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

Section 3
Psychological Trauma

Question 3 | Test | Table of Contents | Child Abuse CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, & MFT CEU

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In the last section, we discussed how the child’s feelings of guilt and responsibility for the abuse and their beliefs affect their self-concept.  We also looked at how the use of externalizing abusive messages could benefit your client.

In this section, we will discuss projection and introjection in the desexualization of childhood sexual abuse.  At the end of the section we will look at the use of the Positive Retrospection exercise.

As you know, an obstacle for adults and children alike in overcoming their sexual trauma is shame.  To deal with this shame, desexualization of the abuse is key to reminding the client that what happened to them was not sexual, but a violation of boundaries.This insight can be a beginning to heal.  

♦ Resolving Conflicts
Here’s how I assisted Jackie, age 21, who had been molested by her grandfather when she was seven, realize her inner reality and began to resolve her conflicts. Jackie found it very reassuring to realize there was nothing sexual about the abuse, as is in the case of rape, molestation, and incest. 

I explained to Jackie, "Your grandfather’s acts were a violation of boundaries.  I know your grandfather led you to believe you were responsible, but the abuse you endured was a traumatic event over which you had no control whatsoever and for which you were not responsible!"  I am continually surprised at how this apparently simple intervention of reframing the abuse from a sexual act to a boundaries violation is so ego-supportive in nature. 

I have found it can sometimes be the turning point that sets in motion the positive self-perpetuating psychological cycle of healing. The reframing from a sexual act to a boundaries violation corrects the cognitive distortions and has the potential for long lasting psychological change.

The deep feelings of guilt "that it was their fault" harbored by survivors of sexual abuse leads to varying levels of stress and inner tension.  A way Jackie used to reduce this stress and inner tension was projection of blame. Like many survivors of sexual abuse, by projecting blame, Jackie lessened her feelings of guilt and shame as these emotions were released. Jackie projected blame onto her grandfather, who abused her when she was seven. 

She sobbed in one session, "My grandfather had a choice!  He made a choice!  I’ve had choices in my life that were difficult. Sometimes I’ve failed. But for the most part I try very hard not to fail. And I don’t think he tried one bit. I think he gave in to his impulses and used me every time he felt like it."

As you can see, Jackie projected her blame onto her grandfather in such a way to defend herself from feeling the emotional pain of the abuse. In short, Jackie would rather feel anger and blame towards her grandfather than the helpless vulnerable hurt of the abuse.

♦ Controlled by Introjection
However, another type of defense that Greg used wasnot projection but introjection.  Unlike projection, introjection occurs when the client partly assimilates the characteristics of the blamed object, in most cases the abuser, onto him or herself.  When this happens, the client remains controlled by the introjection.  But the client is still separated from the introjection enough that the self and the negative do not yet entirely mingle and become one.  However, this sort of defensive operation can lead to the Freudian mechanism of identification with the aggressor

In such a case of identification with the aggressor, as you probably know, the victim of the sexual abuse can indeed become an abuser later on.  In identifying himself with the aggressor, Greg felt that he had obtained the power once attributed to his abuser.  This was evidenced by the fact that Greg, age 14, had been molesting his younger sisters ages 6 and 7. 

After being referred to a therapist on our team, Greg revealed that his Uncle Marcus had abused him when he was 7.  Greg's therapist felt his abuse of his siblings was his attempt to overcome the helplessness he experienced during his own abuse.  In becoming the abuser, Greg, in his mind, was becoming as strong as his Uncle Marcus. 

Can you think of a client you are currently treating that you feel is identifying with his or her aggressor?  At the end of this section, I will explain Positive Retrospection which may be of assistance to you with this client.

♦ Role of the Victim
Now that we’ve discussed projection and introjection, let’s discuss the risk of a client assuming the permanent role of a victim. As you are well aware, clients that have survived sexual abuse divide the world into two main categories:  victims and abusers. We have already discussed those clients that assume the role of abusers. We will now talk about clients who take on the role of a victim. As you might have observed, these types of survivors generally tend to be reclusive and many times refuse human contact for fear of more abuse. 

