Understanding Childhood and Sexual Abuse The American Experience

1
Understanding Childhood and Sexual AbuseThe
American Experience

• Jon R. Conte, Ph.D
• University of Washington
• Seattle, Washington

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Introduction

• Areas of Interest
• Goal of Dialogue and Sharing of Experience
• Please feel free to ask questions or make
  comments
• Expansion of knowledge
• Worldwide National and International Societies
• Child abuse and neglect the International
  Journal
• USA
• Four or Five Specialty Journals
• Local conferences and Trainings
• Every discipline e.g. American Journal Psychiatry
• Issue no longer controlled by professionals
• Politicians, media, non-abuse professionals
• Young professionals entering without a sense of
  history

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History of Awareness

• Ancient History
• Late 1890s, Freud Study of Hysteria
• Effects of Abuse
• Denial of Victim Experience
• What motivated Freud?
• Rise of Modern Feminism and Rape Crisis Center
• Professionals and public forced to see what was
  always there
• Freud to late 1970s
• Sandy Butler- Father Daughter Incest
• Ann Burgess et al- Sexual Assault of Children and
  Adolescents
• Media Attention
• Victims tell their stories
• Basic Research

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Parallel Developments

• Study of Hysteria 1880 Europe
• Study of War Trauma 1918
• Battered Children Syndrome, 1968.
• C. Henry Kempe
• Child Abuse as distinct types of maltreatment
• Domestic violence and rape as separate fields

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Careful Study of history reveals

• Compartmentalization
• Fragmentation
• Denial, rationalization, minimization
• Resulting in periodic amnesia, disbelief, and
  rejection of the truth

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Why Denial?

• Reality of abuse forces confrontation with
• Horror, depravity, violence, and abuse
• Darkness of human nature
• Dark side of families, churches, social
  institutions
• Denial and Defense protect us from what is
  profoundly uncomfortable

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Judith Herman, M.D.Trauma Recovery. 1992 Basic
Books

• Classic documents of fifty or one hundred years
  ago often read like contemporary works. Though
  the field has in fact an abundant and rich
  tradition, it has been periodically forgotten and
  must be periodically reclaimed. This
  intermittent amnesia is not the results of the
  ordinary changes in fashion that affect any
  intellectual pursuit. The study of psychological
  trauma does not languish for lack of interest.
  Rather, the subject provokes intense controversy
  that it periodically becomes anathema. The study
  of psychological trauma has repeatedly led into
  realms of the unthinkable and floundered on
  fundamental questions of belief.

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Implications

• Awareness and true understanding illusive
• Requires a process of self and other education
• Recognize the psychological tendency to deny and
  suppress in clients, significant others and
  ourselves
• Knowledge critical, research on-going
• Resolution not easy or short term
• Understand and manage the impact of this work on
  our lives

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Trauma/Child Sexual Abuse Work

• Requires a relationship
• Reciprocal impact on personal life and work
• Self-awareness and self-understanding
• Manage vicarious trauma

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How many children are abused?

• Underreported as are all crimes
• Methodological issues
• Data

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Reporting

• Professionals do not report unless required to do
  so
• USA laws require reporting when reason to
  suspect

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Reasonable Suspicion

• Low level of suspicion
• Allows professional investigators to make this
  determination
• Recognizes that determining if child abuse
  occurred can be complex
• Relieves professional of obligation to
  investigate and protects relationship with family
• Mandated reporters
• Confidential reports

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• Many clients appreciate intervention
• False reports vs. Unsubstantiated
• False reports rare
• Most often teenagers or adults
• Disguised or unclear disclosure
• Poor practice (e.g. childrens art, leading
  questioning)

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How many children disclose?

• Studies vary
• 40 disclose at the time
• 24 females, 14 males disclosed later
• 33 females, 42 males not disclose until asked
  by researchers
• Study of professional women abused in childhood,
  40 never disclosed
• Retrospective studies, 6 to 12 cases ever
  reported to authorities

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Who do children disclose to?

• Usually parent, then parent of friend
• Most cases come to attention of authorities for
  reason other than child report
• Those who ask

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Do Children with strong evidence deny?

• Yes, 40 children with STD deny when asked
• 10 of children with strong forensic evidence
  deny
• 22 recant at some point

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Why do children recant?

• Reaction of those they tell
• Consequences to child and family
• Pressure from offender or others

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Why do children not disclose?

