Children and Sexual Abuse

Chapter 9 – Sexual Assault

1. Please mention at least 10 characteristics and/or indicators that a child may have been sexually abused

2. Choose one and discuss/develop complete and professional

Guidelines:

· The answer should be based on the knowledge obtained from reading the bookno just your opinion.

Chapter from the Book was attached and online literature with references included.

Remember, the internet may not have accurate information.

· APA style will be strictly enforced. 

· I am expecting minimum of 500 words. 

If part of the question may ask for your opinion. So, you give your opinion based on the knowledge obtained from information from the chapter

· There are 2 questions in the discussion, you must answer both of them completely, in a professional and well written presentation.

I am expecting to answer the question and justified it based on peer review literature or information in your book.

If other Reference are used in addition to the book must have:

Serial/journal articles

5. Volume number, in italics.

6. Issue number. This is bracketed immediately after the volume number but not italicized.

7. Month, season or other designation of publication if there is no volume or issue number.

8. Include all page numbers. Ex: 7(1),24 Sergiev, P. V., Dontsova, O. A., & Berezkin, G. V. (2015).

Sexual Abuse Indicators in Children

Many children are victims of childhood sexual abuse. There are several physical, mental, emotional, and behavioral indicators of possible sexual abuse. It is important to be aware of these indicators if you have any suspicions.

What is Sexual Abuse?

Sexual abuse is defined as any unwanted sexual behavior by a perpetrator who threatens, uses physical force against, or does not receive consent from a person.1 Anyone can be a victim of sexual abuse regardless of gender, age, or race. Anyone can also be an abuser regardless of these same factors.

Sexual Abuse in Children

Child sexual abuse is defined as any sexual behavior with a minor committed by an adult or older adolescent. (rainn.org, 2017)

Legally, minors cannot give consent for any sexual activity with an adult or older adolescent. Perpetrators who commit sexual acts with children are not only breaking the law, but also causing harm to the child that could have lasting effects.

Sexual abuse of a child can include the following:

· Physical contact including fondling, intercourse, oral sex, and anal sex

· Sex trafficking

· Exhibitionism

· Pornography

· Any other sexual activity.

Approximately 93% of child sexual abuse cases include a perpetrator known to the victim. (2) Typically, the perpetrator abuses the child due to the child’s vulnerability and not because of their own sexual orientation. (1)

A heterosexual male may abuse a male child is just as likely as abusing a female. The same applies for female abusers.

Indicators of Sexual Abuse in Children

Because the perpetrator is often someone the child knows, it can be very difficult to identify characteristics of abuse. Often times the abuser will convince the child that the sexual activity is normal or persuade them to remain silent with the use of threats.

Behavioral and physical characteristics may indicate the possibility that a child is being sexually abused. Some sexually abused children do not exhibit these traits and some children who have never been sexually abused can exhibit these indicators. It can be very difficult to tell when a child is being sexually abused because, more often than not, children will not explicitly say they were abused or even know they are being abused. Therefore, it is important to notice changes in a child’s behavior, mood, actions, appearance, etc. These characteristics are merely possible indicators, rather than proof of abuse.

Behavioral Indicators of Sexual Abuse in Children

A child who is being sexually abused may display certain behaviors. The following are examples of these types of indicators;

· A child may act out aggressively and displace their negative feelings toward their perpetrator onto others.

· A child may seem disconnected, unwilling to engage with peers, or seem obsessed with fantasy worlds.

· A child may develop phobias or become afraid of certain rooms or areas of a house.

· A child may attempt to escape the abuse by running away, which can be an indirect way for a child who feels powerless to ask for help.

· A child may have difficulty engaging in physical activities because it is painful to participate in active games and sit during school.

· A child may exhibit sleep disturbances such as frequent nightmares or bed wetting episodes.

· A child may allude to their abuse indirectly by making comments such as, “I want someone to adopt me” or saying they do not like the perpetrator.

· A child may possess age-inappropriate, explicit sexual knowledge.

· A child may exhibit age-inappropriate sexual behaviors with adults, peers, toys, or themselves.

· It is important to be aware of these behaviors in order to help the child.

Behavioral Indicators in Older Children

Older children may display the same behaviors as younger children, as well additional behaviors. The following are examples of indicators of sexual abuse found in older children;

· Adolescents who are being sexually abused may develop eating disorders, anxiety, and/or depression.

· Adolescents may abuse drugs or alcohol to cope with the abuse.

· Adolescents may be excessively promiscuous or engage in prostitution.

· Adolescents may try to prevent abuse by making oneself as unattractive as possible.

· Older Children may experience suicidal thoughts or suicide attempts.

· Older children may possess an unexplained accumulation of gifts or money from the abuser to buy their silence.

· Older children experiencing sexual abuse are not limited to these behaviors. It is important to take note of any additional changes in behavior.

Physical Indicators of Abuse in Children

There are also numerous physical indicators of possible sexual abuse in children. The following are a few examples;

· A child may contract sexually transmitted infections.

· A child may become pregnant.

· A child may have the presence of semen around the genitals or on clothing

· A child may experience or complain of pain or itching in the genital area.

· A child may be unable to sit comfortably or may walk with a limp.

· A child may have torn, bloody, or stained clothes or underwear.

· A child may frequently stick foreign bodies in their rectum or vagina.

· A child may have frequent urinary tract infections or yeast infections.

· A child may have bleeding, bruises, or lacerations on the external genitalia, vaginal, or anal areas.

· A child may also have bruises on other body parts such as the abdomen, arms, or legs.

· An abused child is also not limited to these physical indicators. There may be a variety of other physical abuse.

What To Do If You Suspect a Child is Being Abused

If you suspect that a child is being sexually abused, it is important to step up and protect the child in any way that you can. You may first want to try to talk to the child directly; however, it is important to be aware of the situation, and the tone of voice in which you speak to the child. Try to make the child as comfortable as possible, stay calm, and do not use threatening language. Try to use vocabulary that the child is comfortable with and avoid any language that is too difficult for the child to understand.

It is also important to allow the child to speak and listen to what they have to say without pressuring them to say something in particular. Do not judge the child and avoid blaming the child for any behaviors. It is important to reassure them and let them know that you are there to help them. These conversations may be very difficult for the child; be patient and make sure the child knows that they are not in trouble. If you still suspect the child may be experiencing sexual abuse after your discussion, it is important to report the abuse to the proper authorities like Child Protective Services. Victims of child sexual abuse cannot protect themselves and need an adult to stand up for them.

If you are unable to talk to the child, it is important to seek outside help. Either going to your boss, or even going straight to the authorities. It is always better to be safe and report your suspicions than waiting until something drastic happens. The police or Child Protection Services will be able to help the situation.

Depending on your role in the child’s life, you may be a mandated reporter. Many professions, such as those in education, are mandated reporters. In this case, you will be legally forced to report your suspicions to the authorities. In any case, be sure to let the child know that you are going to get someone who can help. Make sure the child is safe. If you can, do not leave them with their suspected abuser.

Resources

We encourage you to try your best in addressing the situation. It may be an uncomfortable situation, but the child is in need of your help. The following hotlines may be useful in seeking information or reporting suspicions of child sexual abuse:4

· In an emergency, call 911.

· National Child Abuse Hotline: (800)-422-4453

· National Sexual Assault Hotline: (800)-656-4637

Concluding Remarks

Child sexual abuse can have long lasting and devastating effects on a child. It is important to know the signs of sexual abuse in order to be prepared to intervene if abuse is suspected. These victims need adults to protect them because they are unable to do so themselves. Recognizing the signs of sexual abuse in children is the first step in protecting them.

References

1. “Child Sexual Abuse.” Child Sexual Abuse | RAINN. N.p., n.d. Web. 15 Apr. 2017.

2. “Indicators of Sexual Abuse | Child Matters – Educating to Prevent Child Abuse.” Child Matters CPS. N.p., n.d. Web. 15 Apr. 2017.

3. South Eastern Centre Against Sexual Assault & Family Violence. “Indicators of Child Sexual Abuse.” South Eastern Centre Against Sexual Assault & Family Violence. South Eastern Centre Against Sexual Assault & Family Violence, n.d. Web. 15 Apr. 2017.

4. “Preventing Child Sexual Abuse Resources.” Preventing Child Sexual Abuse Resources | National Sexual Violence Resource Center (NSVRC). N.p., n.d. Web. 15 Apr. 2017

Warning Signs for Young Children. (2017, April 17). Retrieved October 7, 2019, from https://www.rainn.org/articles/warning-signs-young-children.

Sexual Abuse Indicators in Children: SexInfo Online. (n.d.). Retrieved October 7, 2019, from https://sexinfo.soc.ucsb.edu/article/sexual-abuse-indicators-children.

Child Abuse and Neglect. (2019, June 27). Retrieved October 7, 2019, from https://www.helpguide.org/articles/abuse/child-abuse-and-neglect.htm.

Chapter 9 – Sexual Assault

Text : Richard K. James/ Burl E. Gilliland (2013). Crisis Intervention Strategies. (7th ed.).

ISBN:978-1-111-18677-7

Defining Rape: The Unique Situation of Sexual Abuse/Rape Survivors

There are many definitions of rape. Some are based on legal constructs; some are derived from other sources.

