexually abused are often unable to develop normal peer relationships. Violence, especially if it was committed by a person whom the child trusted, is deeply felt by him/her as a betrayal. As a result, the child withdraws into him-/herself and does not go for close and trusting relationships with others. In addition, the feelings of guilt and shame that usually arise in child victims of sexual abuse interfere with the establishment of friendships and lead to isolation. Many victims of sexual abuse do not know how to respect the rights of others and they do not form an adequate understanding of the norms of acceptable behavior. Often, their attempts to shake off feelings of helplessness and gain self-confidence take the form of aggression and even sexual exploitation of others. This is especially true for boys. They acutely feel the need to prove their masculinity against the background of a deep experience of their own shame and guilt.
Sexual abuse of a child is a significant risk factor for adverse developmental consequences, but it does not lead to them with 100% probability. Research shows that a significant number of people who are sexually abused during childhood become happy. The so-called compensatory factors contribute to the positive development of a child who is a victim of sexual violence: the availability of timely help, the presence of a person nearby whom the child trusts and who can restore his/her sense of the value of his/her own personality.
Criteria for the degree of psychological harm of sexual abuse against a child
Significant factors that determine the degree of impact on a child of sexual abuse are the duration of violence, its frequency and sophistication, the nature of the relationship between the abuser and the victim, the use of force and/or threats to force the child to hide the truth, the child’s age, the position of the parents (guardians): if an adult does not trust the child, does not protect him/her, the experience of violence becomes more traumatic; if an adult overreacts to the violence that has occurred, the child may feel guilty and responsible for it. The listed factors should be considered as a cluster: the more there are, the stronger the child’s psychological trauma, the greater the need for psychological help. Children who are victims of sexual abuse are characterized by helplessness, deep feelings of guilt (they believe that they somehow deserve what happened to them), the desire to forget, overcome trauma, the need for support and emotional warmth.
Helping a child victim of sexual abuse
It includes the following tasks:
- identification of the sexually abused child;
- treatment of acute medical problems;
- obtaining and recording an accurate reproduction of violence with the receipt of answers to the questions: who? where? when? what?
The specialist works with small children using games and drawing. It is not recommended to conduct the questioning more than three times since each repetition is traumatic for the child and entails secondary trauma. Interviewing a child victim of sexual violence is carried out only in the presence of adults, legal representatives of the child, representatives of guardianship authorities and others who must be out of sight of the child. Often, children under the age of six experience fear of being alone with an unfamiliar adult. In these cases, the child may be accompanied by people close to the child, so that he or she feels their support and care:
- overcoming the acute emotional trauma of the child and his/her family;
- preventing further sexual harassment of the child (if necessary, the isolation of the child from the family);
- further medical and psychological assistance to the child, aimed at achieving his/her well-being;
- collecting the necessary evidence of a sexual offense for law enforcement.
Various specialists are engaged in the solution of all these tasks. They interact with each other: doctors, psychologists, lawyers, social workers.
Interviewing is the most difficult and responsible stage of work with a child victim of sexual violence. This stage includes five stages:
- Establishing emotional contact and trusting relationship with the child. It is recommended to start the conversation with topics that are safe for the child, for example, the psychologist’s story about him-/herself and his/her role;
- Assessment of the child’s development, the level of his/her psychological maturity, including his/her ability to understand the event;
- Obtaining the necessary information. If you cannot call the child to frankness, then he or she should be asked specific questions about what happened. The conversation begins with open-ended general questions, followed by targeted questions about the violence (time and circumstances, the nature of the violence, the perpetrator, etc.). Multiple choice, direct, and leading questions can be asked if all other options for getting information from the child are ineffective;
- Completion of the conversation. At the end of the conversation, it is necessary to express gratitude to the child for the cooperation, regardless of how fruitful the conversation was. In addition, it is necessary to reassure the child if he or she is agitated, to build confidence in his/her security;
- Analysis of the information received. In doing so, it is important to take into account information obtained from various sources. To do this, it is necessary to obtain information about the child’s family, including information about the relationship of parents with each other, with relatives and with the child, about the child’s daily routine, his/her interests and hobbies, about his/her relationship with peers, how he/she studies at school, what he/she is by nature. This information will help to complement the child’s story and see what happened in a wider context.