• Young children do not understand
• Informed consent
• Grooming
• Process of selection
• Recruitment
• Involvement in abuse
• Maintaining cooperation and silence

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Abuse is not impulsive

• No offender abuses every child he comes in
  contact with
• Planned
• Not getting caught is paramount goal
• Threaten, bribe, bargain
• Use what important to child
• Separate child from sources of protection

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Risk Factors Females vs. Males

• Males
• Older at onset
• More likely abused non-family members
• More likely abused by females
• More likely abused by offenders known to have
  abused other children
• Some racial/ethnic differences
• Hispanic women - abused by family members
• Families
• More distressed, dysfunctional, disorganized
• Child
• ever lived away from one of natural parents
• perceive family as unhappy
• unavailable mother
• disability

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Limitations of risk factors

• Limited research
• Any child in the wrong place at the wrong time is
  at risk
• Special Risks
• Catholic Child
• Child of drug using parents

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Grooming techniques

• Force or threat of force
• Gradual increase in sexuality
• Bribe, promise, bargain
• Disguise (e.g. sexual education)
• Use of authority
• Use of relationship
• Pornography
• Other victims

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Results of grooming process

• Conditioned child
• Child who feels responsible
• Child who fears disclosure
• Child feels shame, humiliation, ambivalence
• Child feels s/he has a relationship with offender
• Seventy percent of children are abused more than
  once
• De-conditioning (therapy)

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Limitations of Grooming concept

• Is not a diagnostic factor of any value
• Some children are raped
• Focus on child vs. adult and community

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What are the characteristics of childhood sexual
abuse?

• General population studies
• Parent/parenting figure 6 to 16
• Clinical Samples
• Parenting figure 24 to 33
• All family about 50
• Strangers 5 to 15
• Offenders
• 40 offenders are teenagers
• Overwhelming percent are male

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• Multiple Episodes
• 50 non-clinical
• 75 clinical samples
• Completed or attempted oral, anal, vaginal
  penetration
• 25 non-clinical
• 50 or more clinical
• Average age 9
• range infancy to end of childhood
• Duration varies greatly

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What is the experience of the abused child?

• No words for unexplainable
• Understanding dependent on time, developmental
  level, and context specific
• Complex relationships-ambivalence
• Offender disguises nature of events
• Dynamics of abuse
• Isolation, betrayal, threat, force, manipulation,
  corruption, conditioning
• Linked to disclosure, intervention, treatment

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Who abuses children?

• Particularly difficult question
• Need to face reality that offenders are members
  of families and communities
• Long history of theories which minimize
• Incest is a family problem
• Children fantasize
• Nothing wrong with sex between adults and children

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Abel Data 1987

• 561 men in therapy for sexual offenses
• absolute confidentiality
• data based
• expert interviewers

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Number of Victims
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Number of Acts
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Relationships between paraphilias

• Female incest (N142)
• 11 male incest
• 18 adult rape
• Female non-incest (208)
• 30 female incest
• 10 male incest
• 20 adult rape

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Characteristics of Sexual Offenders

• Polyperverse
• Denial
• Arousal distorts perception
• Rationalize and minimize behavior
• Sexual Arousal
• Sexualization of children
• Normal arousal increases in child age 14 to 18
• Unclear what is arousing
• Childs body
• Psychological Factors

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• Cognitive Distortion
• Fantasy
• Pornography as teacher
• Rehearsal
• Social skills
• Personality characteristics
• Prior history of victimization
• Controllability, risk assessment

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Implications

• Offenders do not self refer
• Denial, distortion, fear great
• first goal of therapy
• Separate offender from family, not child from
  family
• Social supports critical
• Services to non-offending parent and siblings
• Offender suffer consequences to extent possible
• Identification and control first priority

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• Community as protection
• Full disclosure
• Community monitor
• No confidentiality
• Community vs correctional treatment
• Therapy specialized and directed toward nature of
  problem
• Regulated specialization
• Treatment model

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How to get disclosures?

• Rationale for wanting disclosure important
• Harms of sexual abuse
• Human rights/ rights of the child
• Create a climate of acceptance and belief
• Teach children about touching
• Books and Media
• Prevention education
• Touching and telling
• Disclosure vs. prevention programs
• Media depictions and stories

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• Help parents talk to children about touching
• Train professionals to recognize and report
• Talk to children about their experiences
• Behavior (indicators) of some value
• Change in behavior/ functioning
• Symptoms of stress/ anxiety
• Sexual knowledge, developmentally inappropriate
• Sexual behavior

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Multidisciplinary Intervention-

