Information via accrediting organization American Association for Marriage and Family Therapy.
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 9.2% of children are sexually assaulted, according to the 2010 report from the U.S. Department of Health and Human Services. That is close to 1 in 5 girls, and 1 in 20 boys. The overwhelming majority of children are abused by someone they know: 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, therapy for families who are impacted by sexual abuse can help them heal from the abuse and create tools to assure no further abuse will happen in their family, and hopefully for generations to come.
1. Any sexual contact between an adult and child, defined as:
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.
These are not legal definitions and those can vary from state to state. Contact your local police department if you are unsure if sexual abuse has occurred.
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, and sexual dysfunction. Some of the most common consequences are: guilt, shame, re-victimization, 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 experience symptoms. However, there is ample evidence that sexual abuse is damaging and warrants intensive and specialized intervention to stop the abuse and aid in recovery. Even compliant victims who believe they have consented to the sexual contact are likely to be negatively affected since children must trust and rely on adults, and those older than them to keep them safe. Being asked to participate in activities that are inappropriate for their age/stage of development is a violation of their trust & well-being, even if they comply.
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 systems 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.
Treatment for the victim can include individualized counseling sessions that may have elements of play therapy if the child is young. If the child is older, then talk therapy utilizing trauma focused cognitive behavioral therapy (TF-CBT), Solution Focused therapy, or Dialectical Behavior Therapy (DBT) may be used. Group therapy for children of similar ages can be helpful because this format can teach social skills and other social aids to help the child feel less isolated.
Family treatment can include sessions with the entire family to help them process what happened as well as set up new boundaries to keep further harm from happening. The parents should be able to reframe the victim’s acting out behavior as not bad behavior, but a way to communicate with the parents the struggles with which they are trying to cope. Couples therapy can also be helpful to repair damage that may happen to the relationship in the process of working through the legal process. Parenting groups are used to teach new parenting skills and to help the parents process through their grief and guilt. At times, individual therapy for one of the parents can help when there has been abuse in their past or if they are having a more difficult time working through what happened to their child.
When looking for treatment for childhood sexual abuse, whether the abuse was just discovered 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 be most helpful.
Check online for advocacy centers in your area or ask your police representative for available resources. Often, when a police report is taken, information on local resources and a police advocate will be provided. You can also look for a therapist that lists trauma therapy as a specialty skill.
Recovery can take time so make sure you are working with professionals with whom you feel comfortable. You will need to share personal information with them so you do need to trust them as professionals. Make sure they are the right fit for you and do not be afraid to try someone else if you don’t feel you have found the right person for your family.
The essential goal of any family sex abuse treatment program is 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. This educational material will help the family establish new boundaries and rituals to heal from past abuse and to prevent future abuse from occurring.
Finally, healing of the victim is an important treatment goal. Helping the child feel safe again and work through the trauma they experienced will be the main goals of their individual therapy. Research has shown that going through the therapy process is helpful in preventing or minimizing long term effects from happening. Also, important in building resilience is building a strong support group and feeling empowered to prevent further abuse.
Many treatment plans include a therapeutic team with 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.
There are few problems that can leave a family feeling more hopeless than sexual abuse. 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. Hope that they are breaking the cycle of abuse can inspire a family to make the necessary changes towards a healthier future.
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 ensure that no further abuse takes place in their life or future generations of their family.
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 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 paraphilia on the part of the abusing family member.
Cognitive-Behavioral strategies help instruct the family on new ways of thinking about their lives. This can include breaking old thought patterns of how life is and inserting new ways of thinking that lead to a healthier life. Breaking bad habits and barriers to healthy thoughts is a way to recover from past abuse and maintain a new way of thinking.
Psycho-Educational strategies help the family learn information so they can prevent abuse from happening in the future, as well as new parenting techniques so they can have better connection in the family unit.
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. This process is taught throughout therapy in individual, family and group sessions.
Strength-Based interventions focus on what is strong in the family. Solution-Focused interventions pay attention to what is working well for the family and decides how the family can do more of that. Both interventions believe that the family knows what will work best for them and allows them to work with the therapist to decide what they can achieve.
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 that build on their strengths and interests, and at the same time preclude abuse.
When a family begins therapy, they want to feel safe and comfortable. What ensures a safe therapeutic environment includes confidentiality within the family and sometimes between family members. The therapist should maintain a nonjudgmental stance when working with the family where the offender is a part of the family. The parents should not be made to feel as if they are at fault for the abuse.
If the child victim isn’t ready for their parents to know certain facts and details, they have the right to decide when to share that information with their parents. This is an example of how the therapist can work with the child to feel empowered during therapy.
Another example of a safe environment is one where the family is safe from approach by the perpetrator while attending therapy sessions. Also, the family records are confidential as well as their actual sessions. The family must feel that they are protected or they will not be able to progress through their treatment.
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. These boundaries can include who they share their information with, who they allow into their inner circle, and how they communicate with each other. Family rules are an important part of this safety net that extends beyond therapy and into their lives.
Adult Survivors of Child Abuse: A site designed for the adult survivor of physical, sexual and/or emotional child abuse and neglect.
The Rape, Abuse & Incest National Network: The Nation’s largest anti-sexual assault organization.
Voices in Action, Inc.; 1-800-VOICE-8
U.S. Department of Health and Human Services (2010). Child Maltreatment 2010. National Center for Victims of Crime: https://victimsofcrime.org/media/reporting-on-child-sexual-abuse/child-sexual-abuse-statistics
Information via accrediting organization American Association for Marriage and Family Therapy.
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