Introduction
Sexual abuse in childhood is an urgent social issue, which reverberates into adulthood. People who have been subjected to sexual crimes need professional psychological help long after the event transpired. However, despite the overall understanding that therapy is important for healing child sexual abuse (CSA) survivors, the scientific data explaining how to approach such clients is too scarce and has to be systematized. Five papers have been chosen for this purpose, with each having some insight into approaching victims of early sexual abuse. Evaluating these papers is essential in ascertaining the most appropriate way to work with CSA clients for therapists in training.
Evaluation
“Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand” by Fergusson et al. (2013) is a study of effects that child sexual abuse has on adults. The research uses the longitudinal design, thus ensuring the consistency of results over time. The overall timeframe is thirty years, over the course of which 1265 children were assessed eight times: “at birth, four months, one year, annually to age 16, then at ages 18, 21, 25, and 30” (Fergusson et al., p. 671). The methods used for data collection incorporated interviews, standardized testing, and analysis of reports prepared by teachers as well as official records.
The results of the study yielded five primary statistical tendencies. First, there is a strong correlation between child sexual abuse and the probability of mental health issues in later life. Particularly, 95% of those who had experienced such form of abuse reported a psychiatric disorder (Fergusson et al., p. 673). Second, exposure to sexual crimes has been shown to precipitate Post Traumatic Stress Disorder, which leads to the loss of satisfaction form life and relationship degradation. Third, participants who experienced abuse were also more likely to engage in sexual activities at an earlier age, with many of them experiencing unintended pregnancies. Fourth, victims had more hospital contacts and doctor visits than those who were not subjected to sexual violence. Finally, the CSA participants had lower quality of life, which took the form of school abandonment, financial dependence, and low income.
This paper is valuable because of the use of a longitudinal study design. This is the only research that analyzes subjects over a period of decades, while other ones revolve around a series of interviews done within a relatively short period of time. Another benefit of the design is the ability to compare the lives of people who experienced child sexual abuse to those who were not affected in such a way. At the same time, this study has a major limitation, which stems from sample selection. All participants are of the same age, which implies that findings cannot be fully extrapolated to representatives of other birth cohorts.
“Talking therapy services for adult survivors of childhood sexual abuse (CSA) in Scotland: Perspectives of service users and professionals” by Chouliara et al. (2021) is a study of the benefits that therapy talks have for CSA survivors. The research employs semi-structured interviews as the main instrument of data collection. Overall, forty-four participants were involved, with thirteen survivors of child sexual abuse and thirty-one professional therapists working in this field. This setup allowed the researchers to receive input from both CSA survivors and professionals, thus ensuring greater credibility of their analysis.
Overall, the study highlighted the importance of therapy for psychological recovery of sexual abuse survivors. Development of a trusting therapeutic relationship has lifted mental barriers that prevented the victims from disclosing their thoughts. Furthermore, this relationship has fostered the atmosphere of safety, which was also an essential component of the survivors’ openness. Discussions with therapists have broken the sense of isolation that many victims felt. The self-esteem of survivors received a positive boost following the therapy. Finally, they have learned to contextualize abuse, which is an integral component of emotional recovery.
At the same time, the study has identified a number of challenges preventing the delivery of therapy. First, both sides pointed out the difficulty of focusing on trauma, which requires substantial preparation from survivors and professionals alike. Second, the absence of contact between therapists and clients between the sessions had a detrimental effect on the development of trust. Third, ensuring consistency via working with the same professional proved to be another challenge. Fourth, in some cases, acute episodes of mental health had no professional treatment due to the lack of contact. Fifth, professionals themselves experienced strong discomfort from working with psychiatric clients. Finally, a common complaint was the lack of adequate child protection that worried both therapists and CSA survivors.
The value of this study lies in the involvement of both therapists and survivors. Victims of child sexual abuse may not accurately describe their current emotional state, while psychotherapists cannot objectively assess the results of their work. Combining the perspectives of both sides allows for a more comprehensive overview of therapeutic efficiency. The study’s main limitation is that the researchers decided not to check the qualifications of participating therapists for the fear of intrusion. For the same reason the survivors were not asked to share records of history of abuse. These setbacks might compromise the credibility of the study’s findings.
“Working relationally with clients who have experienced abuse: Exploring Counselling psychologists’ experiences using IPA” by Golsworthy and Malcolm (2020) is another study exploring the efficiency of therapeutic work. The authors of the study use interviews to gain insight from six counselling psychologists. Beyond them, there were no other respondents involved, which might compromise the sample size as insufficient. The authors themselves believe that such a selection ensures the involvement of counselling psychologists who are actually able “to contribute meaningfully to the study” (Golsworthy & Malcolm, 2020, p. 147). The interviews were held once, without any subsequent sessions to confirm or complement earlier responses.