Brownmiller (1975) distinguishes between most legal definitions and what she refers to as a woman’s definition of rape. She sees the legal definition of rape as “the forcible perpetration of an act of sexual intercourse on the body of a woman not one’s wife” (p. 380) as much too narrow and protective of male supremacy.

Brownmiller’s preferred definition from a woman’s perspective is that rape is “a private, personal inner space without consent—in short, an internal assault from one of several avenues and by one of several methods [that] constitutes a de- liberate violation of emotional, physical, and rational integrity and is a hostile, degrading act of violence” (p. 376).

That definition appears to encompass the whole scope of rape, as well as other forms of sexual abuse/misuse/harassment. For the purposes of this chapter, your authors will use Koss and Achilles’ (2008) definition of rape as an unwanted act of oral, vaginal, or anal penetration committed though the use of force, threat of force, or when incapacitated; sexual assault refers to a broader range of sexual criminal offenses such as sexual battery and sexual coercion up to and including rape (U.S. Department of Education, 2011).

Sexual Abuse in Childhood

The fact is that child sexual abuse has always been with us (DeMause, 1974; McCauley et al., 2001), but a variety of political, social, and cultural factors have kept child abuse—and most particularly, child sexual abuse—behind closed doors in the United States (Costin, Karger, & Stoesz, 1996) and throughout the world (Schwartz-Kenney, McCauley, & Epstein, 2001).

By the time one of your authors was a school counselor in 1966, mandatory reporting laws for physical abuse had been enacted in all 50 states (McCauley et al., 2001)—although there was considerable comment at that time on just how exactly one was to report such abuse and the still unclear question of whether one could get sued or fired for doing so no matter what the law said! (Indeed, no matter what the law says today, you should be aware that when the subject of child physical or sexual abuse rears its ugly head in a school building, there can be and often are repercussions when abusing parents are confronted.) Oftentimes legal, ethical, moral, and political considerations (see Chapter 15, Legal and Ethical Issues in Crisis Intervention) collide when child physical and/or sexual abuse is involved. (For that reason, you should know exactly what you need to do and how to substantiate it when making a report. We believe it is absolutely mandatory to consult with another professional and have him or her bear witness when doing so.) However, it wasn’t until the rise of the women’s movement and child advocates in the 1970s and their lobbying efforts to open up the blinds that had been closed on this topic that the public really started to become aware of the extent of the problem. In 1974, the Child Abuse Prevention and Treatment Act was passed in the United States, and its definition of who might be covered under the law included sexual abuse. Just as Leontine Young’s book Wednesday’s Children (1964) raised consciousness levels about the physical abuse of children, David Finkelhor’s book Sexually Victimized Children (1979) did the same for awareness about child sexual abuse. The Numbers. Child sex abuse numbers are staggering. This compiled report from the National Sexual Violence Resource Center’s (2015) compilation of child sexual abuse is mind numbing. One in four girls and one in six boys will be sexually abused before they turn 18 years old (Finklehor, Hotaling, Lewis, & Smith, 1990). Thirty-four percent of those who sexually assault children are family members (National Sexual Violence Resource Center, 2011). Twelve percent of women were age younger than 10 at the time of their rape, and a staggering 28% of men were age 10 or younger (Black et al., 2011).

An estimated 325,000 children are at risk of becoming victims of commercial sexual exploitation each year (Adams, Owens, & Small, 2010). Michael Salter’s (2013) book, Organized Sexual Abuse, provides a chilling look into all of the different groups that organize to sexually abuse children.

The good news is that Finklehor and associates (2008) found a 58% decrease in the number of substantiated child sexual abuse cases in the United States between 1992 and 2008. Finklehor and his associates suggest that two decades of prevention, treatment, and criminal prosecutors may have caused this decline. However, we agree with Tabachnick (2013) that the change in the media’s reporting of the graphicness of Jerry Sandusky’s sexual assaults at Penn State moved the full light of media attention onto perpetrators and caused massive public revulsion of a person who was coach in the national spotlight and who was supposed to be a role model for young men being anything but that in one of the most repellant ways possible.

Dynamics of Sexual Abuse in Childhood –

Sexual Abuse Indicators in Children

Manifestations of PTSD do not just spring forth full blown in adulthood (McLeer et al., 1992). Sexually abused children have significantly more specific PTSD symptoms than do physically abused and other psychiatrically hospitalized children (Deblinger et al., 1989; McLeer et al., 1992; Wolfe, Gentile, & Wolfe, 1989).

Sexually abused children are at high risk for PTSD and symptoms of posttraumatic stress, anxiety, and depression in the immediate period after disclosure and termination of the abuse (McLeer et al., 1998).

PTSD, aggressive behavior, and sexually related problems following sexual assault are greater for boys than for girls (Holmes & Slap, 1998). For example, Kuhn, Charleanea, and Chavez (1998) found that sexually assaulted male adolescents were more emotionally distressed, socially isolated, deviant (for example, lying and stealing), and likely to affiliate with deviant peers than males who did not report sexual assault. Even when considering clustering of other types of childhood traumatic caregiver events such as physical abuse, neglect, domestic abuse, emotional abuse, and no caregivers’ trauma such as natural disasters or severe medical problems, when sexual abuse was factored in child sexual abuse had a potent and additive effect on the duration and degree of trauma experienced (Kisiel et al., 2014).

Probably the most ominous finding of this rogue’s gallery of behavioral outcomes was a study that Fox and associates (2015) did on over 22,000 delinquent juveniles in Florida.

They found that each additional adverse traumatic event the child suffered on the Adverse Childhood Experiences Index increased their movement toward becoming serious violent and chronic offenders.

Even when rape and sexual assault on children and adolescents do not later result in full-blown PTSD, the emotional and behavioral fallout is far reaching and destructive. In addition, these children have a wide variety of other problems that include concentration difficulties, poor grades, aggressive behavior, social withdrawing, somatic complaints, overcompliance, depression, antisocial tendencies, behavioral regression, poor body image/self-esteem, eating and sleep disturbances, encopresis and enuresis (loss of bowel and bladder control), hyperactivity, suicidal ideation, and extreme, generalized fears (Conte & Schuerman, 1988; Knauer, 2000; Miller-Perrin, 2001; Sgroi, Porter, & Blick, 1982).

Although the foregoing symptoms may be indicative of many disorders of childhood, the following are not, and are rarely ever found with any stressor other than sexual abuse (Goodwin, 1988; Knauer, 2000, pp. 3–30; McLeer et al., 1992; Miller-Perrin, 2001; Salter, 1988, pp. 230–235).

Sexually abused children come to school early, stay late, and are rarely or never absent.

· They barricade themselves in their rooms or otherwise hide and attempt to seal them- selves off from their assailants.

· They may be “perfect” children to the world and to their teachers. To the contrary, they may engage in inappropriate and persistent sexual play with peers.

· They may have a sexually transmitted disease.

· They will have a detailed and age-inappropriate understanding of sexual behavior.

· They may have physical and somatic symptoms with overlying sexual content such as vaginal or anal bleeding and odors. Sexual drawings, stories, or dreams are common occurrences.

· They may suddenly have money or gifts that can’t be explained.

· They may display blatant sexually suggestive poses such as wide-open legs, rubbing of genital areas, and provocative dress.

· They may engage in excessive, compulsive, and even public masturbation, and may even approach other adults sexually.

· Small children may act out sexually with real or stuffed animals.

· Teenagers may run away and engage in prostitution.

· They may engage in self-mutilation by either cut- ting or burning themselves.

· They may have a sudden dislike for someone or demonstrate inordinate clinging behavior. These behaviors provide a template with which varying patterns of psychopathology seen in adult survivors are drawn.A particular subset of childhood PTSD are the effects of parental abuse and neglect that often occurs in the course of childhood sexual assault.

The differences between how PTSD manifests in abused children with PTSD versus adults with PTSD has become profound enough that a team from the National Child Traumatic Stress network has designated a new disorder called developmental trauma disorder (DTD; DeAngelis, 2007). DTD is characterized by exposure to one or more developmentally adverse interpersonal traumas such as abandonment, betrayal, physical or sexual abuse, and emotional abuse.

Emotional outcomes range across rage, fear, betrayal, resignation, defeat, and shame. A major marker of DTD is dysregulated development that affects physical health, behavior, cognition, relationships, and self-attribution. Negative expectations about caregivers develop because of their abusive history. As a result, these children stop expecting protection from others and believe future victimization is inevitable (van der Kolk, 2005).

Dynamics of Sexual Abuse in Families

The incestuous family may operate much like an alcoholic or battered family does in developing a series of messages or rules that pivot around denial, duplicity, deceit, role confusion, violence, and social isolation (Courtois, 1988, p. 45).

Children receive messages such as:

1. Do not show feelings, especially anger.

2. Be in control at all times; do not ask for help.

3. Deny what is happening, and do not believe your own senses/perceptions.

4. No one is trustworthy.

5. Keep the secret because no one will believe you anyway.

6. Be ashamed of yourself; you are to blame for everything.

Intergenerational Transmission of Sexual Abuse.

Typically, there is high potential for intergenerational transmission of sexual abuse in these families. Parents who themselves have been abused often seem to have blind spots for what is occurring in front of them. Further, Knauer (2000, pp. 18–19) proposes that the original attraction to the abuser is because of the familiar traits that the person sees in him that ring true within her own abusive family of origin. Incestuous fathers display inordinate amounts of jealousy and paranoia over their daughters’ dating and relationships with other males and attempt to rigidly control behavior through threats and intimidation, and the same may happen with mothers who abuse their sons (Knauer, 2000, pp. 49–61; Rosencrans, 1997, pp. 69–83; Salter, 1988, p. 237).

