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CBT for Child Sexual Abuse and Affect Diagnosis & Treatment
6 CEUs It Wasn't Your Fault- Diagnosis & Treatment of Sexual Abuse in Children & Adults

Section 17
Perpetrators of Sexual Abuse

Question 17 | Test | Table of Contents | Child Abuse CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, & MFT CEU

Disclosure in a Therapy Session
Disclosing to a perpetrator in a therapy session gives women structure, support, and control. After all, a therapist's office has been her safe place. A therapist can help women to gain confidence about their reasons for wanting a disclosure as well as help with planning it, identifying expectations, and determining the possible outcomes. This process is how women gain a sense of control over the disclosure and feel prepared. Women are reminded that this is not about revenge or behaving in an abusive manner toward the perpetrator. Disclosure is not about yelling, screaming, or being violent. One act of violence never justifies another. Acting out a revenge fantasy is not constructive to healing and brings women closer to a perpetrator's behavior rather than the behavior of a woman who is healing. If a woman is feeling and thinking more about revenge than honest disclosure, she may have more outrage and grief work to do before she is ready for a healing disclosure with a perpetrator. Remember, adults can express their thoughts and feelings without being abusive.

Therapeutically, I have shared in this process with women. I have found it interesting that a perpetrator who is determined to be safe (not actively violent) for contact chooses to attend the session. First, I send a letter requesting the appointment. I state in the letter that "Lucy Smith has been in treatment for childhood sexual abuse and would like to meet with you." I do not state that he is the perpetrator. I give the time and date of an available appointment. I ask that he call me, not Lucy Smith, to confirm his decision to attend the session. Usually, when he calls he wants to know the reason for the meeting. I state, "She is requesting the appointment to discuss the reason." I then ask whether he is willing to attend. I do not tell him what will be discussed at the appointment since that would be a breach of confidentiality. I do ask him to plan on fifteen to twenty minutes of his time and not a full hour. I have concluded thus far through my own experiences that perpetrators seem to attend these appointments for two reasons: They want to know (1) what a woman remembers about the sexual abuse and (2) with whom she has discussed his behavior.

I have found that when perpetrators admit to the sexual abuse, most of them have taken some responsibility for it even as they made excuses for it. They do not necessarily show remorse for what they did or the harm they caused to her; rather, they show remorse for being exposed and may give some indication of the harm, but not on an emotional level. They do not seem capable of emotional vulnerability within this context of their behavior. Some of the men do apologize and ask to be forgiven; others do not apologize or ask to be forgiven. When an apology is made, these men do not seem to grasp the level of harm they have inflicted upon the child or understand at a meaningful human level the damage they caused to the child or the woman she became.

Symbolic Disclosure
A symbolic disclosure usually occurs when a perpetrator is deceased or unsafe to confront directly or when a woman decides that this kind of confrontation is best for her. The purpose of affirming her recovery, releasing any remaining sense of shame, and breaking the silence of the abuse is still met through symbolic disclosure; it is just accomplished by different means. Women choose a symbolic way, personal to them, that transfers the shame and accountability to the perpetrator, even though he is not directly there to receive them as his responsibility.

In preparing for a symbolic disclosure, a woman has planned a ritual that is significant to her. Women choose a place for this disclosure to occur, a place that has emotional significance to them. I have accompanied women to the house where the sexual abuse occurred or to their homes where they have felt safe and free of the abuse. We have met in my office where women have felt trust and understanding about the trauma of sexual abuse. We have also gone to grave sites where women have burned or buried letters to a perpetrator. Some women have burned an effigy or a picture of the perpetrator. Others may want to cut him out of pictures or destroy a significant gift he gave her. Sometimes they want to include something that is symbolic of a specific memory of the abuse. One woman chopped up the toy chest her grandfather gave her and burned it in her backyard while she told him what he had done to her as a child. She stated, "I never knew that I could feel so good getting rid of that toy chest. As I burned it, I cried, and it was for both of us. I felt clean afterwards and exhausted. It was a good feeling, an incredible feeling." Symbolic disclosure happens at a location that each woman decides is important for her emotional healing; the disclosure often has a spiritual meaning to women and can include a prayer of gratitude for their healing. Emotionally, women who symbolically disclose experience the same kind of relief and empowerment as women who confront a perpetrator directly. As with the direct confrontation, we plan what she will do afterward and we process her experience on the day of the disclosure. I have her call and check in with me a few days later to see how she is doing.

