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Section 10
Conflicts and Issues in Treatment of Child Sexual Abuse: Aggression

CEU Question 10 | CEU Test | Table of Contents | Child Abuse
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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On the last track we will discussed two barriers to treating childhood sexual trauma; transference and splitting. We also looked at Thought Stopping and its use in altering transference situations and the steps in Expanding Client Self Trust.

On this track, we will discuss two more barriers to treating childhood sexual trauma, the barrier of aggression and the barrier of the desire-to-please. We will discuss Corrective Statements that I feel are an effective technique when working with a client who is exhibiting aggression and a desire to please at the end of this track.

Aggression as a Barrier
As you know, aggression is the outward expression of anger. Regardless of whether anger is transferred or reality-based, it can be foundational to building a healthy working relationship if the anger is recognized, evaluated, understood and discussed.

Raven, age 15, was a survivor of sexual molestation at the age of seven, by her babysitter. I felt it was important that I tell Raven, and then show her, that appropriately displayed anger would not destroy either one of us or drive me away. By my listening respectfully and responding appropriately, I modeled the desired behavior for Raven. As you may know, many survivors of childhood sexual abuse, have grown up in environments where expressing their feelings were not permitted. Also, obviously expressing their feelings was even punished. I have found it helpful to specifically communicate to Raven, "Not only do you have permission to share your feelings, but that I want to hear about them."

In addition to directly telling Raven to express her feelings in the session, I found asking Raven about her nonverbal anger cues provided her with a sign, that I was truly interested and aware in learning about her feelings. Raven's first response was, "No one has ever asked to hear about my feelings! In fact, I used to get slapped in the face, if there was any sign when I was unhappy let alone angry." I found by providing validation for Raven's feelings it provided an opportunity to redirect her in a positive empowering manner.

Consider your Raven. Have you specifically told her she has permission to share her feelings, good and bad, with you? I know you thought it, and I know you know it as a therapist; But have had you actually said to your sexually abused client, "Not only do you have permission to share your feelings, but that I want to hear about them." Do you need to consider doing this in your next session? If so, would it be helpful to replay this track, track 10, prior to your session?

Desire-To-Please as a Barrier
In addition to dealing with aggression, another barrier to treating childhood sexual trauma is the desire to please. As you know often times, children who have experienced childhood sexual abuse have been cast into adult roles, one of them being caretaker. Julia, age 17, was sexually molested by her mother's second husband, while he lived with them, when she was seven.

Julia stated, "It makes my mother happy when I look after my younger sister and brothers, while cooking dinner and doing laundry. I can do my homework later, when there is time." As the caretaker, what Julia had learned was "love can be earned by pleasing others". When placing the emphasis on others, she lost the ability to identify her own needs to fulfill them.

Julia continued to struggle with a low self-esteem and her desire to please. She often adopted a submissive role as means of gaining love and acceptance. There were times when she dared to display her own need to be valued, and in doing so placed herself in a vulnerable position to be exploited and used again. In another session, Julia shared, "I was working on this group project with four other kids at school. I just wanted to help where I could. Somehow, I ended up with the bulk of the assignment."

Julia had also learned to use the caretaking role as a means of controlling the degree of closeness or distance in her relationships; including her relationship with me. While it can be confusing, I have found it beneficial to initially follow her lead, to learn her rhythm and maladaptive style and patterns. When Julia began meeting with me, she liked to come in and ask me about my week and worked hard to keep the conversation from focusing on her.

Think about your Julia. Do you know and understand her dance (maladaptive or not) with you and her other interpersonal relationships?

Corrective Statements Technique
Another technique I have found useful when working with clients living with the secrets of childhood sexual trauma is Corrective Statements. As you know, it is common for survivors of childhood sexual abuse to use self-accusation or self-deprecation as a means of characterizing or justifying the trauma. Examples of Julia's needs for information on Corrective Statements is found in Julia's statements "I must have done something wrong to deserve …" and "There is something wrong with me" which helped her to tolerate the abuse.

As Julia revealed these feelings of guilt and shame, I have her reframing her statements. The reframing took place by having Julia distinguish between the event and the herself. Julia would evaluate an event as if she were evaluating herself. To enabled her to normalize her response and create a corrective statement, I helped Julia separate the event from herself.

Some examples of statements I have used with Julia and others are:
"What happened to you was wrong, but there is nothing wrong with you." I found this helps to separate what happened to the client from the client's evaluation of themselves. Here is second example of a Corrective Statement in which I separated the abuse from the abuser. "Because something bad happened to you, doesn't mean you are bad." Here is a third way that I reframed and separate the event from the client. I state, "These are expected after effects of having been abused by a __________ (specific perpetrator(s))" Here is a fourth example of a Corrective Statement. "Because something awful happened to you, doesn't mean you are an awful person."

As I reread these four Corrective Statements to you, have in mind your Julia and see if any would be appropriate in your next session.

4 Correcctive Statements
1. "What happened to you was wrong, but there is nothing wrong with you."
2. "Because something bad happened to you, doesn't mean you are bad."
3. "These are expected after effects of having been abused by a __________ [specific perpetrator(s)]"
4. "Because something awful happened to you, doesn't mean you are an awful person."

Consider replaying this track should you wish to review.

On this track, we have just discussed aggression and the desire to please, two more barriers to treating childhood sexual trauma and the use of Corrective Statements.

On the next track, we will review an exercise for clients called Inner Child Visualization.

Peer-Reviewed Journal Article References:
Betsch, T., Wünsche, K., Großkopf, A., Schröder, K., & Stenmans, R. (2018). Sonification and visualization of predecisional information search: Identifying toolboxes in children. Developmental Psychology, 54(3), 474–481.

Böge, K., Mouthaan, J., & Krause-Utz, A. (2020). Effects of dialogical mindfulness on psychopathology: A pilot study’s results from a seven-day psychosynthesis course about the inner child. The Humanistic Psychologist, 48(1), 84–99.

Ensink, K., Borelli, J. L., Normandin, L., Target, M., & Fonagy, P. (2020). Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties. American Journal of Orthopsychiatry, 90(1), 115–124. 

Feiring, C., Simon, V. A., & Cleland, C. M. (2009). Childhood sexual abuse, stigmatization, internalizing symptoms, and the development of sexual difficulties and dating aggression. Journal of Consulting and Clinical Psychology, 77(1), 127–137.

Pogge, D. L., & Stone, K. (1990). Conflicts and issues in the treatment of child sexual abuse. Professional Psychology: Research and Practice, 21(5), 354–361.

Straker, G., & Jacobson, R. S. (1981). Aggression, emotional maladjustment, and empathy in the abused child. Developmental Psychology, 17(6), 762–765.

Online Continuing Education QUESTION 10
In working with your survivor of childhood sexual trauma, what are two ways of modeling an appropriate anger response? To select and enter your answer go to CEU Test.

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