Adult Survivors of Childhood Sexual Abuse

Survivors of childhood sexual abuse experience an array of overwhelming and intense feelings. These may include feelings of fear, guilt, and shame. Abusers have been known to tell children that it is the fault of the child that they are abused, shifting the blame away from the abuser, where it belongs, and placing it on the child. Along with this, abusers may threaten or bribe the child into not speaking up; convincing the child that he or she will never be believed.i The reaction of a survivor’s friends and family to the disclosure of the abuse also has the potential to trigger immense feelings of guilt, same and distrust, particularly if those individuals denied that the abuse was taking place, or chose to ignore it.

While each individual’s experiences and reactions are unique, there are some responses to child sexual abuse that are common to many survivors:—i

  • Low self-esteem or self-hatred
  • Survivors may suffer from depression
  • Guilt, shame and blame
    • Survivors may feel guilt or shame because they made no direct attempt to stop the abuse or because they experienced physical pleasure
  • Sleep disturbances / dblue ribbonisorders
    • Survivors may have trouble sleeping because of the trauma, anxiety or may directly be related to the experience they had as a child; children may be sexually abused in their own beds.
  • Lack of trust for anyone
    • Many survivors were betrayed by the very people they are dependent upon (family, teachers etc.) who cared for them, who insisted they loved them even while abusing them; learning to trust can be extremely difficult under these circumstances.
    • 93% of victims under the age of 18 know their attacker.—-ii
  • Revictimization
    • Many survivors as adults find themselves in abusive, dangerous situations or relationships.
    • Woman who were sexually assaulted before the age of 18 [are] twice as likely to report being raped as adults.—-iii
  • Flashbacks
    • Many survivors re-experience the sexual abuse as if it were occurring at that moment, usually accompanied by visual images of the abuse. These flashes of images are often triggered by an event, action, or even a smell that is reminiscent of the sexual abuse of the abuser.
  • Dissociation
    • Many survivors go through a process where the mind distances itself from the experience because it is too much for the psyche to process at the time. This loss of connection with thoughts, memories, feelings, actions or sense of identity, is a coping mechanism and may affect aspects of a survivor’s functioning.
  • Sexuality / Intimacy
    • Many survivors have to deal with the fact that their first sexual encounter was a result of abuse. Such memories may interfere with the survivor’s ability to engage in sexual relationships, which may bring about feelings of fright, frustration, or being ashamed.

Adult survivors of childhood sexual abuse often adopt coping mechanisms (or survival strategies) to guards against feelings of terror and helplessness that they may have felt as a child. These past feelings can still have influence over the life and present behavior of an adult survivor. Here are some common coping mechanismsi:

  • Grieving / Mourning
    • Many things were — childhood experiences, trust, innocence, relationships with family members. The survivor may feel a deep sadness, jealousy, anger or longing for something never had.
  • Alcohol or drug abuse
    • The abuse of substances can act as an escape from the intense waves of feelings, the terror and helplessness.
  • Disordered Eating / Eating Disorders
    • Compulsive control of food intake can be a way of taking back control over the body that was denied during the abuse.
  • Self-injury
    • There are many ways survivors have coped with the feelings that can cause emotional or physical injury on the self. Burning or cutting are some ways for a survivor to relieve intense anxiety, triggered by memories of the abuse

 

Treatment—i
In most instances, the survivor never discussed the abuse with others while it was occurring. In fact, many survivors do not remember the abuse until years after it has occurred, and may never be able to clearly recall it. Usually, after being triggered by a memory, this individual learns how, as an adult, to deal with the effects of the abuse.

It is important to speak with someone, whether it be a friend or counselor, about the abuse and past and current feelings.

Community health centers, mental health clinics and family service centers may have counselors who have worked with survivors before. They may also be able to refer you to a self-help group.