The optimal form of work with children who have experienced sexual abuse, as shown by many years of experience, is group psychotherapy. In the course of group work, children have the opportunity to sort out their own conflicting feelings, to analyze internal conflicts and experiences in a calm, benevolent atmosphere. In the process of such work, their sense of isolation decreases, and communication skills develop. Working in a group enables children to feel that they are not alone in their trouble, to believe in their own strength and to feel the joy of friendly relations built on mutual respect.
When organizing a child psychotherapy group, it is important to consider the following: same-sex groups are more suitable for prepubertal children, this contributes to the establishment of more trusting relationships; it is desirable that the number of group members does not exceed eight people; it is better to have a female psychotherapist with girls, and a man with boys. Classes in the therapy group are held weekly and last for an hour and a half.
The work is substantively divided into three stages. The main task of the first stage is to adapt children to group interaction and create an environment conducive to working with painful feelings and mental conflicts generated by the violence that has occurred. In the second stage, the psychotherapist works directly with the psychological trauma received as a result of sexual abuse and the subsequent publicity of the incident. The author analyzes the feelings of shame, guilt, defenselessness, helplessness, responsibility for what happened, the feeling of betrayal and the need to hide what happened in children. The task of the third stage is to help the participants of the psychotherapeutic group to see the “light at the end of the tunnel”, to switch their attention from the trauma they experienced to the continuation of a normal life. Such topics as self-esteem, the ability to defend one’s rights, puberty are touched upon.
Group psychotherapy with children also includes parallel work with parents or guardians who are not involved in sexual abuse. This allows adults who are responsible for the child to feel their involvement in the process of his/her recovery, to analyze their own experiences, and to better understand the impact of mental trauma on the further development of the child. The main goals of working with adults are to:
- help the adult to realize that support for the child and active participation in his/her life are the main conditions for the success of therapy;
- help each parent (guardian) to sort out the conflicting experiences accompanying the mental trauma caused by sexual abuse of the child, and learn to separate their feelings from the experiences of the child;
- explain to an adult the dynamics of the mental state of children – victims of sexual violence, to give a clearer idea of the hidden motives of the child’s behavior;
- help an adult learn empathy and become a more caring and empathic child;
- establish communication between an adult and a child, to help strengthen their mutual affection.
Psychological treatment of sexual abuse in women
Violence against women was and remains one of the most hidden forms of crime (one or two women out of a hundred who have experienced sexual violence turn to the police). Rape of a woman is probably the only type of crime when, in the minds of society, the victim is responsible for the violence committed against her. This position deprives victims of the opportunity to seek help and leaves women alone with the pain that makes their life unbearable.
The psychological consequences of a woman’s rape can be divided into immediate and distant.
The immediate consequence of violence is a decrease in self-esteem caused by the experienced shame, fear, and feelings of one’s own guilt. Almost all victims have thoughts of a ruined future. In addition to low self-esteem, women who have experienced sexual violence often experience emotional distress: they have a bad mood and tendency to cry, feelings of depression, mental pain, and even suicidal intentions. These disorders are accompanied by insomnia or nightmares, anxiety attacks and obsessions. All this cannot but affect communication with other people. As a rule, women who are victims of violence have a narrower circle of acquaintances, as they feel distrust of people, especially men. For example, for many, the courtship situation seems dangerous. The nature of their communication also changes. Immersed in their sadness, they are perceived by others as “cold”, indifferent to everything, selfish. The victims themselves feel dirty, fallen, unworthy.
The long-term consequences of the experienced sexual violence include psychosomatic diseases, violation of sexual relations, alcohol, drug and smoking abuse. In addition, the victims have a feeling that “some part of the body has been killed by the experience of humiliation,” as a result of which the usual ideas about themselves are destroyed. Sexual violence destroys a woman’s idea of the justice of the world order: if you do not commit evil, then nothing bad can happen to you – and the victims find themselves in a state of cognitive dissonance, which increases the feeling of helplessness. The feeling of inferiority, reinforced in the future by numerous failures, usually leads to the fact that unmarried women who have experienced rape associate their lives with men who humiliate them. Women who are victims of sexual violence think that they are not worthy of a better lot, and they may unconsciously provoke others to various forms of violence, for example, physical or emotional.
The literature describes four stages in the development of the psychological response to the trauma of rape:
- shock or psychological numbness;
- severe stress;
- resolution of internal conflict caused by trauma.