Abusive fathers are controlling tyrants who erect a facade of respectability in the community and often try to isolate their children and spouses or partners by forbidding them to socialize outside the home and refusing to let them have close friends. However, because of their sensitivity to power, they become meek and contrite when confronted with their abuse (Herman, 1981, p. 178).

Mothers are often oppressed and economically dependent, abused by their mates, and products of incestuous families themselves (Courtois, 1988, pp. 54–55; Herman, 1981, pp. 178–179).

Mothers may be physically or mentally disabled, causing the eldest daughter to take on the role of “little mother,” which extends to fulfilling the father’s sexual demands (Herman, 1981, p. 179).

Although some mothers may confront the abuse once they discover it, many others engage in denial and helplessness, and when confronted with the reality of the situation may revictimize the child by physical or verbal abuse (Salter, 1988, p. 209). In effect, the child becomes the scapegoat for the family’s problems (Knauer, 2000, p. 18).

Female Abusers.

Females who are abusers are not as much of an anomaly as one might think and are more than likely underreported as sexual abusers. Allen (1991) believes there are about 1.5 million victims in the United States, and Elliot (1994, p. 220) reports a figure of about 500,000 in Canada who have been abused by females. While these numbers may be outrageously high, they also may not be.

A study of Latino and European American adolescents who had been sexually abused found that among male high school students, 52.8% reported that they had been abused by females (Newcomb, Munoz, & Carmona, 2009). A few studies have reported on female sexual abusers and the outcomes for their victims (Allen, 1991; Elliot, 1994; Fehrenbach & Monastersky, 1988; Knopp & Lackey, 1987; Mathews, Mathews, & Speltz, 1989; McCarty, 1986; Nathan & Ward, 2001; Rosencrans, 1997). More often they are discovered as coabusers (Elliot, 1994; Rosencrans, 1997).

The traumatic wake they leave is generally even more devastating because they are seen as the primary caregivers and the persons in whom most trust and nurturing are placed. In particular, it is important to disabuse the myth that boys are not troubled by such sexual behavior and “gain experience from older women.” The research of Rosencrans (1997, pp. 245–253) indicates quite the opposite. The young man who has sex with an older woman is placed in a double bind. If any part of the experience felt good, the victim may believe it wasn’t abusive. If it didn’t feel good, then he may have all kinds of recriminations and start to believe that perhaps he is some kind of deviant homosexual (Lew, 2004, p. 61). Lew (2004, p. 61) believes that this causes male survivors to repress memories of abuse by women far more than they do abuse by men. And when those memories do return with a vengeance, they are far more devastating.

That outcome is exponentially true when the perpetrator is the victim’s mother. “Motherfucker” is one of the most pejorative, vulgar, and demeaning terms in the English language and has all kinds of negative connotations for boys who might engage in such deviant behavior. That term presupposes the son is the instigator of such illicit sexual contact (Gartner, 2005, pp. 29–30). Research indicates that is anything but true. The Freudian notion of an Oedipal complex wherein the son lusts after the mother has little validity. The social myths and cultural artifacts that mask the true malevolence of female perpetrators on male children minimize this problem in much the same way as the issue of male perpetrators was minimized in the past (Speigel, 2003, p. 15). If we turn that term around as “son fucker,” does that reframe your thinking on the matter and shed light on who the true aggressor is? The sexual identity problem that boys face when they have been abused by female caretakers, and particularly mothers, is a psychological abattoir (Elliot, 1994; Mitchell & Morse, 1998; Rosencrans, 1997). Gartner (2005, pp. 106–120) proposes that it can be cataclysmic to the victim to acknowledge he is in an incestuous relationship with his mother. Yet, while the erotic excitement he feels is disturbing, it can also lead to a sense of sexual prowess that can plant the seeds of some very deviant and pathological beliefs about women. This is not a movie plot in which a young man becomes a mature and skillful lover at the hands of an experienced, beautiful, and competent woman. It is sexual abuse at the hands of a woman who is selfish and needy, has failed at marriage, and has severe relationship and pathological problems. Indeed, out of the bad seeds of these relationships may grow some very poisonous adult relationships for these boys. The bottom line is that adult female abuse of boys is extremely serious and can lead to ominous outcomes (Deering & Mellor, 2011).

As an example, the two adult males one of your authors has encountered in his own practice who were sexually abused by their mothers were potentially the most dangerous to women he has ever seen. They had wildly vacillating “madonna–whore” complexes about women they had targeted for their affection that could turn these women from the purest virgin to the sluttiest streetwalker in a moment, all because of some imagined travesty the women had committed. The really scary part of their delusions was that the women had no idea any of this was going on! Rosencrans’s (1997, p. 252) informal interview with law enforcement officers tends to confirm that these abused males have a high potential for sexually related crimes. Our overall knowledge of female sexual abusers probably compares to what we knew about male child abusers 30 years ago.

Therefore, the astute crisis worker needs to ask the following when doing an in- take interview with a sexual abuse victim who is male.

CW: We have talked about the perpetrator. Did any- body else sexually abuse you? I am wondering if there were any females who ever did those sorts of things to you?

Because of the high incidence of sexual abuse perpetrated on boys and their reluctance to talk about being sexually abused as children, tactful questions should be asked of any age male even when this is not the presenting problem. The plain and simple fact is that we still tend to dismiss sexual acts and the harmful aspects they present in males (Alaggia & Milling- ton, 2008; O’Leary, 2009). A case in point is the filing of criminal charges against abusers of male children. While the cases filed against perpetrators when the child is female are woefully small in relation to the number committed, a study conducted by Edelson and Joa (2010) found that charges are even less likely to be filed against perpetrators when the victim is a male child

Phases of Child Sexual Abuse

Sgroi (1982) found that the behavior of the abuser can be traced through five phases:

(1) engagement

(2) sexual interaction

(3) secrecy

(4) disclosure

(5) suppression

These phases apply to both intra- and extrafamilial abuse.

1-Engagement Phase.

The abuser’s objective in the engagement phase is to get the child involved in sexual activity with the abuser. Both access to the child and opportunity (privacy) are needed if the abuser is to be successful. Therefore, if one were looking for possible instances of unreported abuse, one would identify times and situations when the potential abuser and the child were alone together. One must also look for different strategies that two different types of abusers (child molesters and child rapists) may employ. Called grooming, molesters enter a seduction phase wherein they successively approximate a child to accept that the sexual abuse is okay, appropriate, educational, acceptable, and even a duty. This se- duction phase is prior to actual sexual abuse and is not well defined, and there is a lack of consensus on what it actually entails (Bennett & Odonohue, 2014). However, molesters tend to use enticement and entrapment to get the child engaged in sexual activity.

Enticement may include deceit, trickery, rewards, flattery, or the use of adult authority to tell the child in a matter-of-fact way that the child is expected to participate.

Entrapment is used to manipulate the child into feeling obligated to participate through traps, blackmail, and so forth. Molesters may make pornographic pictures or videotapes and convince the child that there is no choice other than going along with the secret activity and may also seek to impose guilt by making the child feel responsible for the abuse.

Online Grooming.

The adage your grandmother told your parents, “Never talk to strangers!” really, really ap- plies here except you don’t talk to them on the Internet either. Whittle and associates (2013) examined both familial factors such as close parental supervision of Internet use when integrated with contextual and environmental risk factors (low income, poor schools, decaying neighborhoods) and found heightened risk for potential contact with potential molesters. If you’ve seen any police sting operations on television, you know how prominent this is and continues to be even with the stings! It is indeed illegal to proposition a child on the Internet for sexual interaction, even if that “child” is a 22-year-old police officer. Factually though, and stings aside, not a lot is yet known about how molesters operate. In Seto’s report (2013) the median year for online offender research is 2009 with the range from 2000 to 2009. Undoubtedly it has expanded a great deal since his study, but the problem is that molesters get tied in with child pornography, and that muddles the picture even more.

Online offenders may engage in only Internet action or become solicitation/traveling offenders. Those are offenders who will attempt to entice a child to meet with them to have sex or en- courage them to run away with them (Seto, 2013).

It is undoubtedly safe to say that future editions of this book will have a lot more to say about the dynamics of online molesters.

Child rapists use threat (particularly the threat of harm) or the imposition of superior physical force to engage the child in the abusive activity. Typically, the rapist will threaten to kill or injure the child or some- one dear to the child or destroy something the child holds dear like a pet or threaten to commit suicide himself, convincing the child that he or she will be blamed for the rapist’s death if the child resists or re- ports the rape. In using superior force, the rapist may simply overpower the child, restrain the child by tying him or her, give the child drugs or alcohol, or physically brutalize the child into submission.

The vast majority (about 80%) of abusers use the first two strategies—enticement and entrapment. Abusers tend to repeat their engagement patterns and show little tendency to move from nonviolent to violent strategies. Molesters are apt to consistently entice or trap children, whereas child rapists tend to use threat or force almost exclusively. The strategy used by the abuser is an important issue in treatment, be- cause survivors typically wonder throughout their lives why they permitted it to occur.