If you are an adult dealing with the effects of childhood sexual abuse, please remember that you are not responsible for the abuse and that you are not alone. You can overcome the effects the abuse may have on your life. Please call the National Sexual Assault Hotline (800.656.HOPE) or visit the Online Hotline. It’s never too late to get help.

i—Adult Survivors of Childhood Sexual Abuse. Dr. Carol Boulware, MFT, Ph.D. 2006.http://www.psychotherapist.net/adultsurvivors.html

ii—-U.S. Bureau of Justice Statistics. 2000 Sexual Assault of Young Children as Reported to Law Enforcement. 2000.

iiiExtent, Nature, and Consequences of Rape Victimization: Findings From the National Violence Against Women Survey. U.S. Department of Justice: Office of Justice Programs: National Institute of Justice. 2006. http://www.ojp.usdoj.gov/nij

 

This product was supported by grant number 2009-D1-BX-K023 awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this product are those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice.
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Sexual Exploitation by Helping Professionals

Sexual exploitation by a helping professional: sexual contact of any kind between a helping professional (doctor, therapist, teacher, priest, professor, police officer, lawyer, etc.) and a client/patient.

  • It is difficult for a client/patient to give informed consent to sexual contact or boundary violations because the helping professional holds a great deal of power over that client/patient.
  • 90% of sexual boundary violations occur between a male provider and a female client/patient (Plaut, S.M., 1997, p. 79).
  • Such behavior is regarded as unethical and, in every licensed profession, can be grounds for malpractice and possible loss of license.

There are three major types of sexual involvement between a client/patient and a professional:

  1. Sexual activity in the context of a professional treatment, evaluation, or service
  2. Seual activity with the implication that it has therapeutic benefit
  3. A sexually exploitative relationship

Why it is not acceptable behavior:

  • The helping professional starts from a position of great power over the client/patient and is expected to respect and maintain professional boundaries.
  • The professional has a responsibility to protect the interests of the client/patient and not to serve his/her own needs.
  • The client/patient has put his/her trust in that professional and the betrayal of that trust can have devastating consequences.

Within the Therapeutic Relationship:

  • Clients in therapy are the most susceptible because the client is already vulnerable and trusts the therapist t0 help her/him feel better.
  • Therapy relationships are particularly intimate, with clients sharing their innermost thoughts, feelings, and experiences.

Issue of Transference:

  • Transference- Way in which a client transfers negative/positive feelings about others to the therapist. Transference in and of itself is not a bad thing. In fact, it is necessary in all therapeutic relationships.
  • Countertransference- When the therapist projects his or her own feelings back onto the client.
  • Problem- When the therapist is unable to recognize transference and countertransference reactions and, instead, responds in a sexual manner.

Common Reactions:

  • Sexual dysfunction
  • Anxiety disorders
  • Depression
  • Increased risk of suicide
  • Feelings of guilt, shame, anger, confusion, worthlessness
  • Loss of trust

Very Low Report Rate:

  • It is estimated that only 4-8% of survivors of sexual exploitation by helping professionals report the exploitation (Gartrell, N., et al.,1987 per TAASA, p. 168, 2004).
  • Often there is reluctance to report because of
    • Anticipated or real pain associated with pursuing the case
    • Fear that she/he won’t be believed.
  • It often takes several years for the client to recognize that she/he has been harmed.

3 Ways to Take Action:

  1. Licensing board complaints- Standards vary by state and profession. Possible punishments include suspension or revocation of a license or rehabilitation programs. In these cases the client’s confidentiality is protected in any public reports of the proceedings.
  2. Civil lawsuits- Client hires his or her own attorney and sues the therapist directly. Usually this is the only way to receive payment for damages. Procedures are public, and the burden of proof is on the client.
  3. Criminal proceedings- An option in some states. In these cases, the state prosecutes (State v. Therapist). The best possible outcome is a criminal sanction (probation, incarceration).

Additional Resources

AdvocateWeb
Stop Educator Sexual Abuse, Misconduct and Exploitation (SESAME, Inc.)
Survivors Network of Those Abused by Priests (SNAP)

Learn more about the laws in your state through RAINN’s state database.

References:
Plaut, S. Michael. “Boundary violations in professional-client relationships: overview and guidance for prevention.” Sexual and Marital Therapy, 12, 1, 1997.
Plaut, S. Michael. “Understanding and Managing Professional-Client Boundaries.” Handbook of Clinical Sexuality for Mental Health. Stephen B. Levine (ed). New York: Brunner-Routledge, 2003.
Texas Association Against Sexual Assault Sexual Assault Advocate Training Manual, 2004.