Childhood Sexual Abuse

Case Study

Tim came to therapy at 24 years old. He said he had recently completed his BA degree, and had engulfed himself in studies for 4 years. Upon graduation, Tim noted, “I entered an emotional tailspin.”  Tim reported being very depressed for several months, including thoughts of suicide.  Before entering therapy, he had been suicidal and was admitted to the psychiatric hospital for 3 days.

While hospitalized, Tim had recurring thoughts of when he was sexually abused from ages 5 to 7 by an older male extended relative.  Symptoms that Tim presented were depression, anxiety, sleep disturbance (both insomnia and nightmares), feeling “psychologically fragile,” and intrusive/disturbing thoughts of earlier sexual abuse.  Tim had suppressed the abuse memories until recently, when he had been experiencing self-disgust and shame related to unwanted feelings of “anger toward God”, self-loathing, and anguish.

While in therapy, Tim’s goals included“dealing with [his] past haunting memories,” experiencing true peace and redemption in the Biblical sense, and symptom reduction (such as never being hospitalized again.) In a case like Tim’s, self-discovery and anger needed to be addressed. Tim felt that guilt feelings related to the abuse were preventing him from pursuing his earlier goal of becoming an ordained minister. “The abuse has robbed me of my calling, and I’ve been held emotionally and spiritually hostage for years” were his feelings. Anger toward his abuser, his caregivers, and ultimately God had to be addressed for Tim to heal.

Bibliotherapy, such as reading “Hind’s Feet on High Places,” a book focused on growing from spiritual battle to peace can prove to be very helpful in treating trauma.  Utilizing Trauma Narrative can also be vastly beneficial.  Tim ended his narrative with a redemptive theme, stating, “What happened in my past, only drives me closer to God.” After one year of therapy, Tim reported that he was “holding on to forgiveness.”  He also experienced no panic attacks or depression, and began attending seminary.  He later married and never again felt the anguish at the level he did when he was 24 years old.

In a case like Tim’s, it is important to develop an understanding of needs of victims of trauma, understand signs/symptoms of trauma, understand what factors help a person recover, and know how to help the victim with intervention and ongoing recovery.

Supporting A Victim of Sexual Trauma

First, it is important to understand the immediate needs of a trauma victim.  Safety is of utmost importance, as is being believed.  It is necessary to convey to the client that being abused was not their fault, and help them regain a sense of control. Therapists typically help a victim of trauma through the stages of the healing process: shock/disarray, denial, blaming, pain/anguish/anger, and finally integration/acceptance. Although symptoms differ slightly between children and adult victims of sexual trauma, there are some similarities.

Children Adults
Generalized fears Intrusive thoughts
Avoidance Distress
Sleep Disturbance Detachment
Preoccupation with certain symbols Loss of pleasure
Posttraumatic play Sleep disturbance
Loss of developmental skills Irritability
  Shame
  Increased startle response

 

In addition to emotional symptoms, there are also neurobiological posttraumatic stress symptoms that manifest themselves in victims of sexual trauma.  These include alterations in emotional regulation, attention/consciousness, self-perception, and relationships with others.  Somatization of emotions and medical issues may also present themselves, along with alterations in systems of meaning (Eric Scalise, 2014; Christine Courtois, 2009).  When treating child survivors, typically one of three modalities of treatment is used. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Expressive Therapies (Play Therapy), and Parent-Child Interaction Therapy (PCIT) are common therapies used to help children that are victims of sexual trauma. Research indicates that post traumatic growth may involve improved relationships, positive changes, a greater appreciation for life, and a greater sense of spiritual development (Tedeschi and Calhoun, 2004).

Alarming Statistics

  • 1 in 3 females experience sexual abuse before the age of 18
  • 1 in 4 females experience rape
  • Only 4% of victims report rape
  • 50% of rape victims eventually seek care
  • For child sexual abuse, 1/3 of offenders are parents and ½ are relatives (Courtois, 2010)
  • 1 in 3 women and 1 in 5 men are sexually abused prior to age 18 by someone they are supposed to trust; many of these abuses are chronic.

 

If you or someone you know is suffering from emotions due to childhood sexual abuse, please call our Genesis office today at (757) 827-7707 to set up an appointment and begin the healing process.  There is hope and healing available for you!