The study has ascertained three main themes appearing in the collected data. First, researchers have observed the emergence of The Holding Environment, which refers to the atmosphere of trust and empathy between therapists and clients. The second theme was labeled as “The Personal Versus The Professional”, which underscored the importance of distinguishing sympathy with survivors from professional judgment (Golsworthy & Malcolm, 2020, p. 151). The final observation was that therapy caused clients to have internal responses, which had to be externally communicated to therapists. This is a challenging task, as it requires deep concentration and extensive knowledge of non-verbal signs.
This research solves the problem of the previous paper, which was the lack of confidence in clinical experience of participating therapists. The authors of this study have ensured that study subjects are capable of sharing experience-based insight. However, the first limitation is that there are too few participants to form a comprehensive assessment that can be extrapolated to larger population. The authors of the study also acknowledge that even experienced professionals are vulnerable to biases, which is the second limitation (Golsworthy & Malcolm, 2020, p. 157). Ultimately, this research is useful for understanding the therapist’s viewpoint when working with CSA survivors since professional challenges are the main focus of the research.
“Survivor‐led relational psychotherapy and embodied trauma: A qualitative inquiry” by Forde and Duvvury (2021) is a study of the effects of a humanistic integrative therapy on CSA clients. The design of the research was qualitative in nature, as participants’ perception was its focus. The number of involved people was twenty-three, with eleven survivors of sexual abuse in childhood and twelve psychotherapists. This is not a longitudinal study as all interviews transpired only once. As a result, any data collected during the research was limited to that specific time period, without any later confirmations or rebuttals.
Analysis of interviews with psychotherapists and CSA survivors has uncovered four main themes. First, it was established that past trauma can heavily influence the current mental state of victims of sexual abuse. However, the humanistic integrative therapy has enabled them to better cope with anxiety and depression, which boosted their psychological well-being. Second, the study has ascertained the reluctance of survivors to accept the present moment while attaching excessive importance to the future or the past. The therapy helps the victims by focusing their minds on their current emotional state. The third theme was the significance of developing the atmosphere of trust between the therapists and clients before starting therapeutic work. Without rapport, clients were not able to overcome shame, grief, and anger. Fourth, for those clients that did build strong rapport with professionals, the therapy helped them release negative emotions and recover from the psychological trauma.
Whereas previous studies, discussed the importance of the overall therapy for CSA survivors, this is the first research that investigates the effectiveness of a particular therapeutic approach. The reason why it is valuable is that this paper has specific practice-related recommendations for working with CSR victims. The authors do admit that their findings are conclusive only for those participants that underwent the entire therapy course. There were also survivors who abandoned it before completion, thus making its usefulness for them doubtful (Forde and Duvvury, 2021). Overall, the paper provides invaluable insight into a narrow and complex field of healing traumas with humanistic integrative therapy.
“How adults tell: A study of adults’ experiences of disclosure to child protection social work services” by Mooney (2021) is a study of the problem of child abuse disclosure. As with previous studies, the primary data collection method was interviews. The sample size is the smallest of all studies – five participants in total, all of whom are CSA survivors. At the same time, this study is unique in that its data collection incorporated two sub-sessions. The first one was a “single question used to induce narrative”, the purpose of which is to ensure that respondents answer the question without being interrupted or directed by the interviewer. The second sub-session consists of follow-up questions by the interviewer based on the participants’ first response. This structure is effective for gaining useful insight from CSA survivors without actively encouraging them to disclose their traumatic experiences.
The study has three key findings relevant to the problem of child sexual abuse disclosure. First, there are systemic barriers preventing victims from sharing their experiences. Specifically, “issues such as poor administration and communication, undue delays and a lack of training and support for staff have been identified in respect of assessment and management of adult disclosures of childhood sexual abuse” (Mooney, 2021, p. 198). Second, participants reported uneasiness, which originated from social workers’ power and authority. For example, understanding that any notion of sexual abuse would be immediately reported made some of the survivors apprehensive and worried. Third, participants’ responses indicated fear of exacerbating their mental condition after approaching social workers. Specifically, Mooney (2021) writes that “system of receiving and assessing adult disclosures has a potential to re-traumatise” (p. 199). In total, incompetence of social workers and psychological pressure dissuaded CSA survivors from seeking help.
