Ethical Boundaries: Treating Childhood Sexual Trauma

"It is estimated that there are 60 million survivors of childhood sexual abuse in America today." As quoted from Forward, 1993.

On this track, we will discuss the three core defenses of memory repression, dissociation, and denial, commonly used by children who are living with their secret of sexual abuse. At the end of this track, we will look at the various ways the Timeline Technique can be used.

Three Core Defenses
#1 - Memory Repression
As you are aware, the first core defense memory repression, occurs when extremely strong feelings of shame and horror are experienced during an encounter of sexual abuse. Douglas, age 12, was sexual abused by his Uncle George at age 5. He had no memory of the abuse when he was referred by Child Protective Services for acting out, fighting and being repeatedly expelled. Douglas stated, "I often feel angry at my friends and teachers. I am always put into detention at school."

It might be noted according to MSNBC News, the suicide rate among sexually abused boys was 1½ to 14 times higher than girls in a similar age group. Reports of multiple substances abuse among sixth-grade boys who were molested were 12 to 40 times greater than their peers in the same age group."

Later as Douglas recalled his abuse, two major factors seem to have contributed to his memory repression.

Two Contributing Factors to Memory Repression
a. The first was his age at the time of the abuse. Douglas was five. As you know, studies indicate the younger the child, the more likely they are to experience complete memory loss of the abuse. An older child, beyond age 7, seems to use a combination of core defenses, in addition to memory repression

b. The second contributing factor to memory repression was the level of the violence that Douglas was subjected to. Douglas had been beaten, tortured and violently sexually penetrated. He subconsciously used memory repression as a means of primary defense and survival. I find the Timeline Techniques described at the end of this track to be beneficial.

#2 - Dissociation
The second core defense used by survivors of childhood sexual abuse is dissociation. For Douglas, dissociation meant that, once he remembered being sexually abused, he felt emotionally disconnected from the experience. Douglas' dissociation included the memories of his trauma, but not the pain of the experience. Generally, I have found that there are three different forms of dissociation.

Three Forms of Dissociation
a. The first form of dissociation would be to for the person to "go numb." As you are aware, when the abuse is recalled, emotions are numb and it is as though the connection to the client's self has been severed. Douglas often talked of his abuse as though it happened to someone else. He stated in a flat expressionless tone, "I remember my uncle hitting him. He wouldn't stop." Notice Douglas used the word "him", rather than "me".

b. The second form of dissociation is "switching off." For survival, Angie, age 15, who was sexually abused when she was 7, would "switch off" the feelings and body sensations experienced during the sexual abuse. It was a simple but effective defense. If she did not feel the pain, then she felt "safe" no matter what was happening to her body. This seems to be most common for very young children who need to feel "safe"

The difference between "going numb" and "switching off" is that when Douglas went numb he would refer to his abuse as though it happened to someone else. In switching off, Angie shut down her body and felt nothing.

c. The third form of dissociation is referred to as "splitting off" and occurs when a child being abused has the feeling of leaving their body. It is a physical sensation of disconnecting and moving away from their body entirely, so as not to feel their overwhelming terror. Josie, age 16, stated, "It seemed like I was a ghost out of my body watching my Dad doing those horrible things to me."

Think about your sexually abused client? Which form or forms of dissociation does he or she use? Going numb? Switching off? Splitting off?

#3 - Denial
In addition to memory repression and disassociation, the third core defense is denial. Renee, age 14 used denial by minimizing or downplaying the extent of the abuse and the impact it had on her life. Renee had been abused starting at the age of 7, for a semester, by her gymnastics coach, Mr. Rogan.

Renee had clear memories of the abuse and could relate in detail what happened to her, but denied that it had any impact on her. Renee stated, "It only happened a few times, so I thought that it was no big deal. Besides it didn't hurt and felt good, even though I was ashamed about it. I would hear my friends talking about sex and boys and realize they were talking about things I had already experienced. I began to feel really angry when I thought about my coach. How could he do that to me?"

The three core defenses of memory loss, dissociation, and denial often work to support and facilitate one another. These three core defenses ensure the emotional, and even physical, survival of the sexually abused child. Douglas', Angie's and Renee's powerful feelings during the abuse were contained utilizing some of these defenses.

Timeline Technique
To assist Douglas, Angie and Renee in their efforts to bring down their core defenses resulting from sexual abuse, I found the Timeline Exercise to be beneficial. Here is how it worked with Douglas.

I provided Douglas with a horizontal sheet of paper that had a line drawn across it. He included the names of family members and significant people with which he interacted and the dates they either; arrived, moved out, interacted with family, visited or had any impact on Douglas. We continued to use the timeline during a number of sessions, as I had Douglas discuss: Who on the timeline did he think of when he was asked about family? Who did he have the least or vaguest memories of? Who was he most comfortable with and least comfortable with? For example Douglas's Uncle George was placed on the timeline at age five.

Three Key Words Technique
Next, I employed the three key words technique. I asked Douglas to list three words next to each person on his time line that described that person. The three words that Douglas listed after Uncle George's name were big, fear, and hate. I then asked Douglas, "Can you tell me more about these three words? What does the word "big" mean to you regarding your Uncle George?" It seemed to be the trigger that marked the beginning of the end of Douglas's memory repression. A key focus, of course, to my responses was to reinforce Douglas for his courage regarding facing his secret of sexual abuse.

Douglas and I continued this exercise in several subsequent sessions by reviewing other observations about the word descriptions and the people who had the most impact on Douglas.

This exercise helped Douglas gain a clearer picture of his family, his past and potential impact, jogging bits of memory as the information gained from the timeline was discussed. Think about your Douglas and his or her sexual abuse secrets. Would he or she benefit from utilizing the Timeline Exercise?

On this track, we discussed the three core defenses commonly used by survivors of childhood sexual abuse of memory repression, dissociation and denial: as well as the role a Timeline Exercise places in assisting your client to uncover their sexual abuse secrets.

On the next track we will look at the secondary consequences of narrow range of emotions, emotional flooding, emotional numbing and shortened attention span.

Online Continuing Education QUESTION 1
What are three forms of dissociation a sexually abused child may experience? To select and enter your answer go to CEU Answer Booklet.