Most often, women who are victims of rape seek psychological help at a stage of severe stress. At this moment, they experience fear, they have obsessive thoughts about the experience of violence, emotional lability, sleep disturbances, depression, and low self-esteem.
Crisis intervention as a form of psychological assistance to women victims of sexual violence
In the practice of psychological assistance to women – sexual victims, two models of individual psychotherapy are used: the crisis intervention model and the short-term psychotherapy model. Let’s consider a model of crisis intervention.
The main goal of crisis intervention is to help a woman get rid of the psychological trauma that has arisen as a result of the experience of violence; integrate the experience of the experienced violence into the general system of the victim’s life experience. To do this, the psychologist must complete the following tasks:
- form an adequate and clear idea of what happened in the woman-victim;
- teach the victim to manage her feelings and reactions, help in overcoming the affect;
- contribute to the formation of behavioral models that allow overcoming the consequences of trauma.
The following scheme of crisis intervention is proposed:
- Introduce yourself to the victim and explain how you are involved with crisis services for women;
- Tell about the help you can give the victim;
- Acknowledge the severity of the incident. Devalue the event: disaster, not disaster;
- Encourage the victim to talk to you about what happened. Be patient and give her time to answer your questions. The ability to talk about traumatic events and related experiences helps a woman to get rid of feelings of helplessness, shame, in connection with the memory of violence. The accumulated experiences and emotional stress are looking for a way out, and it should be provided by active listening;
- Explain that many victims of sexual assault have similar feelings and reactions;
- Find out what the woman knows about the traumatic effects of sexual violence, what she thinks about her actions before and during the rape. Explain that many victims have misconceptions about their responsibility for what happened. In fact, a woman survivor cannot be guilty of being a victim. Even if a woman flirted, even if she allowed herself to be kissed, this does not mean that she agreed to everything “the rest.” Always, in all cases, the responsibility lies with the rapist for the evil he has done. From childhood, we absorb a trusting attitude towards the world and towards people, and the terrible blame lies with those who break this trust. The task of a psychologist is to enable a woman to come to an understanding and rethink what happened;
- Summarize what was said and move on to the problem-solving phase;
- Help the victim identify and prioritize individual experiences. Identify what worries her the most and what needs to be done first. Convince the woman to accept this experience and learn to live with it, after all, now she understands a little more in life than before. Perceiving and absorbing traumatic experiences at a cognitive level will help the victim to control her reactions, build self-confidence and facilitate a return to the usual way of life;
- Together, formulate a plan of action needed to tackle the critical problems caused by the experience of violence. Discuss what the victim would say if this happened to her (his) girlfriend. Suggest alternative solutions for each of the issues discussed. In parallel, self-regulation techniques are taught to help the victim cope with the symptoms of post-traumatic stress disorder. For this are used: relaxation and reduction of stress; physical exercises; decreased sensitivity and cognitive reformation (change of point of view). Strengthen the woman’s confidence that she is in control of the situation, emphasizing that she makes decisions herself and will carry them out as she sees fit; that she is responsible for what will happen in her life next;
- Test the woman victim’s ability to cope with the consequences of violence. Find out who of her family or friends can support her. Victim education and advocacy is an important part of the therapeutic process;
- Prepare the victim for possible reactions to trauma. It should be noted that women who have experienced childhood sexual abuse require a special approach. They can seek help after many years, suddenly realizing that the trauma they received in childhood or a long time ago, prevents them from living, makes them suffer. In this case, the psychologist has the following tasks: Help the woman to realize more fully what happened to her in childhood. This becomes possible thanks to the disclosure of a “terrible secret” that has been kept for many years. And for the first time, at a psychologist’s appointment, a woman gets the opportunity to speak openly and remember her pain; To help get rid of the feeling of loneliness due to the disclosure of the secret; To help the woman in understanding the feelings arising in her and the ability to express them. An important point is the dissociation (separation) of negative feelings in time, i.e. a woman’s awareness that everything that happened is already in the past; To form in the victim a sense of responsibility for herself and her life; To rid the woman of guilt; Support the woman’s desire for a new way of life, to take care of herself, to outline goals for the future. Realizing what happened to her, the woman learns to receive what she was deprived of for many years. She must decide how to live further, whether to change something in the family situation.