On the other hand, in this case, the client may act aggressively instead of passively. I feel this is due to the body’s overcompensation of protection in order to prepare or defend against another attack of abuse.

Seven year old Jeremy, for example, had been molested by his stepfather’s friend Charlie, who lived down the street. After being abused, Jeremy insisted on wearing masks and costumes whenever he was taken by Charlie’s house. Jeremy did not cease wearing the disguises until he had been reassured by his parents that Charlie had been put in jail and would not be back for a long time. 

Jeremy told me, "When he comes out of jail, I’ll be big enough to beat him up."  Jeremy’s actions, I believe, were a materialization of his sense of danger after he was sexually abused.  The disguises were Jeremy’s mode of protection from his abuser.

♦ Positive Retrospection Exercise
To help clients like Jackie, Greg, and Jeremy cope with their guilt and negative self-image, I found the "Positive Retrospection" exercise beneficial.  For example, with Jackie, I had her think back to a certain period in time or a specific instance in which there was much encouragement and positive reinforcement.  For instance, this kind of memory could be as general as a sports team they had been a part of or as particular as a compliment someone gave them. Jackie recalled a memory of her third grade teacher who had said to her, "We small ones are more powerful than people realize." 

The next step, in the Positive Retrospection exercise was after Jackie had truly focused on that memory, I had her write down three words, preferably emotions, that describe how it made her feel.  Her three words were "gratitude," "happiness," and "confident."  I then asked Jackie to concentrate on these emotions in the coming weeks and to try to focus on events in her life that renewed her feelings of gratitude, happiness, and confidence. 

In this way, she began starting to rebuild her self-image and with these positive focal points.  By recalling positive experiences Jackie, Greg and Jeremy were able to reframe the context of the abuse and initiate putting it into perspective.  This Positive Retrospection exercise reduced Jackie’s, Greg’s and Jeremy’s feelings of shame that resulted from their sexual abuse. 

In this section, we have discussed projection, introjection, and clients who take on the role of a victim in feeling the abuse was their fault.

In the next section, we will look at the process of grieving the loss of security; the loss of childhood; and the use of the "Story Telling" technique.

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

Peer-Reviewed Journal Article References:
Classen, C. C., Palesh, O. G., Cavanaugh, C. E., Koopman, C., Kaupp, J. W., Kraemer, H. C., Aggarwal, R., & Spiegel, D. (2011). A comparison of trauma-focused and present-focused group therapy for survivors of childhood sexual abuse: A randomized controlled trial. Psychological Trauma: Theory, Research, Practice, and Policy, 3(1), 84–93. 

Goodman, G. S., Goldfarb, D., Quas, J. A., & Lyon, A. (2017). Psychological counseling and accuracy of memory for child sexual abuse. American Psychologist, 72(9), 920–931.

Misurell, J., Springer, C., Acosta, L., Liotta, L., & Kranzler, A. (2014). Game-based cognitive–behavioral therapy individual model (GB-CBT-IM) for child sexual abuse: A preliminary outcome study. Psychological Trauma: Theory, Research, Practice, and Policy, 6(3), 250–258.

Shevlin, M., Murphy, S., Elklit, A., Murphy, J., & Hyland, P. (2018). Typologies of child sexual abuse: An analysis of multiple abuse acts among a large sample of Danish treatment-seeking survivors of childhood sexual abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 263–269.

Tener, D., Lusky, E., Tarshish, N., & Turjeman, S. (2018). Parental attitudes following disclosure of sibling sexual abuse: A child advocacy center intervention study. American Journal of Orthopsychiatry, 88(6), 661–669.

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.

What is one step of the Positive Retrospection exercise? To select and enter your answer go to Test.

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