Therapy Alternatives -- Child Sexual Abuse Alternatives

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Alternatives to
Child Sexual Abuse

Other Child Abuse ~ Spousal/Partner Abuse ~ Elder/Dependent Adult Abuse ~ Other Populations

NOTE: Although abuse occurs in every country, information on this page pertains to the United States, except as otherwise indicated.

Definition

Child sexual abuse is any use of a child for the sexual gratification of an adult. In child sexual abuse, an adult has influenced or forced a more vulnerable person (the child) to engage in sexual activity when he or she is not developmentally able to consent to sexual activity. Sexually abusive behaviors include exhibitionism, child pornography, sexualized kissing, and fondling.(1)

Many experts believe that sexual abuse is underreported because of the secrecy that so often characterizes these cases.(2) Both victim and perpetrator, as well as many others in the child's life, are motivated to keep silent about the abuse for fear of the consequences.

back to top Prevalence

Most children are never abused. However, although the number of children investigated by the Child Protective Services (CPS) system in the US has steadily declined each year from 1993 to 1999, there were still almost 100,000 children sexually abused in the 50 United States in 1999.(3) Even more alarming, epidemiology studies of adults in varying segments of the community have found that 15 to 33 percent of females and 13 to 16 percent of males were sexually abused in childhood.(4)

An estimated 826,000 children were victims of abuse and neglect in 1999. This estimate is based on data from all 50 States. In those States, 11.8 children for every 1,000 children in the population were victims of abuse or neglect. 11.3% of these children were sexually abused. In addition, more than a third of all victims were reported to be victims of other or additional types of maltreatment.(3)

Male parents were identified as the perpetrators of sexual abuse for the highest percentage of victims.(3)

back to top Some Symptoms of Possible Child Sexual Abuse(5)

Bed-wetting (enuresis) or fecal soiling (encopresis)

Eating disturbances

Fears/phobias/compulsive behaviors

Age-inappropriate behaviors (pseudomaturity or regressive behaviors)

Sleep disturbance

Depression, low self-worth, or withdrawal

Overly compliant

Age-inappropriate excessive self-consciousness of body

Sudden possession of money, new clothes, or other gifts

Self-destructive behavior, self-defeating behavior

Suicidal thoughts, plans, attempts

Crying without apparent reason

Fire setting

Sexually transmitted diseases, genital infection

Physical trauma or irritation to the anal or genital area

Difficulty walking or sitting due to genital/anal pain

Pain on voiding/elimination

Psychosomatic symptoms

Age-inappropriate knowledge of sexual behavior

Inappropriate sexual behavior with siblings, peers, or objects

Compulsive masturbation

Excessive curiosity about sexual issues and/or genitalia

Promiscuity or prostitution

back to top Ways to Heal(6)

The aim of treatment is to facilitate the healing process and work towards the goals outlined in a beginning assessment stage. Young children communicate with play more than with words; therapy with them will probably take a different form than with older children. Working with young children, therapy often takes the form of symbolic play.

Any of the following modalities may be helpful.

Individual Sessions: One therapist, one client (the client could be the abused child, a parent, a sibling, or anyone affected by the abuse). Individual therapy provides privacy for whomever may not feel comfortable or able to discuss her or his issues in the presence of others. Almost all children who've been sexually abused should be offered individual sessions.

Groups: A group of people with similar experiences assist in discussions and/or activities led by one or more trained group facilitators. Group therapy provides individuals with an opportunity to share information and learn from the experiences of others, while limiting the isolation that many people may feel in a one-to-one counseling situation. Although group therapy can serve as a type of support, there are groups set up specifically for the purpose of providing support for participants.

Family Sessions: One family (the definition of family members can be very broad, i.e., non-offending parent, partner, siblings, stepparents, step-siblings etc.) works with one therapist (therapist can work both with the family as a whole as well as with individual family members). Because sexual abuse affects more than just the "victim", family therapy helps to deal with the dynamics of family functioning and interactions.

