What can adult survivors of child sexual abuse teach psychologists?

1. What can adult survivors of child sexual abuse teach psychologists? Dr Vicky Gunn Learning and Teaching Centre

2. Introduction • Some background research information on extent and long-term consequences of child sexual abuse.

3. From a scan of USA research evidence: • “First and foremost, exposure to unwanted sexual attention in childhood is not uncommon….. • ………………..there is consistent evidence to suggest that 5-10% of children are exposed to severely abusive acts involving actual or attempted sexual penetration.” (Fergusson & Mullen, 1999)

4. Impact of child sexual abuse • Depression, anxiety • Risk-taking behaviours (self-harm; aggression; eating disorders) • Relationship fear • Sexual fear / sexualization • Low self-esteem • Fragmented self (post-traumatic stress disorder/ dissociative disorders)

5. Perspectives from practice

6. Pain kept in the family:geneaologies of abuse Grandmother +Grandfather Grandmother + Grandfather (abused as child) (abuser) (abusive) (abuser) Father + Mother Sibling Sibling + Partner Sibling Sibling Sibling (abuser) (abused by father) (abuser) (abused by father) Child Child Child Child Child Child Child Child (abused by grandfather and (abused by father) (overly protected father) emigrate)

7. The power of emotional pain • “Sometimes I’ll just be walking down the road and suddenly I’ll feel such pain, like I’ve been sliced by a knife. Other days the pain just goes on in my head constantly.”

8. The weight of memory “Things would be basically ok; I’d be coping; and then there’d be an anniversary; his death was really hard. I’d be ill for weeks after the anniversary.”

9. Memories, triggers and crisis • Awareness of the person’s potential trigger points, as they are revealed by the individual, is critical to understanding when things may be harder.

10. The power of shame • “At my deepest, darkest inside, I feel to blame…” Jonie (Kuafmann, 1992)

11. Dissociation and keeping a distance “When it happened I would imagine myself out of my body, up onto the ceiling, looking down at what was happening…it was like looking along a long tunnel.”

12. “A natural, protective response to overwhelming traumatic experiences, dissociation can become an automatic response to stress.” Kisiel, & Lyons (2001)

13. Revictimization – losing safety Women survivors, “are more likely to experience unwanted intercourse with both acquaintances and strangers due to the misuse of the perpetrator’s authority [than non-victims of CSA].” (Messman-Moore & Long, 2000) • “Childhood trauma, particularly sexual abuse, may set in motion chain reactions of trauma across the life cycle…” (Banyard, Williams, Siegal, 2001)

14. Resilience • Not everyone who is sexually abused seeks psychological support; • Not everyone who is abused seems to have clinically recognisable levels of distress in adulthood; “little attention has been paid to survivors who do not exhibit negative consequences or who manifest resilience.” (Hyman & Williams, 2001)

15. Surviving • Lack of resilience does not mean weakness; • Survivors have complex relationships between emotional strength and emotional hyper-sensitivity; • Some survivors become manipulative to survive. We might not like this.

16. For the scientists in the audience • Links between: physical stress responses, neuro-endrocrinology (especially allostatic load imbalance) and the neurophysiology of memory – might be a useful way to begin to explore the physiology of resilience and survival.

17. Listening to the Survivor’s testimony:

18. How does listening to the following make you feel? “We were hyper-alert beings, watching for shadows, listening for footsteps, sniffing the air for a certain fragrance, waiting for the open hand or fist to connect to our bare skin in a flurry of searing pain. For many survivors, even our sleep was disturbed by sexual violence and abuse. Our bedrooms, instead of being a sanctuary, were traps where we were the prey.” Susan Jeavons

19. Developmental psychology, ego strength, and dealing with what we don’t want to hear

20. An example from recent research “The prototypical picture of sexual abuse was weekly genital or anal intercourse by a family member who was moderately close, lasting between one and three years.” (Kisiel & Lyons, 2001) • Sample of 114 subjects, aged 10-18, wards in psychiatric care (ie extreme group).

21. The hearer’s anger “How could they?” “I used to get so angry listening to what my client was saying that I’d fantasize about going to get the person who did it. The trouble is, I’d stop listening to my client and get caught up in my anger.”

22. The hearer’s grief “I could never view the world in quite the same way. I had a reasonably protected childhood. All the usual stuff of family rows and stuff, but I was physically safe. Now I walk down the street looking at people, wondering, ‘are they doing it?”

23. The hearer’s frustration • “I couldn’t understand why she kept going back to visit her family. She’d say, ‘I have to go home every weekend.’ I mean, I knew in my head why, but in my gut I just wanted to scream TELL THEM TO GO TO HELL.”

24. Rationalizing extent: from disbelief to moderation to acceptance • Personal defence mechanisms in the face of someone else’s pain = powerful: • Sometimes easier to disbelieve; • Sometimes easier to make simplistic assumptions about how survivors should be;

25. Freud’s rationalization: • Lolita syndrome – ie the seductive child • Oedipal theory – What role does our own shame at not being able to protect children lead us to consider disclosures as potentially about fantasy?

26. Mental illnesses expressed through social constructions • Post-modern society obsessed with issues of sexual abuse. • Delusional disorders take societal contextual forms for expression. • Some people who disclose may suffer with delusional disorder (attached to ‘false memory syndrome’) – • Munro challenges this latter point (Munro, 1999)

27. Comfort zone • Fall back to the emphasis on fantasy? OR • Recognize that some folk may have forms of delusional disorder, but not at the expense of negating the sheer scale of child sexual abuse within the population?

28. Survivors of child sexual abuse teach us about the limits of ourselves and our humanity. • Medicalizing survivors as ‘other’ may make the truths they present more palatable, but palatable for whom? • Engaging with survivors may set off our own trains of emotional stress.

29. References • Banyard, V., Williams, L. & Siegal, J. (2001) The Long-Term Mental Health Consequences of Child Sexual Abuse: An Exploratory Study of the Impact of Multiple Traumas in a Sample of Women, Journal of Traumatic Stress, 14(4), 697-715. • Fergusson, D. M. & Mullen, P.E. (1999) Childhood Sexual Abuse: An Evidenced-based Perspective, Sage: London. • Hyman, B. & Williams, L. (2001) Resilience Among Women Survivors of Child Sexual Abuse, Affilia, 16: 198-219. • Kaufmann, G. (1992, 3rd edn.) Shame: The Power of Caring, Schenkman: Rochester. • Kisiel, C.L. & Lyons, J.S.(2001) Dissociation as a Mediator of Psychopathology Among Sexually Abused Children and Adults, American Journal of Psychiatry, 158(7): 1034-1039. • Messmann-Moore, T. & Long, P. (2000) Child Sexual Abuse and Revictimization in the Form of Adult Sexual Abuse, Adult Physical Abuse, and Adult Psychological Mistreatment, Journal of Interpersonal Conflict, 15: 489-502. • Munro, A. (1999) Delusional Disorder: Paranoia and related illnesses, Cambridge.