Understanding Childhood and Sexual Abuse The American Experience

1. Understanding Childhood and Sexual AbuseThe American Experience Jon R. Conte, Ph.D University of Washington Seattle, Washington

2. Introduction • Areas of Interest • Goal of Dialogue and Sharing of Experience • Please feel free to ask questions or make comments • Expansion of knowledge • Worldwide National and International Societies • Child abuse and neglect: the International Journal • USA • Four or Five Specialty Journals • Local conferences and Trainings • Every discipline e.g. American Journal Psychiatry • Issue no longer controlled by professionals • Politicians, media, non-abuse professionals • Young professionals entering without a sense of history

3. History of Awareness • Ancient History • Late 1890s, Freud Study of Hysteria • Effects of Abuse • Denial of Victim Experience • What motivated Freud? • Rise of Modern Feminism and Rape Crisis Center • Professionals and public forced to see what was always there • Freud to late 1970s • Sandy Butler- Father Daughter Incest • Ann Burgess et al- Sexual Assault of Children and Adolescents • Media Attention • Victims tell their stories • Basic Research

4. Parallel Developments • Study of Hysteria 1880 Europe • Study of War Trauma 1918 • Battered Children Syndrome, 1968. • C. Henry Kempe • Child Abuse as distinct types of maltreatment • Domestic violence and rape as separate fields

5. Careful Study of history reveals • Compartmentalization • Fragmentation • Denial, rationalization, minimization • Resulting in periodic amnesia, disbelief, and rejection of the truth

6. Why Denial? • Reality of abuse forces confrontation with: • Horror, depravity, violence, and abuse • Darkness of human nature • Dark side of families, churches, social institutions • Denial and Defense protect us from what is profoundly uncomfortable

7. Judith Herman, M.D.Trauma & Recovery. 1992 Basic Books “Classic documents of fifty or one hundred years ago often read like contemporary works. Though the field has in fact an abundant and rich tradition, it has been periodically forgotten and must be periodically reclaimed. This intermittent amnesia is not the results of the ordinary changes in fashion that affect any intellectual pursuit. The study of psychological trauma does not languish for lack of interest. Rather, the subject provokes intense controversy that it periodically becomes anathema. The study of psychological trauma has repeatedly led into realms of the unthinkable and floundered on fundamental questions of belief.”

8. Implications • Awareness and true understanding illusive • Requires a process of self and other education • Recognize the psychological tendency to deny and suppress in clients, significant others and ourselves • Knowledge critical, research on-going • Resolution not easy or short term • Understand and manage the impact of this work on our lives

9. Trauma/Child Sexual Abuse Work • Requires a relationship • Reciprocal impact on personal life and work • Self-awareness and self-understanding • Manage vicarious trauma

10. How many children are abused? • Underreported as are all crimes • Methodological issues • Data

11. Reporting • Professionals do not report unless required to do so • USA laws require reporting when “reason to suspect”

12. Reasonable Suspicion • Low level of suspicion • Allows professional investigators to make this determination • Recognizes that determining if child abuse occurred can be complex • Relieves professional of obligation to investigate and protects relationship with family • Mandated reporters • Confidential reports

13. Many clients appreciate intervention • False reports vs. Unsubstantiated • False reports rare • Most often teenagers or adults • Disguised or unclear disclosure • Poor practice (e.g. children’s art, leading questioning)

14. How many children disclose? • Studies vary • 40% disclose at the time • 24% females, 14% males disclosed later • 33% females, 42% males not disclose until asked by researchers • Study of professional women abused in childhood, 40% never disclosed • Retrospective studies, 6% to 12% cases ever reported to authorities

15. Who do children disclose to? • Usually parent, then parent of friend • Most cases come to attention of authorities for reason other than child report • Those who ask

16. Do Children with strong evidence deny? • Yes, 40% children with STD deny when asked • 10% of children with strong forensic evidence deny • 22% recant at some point

17. Why do children recant? • Reaction of those they tell • Consequences to child and family • Pressure from offender or others

18. Why do children not disclose? • Young children do not understand • Informed consent • Grooming • Process of selection • Recruitment • Involvement in abuse • Maintaining cooperation and silence

19. Abuse is not impulsive • No offender abuses every child he comes in contact with • Planned • Not getting caught is paramount goal • Threaten, bribe, bargain • Use what important to child • Separate child from sources of protection

20. Risk Factors: Females vs. Males • Males • Older at onset • More likely abused non-family members • More likely abused by females • More likely abused by offenders known to have abused other children • Some racial/ethnic differences • Hispanic women - abused by family members • Families • More distressed, dysfunctional, disorganized • Child • ever lived away from one of natural parents • perceive family as unhappy • unavailable mother • disability

21. Limitations of risk factors • Limited research • Any child in the wrong place at the wrong time is at risk • Special Risks • Catholic Child • Child of drug using parents

22. Grooming techniques • Force or threat of force • Gradual increase in sexuality • Bribe, promise, bargain • Disguise (e.g. sexual education) • Use of authority • Use of relationship • Pornography • Other victims

23. Results of grooming process • Conditioned child • Child who feels responsible • Child who fears disclosure • Child feels shame, humiliation, ambivalence • Child feels s/he has a relationship with offender • Seventy percent of children are abused more than once • De-conditioning (therapy)