Please note: while a child experiencing any abuse may benefit from therapy, a child who has been sexually abused should be referred for therapy as soon as possible. Even if the family is participating in other treatment, the child should be referred for her or his own individual sessions; it is important to evaluate the impact of abuse without the family issues overshadowing the child's experience.(7)

Given the prevalence of parental abusers, individual therapy (and removal from the home) may be the only appropriate treatment for sexually abused children in many cases.

Sources:

1. "The Problem", Giardino, A. P. In: Finkel, M. A.; and Giardino, A. P. (Editors). Medical Evaluation of Child Sexual Abuse: A Practical Guide. Second Edition. 2001. Sage Publications Inc.: Thousand Oaks, CA.

2. "What is Child Maltreatment?", 2001. US Dept. of Health & Human Services, Admin. for Children & Families. http://www.calib.com/nccanch/prevmnth/childmal.htm

3. "Child Maltreatment: 1999 Reports From the States to the National Child Abuse and Neglect Data System". 2001. US Dept. of Health & Human Services, Admin. for Children & Families. http://www.acf.dhhs.gov/programs/cb/publications/cm99/index.htm

4. "Mental Health: A Report of the Surgeon General". 1999. U.S. Dept. of Health & Human Services, Substance Abuse and Mental Health Services Administration. http://www.mentalhealth.org/features/surgeongeneralreport/chapter4/sec1_1.asp

5. "Therapist's Guide to Clinical Intervention: The 1-2-3's of Treatment Planning", S. Johnson. 1997. p125-126. Academic Press: San Diego.

6. "When a Child or Youth is Sexually Abused ... A Guide for Youth, Parents and Caregivers." 1997. Central Agencies Sexual Abuse Treatment Program. http://www.casat.on.ca

7. "Therapist's Guide to Clinical Intervention: The 1-2-3's of Treatment Planning", S. Johnson. 1997. p. 126. Academic Press: San Diego.

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*Alternatives to*		Child Sexual Abuse

		Other Child Abuse ~ Spousal/Partner Abuse ~ Elder/Dependent Adult Abuse ~ Other Populations

NOTE: Although abuse occurs in every country, information on this page pertains to the United States, except as otherwise indicated.
		Definition

		Child sexual abuse is any use of a child for the sexual gratification of an adult. In child sexual abuse, an adult has influenced or forced a more vulnerable person (the child) to engage in sexual activity when he or she is not developmentally able to consent to sexual activity. Sexually abusive behaviors include exhibitionism, child pornography, sexualized kissing, and fondling.(1) Many experts believe that sexual abuse is underreported because of the secrecy that so often characterizes these cases.(2) Both victim and perpetrator, as well as many others in the child's life, are motivated to keep silent about the abuse for fear of the consequences.









back to top		Prevalence

		Most children are never abused. However, although the number of children investigated by the Child Protective Services (CPS) system in the US has steadily declined each year from 1993 to 1999, there were still almost 100,000 children sexually abused in the 50 United States in 1999.(3) Even more alarming, epidemiology studies of adults in varying segments of the community have found that 15 to 33 percent of females and 13 to 16 percent of males were sexually abused in childhood.(4) An estimated 826,000 children were victims of abuse and neglect in 1999. This estimate is based on data from all 50 States. In those States, 11.8 children for every 1,000 children in the population were victims of abuse or neglect. 11.3% of these children were sexually abused. In addition, more than a third of all victims were reported to be victims of other or additional types of maltreatment.(3) Male parents were identified as the perpetrators of sexual abuse for the highest percentage of victims.(3)



back to top		Some Symptoms of Possible Child Sexual Abuse(5)