2- Sexual Interaction Phase.

Types of abuse may include (blatant or surreptitious) masturbation (the abuser may masturbate prior to making physical contact with the child), fondling, digital penetration, oral or anal penetration, dry intercourse, intercourse, forcing or coercing the child into touching the abuser’s genitals, forced prostitution, and pornography. Children may be coaxed into cooperating, though not consenting, because abusers—as adult authority figures—often command, engage, or enlist cooperation from the child. Children lack the maturity, experience, and age to be able to consent, but they may cooperate because of their subservient status.

3-Secrecy Phase.

Abusers communicate to children that others must not discover the sexual activity. The objective of abusers is to continue the activity. This necessitates avoiding detection and maintaining access to the child while continuing the abuse. The techniques for maintaining the secrecy may involve incorporating “rules” or “games,” implicating the child in the activity, and setting the child up to be responsible for keeping the secret.

4-Disclosure Phase.

Sometimes the abuser is discovered accidentally. Other times the abuse is disclosed intentionally by the child or someone else. Intentional disclosure is usually made by the child. Intentional disclosure often enormously complicates the discovery and existence of sexual abuse, because parents and others refuse to face it or believe it. Accidental discovery may occur as a result of such consequences as pregnancy, STDs, sexual acting out, promiscuity, and physical trauma. The way the abuse is disclosed can affect the child’s self-esteem and reaction to treat- ment. For instance, disbelieving adults sometimes respond by blaming and punishing the child—and allow the sexual abuse to continue.

5-Suppression Phase.

The suppression phase may begin as soon as disclosure takes place. Suppression may be attempted by the abuser, the child, the parents, other family members, professionals, the community, or an institution.

There are many reasons for suppression: fear of publicity; fear of reprisal; to protect the reputation of a family, an abuser, or an institution; to avoid prosecution; to avoid responsibility; to protect the child; to avoid embarrassment; to avoid the kinds of confrontation and intervention required to deal effectively with the difficult and sensitive situation; and fear of getting involved.

6-Survival Phase.

On the basis of our own experiences and the reports of other writers (Besharov, 1990; Kendrick, 1991), we have added another phase, the survival phase. During this phase, it is important to implement strategies for helping the child and the family respond to and recover from the abuse as much as possible. This phase includes stopping the abuse, providing needed medical and psychological treatment for the child, and helping the significant others close to the child to overcome the trauma, fear, anger, betrayal, and despair caused by the abuse (Benedict, 1985). It also involves preventing further abuse (Bass & Thornton, 1983) and prosecuting and/or getting counseling for the abuser (Benedict, 1985).

Intervention Strategies with Children Assessment

Assessment includes thorough documentation of the abusive events for possible legal use. Using anatomically correct dolls helps confirm what actually occurred in the abuse. No specific measures currently exist for measuring the effects of psycho- logical abuse in young children, although a complete psychological evaluation may be useful in gauging the child’s overall level of functioning (McLeer et al., 1992; Wheeler & Berliner, 1988, p. 235). The previously mentioned behavioral indicators of childhood sexual abuse and PTSD criteria for children are currently the best indicators that sexual abuse has occurred. Peterson and Hardin (1997) have developed a guide for screening children’s art for sexual abuse. The child is asked not to verbally disclose but rather illustrate different subjects and situations. Different indicators of sexual abuse may appear as the child illustrates the requested subject matter—such as a picture of people doing something at home. Assessment includes an analysis of style, treatment of figures, and actions with negative aspects. Point values are awarded for a variety of criteria commonly found in abused children’s drawings. Once the point value reaches a certain level, child abuse should be suspected (Peterson & Zamboni, 1998). However, it doesn’t take a doctorate in projective techniques to see how different the drawings of children who have been abused are (Kaufman & Wohl, 1992). We would propose that most children do not draw families that are joined by penises and vaginas or have clubs growing out of their arms that are raining blows down on other family members—but sexually and physically abused children do because that’s the way their families interact.

Therapeutic Options

Because of the complex nature of child abuse, interventions should comprise multiple components targeting a variety of problem areas (Miller-Perrin, 2001).

The first component is play therapy (Gumaer, 1984; Malchiodi, 2008; Webb, 2007; White & Allers, 1994). White and Allers (1994) have identified several characteristics behaviors that maltreated children may manifest during play therapy: developmental immaturity, opposition and aggression, withdrawal and passivity, self- deprecation and self-destruction, hypervigilance, in- appropriate sexuality, and dissociation. The second component is cognitive-behavioral therapy that is trauma focused (Cohen, Mannarino, & Deblinger, 2006; Neubauer, Deblinger, & Sieger, 2007). Farrell, Hains, and Davies (1998) found that selected cognitive-behavioral interventions (skills learned through procedures such as relaxation train- ing, positive self-talk, cognitive restructuring, stress inoculation, and emotive imagery) may effectively de- crease the anxiety and depression levels in sexually abused children ages 8–10 who exhibit PTSD symp- toms.

Deblinger, Thakkar-Kolar, and Ryan (2006) propose a cognitive behavioral approach that involves:

1. Psychoeducation that teaches children about faulty misconceptions they may have and offers new information to help children understand they are not so isolated and alone.

2. Behavioral rehearsal and modeling skills that are taught to both children and nonoffending parents to teach them how to regulate emotional expression and develop new cognitive coping skills.

3. Relaxation training and graded exposure treatment to the trauma that allows the child to learn that his or her fears and avoidance of the feared situation, object, or person are not nearly as frightening or upsetting as previously thought.

The third component is a trauma systems approach (Saxe, Ellis, & Kaplow, 2007). Incorporating an ecosystemic approach that involves not only children and parents, but community systems such as social services agencies, mental health facilities, and schools, increases the chances of stopping emotional and behavioral dysregulation across the entire system where the trauma operates. Saxe and his associates propose that two major components are operating with a traumatized child.

First, a traumatized child has difficulty regulating emotional and behavioral states.

Second, the social environment and system of care are not able to help the child regulate these emotions and behaviors.

Saxe, Ellis, and Kaplow (2007, pp. 95–108) propose 10 principles of treatment if the system is to be changed.

1. Fix a broken system, not just the identified client. Relentlessly attack the whole trauma system.

2. Put safety first. Nothing takes precedence over safety.

3. Create clear, focused plans that are based on facts and target specific components of the child’s emotional dysregulation and the level of instability in the child’s environment and system of care.

4. Don’t “Go” before being “Ready.” Build an alliance with the family, understand logistical problems such as childcare and transportation, and create an understanding of what treatment will involve and who will be included.

5. Use resources to gain maximum benefit. Carefully plan and coordinate the tactics and strategy with the system’s players for the best possible outcome. Time and money are scarce in the treatment world. Plan carefully so neither gets wasted.

6. Accountability is critical. Accountability has two parts. First is the worker’s ability to put words into action and evaluate how well those actions are working and change them if they aren’t. Second, and more daunting, is requiring that children, parents, and others in the social ecosystem be accountable as well.

7. Deal with the reality of the situation. If resources aren’t there, if family systems are compromised, if children are developmentally delayed, then under- stand the reality of the situation and adjust goals and expectations to it.

8. Take care of yourself and the treatment team. All the king’s horses and all the king’s men do not put Humpty-Dumpty back together again if the horses and men are broken themselves. There’s a chapter ahead of you in this book on burnout. Guess what one specific area of crisis intervention has high burnout rates? That chapter is the real deal if you are going into this business, so read it carefully.

9. Look for the strengths in the system. The trauma system of the child is rife with pathology and failure. It is easy to find things wrong. Yet there is resiliency and strength within this system. It is your job to keep a positive view of it and make lemonade out of the lemons.

10. Leave a better system. As with all crisis intervention, you are not an adoption agency taking on children and families to raise forever.

Teaching families how to take care of themselves is the end goal.

You’ll soon meet crisis workers from the Carl Perkins Child Abuse Center, who operate out of Jackson, Tennessee, and cover much of rural west Tennessee. They operationalize all of the foregoing 10 principles and then some! When the entire ecosystem of the child is brought into play, involving all of the players in the treatment using combinations of play and cognitive-behavioral therapy, outcomes for parents include better parenting practices, improvement in depressive symptoms, reduction in abuse- specific emotional distress, and greater support for the child. Children have less externalization of problems, fewer depressive symptoms, reduced behavior problems at home and school, and feel less shame, guilt, depression, and anger due to the abuse. Perhaps even more important, social services, schools, law enforcement, judiciaries, and mental health services all play well together. When this happens, the sum is in- deed greater than its parts.

Need for Affirmation and Safety

Initial intervention techniques call for intentionally and positively managing the crisis of disclosure and the resulting fear and anxiety. Affirmation and validation are crucial in regard to what has happened, what is happening, and what will happen to the child, the offender, and significant others. The admonition in the PTSD chapter on not using flooding techniques with children holds even more firmly with sexual abuse. If prolonged exposure techniques are to be used, they should be done with gradual and graded exposure to the aversive stimulus, with plenty of time for processing between exposures. Children should also be taught progressive relaxation techniques so that they can learn how to remove themselves from the feared stimuli. Because small children are not fully developed cognitively, most instrumental and operant behavioral techniques that may be used with adult survivors are also not efficacious. Yet anxiety about and fear of the abusive events and the abuser need to be reduced, and this calls for reexposure to the trauma. Contrary to most popular professional opinions (there are a lot of cognitive behaviorists out there!), your authors believe this work is best accomplished by the use of play therapy, in which the child is given puppets, dolls, and drawing materials to safely distance himself or herself from the trauma. By gently and directivity encouraging reenactment and discussion through the safety of the play material, the therapist may enable the child to gradually extinguish fear and anxiety feelings and develop skills in communicating healthy inner feelings and experiences without revictimizing the child (Baker, 1995; Gil & Johnson, 1993; James, 2003; Malchiodi, 2008; Merrick, Allen, & Crase, 1994; Oates et al., 1994; Pifalo, 2002; Sadowski & Loesch, 1993; Webb, 2007).

