Sexual Abuse

Overview of Sexual Abuse: A history of being abused sexually is often a root cause of emotional and psychological difficulties later in life. Abuse by a parent can lead to severe issues with anxiety, self-esteem, anger, depression, and blocks to intimacy. Most people who are abused as children manage to function as adults, but maintaining a sense of peace and happiness can be very challenging. Often, memories arise most dramatically when people who were abused begin to form intimate relationships.

Since sexual abuse is usually committed not by a stranger but by someone but by someone known to and trusted by the child, it brings with it a great sense of confusion, betrayal, and, often, guilt – for having experienced any pleasurable feelings (young victims do not always immediately experience fear or pain during abuse, and may experience moments of pleasure), or  for having trusted the abuser or, conversely, for having gotten the person in trouble by revealing the abuse. Abusers often threaten, lie to, or reward their victims, adding another layer to the emotional trauma.

Sometimes people get advice – from others, or from their own internal voice – to just “move  on,” “forget the past,” or “let go of negative memories.” Such advice may be well-intended (although, if it comes from the abuser, it may be quite self-serving) but it is not easy to accomplish, and may not be healthful at first. While letting go and practicing forgiveness is a good eventually goal for a survivor of abuse, dealing first with feelings of anger, grief, guilt, anxiety and other painful emotions resulting from the abuse is likely necessary before trying to “move on.”

The Medical Model and Sexual Abuse: Therapy can help in a number of ways, including increasing insight into the nature of feelings that are arising, clarifying values and choices, helping with anger management and communication skills, uncovering and working through shame, and facilitating emotional catharsis. In situations where symptoms of post traumatic stress are present, Eye Movement Desensitization and Reprocessing has been shown to be very effective.

If memories of abuse are intense and interfere with one’s life in significant ways, Post Traumatic Stress Disorder may be diagnosed.  Depression, Anxiety, and some Personality Disorders (particularly if abuse is persistent and severe) are a possible outcome of physical abuse. Dissociative Identity Disorder (formerly known as Multiple Personality Disorder) rarely occurs unless there is a history of severe abuse. For children, Oppositional Defiant Disorder and Conduct Disorder sometimes develop in the aftermath of serious abuse.

Dissociation, especially during sexual encounters (even consensual ones), is sometimes observed in people with a history of abuse. Dissociation is a feeling of being out of one’s body, which may take several forms:

• Floating above oneself, as if watching from the outside
• Total numbness
• Taking on a different identity temporarily, with no memory of one’s real identity (sometimes called multiple personalities)
• Imagining oneself to be in another place or time and totally losing touch with one’s actual surroundings

Dissociation may also include periods of impulsive behavior not remembered later, in which a person carries out tasks, travels, speaks, and so forth, but all as if in a trance or a dream. These episodes are called dissociate fugues, a DSM diagnosis.

Dissociated people sometimes cannot speak, and other times may not hear what is said to them for brief periods. Dissociation is a way of coping with intense feelings of distress, including terror and rage, which usually stem from trauma.

It can be treated in therapy through the learning of specific coping skills, the examination of needs and beliefs, and catharsis of emotion.

 
Case Examples of Sexual Abuse:

Pat, 44, recently ended a relationship with a man because she found herself dissociating during sexual encounters. She is aware that she was sexually abused as a child but isn’t sure how to get over it. Her therapist helps her identify some irrational and some rational fears and ways to protect herself from the rational ones. She also refers pat to a support group with a good reputation where she can talk about her experience and her emotions. Pat is finally referred for EMDR (eye movement desensitization & reprocessing) a proven technique for overcoming trauma. Meanwhile, in therapy, she is able to confront and work through feelings of helplessness, rage, and grief, and begins to learn communication skills for use with potential sexual partners, as well as ways to choose appropriate partners, which has always been difficult for her. The experience of talking about her abuse with her therapist, who uses gentle redirection and encouragement to keep Pat fully present (as opposed to dissociating) during their sessions, helps Pat learn how to do this on her own.

Roy, 34, presents with depression and reports he is having memories of being abused by his father. His wife tells him to “get over it”, but Roy finds he has great anxiety about showing affection for his son, who is four, and his wife is frustrated. He is afraid to disclose this in therapy, worrying that the therapist will call social services, but he says, “I really want to get better so I can be a good father.” The therapist explains the rules of confidentiality, and assures Roy that unless he actually abuses or neglects his son, his privacy is protected; thoughts and feelings are not reportable offenses. The therapist helps Roy achieve a catharsis of grief and anger at his father, and helps Roy clarify his sense of boundaries for himself and his own son.

Therapy for Sexual Abuse: There is a wide range of Psychotherapy Treatment Models or types of therapy used in the treatment of sexual abuse. Most of these approaches fall into three historic camps of psychology: Psychoanalytic / Psychodynamic approaches; Behaviorism and; Humanism. Regardless of the type of therapy, there are some generally agreed upon elements of healthy therapy which are universal to all forms of psychotherapy. Before beginning therapy for sexual abuse or any other issue, it is helpful to familiarize oneself with these elements.

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Sexual Abuse Article Summaries