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Child Sexual Abuse: What Can We Do?

 

No individual is safe from sexual abuse, with children being at the forefront of the risk for sexual assault and ongoing abuse. Dax Shepard is a well-known actor who suffered at the hands of another individual when he was a child. Dax is a man who seems to have it all—a successful career in Hollywood, a loving family, and a charming personality that endeared him to many. Behind the bright lights and the smiles he flashed on camera, there lurked shadows of addiction, pain, and memories of sexual abuse from a young age. As time progressed, Dax found himself spiraling deeper and deeper into addiction, using drugs and alcohol to numb the pain of his past.

Child Sexual Abuse (CSA) is an extremely prevalent problem facing people today, with just over 10% of the population suffering from this kind of abuse (Peréz-Fuentes et al., 2013). Among U.S. children, one in five girls and one in 20 boys experience CSA before the age of 18 (Finkelhor et al., 2014). There are a multitude of adverse outcomes for victims of CSA, including the development of mental health issues such as depression, suicidality, low self-esteem and most commonly PTSD (McCutcheon et al., 2010). Additionally, many behavioral issues (i.e. risky sexual behavior and substance use) have also been linked to victims of CSA (Konkolÿ Thege et al., 2017).

The biggest problem surrounding this topic is the lack of intervention in relation to research and a lack of knowledge or skills for victims and their families to identify and/or prevent abuse. This problem exists, in part, due to a lack of education in children (Solehati, et al., 2023). In fact, there is a lack of education on all sides of the problem, spanning children to adults. Children must be better educated on grooming techniques, warning signs among their peers, as well as basic definitions of sex and anatomy. Adults must be educated to properly intervene, see warning signs in children, as well as reduce stigma. It is important for adults to listen to children when they speak about potential CSA. CSA and the possibility of an ensuing SUD have become a large issue in society due to the uncomfortable nature of the subject. Many people do not speak on or about sexual abuse of children because it is uncomfortable; however, closing off the narrative leads to a lack of disclosure, processing, and healing. The lack of awareness, education, and open dialogue leads to a much harder path to recovery for victims. By making our own lives more comfortable and closing off dialogue and education, the lives of the victims become significantly more challenging.

With cultural competency in mind, MFTs can psychoeducate parents on the benefits of speaking candidly about the trauma that has occurred.

To help alleviate this issue, marriage and family therapists (MFT) can utilize brief screening tools (e.g. SPAQ) in early sessions to identify individuals who may have experienced CSA. Once confirming the existence, the Child Sexual Abuse Assessment Tool can be utilized to determine appropriate developmental sexual behavior. MFTs can then educate clients on the prevalence of CSA, normalize their experience and encourage open communication between partners, children or parents. With cultural competency in mind, MFTs can psychoeducate parents on the benefits of speaking candidly about the trauma that has occurred. Concerns of retraumatization can be addressed and realistic goals for treatment can be established. When individuals understand the pervasiveness of CSA, they can take preventative measures to keep their loved ones safe. As an MFT working in school settings, it is of the utmost importance to implement psychoeducation seminars for students and adults that are in and around the campus. Topics of discussion can include but are not limited to appropriate touch and terminology, warning signs sexual abuse may be occurring, and how to approach a suspected victim. Psychoeducation in this setting will help target an at-risk demographic while providing those who can protect the children with the knowledge to notice and act when CSA is ensuing.

Those who have experienced sexual trauma are almost four times more likely to develop a substance use disorder (SUD) because of PTSD than their counterparts (Levin et al., 2021). Additionally, research indicates that individuals with PTSD are more likely to have chronic medical conditions, physical health problems and cognitive impairments (O’Doherty et al., 2015). Some believe that victims of CSA use substances, especially alcohol, as an attempt to self-medicate because of the lingering psychological trauma (Leeies, 2010). By engaging in these unhealthy coping skills at such a young age, victims habituate behaviors that can prove detrimental to their overall well-being.

Once a child has identified sexual abuse has occurred, MFTs play a crucial role in alleviating the harmful consequences surrounding victims and their families. The most common intervention for CSA is Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), which aims to reduce traumatic symptoms such as anxiety, hypervigilance, depression, experiential avoidance, and intrusive thoughts (Liotta et al., 2015). Including the caregiver in sessions helps build support, increases communication about the trauma, teaches coping skills and increases the likelihood that skill acquisition will generalize to the home environment. Educating oneself on this modality will ensure victims receive effective, evidence-based treatment. With consent from parents, MFTs can also educate children on appropriate sexual behavior, terminology and feelings towards themselves or others depending on their developmental status. Illuminating the need for therapy throughout these different developmental stages will ensure victims receive adequate care as they mature. Through a systemic approach and early interventions guided by MFTs, victims have a better chance at healing before maladaptive behaviors develop.