References:

  • AACC’s Stress and Trauma Care training program. (2009). Forest, VA: American Association of Christian Counselors.
  • Allender, Dan (2008). The Wounded Heart: Hope for Adult Victims of Childhood Sexual Abuse. Colorado Springs, CO: NavPress.
  • Borja, S. E., Callahan, J. L., Long, P. J. (2006). Positive and negative adjustment and social support for sexual assault survivors.  Journal of Traumatic Stress, 19 (6), 905-914.
  • Chang, C., Kaczkurkin, A. N., McLean, C. P., &Foa, E.B. (2017). Emotion regulation is associated with PTSD and depression among female adolescent survivors of childhood sexual abuse. Psychological Trauma: Theory, Research, Practice, and Policy.Advance online publication.
  • Chard, K.M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73, 965–971.
  • Cohen, J. A., Mannarino, A. P., &Deblinger, E. (2006). Treating traumatic grief in children and adolescents. New York, New York: The Guilford Press.
  • Courtois, C. A. (2010). Healing the incest wound: Adult survivors in therapy 2nd ed. New York; W.W. Norton.
  • Courtois, C.A. and Ford, J.D. (2009). Treating Complex Traumatic Stress Disorders: An Evidence-based Guide. New York, NY: The Guilford Press.
  • Foa, E. B., Keane, T. M. and Friedman (2000). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York, NY: Guilford Press.
  • Gil, E. (2006). Helping abused and traumatized children: Integrating directive and non-directive approaches. New York, NY: Guilford Press.
  • Heegaard, M. (1992). When Something Terrible Happens: Children Can Learn to Cope with Grief . Minneapolis: MN: Woodland Press.
  • Hathaway, W. L. (2003). Clinically significant religious impairment. Mental Health, Religion & Culture6(2), 113.
  • Helping Victims of Sexual Assault. Retrieved January 20, 2011, from http://www.aardvarc.org/rape/about/howhelp.shtml
  • Langberg, Diane (1999). On the Threshold of Hope. Carol Stream, IL: Tyndale House Publishers.
  • Langberg, Diane (2003). Counseling Survivors of Sexual Abuse. Longwood, FL: Xulon Press.
  • Lassri, D., Luyten, P., Fonagy, P., &Shahar, G. (2017). Undetected scars? Self-criticism, attachment, and romantic relationships among otherwise well-functioning childhood sexual abuse survivors. Psychological Trauma: Theory, Research, Practice, and Policy.Advance online publication.
  • McNiel, C. B. &Hembree-Kigin (2011). Parent-child interaction therapy (2nd). New York: Springer Science+Business Media.
  • Owens, G.P. & Chard, K.M. (2001). Cognitive distortions among women reporting childhood sexual abuse. Journal of Interpersonal Violence, 16, 178-191.
  • Rape, Abuse and Incest National Network. (2009). Get Info. Retrieved January 20, 2011, from http://www.rainn.org/get-information
  • Resick, P. A., Galovski, T. E., Uhlmansiek, M. O., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243–258.
  • Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., &Feuer, C. A. (2002). A comparison of cognitive processing therapy with prolonged exposure therapy and a waiting list condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867–879.
  • Resick, P. A., &Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage.
  • Scalies, E. (2014). The neurobiology of trauma and traumatic relationships. Christian Counseling Today, Vol. 20/3, 28-32.
  • Schulz, P. M., Resick, P.A., Huber, L.C., Griffin, M.G. (2006). The effectiveness of cognitive processing therapy for PTSD with refugees in a community setting. Cognitive and Behavioral Practice, 13, 322-331.
  • Sweeney, D. (2014). The Neurobiology of Trauma: Use of Expressive Therapies with Children. Counseltalk Webinar (aacc.net).
  • Tedeschi, R. G., Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence.  Psychological Inquiry, 15, 1-18.
  • TF-CBT Web . Retrieved from: http://tfcbt.musc.edu/
  • Virginia Sexual and Domestic Violence Action Alliance. (2005). Action Alliance Newsletters. Retrieved from http://www.vsdvalliance.org/secPublications/newsletters.html
  • Walker, D. F., Reese, J. B., Hughes, J. P., &Troskie, M. J. (2010). Addressing religious and spiritual issues in trauma-focused cognitive behavior therapy with children and adolescents. Professional Psychology: Research and Practice, 41, 174-180.
  • Walker, D. F., Reid, H. D., O’Neil, T. & Brown, L. (2009). Changes in personal religion/spirituality during and after childhood abuse: A review and synthesis. Psychological Trauma: Theory, Research, Practice, and Policy, 2(1), 130–145.

 

Article by: Dr. Trina Young Greer, Psy.D

Edited 2017 by: Sarah Warner, M.S.