Regaining a Sense of Control

Anger and grief are emotional by-products for children of sexual abuse. Venting of these feelings should be encouraged, particularly because most adults are not comfortable with them and may attempt to repress such feelings when children exhibit them (Wheeler & Berliner, 1988, p. 237). Drawing, painting, modeling clay, sand play, writing, and learning to verbalize emotions are all therapeutic vehicles to ventilate angry feelings and loss. Play techniques can also give the child a renewed sense of empowerment by allowing play, figures to be acted on, thus reducing long-standing feelings of helplessness (James, 2003; Malchiodi, 2008; Sadowski & Loesch, 1993; Webb, 2007). Punching out a Bobo doll or picking up a play telephone and calling the police can give children a sense of control in a situation in which they have little (Salter, 1988, p. 215). Along with relaxation and other stress reduction measures, play techniques such as sand tray therapy can be used to teach the child to control anger when the child constantly acts out with peers or significant others.

Education

Education about adult sex offenders and sex itself is important for children because they will have little if any knowledge of why or what has happened to them. Shame is a predominant feature of the child’s response to abuse (Knauer, 2000, pp. 74–82). Children need to know that it is the adult and not the child who made the mistake. Children who have been physically injured need to have these injuries explained and be told that their bodies will be okay. Many children believe that others will be able to tell what happened by looking at them. Children need to know that al- though they may feel different, sexual abuse does not make them look different.

Understanding developmental stages is critical in what kind of education is provided and how therapy is delivered (Saxe, Ellis, & Kaplow, 2008, pp. 7–12).

Cognitively, young children usually have little understanding of sexual functions. Typically, they will not initiate questions about sex, but when workers initiate education about sex through slides or books, children will respond with their own questions. Every child who has been sexually assaulted needs some type of sex education and information on what the assault means (Baker, 1995; McLeer et al., 1992; Oates et al., 1994; Salter, 1988, pp. 217–218).

In addition to the play therapy techniques (such as drawing, painting, modeling, and sand play, mentioned earlier), a highly effective means of teaching important social and survival lessons to children is through outreach services into schools, churches, and community centers with professionally developed puppetry programs. One example is the Kids on the Block (1995) system, which uses the unique and dynamic medium of puppetry to educate children and their adult caregivers on how to think about and respond to important and emotionally charged issues that impact children’s lives. Trained volunteers perform with puppet characters designed to realistically represent children and the dilemmas they may face. Through carefully researched and scripted dialogues, these puppets (“children”) talk about important issues and then engage in interactive question-and-answer periods with children in the audience, who converse directly with the puppets. This form of puppetry has proved to be an effective strategy for expunging children’s myths and mis- conceptions about physical and sexual abuse and replacing them with facts and sensitivity (Sullivan & Robinson, 1994).

Assertiveness Training Assertiveness training may be seen as more a preventive measure to keep children out of harm’s way than a remedial measure for sexually abused children. Yet, sexually abused children have learned to be compliant to deviant requests and clearly need to learn how to “Just say NO!” (Salter, 1988, p. 219). Because abused children are at greater risk for revictimization, teaching them cues and warning signs and appropriate assertion responses is important so that they can avoid future abuse (Miller-Perrin, 2001; Wheeler & Berliner, 1988, p. 242).

Intervention Strategies for Child Sexual Abuse: The Case of Elizabeth

Elizabeth, age 8, is the middle child in the family. She, her 11-year-old brother, and a 5-year-old sister live with her mother and stepfather, whom her mother married nearly 2 years ago. Elizabeth’s mother, Mona, and father divorced when the youngest child was about 1 year old. Elizabeth’s stepfather started off by fondling her. This went on for several weeks. Although Elizabeth was bewildered, scared, and intimidated, no one else knew about the abusive activity. Recently, while everyone else was out of the house, her stepfather raped her. He threatened to kill Elizabeth, Mona, and her sister if she told anyone. The following morning Elizabeth confided in her brother, who in turn, told Mona what had happened. Incredulous over this discovery and paralyzed as to what to do, Mona called the child abuse hotline that she remembered seeing advertised on TV and in the local newspaper. The following dialogue and discussion is representative of what an absolutely outstanding child advocacy agency, the Exchange Club–Carl Perkins Child Abuse Center of Jackson, Tennessee, does

Disclosure Mona: (calling the child advocacy hotline; angry, crying un- controllably, barely in control)

Hello. Hello! I want to report a (choke, sob) rape. He . . . that bastard . . . he raped my baby. That sonofabitch raped my daughter. Oh, how could I have not seen . . . How could I have let this happen? (Continues ranting and raving in hysterics, beseeching the hotline worker for help and railing at her husband.)

CW: OK, I understand you’re extremely upset and have every right to be, but I need for you to be in control right now. My name’s Delaine. I need to know your name, where you live, and whether you’re safe from who did this to your daughter.

Mona: (Regaining a bit of control, gives her name and ad dress.) It was my . . . It was . . . my husband . . . Leon. Her asshole stepfather . . . I found her underwear. It was all bloody . . . Oh my God! My baby . . . My poor baby. He’s gone in his truck . . . He’s headed for Chicago on a run…I’ ll kill him…By God! I will kill him if it’s the last thing I ever do!

CW: So you are safe, and he’s not in the house. How badly hurt is your daughter? Does she need an ambulance and medical attention?

Mona: I don’t know. She’s kinda in a daze. Just walking around holding on to her teddy bear. Oh, that bastard! I’ll castrate that bastard before I kill him!

CW: Mona, I hear how angry and shocked you are, but I need for you to follow me very closely. This is extremely important. I want you not to do anything with Elizabeth. Don’t wash her up or change her clothes. I want you to take her to Madison County General Hospital and bring her underwear with you in a plastic baggie. Do you have a way to get to the hospital? Are you OK enough to get to the hospital? (Gets acknowledgment from the mother that she can get to the hospital.) There are going to be people at the hospital who are going to want to talk to you and Elizabeth, and we’re going to need to do a medical exam of her. This is not going to be easy, but we know how to do this. You did the right thing. I’ll meet you at the hospital, and I’ll help you get through this. We will get through this! Do you understand? Now tell me what you’re going to do and when you’ll get to the hospital. (Mona restates what the crisis worker has told her and assures the worker she can do those things.)

The initial shock that accompanies discovery and disclosure is invariably highly dramatic and volatile for parents who have been blind to the perpetrator’s intent. Because rape is a violent crime, the primary consideration of the crisis worker is to determine if people are now safe from the perpetrator and if they need medical attention. The initiating crisis is multi- fold. The crisis worker needs to make sure that there is no physical injury to the child and that the out-of- control parent is sufficiently functional to take care of the child and do the things necessary to preserve evidence. She will also need to restore the mother to equilibrium. Exacting revenge by assaulting the perpetrator would put both mother and daughter in jeopardy. The scene at the hospital can be extremely threatening, and the crisis worker does all she can to indicate that the mother has done the right thing and that, as difficult as it may be, the crisis worker will be there with her to the conclusion. The crisis worker’s initial job will be to do crisis intervention with the mother by making sure everyone is safe and helping her get back in control of her emotions and actions (Bottoms, 1999; Knauer, 2000, pp. 31–47).

Immediate Aftermath

In cases where there is physical injury, the survivor will need immediate medical evaluation and care. The crisis worker, after determining that the mother can get herself and her daughter to the hospital, immediately makes other phone calls to the Department of Human Services and the police department. She also calls the hospital and informs them that a child sexual assault victim is on her way and that a sexual assault team needs to be assembled. After making these phone calls, she immediately leaves for the hospital.

Mona: (at the hospital, in a room with the crisis worker) All I can think about is that no-good lying creep. He’s lucky he’s on the road, or he’d be dead now. I’d shoot the asshole’s balls right off of him. I’ve got a .38 Special, and by God…as God is my witness… I will do it. What’s happening to my daughter? They took her away. Is she going to be all right? I’ve read some stuff on this. It’s not just him raping her now, but she’ll be scarred for life! How could it happen? How could I be so stupid? What in the hell is wrong with me? He was so nice to her, to all of us! How, oh how could I have been so stupid? (Starts uncontrolled sobbing and pacing, slamming her purse down again and again.)