Despite numerous negative health concerns, many victims do not disclose, or minimize their experiences of CSA (McLean et al., 2014). In one study, 19% of participants disclosed their abuse after a year had passed and 26% had not disclosed before taking the survey (Kogan, 2004). Unsurprisingly, there are a variety of factors contributing to low disclosure rates. Both age and gender are significant predictors in that younger children are less likely to disclose than older children and boys appear to be more reluctant to disclose than girls (McElvaney, 2015). In 91% of CSA cases, it is someone known and trusted by the victim or the victim’s family that perpetuates the abuse (CDC, 2022). Children who are abused by a family member are less likely to disclose and more likely to delay disclosure than those abused by someone outside the family (McElvaney, 2015). Knowing this, it becomes imperative to train teachers, physicians and any adult who interacts with children often to recognize the signs that CSA may be occurring.

Child sexual abuse is a rampant problem within society today, a problem that leads to PTSD and often substance use disorders in survivors (Tonmyr et al., 2017). One way to mitigate the lifelong negative effects of SUD is to address the low disclosure rates of CSA. Not disclosing CSA leads the victim to internalize the abuse alone, often in a negative and self-blaming way which can affect treatment (Øktedalen et al., 2015). A child may not disclose due to a lack of education, a fear of being stigmatized as well as not being believed, feelings of shame, feelings of guilt, reactions of others, and a lack of open dialogue on the subject (McElvaney et al., 2013). To raise the disclosure rates, it is essential to bring more awareness and exposure to the general population. There should be focused training implemented for anyone working with children, clarifying how to approach potential CSA victims and how to recognize when it occurs. This training would address preventative measures and anatomical terms of body parts, foster open discussions about CSA, and how to address potential concerns as well as make reports. Opening the dialogue is essential; while it is uncomfortable, it can be helpful for the growth and healing of victims. Increasing disclosure rates will lead to processing and addressing the trauma, leading to a better outcome (Easton, 2020), and hopefully mitigating the risk factor of SUD. Early interventions should be set in place to help replace maladaptive coping mechanisms such as alcohol and drugs.

With earlier interventions as well as education on warning signs of CSA, help can be given to victims to prevent further suffering at the hands of substances.

Amidst the chaos of Dax’s memories and current life, there was a voice within him—a voice that refused to be silenced. It was the voice of a young boy who had been silenced for too long, the voice of a survivor who refused to be defined by his trauma. Dax’s journey to recovery was not an easy one. It was marked by relapses and setbacks, moments of despair, and moments of hope. But through it all, he found solace in the love and support of his family and friends, and in the power of therapy and self-reflection. As Dax peeled back the layers of his past, he uncovered painful memories of sexual abuse that had been buried deep within his psyche. It was a revelation that shook him to his core, but it also gave him the courage to confront his demons head-on and reclaim control of his life. With earlier interventions as well as education on warning signs of CSA, help can be given to victims to prevent further suffering at the hands of substances. Today, Dax Shepard stands not as a victim of his past, but as a survivor. Unfortunately, this story is not an outlier, it is similar to many survivors of CSA, with children being afraid to speak up and adults who do not acknowledge the signs that are present. As a society we need to open a space to begin having more honest and open discussions about child sexual abuse. Staying silent only further protects perpetrators and creates a sense of anxiety that prevents children from speaking up and receiving the support they deserve.

Margo.Plater

Margo Plater, is a first year MFT student at Chapman University, she is also a student member of AAMFT. Margo hopes to work with adolescents and those suffering from substance abuse and or trauma. She hopes to help her clients find healthy ways to cope with previous trauma and or life stressors, and set foundations for a sustainable lifestyle and a strong support system.

Julie Payne, DMFT, LMFT, is an AAMFT Professional member holding the Clinical Fellow and Approved Supervisor designations and a Clinical Assistant Professor at Chapman University in the Marriage and Family Therapy Program. She has over 17 years of clinical experience working in community-based mental health and private practice settings. Dr. Payne is currently licensed and practicing in California and Texas specializing in working with families and individuals living with chronic illness/pain, military families, children and adolescents, and trauma.

Andrew Siongco, is a 1st year MFT Student at Chapman University. As an aspiring MFT, Andrew has worked with children and adolescents for over five years. He hopes to facilitate productive communication between parents and children to deepen connections, address generational trauma and increase the overall well-being of every individual he meets.


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