This paper is especially important because it explores the rarely discussed issue of sexual abuse and recovery. Before any therapy can begin, the fact of child sexual abuse should be established first. Yet, no other study accentuates the importance of disclosure as Mooney (2021) does. Furthermore, the author of the research collects data in a unique way – instead of directly asking participants predefined questions as other studies do, he allows them to choose what to talk about. This subtle technique eases psychological pressure on survivors and minimizes professional bias. However, this approach does have a potential weakness in that participants could have offered responses, which are not relevant for the study. Meanwhile, the strict protocol did not allow the interviewers to correct them.
Critical Review
Four main themes can be identified among the explored papers. The first theme is the inherent significance of therapy for CSA survivors. All studies argue that sex-related psychological traumas can persist for decades, causing depression, anxiety, and other mental health issues. Therefore, it is important to ensure that victims receive therapy or at least understand its significance even if they do not consciously recognize the presence of trauma. Mooney (2021) showcases how to communicate with reluctant clients – allowing them to lead conversation and asking follow-up questions. The goal should be to keep the CSA survivors engaged and motivated enough to complete the therapy.
The second theme is the importance of the atmosphere of trust for a successful therapy. Chouliara et al. (2021), Golsworthy and Malcolm (2020), and Forde and Duvvury (2021) all argue for building rapport with clients. It is essential to understand that a positive atmosphere should be established before the therapy begins. The more the client is convinced that they can trust the therapist, the more they will be willing to share. Similarly, positive relationship will motivate the client to put efforts into therapy. Chouliara et al. (2011) advise that therapists keep contact with clients between sessions. Such a subtlety informs the survivor that the therapist is engaged and willing to help.
The third theme is the fear of the system that surrounds sexual abuse and recovery. Mooney (2021) and Chouliara et al. (2011) were specific in outlining the negativity perceived by CSA survivors in relation to social workers and therapists. Both are seen as figures with power and authority, which prevents survivors from connecting with them. Therefore, it is important for therapists to use conversation techniques that make the formal context seem less strict. It is important to avoid situations when the client’s fear of therapist’s authority is reinforced. If such an atmosphere is created, the survivor is likely to reject therapy and become unresponsive.
The fourth theme is the importance of focusing on the present. Forde and Duvvury (2021) and Chouliara et al. (2021) have a common approach to contextualizing abuse. CSA survivors tend to live buried in past anxieties or apprehensive of future, which prevents them from healing. Therapists should guide the client into accepting their current state and allowing them to express their buried feelings. As Forde and Duvvury (2021) write, “for healing to begin, one must face the difficult emotions deeply buried, breaking not only the silence but also the very defences put in place to survive” (p. 641). Subsequently, the therapist should be patient and allow time take its course.
Conclusion
This literature review consisted of five papers illuminating various aspects of administering therapy CSA clients. The study by Fergusson et al. (2013) provided compared lives of victims and those unaffected by abuse over thirty years. The research by Chouliara et al. (2021) underscored the importance of consistency in therapy. The study by Golsworthy and Malcolm (2020) focused on the challenges faced by therapists when working with untrusting clients. Forde and Duvvury (2021) provided evidence of the efficiency of a humanistic integrative therapy. Mooney (2021) looked into reasons preventing CSA survivors from reporting abuse. Among these sources, four major themes have been identified: importance of therapy, significance of trust, fear of the system, and the necessity to focus on the present. Combined together, they provide guidelines necessary for helping therapists in training work with CSA survivors.
References
Chouliara, Z., Karatzias, T., Scott-Brien, G., Macdonald, A., MacArthur, J., & Frazer, N. (2011). Talking therapy services for adult survivors of childhood sexual abuse (CSA) in Scotland: Perspectives of service users and professionals. Journal of Child Sexual Abuse, 20(2), 128-156. Web.
Fergusson, D. M., McLeod, G. F., & Horwood, L. J. (2013). Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child Abuse & Neglect, 37(9), 664-674. Web.
Forde, C., & Duvvury, N. (2021). Survivor‐led relational psychotherapy and embodied trauma: A qualitative inquiry. Counselling and Psychotherapy Research, 21(3), 633-643. Web.
Golsworthy, R., & Malcolm, C. (2020). Working relationally with clients who have experienced abuse: Exploring Counselling psychologists’ experiences using IPA. The European Journal of Counselling Psychology, 8(1), 144-162.
Mooney, J. (2021). How adults tell: A study of adults’ experiences of disclosure to child protection social work services. Child Abuse Review, 30(3), 193-209. Web.