Mental health articles

Child Sexual Abuse and Repeated Victimizations
Child sexual abuse typically involves a child victim and a perpetrator known
to the victim, usually a family member, caretaker, or neighbor. Th e impact
of the abuse depends on the age of the victim and the perpetrator, behavior,
type of contact, and perception of the abuse. Like other kinds of sexual victimization,
it is best to consider child sexual abuse along a continuum rather
than as a dichotomous, yes-or-no phenomenon. In general, though, child abuse is devastating. Children who experience sexual violence are most
vulnerable to repeat victimization and negative life outcomes for years aft erward,
including mental, reproductive, and sexual health problems; studies
show that 12–17% of girls and 5–8% of boys suff er these consequences (Doll,
Koenig, & Purcell, 2004).
Walker (2004) cautions that the reactions of repeatedly victimized people
should not be pathologized, although we might be tempted to do so because
they frequently display poor judgment or self-destructive behaviors. Th ose
who have been repeatedly victimized perceive life diff erently from those in the
majority culture, oft en experiencing their world as hurtful rather than caring
and their family as unsafe rather than secure. Lynn, Pintar, Fite, Ecklund, and
Staff ord (2004) suggest that they may deal with this discrepancy between their
own and the mainstream worldview by making choices that reduce the dissonance—
repeatedly putting themselves in vulnerable situations to fi t their
expectations of an unsafe world. Using this framework, their behaviors can be
understood as dysfunctionally functional rather than pathological (Lynn et
al., 2004, p. 173). To break the pattern of repeated victimizations, counselors
need to help clients recognize traumas, fi nd new and constructive ways of
coping, separate from dangerous relationships, and avoid high-risk behaviors.
Some clients may fi nd additional healing in reaching out to other victims or
engaging in activism against sexual assault.
Th e following case illustrates heightened vulnerability, dissociation from feelings,
and use of numbing to handle anxiety, all associated with revictimization.

Bass and Davis (1988), writing for victims of child sexual abuse, advise that
the healing process begins by taking stock, recognizing the damage, and honoring
what the victim had to do to survive. Healing steps include accepting that
the abuse happened; breaking the silence; understanding that it wasn’t one’s
own fault; identifying the child within; trusting oneself; grieving; and anger.
Sometimes there is a diffi cult stage where remembering is easily triggered and
can be overwhelming. Resolution may include disclosures and confrontations,
forgiveness, and spirituality. It entails developing self-esteem and personal
power, experiencing feelings, and reconnecting with one’s body and with intimacy
and sex. Resolution also requires that victim/survivors understand the
impact of the abuse on their interactions with romantic partners, families of
origin, friends, and their own children. Follow-up readings (e.g. by Davis [1990,
1991]) are also helpful for counselors, clients, and those close to clients.
It is important to utilize grounding and containment strategies along with
relaxation techniques so that clients can create emotional distance from the
abuse when reprocessing it. Containment, a key clinical concept for regulating
regression, dissociation, and/or retraumatization, provides safety for
victims by creating a “holding space” for unprocessed memories so they can
be identifi ed, explored, and expressed. Visual, physical, or cognitive grounding
strategies, such as deep breathing, help clients who dissociate or have
intrusive memories.
Oft en victims of child sexual abuse tell no one, keeping their secret out
of shame, fear, or the wish to protect others. Th e therapist may be the fi rst
person they disclose it to, and this revelation must be authentically heard and
not lost or minimized, as counselors are entrusted recipients. Th e following
case exemplifi es how sexual victimization is sometimes hidden even from the victim.

Th ere has been controversy over the accuracy of recovered memories of
abuse. Pope and Brown (1996) provide an in-depth discussion of clinical considerations
when working with clients who report recovered memories, and
suggest that this work requires specifi c competencies and knowledge.

Tags: sexual abuse