CW: You’ve certainly been through a lot in the last few hours. And you’ve done a remarkable job of taking care of Elizabeth. Your concerns about her physical injuries now and her psychological injuries later are certainly justified. I’m not going to sugarcoat this. You’re obviously a very good mother who has suddenly been thrust into this—nothing you or Elizabeth did cause it. It was perpetrated on her and you. We are here to assist you in any way we can. We want to provide someone to be with you and Elizabeth during these critical hours, as well as providing aftercare and follow-up counseling. But right now, even though your husband is away, I’m concerned about your anger. It’s certainly justifiable, but what Elizabeth needs is for you to be the best mother you can be right now. If you shoot your husband, how will you be able to support your daughter when she needs you most? You won’t! You will be in jail. That’s where your husband deserves to be, not you. Let the police handle your husband. What we need to do is handle this and care about Elizabeth. Can you do this? That’s really what you want, isn’t it, to help your daughter get through this?

Mona: I . . . I . . . I guess so. I appreciate it. Every- thing happened so fast! I don’t know how I man- aged without falling apart. It’s like a wild, awful dream—an ugly nightmare. I don’t know how I’ll handle it when the dust settles. I’m so mad— I could kill him! I feel like I’ve been raped too. There’s so much on me right now. I don’t know if I’m capable of bearing up under all that’s got to be done. Damn, damn, damn that man! Excuse me, I shouldn’t blow up like that.

CW: That’s all right. You have a perfect right to be angry and to say it. It’s good that you care enough to be upset, and it’s good to see you direct your anger at him—the real cause of Elizabeth’s hurt and your anger. Both of you deserve better treatment than he gave you, and no child asks to be raped.

Mona: That’s right. I trusted him! And he took advantage of her. She was helpless—a helpless child. I’ve got to show her where I stand on this. First, I’m going to take good care of her, and then I’m going to send that rotten louse to jail for good!

CW: Mona, I know things are really crazy right now, and you don’t know what’s happening. I want to take care of that by telling you what’s going to happen and how things are going to be done, so you know what’s going on and don’t feel so out of control. I’ll go through each step of what is going to happen today and what we can do to ensure that Elizabeth gets through this in good shape. I’m going to explain what will happen very carefully to you. If you have any questions, stop me. There are no stupid questions about this. I want you to fully understand what’s happening, so you can start to get back in control.

Mona, the important thing is that you gain control. Right now, I’m being very directive, and will be doing so until you get past this emergency and back on top of things. You have choices, and if, at any time, you feel like making any of the choices yourself, please feel free to do so. You can stop me at any time, and that will be OK. (The crisis worker patiently goes through all the details of what is going to happen, stopping whenever Mona has questions, and checking to see that she under- stands what she’s being told.)

The crisis worker permits her to express her anger, isn’t threatened by Mona’s outburst, encourages her to keep owning and expressing her feelings, and lets her know that neither she nor Elizabeth was to blame for the assault. That strategy is important in letting Mona know that she can be in control and that the worker believes in her, without the worker’s jumping in and expressing the anger for her. This is no place for the human services worker who is not calm, cool, and detached in her or his professional demeanor. That the worker must be as solid during a crisis as the rock of Gibraltar is never more true than here. There is probably nothing more heart wrenching and sickening than the aftermath of a severe sexual or physical assault on a child. Intervention here clearly calls for a strong constitution. But more important, if the worker manifests her or his own anger directly at the parent or the perpetrator, then that anger may be mis- interpreted as being directed toward the victim. At times, when the perpetrator is still an immediate threat, the worker must take on the trappings of a crisis worker who deals with battering victims. The family may need to be moved to a safe place until the perpetrator is apprehended. The crisis worker continuously reinforces the mother for doing the right thing and for caring about her daughter. This is an extremely important strategy, because adult caregivers may engage in severe guilt and recrimination because they believe they should have been more vigilant. The crisis worker also must make sure that the mother will not exact revenge on the perpetrator and put herself in jeopardy with the law (Knauer, 2000, p. 46). It will indeed do Elizabeth little good if her mother is facing a charge of assault with intent to commit murder. Finally, the crisis worker patiently educates the parent on what is going to happen. Education about the aftermath of a child assault is critical in giving parents back the sense of control they feel they have lost. Two components of education are important. First, detailing what the legal proceedings are and what the mother and child need to prepare for allows them to know what is ahead of them and not be blind- sided by all the legal, social, and psychological ramifications of a child sexual assault. Second, giving the parent information on how to deal with the child in the immediate aftermath of the discovery is critical in ensuring that the child is not revictimized and that the parent does not feel guilty for doing or saying the wrong thing (Bottoms, 1999). An even more shocking revelation may occur during the initial disclosure and interview. That is, it is not uncommon for the parent to disclose that she was also sexually abused as a child and swore this would never happen to any of her own children. The worker, although taken aback, immediately discriminates between what Mona’s mother didn’t do and what Mona did do. She underscores and reinforces Mona for taking action and reaffirms her as a fit parent.

Prosecuting the Perpetrator Interviewing the Child

Whenever a child is sexually assaulted, there are two primary concerns.

· First is taking care of the child and seeing that she or he is safe.

· Second is obtaining evidence to prosecute the perpetrator.

If the child has not been injured or if the discovery is made a good while after the assault, then an interview needs to be conducted that will allow the necessary evidence to be obtained. In the past, report of a child assault would entail numerous interviews with medical staff, police, and social services. The intimidating circumstances and the necessity to repeat the story over and over have a high potential for making the child feel terrorized, guilty, confused, and unequal to the task of meeting the demands of a variety of strange and threatening adults. The potential for revictimizing the child and the parent while going through this procedure is extremely high if not handled appropriately (Bottoms, 1999).

To stop this from happening, the Carl Perkins Center uses an interview procedure that many other child advocacy agencies employ. This approach is a good model for dealing with cases of sexual or severe physical assault on children and is now starting to be instituted across the country. One trained forensic interviewer with a listening device in her or his ear con- ducts the interview and tape-records it at a safe house. Other agencies’ staff are behind a one-way mirror. If they need more information on a particular part of the assault, they transmit that information to the worker in the room via the worker’s earpiece. Note here the emphasis on trained. Because this is a criminal matter, the worker needs to be able to obtain in- formation without biasing the child’s testimony. In other words, the typical mental health worker will not have the expertise to do this. However, the psychological well-being of the child is critical in the aftermath of disclosure, and a typical police interrogation would likely put the child under severe duress. Therefore, whoever does the interview should be skillful not only in obtaining evidence, but also in making the child feel safe while the interview occurs. At Carl Perkins the interview is conducted in a pleasant, child-friendly room by a very caring child-centered forensic worker at the center, not in the stark confines of a police interrogation room (Bottoms, 1999). The worker may also use “good touch–bad touch” with a doll or a figure drawing to have the child indicate where on his or her body (e.g., genitals, mouth) the assault took place. (Note: Mouth is included here because oral sex is a common occurrence in child sexual abuse [Knauer, 2000, pp. 5–6].)

If there is no prior knowledge of abuse and the child discloses an assault in a spontaneous manner, then the crisis worker needs to be cool-headed, listen have staged a Kids on the Block puppet show at a local school. After the presentation on prevention, they invite children who may have been victimized to come down and talk to them about their experiences. At times they have been flooded by children! In that case, the worker needs to write down pertinent informa- tion in a calm manner and make an immediate referral to Children and Family Services (Bottoms, 1999). After the examination, the crisis worker needs to affirm to children that they are okay physically, that some part of their body is not “broken,” that they do not now have AIDS, that they will not die, and in the case of a girl, that she is not pregnant (Bottoms, 1999).

It is extremely important for young children who have little information about how their body functions to immediately allay fears of what may happen to their body as a result of the assault. A somewhat controversial issue is whether the initial examination should be done at the child advocacy center, as opposed to a hospital. Many times, the child-friendly atmosphere of the center is much more conducive than a hospital for examining victims. The counterargument is that examinations should not be done at the center because the child might associate that frightening procedure with the center’s physical environment and generalize it to the staff’s subsequent attempts to work there with the child (Bottoms, 1999).

Preparing the Child for Testimony

Interviewing children about their potential sexual abuse is a tricky business and best done by practiced forensic examiners. There is no set protocol free of trail ramifications, so the goal is to elicit reliable and complete information without tainting it (Saywitz & Dorodo, 2013). The last thing that needs to happen is raising the specter of “false memories.” Sexual assault is a criminal matter, and at some point, the child will probably have to testify in a courtroom. That

appearance may be terrifying to a small child who will have to give testimony against a caretaker who may have either been very nice to the child or made threats against the child and his or her family. Depending on the age of the child, the Carl Perkins Center uses puppets, books, and videos to educate the child on what testimony in a courtroom entail. Immediately before the child’s appearance in court, a staff member from the center will take the child to the courtroom to acclimate him or her to what may be perceived as a frightening experience. The staff explains about everybody’s role and how things will happen. He or she will role-play traffic court, so the child gets an idea of how courts operate. Children can explore the courtroom, ask questions, and sit in the judge’s and witness chairs, so that they become familiarized with a courtroom and are not terror stricken when they are asked to engage in the real situation. Another problematic area is time of court appearance. Courts are notorious for not starting on time. Sitting all day on a bench outside a court waiting for it to convene while the perpetrator is seated on an adjacent bench is clearly not conducive to the child’s or the family’s good mental health. As a result, the Carl Perkins staff keeps the child and the family at the center until a call is received from the courthouse that court is about to convene. Only then are the child and family transported to the

courthouse. After the court appearance, the child is brought back to the center and debriefed. Questions such as “How did that feel?” and “What was that like for you?” are posed to alleviate the residual fears of having confronted the perpetrator at close range (Bottoms, 1999). The span of time from disclosure and discovery of the assault to court appearance may be up to a year, and there will be lots of trans crisis points as time seems to drag on interminably. It is important that each one of these crisis points be met head-on by crisis workers. Thus, the Carl Perkins Center staff

immediately swings into action in dealing with the child and the family and stays with them in support and therapeutic roles for at least a year after the initial contact is made (Bottoms, 1999).

