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Working with Adult Survivors of Child Sexual Abuse

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Elsa Jones, working from the Family Institute in Cardiff, has been treating adult survivors of child sexual and physical abuse for several years, and she has clearly and frankly described her work in this book. She begins be describing the context for working with her clients; then describes the way she has welded systemic thinking and a feminist perspective into a theoretical model she uses to understand the problem and to guide her own work with the survivors. The descriptions of the therapeutic process are, at the same time, profound and simply conveyed. Her work is further clarified by the inclusion of twenty case examples. She shares her own dilemmas about working with adult survivors, and in this way the book offers the reader support for the emotional impact of this work as well as a theoretical framework and suggestions about therapeutic technique.

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CHAPTER ONE. Background

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The guidelines that are offered in this book were first proposed by myself and my then colleague, Bebe Speed, to help us think about work we were currently doing with women clients who had been sexually abused as children. These ideas have been refined and elaborated over the ensuing years as a result of feedback from workshop attenders and clients.

There is now a wide and constantly proliferating literature on sexual abuse, ranging from theory and research, to work with the families of children where sexual abuse has been disclosed or is suspected, to survivors’ own accounts. My own work is firmly based on the experience and knowledge of the many other contributors to this field (of whose work only a small selection is cited in the bibliography). The knowledge accumulated by those working with the disclosure, management, and therapeutic response to the sexual abuse of children forms the bedrock on which workers with adult survivors rest their understanding of the likely experiences and effects for their own clients. While there are—and probably always will be—differences of interpretation and emphasis amongst those writing about sexual abuse, there is also broad agreement, particularly amongst those working therapeutically with abused children or adults, about the kind of helping approaches that are found useful by such clients. As Hall and Lloyd (1989) and Trepper and Barrett (1989) point out, books about therapeutic approaches (as opposed to theory) are in a minority; it has therefore seemed worthwhile to contribute my own ideas about ways of working with survivors.

 

CHAPTER TWO. Feminism and family therapy

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Over recent years family therapists, like therapists working in other modalities, have subjected their theories and practices to the critical lens of feminist thought (e.g. Goldner, 1985, 1988, 1991; Hare-Mustin, 1986; Pilalis, 1987; Perelberg & Miller, 1990). It would be over-optimistic to claim that these critiques have now so transformed systemic therapy that sensitivity to problems of power or gender imbalance in families are part and parcel of the thinking of family therapists. Nevertheless, the increasing awareness of feminist critiques, and the light they throw on evolving systemic theory and practice, have enabled us to begin to think more clearly about certain previously obscured aspects of our work.

Throughout most of the world, and certainly in the West, we have for several thousand years lived in androcratic cultures. This has major implications, not only for the lives of our clients and ourselves, but also for the theories and practices that will evolve within these cultures. It is therefore axiomatic that systemic therapy (indeed any therapy) will embody certain principles pertaining to the maintenance of the androcratic status quo; moreover, these organizing principles will normally be invisible to us. The papers, books, workshops, discussions, and battles between colleagues that have been informed by feminist critiques have been part of the process of allowing us as therapists to begin to acknowledge the significance, firstly, of the cultural/political system within which we live, and secondly, of the influence of gender roles on ourselves and our clients.

 

CHAPTER THREE. Hearing the relevant account

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Someone who was abused in childhood is likely to have had experiences convincing her that others do not want to know about what happened to her. She may have tried to tell various people, only to be met with disbelief, incomprehension, outrage, or “deafness”. She is likely to have formed the opinion that she is to blame for what happened (cf. chapter four), and to doubt the ability of others to accept her if they knew her history. She may indeed have been told by her abuser that she is to blame, that it is her wickedness, seductiveness, and so on that is responsible for his sexual behaviour; she may also have had responses of horror and rejection from others when disclosing the abuse. These and similar experiences will make her very cautious in therapy about telling the full account. She will be monitoring the therapist’s responses with all the subtlety and cautiousness at her command, to assess whether it is safe for her to tell more, or whether she should withhold further detail.

A not uncommon situation in therapy might be the following: a client seems to have told all the relevant details of her experience. The therapist therefore judges that it may now be appropriate to move on to other topics, to begin to consider how these experiences play a part in the client’s current life, to attend to issues of the client’s self-esteem, to consider how past and present relationships are linked in with the abuse, and so on. However, the therapy gets “stuck”, therapist and client seem at an impasse, it feels to the therapist as if the client is mistrustful, sad, or resigned.

 

CHAPTER FOUR. The question of blame and responsibility

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In working with adult survivors it seems to me important, as early in the therapy as is practicable, to make a clear statement about the issue of blame and responsibility. This comes from the experiences of colleagues working with children who have been or are being abused. It may not seem like a major issue to readers who are not systemic family therapists; however, within the family therapy community this statement initially elicited some criticism. It seemed to family therapists not possible to make such an apparently “linear’ statement, while still retaining the possibility of working “neutrally” with all family members, and while intending to consider the parts played by all family members within the system within which abuse occurred. In my experience it has indeed been possible to combine these two apparently incompatible attitudes.

Within the first or second session, once at least an outline of the childhood abuse has been given, I will look for the opportunity to say the following: ‘There is something I want to say to you, which is based on my experience and that of many other colleagues working with the children who have been sexually abused. When a sexual act happens between an adult and a child, regardless of what the child may have done, the child is not to blame. It is the adult who is responsible for what has happened/’ I will then expand on this by saying that in our culture children are taught that they must obey adults; they learn that when something uncomfortable happens between adult and child the usual interpretation is that it is the child who has been naughty.