• Each discipline different role
• Cooperation and collaboration
• Team investigation
• Sharing of information and tasks
• Respect differences of role and skills
• No one discipline rules
• Protect child victims and all children
• Move as swiftly as possible
• Prevent contact between child and alleged
  offender
• Prevent System-induced trauma

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Law enforcement

• Collects and preserves evidence for criminal
  prosecutions
• Performs criminal history record checks
• Interviews adult witnesses and accused persons
• Obtains search warrants
• Can interview child and other children
• Protects society

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Medical Professionals

• Conducts forensic medical examinations
• Preserves any physical evidence
• Interprets medical findings for team
• Interviews child about experiences, medical
  conditions, and records statements and behavior
• Reassures child that s/he is healthy

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Child Protective Services

• Accepts reports
• Interviews alleged child victim
• Interviews siblings/ non-offending adults
• Arranges and coordinates system response
• Conducts risk assessment
• Develops safety plan, including removal of
  offender
• Undertakes family or juvenile court action as
  necessary
• Arranges for placement of child if necessary
• Protects alleged victim of victimization or
  manipulation

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Specialized forensic evaluations of child

• Complex cases or where CPS lacks specialized
  skill
• Experts in forensic child interviewing
• (see below)
• Conducts multiple forensically valid interviews

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Prosecutor

• Participates in overall investigative strategy
• Assesses quality of evidence
• May participate in suspect interview
• Determines appropriate charges
• Prepares evidence
• Conducts trial

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Mental Health Professional

• Offender therapist not part of the team
• Provides on-going therapy for victimized child
  and family

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Mental health issues

• Attitude of law toward therapy
• Contamination
• Child focus on prosecution and process
• Support vs. Therapy
• Child vs. Family as client
• Confidentiality with team

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Problems in multidisciplinary teams

• Team conflicts and emotions
• Power hierarchy
• Inadequate knowledge and personal bias

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Specialized assessments of children for possible
abuse

• Dramatic increases in knowledge
• Children as witnesses
• Child language and development
• Protocols vs. indicators
• Awareness of limitations of childrens reports
• Objectivity
• Avoid leading and suggestive questioning
• Understanding the childs language, world, and
  experiences

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Abuse-specific psychotherapy

• Different than regular child therapy
• Focus on trauma and impacts
• Set basic principles and ideas based on
  understanding abuse and trauma
• Child focus, developmentally appropriate

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Principles

• Assessment linked to trauma
• Safety is necessary but not sufficient condition
  for healing
• Anxiety is key
• Surface trauma
• Identify what is anxiety-producing
• Trauma narrative provides exposure
• Expect Transference

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• Educate about abuse
• Identify and manage impacts/symptoms
• No single theory of etiology
• Post-traumatic effects
• Cognitive distortions
• Altered emotionality
• depression
• anxiety
• Dissociation
• Impaired self-reference
• Disturbed relatedness

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• Intimacy disturbance
• altered sexuality
• assumptions regarding aggression in relationships
• adversariality and manipulation
• aggression
• Avoidance
• use of psychoactive drugs
• suicidality
• tension-reducing behaviors
• Cognitions, meaning
• Abuse as a learning experience
• Manage counter-transference

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Working with Parents

• Establish collaborative alliance
• How much information to share
• Childs developmental level
• Parent capacity
• Help parent cope with own feelings
• guilt, anger, denial
• Parent history of abuse

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• Help parent help child
• Talk about abuse
• Manage behavior
• Repair relationship
• Deal with distortions from offender
• Deal with system
• Deal with impact on parent-child relationship

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For Your Own GoodBy Alice Miller

• When Galileo in 1613 presented mathematical
  proof for the Copernican theory that the earth
  revolved around the sun and not the opposite, it
  was labeled false and absurd by the church.
  Galileo was forced to recent and subsequently
  became blind. Not until three hundred years
  later did the church finally decide to give up
  its illusion and remove his writings from the
  index.

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• Now we find ourselves in a situation similar to
  that of the Church in Galileos time, but for
  us today much more hangs in the balance.
  Whether we decide for truth or for illusion will
  have far more serious consequences for the
  survival of humanity that was the case in the
  17th century. For some years now, there has been
  proof that the devastating effects of the
  traumatization of children take their inevitable
  toll on society- a fact that we are still
  forbidden to recognize. This knowledge concerns
  every single one of us, and - if disseminated
  widely enough - should lead to fundamental
  changes in society above all, to halt in the
  blind escalation of violence.

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Jon R. Conte, Ph.D.School of Social
WorkUniversity of WashingtonBox 3459004101
15th Ave. NE.Seattle, WA, 98105USAcontej_at_u.was
hington.edu