Aftermath

It should be a given from all you have read in this chapter that any child who has been sexually abused needs counseling (Knauer, 2000, p. 46). Discovery of an incestuous relationship throws the entire family into crisis. The father, and possibly the mother, faces loss of what has become an addictive behavior, possible criminal sanctions, loss of his or her family, and social stigmatization. The nonoffending parent finds herself or himself torn between her or his partner and the assaulted child. The child may find herself or himself discredited, shamed, punished, and still unprotected (Herman, 1981, p. 183). The worker will also face a crisis in deciding what to do and whether or not to believe the child’s story. However, discovery of child sexual abuse is no different from discovery of any other physical abuse, and state laws mandate that it must be reported (Sandberg, Crabbs, & Crabbs, 1988).

It is a criminal activity and should be dealt with in that manner. For those workers who are unsure of themselves, it may be reassuring to know that fewer than 5% of complaints of child sexual abuse are false.

Conversely, it is not uncommon for children to re- tract their complaints under pressure from the family (Goodwin, 1982). Therefore, until clearly proved otherwise, the child’s allegations should be accepted as valid, and the worker’s primary consideration should be reporting the abuse to Child Protective Services and obtaining safety for the child (Sandberg, Crabbs, & Crabbs, 1988).

Because the behavior is both criminal and addictive, treating the problem via family therapy is fruit- less. What is called for is immediately referring the problem to and cooperating with family services and law enforcement agencies that do not subscribe to a family reunification policy (Sandberg, Crabbs, & Crabbs, 1988). It then becomes much more possible to remove the father from the home through a court or- der. Removing the child from the home has negative ramifications because it may be construed as banishment and may also serve to strengthen parent bonds against the child. The child needs assurance that she is not to blame for the incest; she should be praised for her courage and clearly told that she is helping, not hurting, her family and will not be abandoned even if she retracts her story (Herman, 1981, pp. 184–185).

Counseling

Aftercare is critically important to prevent a host of maladies from appearing in later childhood and carrying on into adulthood. Universal characteristics such as lying, stealing, fighting, verbal and behavioral oppositional defiance, and promiscuity are typical aftermath behaviors that will assail children who have been sexually victimized.

Boys will typically perpetrate sexual assaults on other children, bully other kids, vandalize property, and generally direct their anger outward.

Girls typically turn their anger inward and engage in alcohol and drug abuse, eating disorders, and promiscuity.

Reducing problem behavior is important along with dealing with the trauma (Miller-Perrin, 2001). The Carl Perkins Center attempts to deal with these is- sues before they become major behavioral problems, through play therapy, therapeutic games, and role plays that deal with the inappropriate behavior in both group and individual counseling. The Center follows a variation on the trauma systems approach (Saxe, Ellis, & Kaplow, 2007), including trauma-focused cognitive-behavioral therapy (Neubauer, Deblinger, & Sieger, 2007), play therapy group work (Haen, 2008; Malchiodi, 2008; Nisivoccia & Lynn, 2007), and work with the family, school, and social service systems (Saxe, Ellis, & Kaplow, 2007; Steele & Malchiodi, 2008). This comprehensive approach is all part of the postvention package of a 1-year follow-up (Bottoms, 1999).

Group Counseling

Group counseling is used to normalize the assault and help children understand they are not alone. The group breaks the isolation as children start to share their fears and feelings of shame and guilt. Peer interaction leads to expression of shared feelings, bonding, and higher self-esteem. By validating their experiences, the group helps shift the focus of responsibility off children and onto the perpetrators. Further, the typical parameters of group rules help children learn behavioral limits, identify appropriate interpersonal boundaries with others, and learn to ex- press feelings appropriately (Knauer, 2000; Nisivoccia & Lynn, 2007).

Children meet in groups twice a month for a year. These issues are not sugarcoated. Group leaders discuss these problems in a straightforward manner and teach children how to deal appropriately with the feelings, behaviors, and thoughts that are likely to confront them as they work through the trauma, they

have experienced. The idea is that if these problems are talked about openly and honestly, then survivors will not be further victimized and will be empowered to start taking control of their lives back (Bottoms, 1999).

The assaulted child may have been told, not only by the perpetrator but also by other family members, that the child himself or herself is the cause of the family’s breakup. Constant reinforcement is used to convey to children that the assault wasn’t their fault. Workers who are not versed in dealing with sexually abused clients will not understand the importance of driving this point home. The fact is that many, many sexually abused clients will believe it is their fault and that they, and they alone, as a result of their disclosure, have caused all the problems that have occurred for the family (Bottoms, 1999).

Groups are set up in age ranges of 2 to 3 years. Groups are not run for 3- to 5-year-olds because of their short attention span and lack of mature cognitive development. The 3- to 5-year-olds receive only individual counseling. Because of the curriculum and techniques used, groups are also divided into readers and nonreaders. Group participants also receive individual counseling, twice a month on alternate weeks from when groups meet. Different children manifest different problems as they work through the trauma of the abuse. When a child starts to manifest a particular characteristic, such as stealing, then individual counseling is tailored to fit that child’s specific needs (Bottoms, 1999). Particularly for younger children, any group therapy should not be entirely devoted to “talking” therapy. Play is the medium that gets the message across; puppets (Webb, 2007), dramatic enactment (Haen, 2007), bibliotherapy (Malchiodi & Ginns-Gruenberg, 2008), sand play (Carey, 2006), art (Malchiodi, 2008), and particularly for older children, board games (Schaefer & Reid, 2001) all provide mediums to get the message of abuse across and teach children cooperative, prosocial behaviors that many of them lack.

Boundary Issues

Boundary issues are endemic to this population. The positive feedback and attention these children receive from engaging in sexual activities with long-term perpetrators transfer over to and generalize to a variety of other situations and people. Thus, one of the primary thrusts of counseling at Carl Perkins is to reestablish appropriate personal and interpersonal boundaries. Sexual assault turns understanding of normal developmental boundaries upside down and children may become erotized, meaning that psychologically the children may believe that the only way to gain attention is to be sexual. Physically, the feeling may have been enjoyable, and they do not perceive it as abuse (Knauer, 2000, p. 10).

An example of the lack of understanding that sexually assaulted children have of interpersonal boundaries is related by the Assistant Director of the Carl Perkins Center:

Assistant Director:

I was on a home visit working with the mother of a young girl who had been sexually abused. My purpose for the visit was to work with the mother in teaching her parenting

techniques to use with the daughter. I really wasn’t there to deal with the young girl, but she

incessantly demanded attention from both me and the mother. Providing her with alternative activities such as coloring books and dolls didn’t satisfy her demand for us to attend to her. The little girl left the room and then reappeared with a negligee on and tried to get me to look at her. When that didn’t work, the girl got up and sat as close to me as she could. When I still continued to attend to the mother, she climbed in my lap. When I still did not attend to her, she started kissing me, and finally attempted to stick her tongue in my mouth. In her attempt to get my attention and affection, she knew no interpersonal boundaries. It doesn’t take a rocket scientist to figure out how that had come to be. Love, attention, and sex are all rolled into one as far as these kids are concerned. I can’t tell you the number of times we have discovered these 6-, 7-, and 8-year-olds having sex with other kids when they should be playing with dolls and trucks with those kids. So, a lot of time is spent on talking about what appropriate boundaries are..

Group Support Work with Nonoffending Parents

For mothers, the notion of entering a support/therapy group may be very threatening. However, it is quite possibly the only way they will be able to get their families back together. Mothers should be told this fact in plain and simple terms and should be strongly encouraged to join such groups. Groups for spouses of abusers enable members to come to terms with doubts of their own womanhood, regain a sense of control and empowerment in themselves and their families, reduce blame and guilt in themselves, and restore mother–daughter bonds (Brittain & Merriam, 1988; Salter, 1988, p. 211).

Preventing Revictimization

Perhaps most tragic of all the issues that assail a family is revictimization of the child by the nonoffending parent. Often a role reversal occurs whereby the child not only is the sexual object of the perpetrating parent, but also becomes the chief confidant and comfort provider for the nonoffending parent. She or he takes on the role of being the real partner of the nonoffending parent and usurps the nonoffender parent’s role. This role reversal may be completed by the nonoffending parent’s psychologically taking over the child role. Therefore, crisis workers spend a good deal of time with nonoffending parents, teaching them to reassume the role as head of household and to stand their ground when the child attempts to reassume her or his pseudo-adult role. Finally, time is spent on talking about the nonoffending parent’s not falling into another relationship that has the same outcome, as the parent may be highly likely to do (Bottoms, 1999). What the Carl Perkins Center does with families who have been involved with sexual abuse is not short- term, brief therapy. The multiple crises that erupt after disclosure should make it readily apparent that there are no quick fixes to this horrific problem. At least a year of continuing crises may be expected as the family attempts to restabilize and reinvent itself, and to be successful, it will need help every step of the way.