		Bed-wetting (enuresis) or fecal soiling (encopresis) Eating disturbances Fears/phobias/compulsive behaviors Age-inappropriate behaviors (pseudomaturity or regressive behaviors) Sleep disturbance Depression, low self-worth, or withdrawal Overly compliant Age-inappropriate excessive self-consciousness of body Sudden possession of money, new clothes, or other gifts Self-destructive behavior, self-defeating behavior Suicidal thoughts, plans, attempts Crying without apparent reason Fire setting Sexually transmitted diseases, genital infection Physical trauma or irritation to the anal or genital area Difficulty walking or sitting due to genital/anal pain Pain on voiding/elimination Psychosomatic symptoms Age-inappropriate knowledge of sexual behavior Inappropriate sexual behavior with siblings, peers, or objects Compulsive masturbation Excessive curiosity about sexual issues and/or genitalia Promiscuity or prostitution









back to top		Ways to Heal(6)

		The aim of treatment is to facilitate the healing process and work towards the goals outlined in a beginning assessment stage. Young children communicate with play more than with words; therapy with them will probably take a different form than with older children. Working with young children, therapy often takes the form of symbolic play. Any of the following modalities may be helpful. Individual Sessions: One therapist, one client (the client could be the abused child, a parent, a sibling, or anyone affected by the abuse). Individual therapy provides privacy for whomever may not feel comfortable or able to discuss her or his issues in the presence of others. Almost all children who've been sexually abused should be offered individual sessions. Groups: A group of people with similar experiences assist in discussions and/or activities led by one or more trained group facilitators. Group therapy provides individuals with an opportunity to share information and learn from the experiences of others, while limiting the isolation that many people may feel in a one-to-one counseling situation. Although group therapy can serve as a type of support, there are groups set up specifically for the purpose of providing support for participants. Family Sessions: One family (the definition of family members can be very broad, i.e., non-offending parent, partner, siblings, stepparents, step-siblings etc.) works with one therapist (therapist can work both with the family as a whole as well as with individual family members). Because sexual abuse affects more than just the "victim", family therapy helps to deal with the dynamics of family functioning and interactions.










		*Please note:* while a child experiencing any abuse may benefit from therapy, a child who has been sexually abused should be referred for therapy as soon as possible. Even if the family is participating in other treatment, the child should be referred for her or his own individual sessions; it is important to evaluate the impact of abuse without the family issues overshadowing the child's experience.(7) Given the prevalence of parental abusers, individual therapy (and removal from the home) may be the only appropriate treatment for sexually abused children in many cases.




		Sources:
		1. "The Problem", Giardino, A. P. In: Finkel, M. A.; and Giardino, A. P. (Editors). Medical Evaluation of Child Sexual Abuse: A Practical Guide. Second Edition. 2001. Sage Publications Inc.: Thousand Oaks, CA.


		2. "What is Child Maltreatment?", 2001. US Dept. of Health & Human Services, Admin. for Children & Families. http://www.calib.com/nccanch/prevmnth/childmal.htm


		3. "Child Maltreatment: 1999 Reports From the States to the National Child Abuse and Neglect Data System". 2001. US Dept. of Health & Human Services, Admin. for Children & Families. http://www.acf.dhhs.gov/programs/cb/publications/cm99/index.htm
		4. "Mental Health: A Report of the Surgeon General". 1999. U.S. Dept. of Health & Human Services, Substance Abuse and Mental Health Services Administration. http://www.mentalhealth.org/features/surgeongeneralreport/chapter4/sec1_1.asp
		5. "Therapist's Guide to Clinical Intervention: The 1-2-3's of Treatment Planning", S. Johnson. 1997. p125-126. Academic Press: San Diego.
		6. "When a Child or Youth is Sexually Abused ... A Guide for Youth, Parents and Caregivers." 1997. Central Agencies Sexual Abuse Treatment Program. http://www.casat.on.ca
		7. "Therapist's Guide to Clinical Intervention: The 1-2-3's of Treatment Planning", S. Johnson. 1997. p. 126. Academic Press: San Diego.



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