Sending a Letter
Sending a letter to the perpetrator is also an option for women. I may send a brief cover letter to accompany it if a woman asks me to do so. In my letter, I simply state, "Enclosed you will find a letter from Lucy Smith who has been in treatment for childhood sexual abuse. I am forwarding this letter to you at her request." If she gives me permission, I also state that she desires no contact from him at this time other than to receive and read the letter. Just as in a direct or symbolic confrontation, the woman has decided what she will state in the letter and has identified her boundaries with the perpetrator. She brings the letter to a session to read, think through, and refine before mailing it; she may choose to send it registered mail so that she receives a receipt upon its delivery. We discuss her feelings and the process she has been through in writing and sending the letter. She decides how she will respond if he chooses to contact her after receiving the letter. Writing a letter to the perpetrator sometimes leads to a meeting at my office. It can also occur in conjunction with a symbolic confrontation or meeting with him in a public place. The decision is up to each woman and is based on her needs.

Meeting with the Perpetrator in a Public Place
A woman may choose to contact the perpetrator herself and request a meeting with him outside of her therapy. She does so with the recommendation and intent of meeting him in a public place with at least one support person present. Women have chosen to meet in restaurants, churches, museums, and libraries. These places have a sense of openness. They are not isolated, and a woman can leave at any time; other people are there, which adds a sense of comfort, safety, control, and security. As with the other disclosures, a woman has written a letter and has identified her boundaries. We schedule an appointment after the disclosure for her to process and relate what occurred. She is encouraged to have a support person present, either nearby or inside the public meeting place. Again, it is important for her to know what her plans will be after the meeting and to check in a few days following the disclosure. Like the letter-writing option, this type of disclosure can occur in conjunction with a symbolic confrontation.

Similarities of the Confrontations
The four types of confrontations discussed here have the following similarities. First, a woman has chosen to have the disclosure and thus comes to that decision from a position of strength. Second, she has written a letter stating what she plans to say to the perpetrator about the sexual abuse, its effects on her, and what her boundaries are with him today. Third, she chooses who will accompany her to the disclosure for support and what people she will tell within her support system. By having someone she knows attend the meeting or be nearby, she has also identified to this person what kind of support she needs at the time of the meeting with the perpetrator and afterward. Fourth, she meets with the perpetrator and completes the disclosure. After the disclosure, she attends a therapy session to process her thoughts and feelings and to share what occurred during the disclosure and what her plans are for the next few days. Fifth, she shares the disclosure with her recovery group. The women in her recovery group are one of her main support networks, and they are encouraging during her decision to have the disclosure. The women in her group, who have already completed this process, can share their experiences. Sixth, she writes a letter to herself stating what the disclosure means to her healing and her life today. It is a letter about strength, empowerment, courage, knowledge, closure, and truth.
- Duncan, K. A. (2008). Ending the Pretense. In Healing from the trauma of childhood sexual abuse: The journey for women (pp. 134-138). Westport, CT: Praeger.


Personal Reflection Exercise #7
The preceding section contained information about confronting the perpetrator. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Pereda, N., & Segura, A. (2021). Child sexual abuse within the Roman Catholic Church in Spain: A descriptive study of abuse characteristics, victims’ faith, and spirituality. Psychology of Violence, 11(5), 488–496.

Pruiksma, K. E., Cranston, C. C., Rhudy, J. L., Micol, R. L., & Davis, J. L. (2018). Randomized controlled trial to dismantle exposure, relaxation, and rescripting therapy (ERRT) for trauma-related nightmares. Psychological Trauma: Theory, Research, Practice, and Policy, 10(1), 67–75.

Vargen, L. M., Weinsheimer, C. C., Coburn, P. I., Chong, K., & Connolly, D. A. (2018). Youth-perpetrated child sexual abuse: The effects of age at court on legal outcomes. Psychology, Public Policy, and Law, 24(2), 248–258.

In the four types of confrontation Duncan describes, what are the similarities? Record the letter of the correct answer the Test.

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