Recent social movements in the United States have opened a dialogue and broadened our awareness about sexual abuse. This traumatic event, or series of events, can leave an indelible imprint in the psyche and thus, deserves compassion and attention. Childhood sexual abuse deserves immediate attention and restructuring of the environment so as to prevent revictimization. A variety of symptoms may arise in children who have been sexually abused including depression, anxiety, fearfulness, anger, sexually reactive behaviors, guilt, shame, and many more. Research indicates the duration and frequency of abuse, the relationship of the perpetrator to the child, and parental (particularly maternal) support affects the severity of these painful psychological experiences (Kendall-Tackett et al., 1993). This latter consideration within the past few decades has proven to be one of the most powerful mediating factors in sexually abused children, adolescents, and adults. The experience of being validated, believed, and supported actively work against the tendency for shame, anxiety, guilt, etc. that may become embedded in the psyche of sexual abuse victims (Hong et al., 2011). In fact, the lack of parental support within families who have endured child sexual abuse is significantly predictive of psychological symptoms that persist into adulthood such as maladjustment, mistrust, feeling distanced from loved ones, and avoidance tactics (Merrill et al., 2001). Avoidance in particular has shown to be particularly strong as adult victims of childhood sexual abuse learn to disengage as a means to adapt against persistent fear, confusion, embarrassment, sadness and stigma (Coffey et al., 1996). However, the development of effective coping strategies and parental support are found to directly predict posttraumatic growth – defined as experiencing positive psychological change after facing a traumatic life event (Kaye-Tzadok & Davidson-Arad, 2016).

Parents who are struggling with the aftermath of childhood sexual abuse often report anger, helplessness, immense guilt and shame, and a hesitancy towards letting their children interact with other adult figures. This finding is increasingly poignant when considering the tendency for children to look to their parents for answers of “why” and for how to move past the traumatic life event. Parents often report a sense of paralysis in these moments, believing every word they say carries great weight, must be said careful and sensitively, and above all, must be helpful. This pressure on parents and other non-offending caregivers of children who have endured sexual abuse may be further complicated if these adults have histories of sexual abuse. Research indicates adults who have endured childhood sexual abuse may struggle to accurately mentalize their children in these moments due to an influx of associations and memories compounded by the social pressure of helping their child. In these high-stress moments, parents may automatically presume, without meaningful reflection, what their child feels, thinks, anticipates, desires, and reasons about their complicated experience (Bateman & Fonagy, 2019). This parental domination over the child’s unique subjective experience, no doubt grounded in a loving and helpful initiative in parents, risks reminding the child of the milieu surrounding the sexual abuse – when their own unique feelings, thoughts, wishes, and expectations were secondary to those of a perpetrator during the sexual abuse. Instead, parents are advised to effectively mentalize – to consider the entire mental state of self and others based on their circumstances, patterns of behavior, thoughts, feelings, and wishes – by reflecting with the child about their experience. In this endeavor, parents should be prepared to “get it wrong” when inquiring what their children make of their experience. While it may be frustrating for a parent to mistakenly interpret their child’s mental states, it is this very empirically proven curative workhorse of mentalization with traumatized individuals (i.e., genuine curiosity and retrying) that allows people to engage with their inner experiences with another person – a powerful tool for intimacy, connection and social harmony.

Thankfully, for those struggling with the aftermath of sexual abuse there is hope. Promising treatments such as Trauma Focused Cognitive Behavior Therapy (TF-CBT) and mentalization based strategies help to ease psychological turmoil. Studies indicate TF-CBT displays improvements in PTSD symptoms, de-stigmatization, decreased shame, self-blame, and other problematic behaviors – treatment gains that are maintained up to 1 year after treatment ends (Feiring et al., 2009; Webb et al., 2014). Moreover, TF-CBT is proven effective across wide age ranges and with severaly traumatized youths with complicated symptoms of posttraumatic stress (Knutsen et al., 2019). Other helpful interventions include mentalization based strategies for individuals, families, and groups who have endured trauma (Bateman & Fonagy, 2019). Mentalization based treatments for individuals and their families are associated with significant reductions in behavioral and emotional difficulties in children and young people, as well as significant reductions in the common parental sense of “stuckness” prior to seeking treatment (Stob et al., 2019; Keaveny et al., 2012; Bateman & Fonagy, 2019). At Town Center Psychology, our clinicians aim to provide a supportive, mentalizing, and inviting environment to process and cope with trauma. If you would like to begin the process of healing and adapting to the aftermath of sexual abuse, please consider consulting with the clinicians at Town Center Psychology. You are not alone!

References

Bateman, A & Fonagy, P. (2019). Handbook of mentalizing in mental health practice: Working with families. American Psychiatric Publishing.

Coffety, P., Leitenberg, H., Henning, K., Turner, T., & Bennett, R. T. (1996). The relation between methods of coping during adulthood with a history of childhood sexual abuse and current psychological adjustment. Journal of Consulting and Clinical Psychology, 64, 1090-1093. doi: 10.1037/0022-006X.64.5.1090

Feiring, C., Simon, V. A., & Cleland, C. M. (2009). Childhood sexual abuse, stigmatization, internalizing symptoms, and the development of sexual differences and dating aggression. Journal of Consulting and Clinical Psychology, 77, 127-137. doi: 10.1037/a0013475

Hong, P. Y., Ilardi, S. S., & Lishner, D. A. (2011). The aftermath of trauma: The impact of perceived and anticipated invalidation of childhood sexual abuse on borderline symptomatology. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 360-368. doi: 10.1037/a0021261

Kaye-Tzadok, A. & Davidson-Avad, B. (2016). Posttraumatic growth among women survivors of childhood sexual abuse: Its relation to cognitive strategies, posttraumatic symptoms, and resilience. Psychological Trauma: Theory, Research, Practice, and Policy, 8, 550- 558. doi: 10.1037/tra0000103

Keaveny, E., Midgley, N., Asen, E., Bevington, D., Fearon, P., Fonagy, P., et al. (2012). Minding the family mind: The development and initial evaluation of mentalization-based treatment for families. In N. Midgely and I. Vrouva (Eds.), Minding the child: Mentalization-based interventions with children, young people and their families (pp. 98-112). Routledge.

Kendall-Tackett, K. A., Williams, L. M., Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113, 164-180. doi: 10.1037/0033-2909.113.1.164

Knutsen, M. L., Sachser, C., Holt, T., & Goldbeck, L. (2019). Trajectories and possible predictors of treatment outcome for youth receiving trauma-focused cognitive behavioral therapy. Psychological Trauma: Theory, Research, Practice, and Policy, 12, 336-346. doi: 10.1037/tra0000482

Merrill, L. L., Thomsen, C. J., Sinclair, B. B., Gold, S. R., & Milner, J. S. (2001). Predicting the impact of child sexual abuse on women: The role of abuse severity, parental support, and coping strategies. Journal of Consulting and Clinical Psychology, 69, 992-1006. doi: 10.1037//0022-006X.69.6.992

Stob, V., Slade, A., Brotnow, L., Adnopoz, J., & Woolston, J. (2019). The family cycle: An activity to enhance parents’ mentalization in children’s mental health treatment. Journal of Infant, Child, and Adolescent Psychotherapy, 18, 103-119. doi: 10.1080/15289168.2019.1591887

Webb, C., Hayes, A. M., Grasso, D., & Laurenceau, J. P. (2014). Trauma-focused cognitive behavior therapy for youth: Effectiveness in a community setting. Psychological Trauma: Theory, Research, Practice, and Policy, 6, 555-562. doi: 10.1037/a0037364