Diagnosis & Treatment of Sexual Abuse and Human Trafficking

On the previous track we discussed three types of dreams: trauma dreams, freedom dreams, and resolution dreams.

On this track, we will discuss the child's feelings of guilt and responsibility and the child's beliefs regarding treatment of the child in the role of victim. We will also look at the use of externalizing abusive messages.

As you are aware, how a trauma is defined or interpreted by the child's parents and therapist determines how the child views the event. If the child's feelings of guilt and responsibility are dealt with effectively, the child ideally will feel that his or her parents or therapists are letting them know "It wasn't your fault."

Gloria, age 15, had been sexually abused by her older brother, Tony beginning when she was 8. At the time, Tony was 16 and had sexual contact with Gloria on a regular basis over four years. When Gloria was 12, she refused to go along with Tony's demands and he then proceeded to rape her on two occasions. Tony's third attempted rape ended by Gloria stabbing him with a pair of scissors.

When Gloria had turned to her parents for help, she was asking for their support on many levels.

Gloria asked her parents 3 questions:
1."Do brothers do this to sisters?"
2. "Is this what I deserve?" and
3. "Is this what I am?"

Gloria's mother dismissed the event, leading Gloria thinking "No one can protect me, I am helpless. To be loved means to be abused." Gloria's father reacted with anger and violence, making Gloria believe "Adults only get angry when you ask for help," Thus, Gloria learned, "If something bad happens, the appropriate response is a violent one".

How Gloria's trauma was defined or interpreted by her parents made the trauma one of the fundamental building blocks of her personality. This was evidenced by Gloria's involvement at age 15 with an older boy, John, age 19, who beat her and forced her to take Ecstasy, on several occasions. Gloria's parents thought she was too young to be dating a boy John's age, so she began seeing him secretly. She began to receive failing grades in most of her classes. Gloria was fired from her babysitting job after she was caught sleeping while the children were outside playing.

Now that we've seen the beginnings of Gloria's beliefs that violence equals love; let's look at how to reframe the guilt and responsibility that is the basis of her belief. As you know, a child's beliefs surrounding the trauma are crucial to the child's construct of self and view of reality.

Three Key Treatment Factors
At this point in Gloria's treatment I felt three key factors were significant:
Factor # 1 - It is important to know what the sexual trauma meant to the Gloria when it happened,
Factor # 2 - What it means to Gloria now
Factor # 3 - How it will affect the Gloria's future personality development.

I found most probably like you, that the cognitive therapy method of externalizing abusive messages is beneficial to helping sexual abused clients to address and grow past their feelings of guilt and responsibility. With Gloria externalizing helped her to understand the trauma in such a way that it would no longer be incorporated into her construct of self. The key to accomplishing this task... was to assist Gloria to externalize the trauma from her constructs of her present and future self. A goal in my sessions was to clearly define the abuse events as something wrong that was done to her, in short, it was not her fault.

I showed her that her belief that "I am the sort of person that these things happen to" had been internalized. I stated, "What do you think of the idea that you are acting out of the belief that you are the sort of person that abusive things happen to by allowing John to abuse you?"

Creating Affirmations
I felt it beneficial for Gloria to create an affirmation to externalize the internalized abusive messages. Instead of stating "I am the sort of person that bad things happen to, I deserve this." Gloria created the affirmation "I'm a good person that was in a bad situation. I did the best I could. This affirmation helped Gloria in beginning to develop a positive construct of self.

Would the construction of an affirmation be beneficial to your Gloria during his or her next session? Would replaying this track, track 2, be beneficial?

I asked Gloria to list three harmful patterns that she experienced. I stated to Gloria, "Sorting out what helped you, from what affected you negatively, is part of moving from awareness to assessment to change." To facilitate this process from awareness; to assessment; to change, I asked Gloria to answer three statements.

3 Statements to Facilitate the Process from Awarness to Assessment to Change

--1. The first was to give an example of how the patterns of abuse functioned in her family. Gloria stated, "We grew up dreading my father's humiliating criticisms."

--2. Second, after discussing family patterns, I asked Gloria to state specifically how these patterns of abuse affected her attitudes and behaviors. Gloria stated, "Now, when I'm afraid I may be wrong, I don't take the risk to say or do anything for fear of being criticized."

--3. Thirdly, after asking Gloria about a pattern of abuse and how this pattern affected her attitudes and behaviors; I asked Gloria to state how the pattern of abuse blocks her growth or harms her relationships with others.

Gloria stated, "I feel this pattern of my father's humiliating criticisms is holding me back from standing up to people when I need to be more forceful, like with my boyfriend John. I didn't want to do the drugs and a lot of times I didn't want to have sex with him, but his cuts and criticisms were so much like my father's voice, I just couldn't stand up to him."

Would it be beneficial to your Gloria to discuss family patterns of abuse, outside of sexual abuse; how these pattern effect his or her attitudes or behaviors; and how these patterns sever to block her growth; to reinforce the concept that "It's not his or her fault."

On this track, we discussed how the child's feelings of guilt and responsibility and their beliefs affect treatment of the child victim. We also looked at how the use of externalizing abusive messages could benefit your client.

The next track will discuss projection and introjection in the desexualization of childhood sexual abuse, as well as the use of a "Positive Retrospection" exercise.

- Duncan, K., PhD. (2004). Healing from the Trauma of Childhood Sexual Abuse. Westport, CT: The Journey for Women, Praeger.

QUESTION 2
When clients have feelings of guilt and responsibility for the abuse, what is one technique to externalize these internalized self-blaming attitudes? To select and enter your answer go to Answer Booklet.