Individual Counseling

There are two major purposes in individual counseling following childhood sexual abuseThe first is making it safe enough for the child to discuss the as- sault. Avoidance is typically a hallmark of a traumatic event for children and children are generally reluctant to discuss it (Webb, 2007, p. 51).

Second is reenactment of the trauma and cognitively restructuring it so that it no longer is the axis on which the child’s life turns.

Intervention with abused children should never be done in isolation but should include the nonoffending members of the family (Mohl, 2010). Neubauer and her associates (2007) and Saxe and his associates (2007) propose that trauma therapy with children should have parallel parent training and therapy occurring at the same time. Neubauer and her associates propose that individual therapy should progress with the nonoffending parent and child seen separately first. The reason for doing so is to create a safe atmosphere for both the parent and the child to start to openly discuss their thinking and feeling about the abuse, which will not be easy to do under the best of circumstances. Later on, when both the child and the parent have received a good deal of processing and training, they are brought together in conjoint therapy. At this time the child tells the complete story of the abuse, and the parent openly discusses her or his own feelings and rein- forces the child’s proactive behavior. The end result is that emotional and behavioral dysregulation is first stabilized and then, through the course of therapy, psychoeducation, and parent training, both parent and child can transcend the abuse and move on with their lives (Saxe, Ellis, & Kaplow, 2007).

Session 1: Establishing Safe Ground. In this opening session the worker seeks to establish safe therapeutic ground for the child by asking him or her to talk about something they like or want to do.

Just as she will do with Elizabeth, the worker is not only training Mona in new ways of parenting, she is also teaching her to catch the positive self-enhancing statements she is giving herself and the negative ones that help extinguish attempts at new behavior. In short, she is teaching Mona how to regulate her emotional behavior as well The Carl Perkins staff meet with the nonoffending parent twice a month for a year.

After the abuse has been discovered, children tend to behave differently. Without knowledge and training, parents are likely to be shocked by these previously unseen behaviors as the child acts out (Knauer, 2000; Miller-Perrin, 2001).

Thus, home visits and parent training to educate and normalize the behavioral changes that are likely to occur are critically important. If such training does not occur, then warfare between the parent and the child will create another crisis. Forewarned is forearmed, and if parents start seeing these behaviors, the center staff immediately start tackling these is- sues with the child. Therefore, center staff keep close contact with the home to catch and stop inappropriate behavior before it gets started (Bottoms, 1999).

A classic example of acting-out behavior is stealing or shoplifting. The immediate knee-jerk reaction of many parents is to use shame as a way of modifying the behavior. Yet using shame to extinguish behavior compounds all kinds of shame-based issues the child may already have. Another example is sexual acting out. A parent who has started to date again after removal of the perpetrator will be horrified when the child attempts to become intimate with this new person. Because of the vacuum left by the removal of the perpetrator, the child’s need for love and affection, and her or his confusion over boundaries, the parent’s new boyfriend or girlfriend may become a target for the child’s commingled notions of how love and sex are intertwined and how she or he can obtain that love through sexual gratification (Bottoms, 1999). We will speak a good deal about making home visits and their potential for violence in Chapter 14, Violent Behavior in Institutions. However, you should clearly understand that even though one perpetrator has been removed from the home (or thought to be re- moved) you still need to be cautious and planful when making a home visit, and that plan includes your own personal safety. Saxe and his associates (2007) pro- pose an “On-the-SPOT” decision tree (p. 179) that dictates what you will do if you enter a home that is in crisis and violence boils over.

The first question to ask yourself is “Is everything cool and calm here, or is something unusual happening that appears headed toward a crisis?” The very next question is “How safe am I?” If the answer to that question is “I’m not sure” or “Not very,” then get out now! Home intervention also includes many case management activities. Getting ready for court, obtaining an attorney, looking for alternative living arrangements and transportation, dealing with school issues, and applying for victims’ compensation and other state support mechanisms for families are but a few of the many support activities that will be needed to help the family restabilize (Bottoms, 1999). As Saxe and his associates propose (2007), this is a systemic effort and nothing less than dealing with the whole system will do.

CrisisSession.

All of the foregoing sounds swell, but the fact is that the therapy of child sexual abuse rarely pro gresses in a nice, linear, ever upward, ever onward manner. There are transcribes aplenty with which to reckon.

Drawing or constructing a bridge lets clients concretely fill in gaps when they see little way across “troubled waters.” Bridging exercises are mainly used for assessment to determine where people have been and where they are going (Martin, 2008). Here we use bridging as a therapeutic vehicle to get Elizabeth mobilized again and show her where she has been, whence she has come, and where she is going. Here the crisis worker takes action and very actively and directly gets into the game, but as soon as Elizabeth mobilizes herself, the crisis worker assumes a collaborative mode and then becomes nondirective as Elizabeth regains control.

Last Sessions: Transcending.

What Saxe and associates (2007) call the transcendent phase of intervention occurs when the caregiving parent and abused child are brought together in conjoint therapy. The notion is that both caregiver and child are now able to talk openly and honestly about the abuse. The worker may start these sessions by acting as a game show host and asking both clients questions about sexual abuse (Neubauer, Deblinger, & Sieger, 2007). As survivor and caregiver reaffiliate, the child is encouraged to read passages from her book; Saxe and associates (2007, p. 276) recommend about three chapters per session. As the child reads the chapters, the caregiver expresses his or her own thoughts about what the child has written and gives the child a whole lot of reinforcement for having done such an awesome job of getting her feelings, thoughts, and behaviors about the sexual abuse down on paper (Neubauer, Deblinger, & Sieger, 2007).

SUMMARY

The sexual assault research consistently finds that the incidence of sexual assault is greatly underreported. The majority of reported rapists and other sexual abusers are males, and they come from all walks of life. Most abusers appear to perceive those they attack as objects of prey rather than as people. They usually assault not out of lust or desire for sexual gratification but out of a perceived need to control, exert power over, punish, vanquish, defeat, hurt, destroy, degrade, or humiliate others. Typically, abusers deny, minimize, and/or rationalize their behavior to the extent that they themselves rarely define their attacks as abuse. Instead, they usually claim that the survivor asked for, deserved, seduced, wanted, needed the experience in order to grow up, or somehow caused the abusive activity to occur.

Rape is a complex phenomenon that encompasses and affects the psychosocial, cultural, and personal aspects of society. There are no cause-and-effect formulas that explain why one person sexually assaults another. Consequently, many erroneous assumptions, beliefs, and myths about rape are held by different people, and women and men often differ in their perceptions about rape. Date and acquaintance rape, especially on college campuses, has become a pressing problem. The problem is exacerbated by the use of drugs and/or alcohol that is usually found to be associated with date rape. One impediment to preventing date and acquaintance rape is the differential perceptions between men and women. The research consistently reveals that men are more tolerant of rape than are women. Recently, the human services professions have directed a great deal of attention to rape and sexual assault on children. Substantive work has been done in the areas of crisis work, counseling, legal, social, and psychological interventions to help children and to prevent child sexual abuse. Such intervention and prevention have been made even more urgent in light of recent findings that child sexual abuse extends debilitating traumas far into the adulthood of survivors. An enormous amount of research has shown that adult survivors of child sexual abuse often suffer a wide diversity of emotional, physical, psychological, and social pathologies that manifest themselves in various degrees of trans crisis and PTSD symptoms later in adulthood.

These findings have greater urgency than ever before to help victims of sexual abuse and to stop offenders from assaulting.

Crisis intervention and other human services work in the area of rape and sexual assault of children require unique and specialized knowledge and strategies. Children are vulnerable to many kinds of pressures, and perpetrators of child sexual abuse know all the angles needed to ensnare child victims. The legal, medical, social, mental health, law enforcement, and human services professions as well as the court system are becoming increasingly integrated in attempting to stop the abuse and to work with abused children and their families. There is ominous research on sexual predators’ use of the Internet, and that arena will surely deserve even more attention in studies on controlling and containing child sexual abuse. In recent years the public, too, has become increasingly aware of the phenomenon of rape and other forms of sexual abuse, and that new aware- ness appears to have ushered in a greater sensitivity to and advocacy for the rights and needs of survivors. However, much remains to be done. Society still needs to overcome a number of long-standing myths about rape and other forms of sexual abuse. And survivors’ families, friends, and coworkers need to be willing and able to respond to survivors with openness, genuineness, acceptance, understanding, and respect, all of which are key attitudes or conditions for nurturing recovery from the debilitating trauma and effects of sexual assault. Given the high incidence of sexual assault and its underreporting, it is highly likely that a number of you—both male and female—may have experienced this crisis. As a result of reading this chapter, you may experience or be experiencing some of the repercussions this chapter speaks of in people who have been sexually assaulted and abused. We urge you to not be ashamed, embarrassed, or guilty but to understand that this crisis is common to a whole lot of people and to get help! If you don’t feel there is help in your community or you are too embarrassed to ask, call the National Office on Violence Against Women’s hotlines: the Rape, Abuse, and Incest National Network Hotline at 1-800-656-HOPE (4673), the National Sexual Violence Resource Center at 1-877-739-3895, or the National Teen Dating Abuse Helpline at 1-866-331- 9474. If you are attempting to recover on your own from a sexual assault, get Aphrodite Matsakis’s The Rape Recovery Handbook (2003). It is a step-by-step help program for survivors of sexual assault. It’s user friendly, talks straight to you, and has really helpful exercises in it

 
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