24. Limitations of Grooming concept • Is not a diagnostic factor of any value • Some children are raped • Focus on child vs. adult and community

25. What are the characteristics of childhood sexual abuse? • General population studies • Parent/parenting figure: 6% to 16% • Clinical Samples • Parenting figure: 24% to 33% • All family: about 50% • Strangers: 5% to 15% • Offenders • 40% offenders are teenagers • Overwhelming percent are male

26. Multiple Episodes • 50% non-clinical • 75% clinical samples • Completed or attempted oral, anal, vaginal penetration • 25% non-clinical • 50% or more clinical • Average age 9 • range infancy to end of childhood • Duration varies greatly

27. What is the experience of the abused child? • No words for unexplainable • Understanding dependent on time, developmental level, and context specific • Complex relationships-ambivalence • Offender disguises nature of events • Dynamics of abuse • Isolation, betrayal, threat, force, manipulation, corruption, conditioning • Linked to disclosure, intervention, treatment

28. Who abuses children? • Particularly difficult question • Need to face reality that offenders are members of families and communities • Long history of theories which minimize • Incest is a family problem • Children fantasize • Nothing wrong with sex between adults and children

29. Abel Data 1987 • 561 men in therapy for sexual offenses • absolute confidentiality • data based • expert interviewers

30. Number of Victims

31. Number of Acts

32. Relationships between paraphilias • Female incest (N=142) • 11% male incest • 18% adult rape • Female non-incest (208) • 30% female incest • 10% male incest • 20% adult rape

33. Characteristics of Sexual Offenders • Polyperverse • Denial • Arousal distorts perception • Rationalize and minimize behavior • Sexual Arousal • Sexualization of children • Normal arousal increases in child age 14 to 18 • Unclear what is arousing • Child’s body • Psychological Factors

34. Cognitive Distortion • Fantasy • Pornography as teacher • Rehearsal • Social skills • Personality characteristics • Prior history of victimization • Controllability, risk assessment

35. Implications • Offenders do not self refer • Denial, distortion, fear great • first goal of therapy • Separate offender from family, not child from family • Social supports critical • Services to non-offending parent and siblings • Offender suffer consequences to extent possible • Identification and control first priority

36. Community as protection • Full disclosure • Community monitor • No confidentiality • Community vs correctional treatment • Therapy specialized and directed toward nature of problem • Regulated specialization • Treatment model

37. How to get disclosures? • Rationale for wanting disclosure important • Harms of sexual abuse • Human rights/ rights of the child • Create a climate of acceptance and belief • Teach children about touching • Books and Media • Prevention education • Touching and telling • Disclosure vs. prevention programs • Media depictions and stories

38. Help parents talk to children about touching • Train professionals to recognize and report • Talk to children about their experiences • Behavior (indicators) of some value • Change in behavior/ functioning • Symptoms of stress/ anxiety • Sexual knowledge, developmentally inappropriate • Sexual behavior

40. Multidisciplinary Intervention- • Each discipline different role • Cooperation and collaboration • Team investigation • Sharing of information and tasks • Respect differences of role and skills • No one discipline rules • Protect child victims and all children • Move as swiftly as possible • Prevent contact between child and alleged offender • Prevent System-induced trauma

41. Law enforcement • Collects and preserves evidence for criminal prosecutions • Performs criminal history record checks • Interviews adult witnesses and accused persons • Obtains search warrants • Can interview child and other children • Protects society

42. Medical Professionals • Conducts forensic medical examinations • Preserves any physical evidence • Interprets medical findings for team • Interviews child about experiences, medical conditions, and records statements and behavior • Reassures child that s/he is healthy

43. Child Protective Services • Accepts reports • Interviews alleged child victim • Interviews siblings/ non-offending adults • Arranges and coordinates system response • Conducts risk assessment • Develops safety plan, including removal of offender • Undertakes family or juvenile court action as necessary • Arranges for placement of child if necessary • Protects alleged victim of victimization or manipulation

44. Specialized forensic evaluations of child • Complex cases or where CPS lacks specialized skill • Experts in forensic child interviewing (see below) • Conducts multiple forensically valid interviews

45. Prosecutor • Participates in overall investigative strategy • Assesses quality of evidence • May participate in suspect interview • Determines appropriate charges • Prepares evidence • Conducts trial

46. Mental Health Professional • Offender therapist not part of the team • Provides on-going therapy for victimized child and family

47. Mental health issues • Attitude of law toward therapy • Contamination • Child focus on prosecution and process • Support vs. Therapy • Child vs. Family as client • Confidentiality with team

48. Problems in multidisciplinary teams • Team conflicts and emotions • Power hierarchy • Inadequate knowledge and personal bias

49. Specialized assessments of children for possible abuse • Dramatic increases in knowledge • Children as witnesses • Child language and development • Protocols vs. indicators • Awareness of limitations of children’s reports • Objectivity • Avoid leading and suggestive questioning • Understanding the child’s language, world, and experiences

50. Abuse-specific psychotherapy • Different than regular child therapy • Focus on trauma and impacts • Set basic principles and ideas based on understanding abuse and trauma • Child focus, developmentally appropriate