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Section 4
Perceptions in Childhood Sexual Abuse

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In the last section, we discussed projection and introjection in the desexualization of childhood sexual abuse.  We will also look at the use of the Positive Retrospection" exercise.

In this section, we will discuss grieving the loss of security, the loss of childhood and the benefit of using "Story Telling" technique

As you have observed in your own work, children who have experienced sexual abuse at a young age tend to lose vital emotional functions and these become painfully apparent when the child grows to adulthood. 

Now let’s look at some losses that survivors of sexual abuse suffer, then we will explore some grieving techniques to facilitate the client growing past these losses. 

I have found in working with clients experiencing sexual abuse, loss of security affected their experience of safety, trust, comfort, certainty, and predictability. In addition, to loss of security, the survivor of sexual abuse also experiences loss of childhood via loss of innocence, spontaneity, memory, and freedom of choice. Also these clients lose a sense of self. By this I mean they lose a feeling of empowerment, esteem, and identity. Other losses they suffer are attachment, nurturing, and meaningful relationships.

In the grieving process, some patients experience a multitude of fears such as uncontrollable crying, being destroyed, and appearing "weak". Judith Herman writes, "The telling of the trauma story thus inevitably plunges the survivor into profound grief. Since, so many of the losses are invisible or unrecognized, the customary rituals of mourning provide little consolation."

♦ Loss of Security
Seven year old Samantha was experiencing loss of security when she was referred to me after being sexually abused by her mother’s boyfriend. Instantly, Samantha became demanding, clingy, and possessive, and constantly followed her mother around the room. She seemed anxious and quick to please. Her mother, Lynette, was a single parent and working two jobs along with coping with chronic illness. As a result, Lynette became emotionally overwhelmed and rejected Samantha’s affections. This led to Samantha’s over-zealous desire for physical contact and fear of separation. 

Some visible signs that a client needs to grieve an emotional loss include, sadness, anger, loneliness, fatigue, helplessness, shock, yearning, and numbness. Symptoms that exist for an extended period of time may indicate that are even more severe

As you well know, posttraumatic stress disorder stems from events that threatened death, serious injury, or personal integrity of the self.  To qualify for posttraumatic stress disorder, clients must experience symptoms in three categories:  re-experiencing, avoidance, and arousal. 

For survivors of sexual abuse trauma, a memory is unalterably fixed on their consciousness.  Whether or not they want to, they relive the trauma over and over again. Any attempts to block this memory are futile. The remembrance is especially intrusive the more severe the trauma. In addition, many times the way in which the memories manifest themselves is foreign.  Sometimes it may be just a fragment of the memory, for instance, the face of the abuser may suddenly appear out of nowhere. 

♦ Two Psychological Dilemmas
#1 - Loss of Territorial Boundaries
Now let's talk about the psychological dilemmas that result from sexual assault of adolescents.  The first of these is the loss of territorial boundaries as discussed earlier.  More than anything else, a rape is a violation of the territorial boundary of the skin.  This can leave the adolescent feeling incomplete.  Because adolescents are still in the process of discovering who they are, this disruption can be particularly devastating.  I feel it’s essential to work to rebuild a healthy sense of personal boundaries.

#2 - Controlling their Environment.
A second psychological dilemma occurs when the client questions their ability to control their environment.  Jess age 14, experienced this dilemma after she was raped by her mother’s boyfriend. From the age when they learn the word "no", adolescents like Jess are constantly trying out their degree of control over different aspects of life.

When a trauma such as rape occurs, their sense of control is skewed and they might react in different ways.  Jess reacted by exerting an extraordinary amount of independence while in a foster home and later when she began to live with her biological father, George.  Jess became angry, acted out, and flouted rules and limits her father set for her.  I believe Jess’s belligerent behavior was her attempt to regain the control she had lost after her rape. 

♦ Using the Story Telling Technique
I've found that one way to aid Samantha in trusting and rebuilding those emotional characteristics that she had lost is through the "Story Telling" technique.  Samantha was allowed to place her name on a tape.  I then told her to tell me a story.  If the client is shy, I ask them a few basic questions to make the child more comfortable.  Next, I ask the client to tell me a story.  The more stories they tell, the more comfortable I find they will feel with me. Thus, the more I can translate from the story about the client to their real life. 

For example, Samantha said, "Once upon a time, there lived a pelican and this pelican went like that-eeeeeee. He was embarrassed with that noise. He tried not to do it but that's all he could say. So then he tried to kill himself. Then he tried to say something else. Then he found out that he didn't have to kill himself."  I felt he sound the pelican made was perhaps symbolic of Samantha’s need to speak out and the consequences of doing so. She soon learned that if she denied the abuse verbally, she would not be embarrassed or punished. 

In this section, we discussed grieving the loss of security and loss of childhood and the use of the "Story Telling" technique

In the next section, we will discuss the ways play therapy can be used when dealing with repetitive rituals, control, and regressive behavior.  We will also look at when setting boundaries in play therapy would be beneficial.

Peer-Reviewed Journal Article References:
Bramsen, R. H., Lasgaard, M., Koss, M. P., Shevlin, M., Elklit, A., & Banner, J. (2013). Testing a multiple mediator model of the effect of childhood sexual abuse on adolescent sexual victimization. American Journal of Orthopsychiatry, 83(1), 47–54.

O'Rinn, S., Lishak, V., Muller, R. T., & Classen, C. C. (2013). A preliminary examination of perceptions of betrayal and its association with memory disturbances among survivors of childhood sexual abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 5(4), 343–349.

Pulverman, C. S., & Meston, C. M. (2020). Sexual dysfunction in women with a history of childhood sexual abuse: The role of sexual shame. Psychological Trauma: Theory, Research, Practice, and Policy, 12(3), 291–299.

What is one technique used with a sexually abused client who is in the grieving process? To select and enter your answer go to Test.

Section 5
Table of Contents