 

CHAPTER FIVE. The relationship with the abuser

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Each survivor will have a different perspective on the importance of her relationship with the abuser, and how this has affected, and perhaps continues to affect, her views of herself and others. This perspective will be influenced by many factors, some of which will be idiosyncratic. However, the nature of the relationship preceding the abuse may make a difference to the impact that the abuse had; for instance, some researchers suggest that the closer the relationship between abuser and abused, the more likely it is that the abuse will be experienced as severely harmful, e.g. as in father-daughter incest. There are also more pervasive effects, such as those discussed in sections 3 and 4 below, which depend less on whether the abuser is a father or a stranger, and more on the kind of message the child receives about the acknowledgement or invalidation of their experiences by the adult world.

1. THE ABUSER AS OUTSIDER

How central this area is to the course of the therapy will depend partly on the formal and emotional relationship between the abuser and the child. In situations where the abuser was someone outside the child’s significant relationships—a stranger, a neighbour, a new step-parent whom the child disliked from the word go—the survivor may, long before coming into therapy, have relegated this person to an unambivalent position in their world of relationships. I see no reason why I should attempt to change the views of a survivor who has decided, to her own satisfaction, that her abuser was an unmitigated villain. It is not my business to try to persuade her to adopt a more “systemic” or compassionate view of this person’s background, constraints, and so on. Her preoccupations are likely to be directed towards the behaviours and relationships of others in her immediate circle at the time, and this will then determine the focus of therapy.

 

CHAPTER SIX. The relationship with the “protector”

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For many abuse survivors, this is often the most difficult area of therapy. Who the “protector” is seen to be will depend on the circumstances of the abuse. For example, if a child was abused by someone outside the family, both parents may have been regarded by the abused child as the people who should have protected her. Most commonly, in the cases we see, the abuser was a father or stepfather, so that from the survivor’s point of view her mother is the person to whom she hoped to look for protection from abuse.

In this situation the relationship, in childhood and in adulthood, can be a very complicated one, and is usually characterized by considerable ambivalence. An abused child assumes a certain degree of omniscience and omnipotence in parents, and so assumes that her mother must know of the abuse and be able to protect her against it. When this fails to happen, the survivor may feel angry, but is unable to express or even acknowledge this, since the non-protecting parent may be the last or, indeed, the only “safe” parent she has left. It may therefore seem dangerous to confront this parent, while what feels like betrayal—because of this parent’s failure to prevent the abuse—may continue to be a source of grief, anger, and incomprehension.

 

CHAPTER SEVEN. The wider system

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1. FAMILY PATTERNS IN THE PAST, THE PRESENT, AND THE FUTURE

Unless a survivor can locate her experiences within the context of the wider systems within which she lives, she is likely to remain in a victim position, and to have certain reservations about the way in which her own behaviours may have contributed to her abuse (examples illustrating the influence of patterns in the past and the present are given in sections a and b below). A survivor may blame herself for her failure to disclose the abuse, without also thinking about the factors that constrained her behaviour, such as, for example, her mother’s illness and vulnerability, the failure of the police to listen to her which meant that she was repeatedly returned home after running away, her father’s depression after being made redundant, her grandfather’s death, her own loneliness and desire for closeness, the family’s isolation after moving house, etc., etc. It is therefore crucial that this contextu-alizing work should be done, but it is unlikely that it can be done fully until the survivor has dealt to some degree with the issues described in chapters five and six. While her thinking and behaviour within relationships get organized by guilt, self-blame, and “family secrets”, she will find it difficult to begin to consider the other ways in which her life is patterned by styles of interaction learned within an abusing system.

 

CHAPTER EIGHT. Dilemmas

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1. PERSONAL IMPLICATIONS FOR THERAPISTS

Most therapists who work with survivors agree that the stress for therapists may be greater than in many other areas of work. There are presumably numerous reasons for this, but I shall refer briefly to only a few of these.

Given the high incidence of sexual abuse, it is quite likely that some therapists will themselves be abuse survivors. This is made more likely by the fact—generally acknowledged—that those of us who choose to go into the helping professions do not do so only for reasons of altruism, but are often motivated by the desire to understand or solve some of our own and our families’ problems. Working with sexual abuse can therefore trigger memories of abuse for therapists; these memories may refer to facts previously known, or may be brought into awareness for the first time, e.g. in the form of “flashbacks” in response to material discussed by clients. If a therapist is herself an abuse survivor this is no reason not to work with survivors; indeed, she may well bring an increased depth of understanding to her work, provided firstly that she can be sure that she has previously, in some other forum, dealt with the effects of her own abuse, and secondly provided that she has the opportunity to examine and talk through the current effects of clients’ revelations on her own state of mind. This support is crucial if she is to avoid imposing her own preoccupations or distress on clients; supportive opportunities to look at her practice and her own responses may be

 

CHAPTER NINE. Questions

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1. IS SEXUAL ABUSE ALWAYS HARMFUL?

This is a very difficult question, one that gets asked repeatedly and stirs up considerable emotion in all who attempt to discuss it. As clinicians and researchers, most of our knowledge about the longer-term effects of sexual abuse comes from the testimony of people who have sought out help—that is, from people who do consider themselves to have been affected significantly and adversely. It is very hard then to know or guess whether there are significant numbers of survivors who do not seek out professional help, and who do not need it. While the figures and their reliability are discussed in some detail in most of the literature on this topic, my own conclusion has to be that we do not, at present, know. For widely differing views on this contentious topic, see, for example, La Fontaine (1990) (valuable not only for her clarity and judiciousness, but also because she looks at U.K. and American figures, which most other writers do not do), Furniss (1991), Haugaard and Repucci (1988), and Frude (1985, and in press).

 

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