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A New Way to Help Traumatized Clients Relieve Guilt, Shame, and Isolation

January 19th, 2016

A New Way to Help Traumatized Clients Relieve Guilt, Shame, and Isolation

dthythAs a graduate student at Harvard in the mid-1990s, I participated in research studies carried out by the psychology department that began in October 1996 and continued until August 2005 to interview adults who had experience sexual abuse as children and learn what effects the abuse had had on their traumatized lives. Although I was sure I knew what I would discover—that the abuse would be remembered as a horrible experience that overwhelmed the people I interviewed with fear when it happened and had always been viewed as a traumatizing occurrence—what I heard in the hundreds of interviews I conducted was quite different. In nearly all the cases, the adults I questioned had not experienced the abuse as traumatic when it occurred and only came to regard it as so years later. And in many of the cases, they had never been questioned about their evolving sense of the abuse and the ongoing impact that it had on their lives, but only about what the traumatic experience had been like at the time. These findings led me to question the progress professionals in the sexual abuse field have made when it comes to understanding and treating child sexual abuse.

Certainly we have advanced to the point that the right things are being said (sexual abuse is common and harmful; it is never the child’s fault). Funding in the trauma field has been secured, research conducted, studies and books published, treatment centers established, and public awareness raised through sex-education programs and campaigns in the media. But is any of it translating into actual progress for victims? Do they feel that they’re being helped, that they’re understood and their needs are being served effectively?

The trauma model’s main purpose—one of the primary reasons why mental health professionals welcomed it with such enthusiasm in the 1980s—was to provide an explanation for how and why sexual abuse wreaks such psychological and social havoc in victims. Armed with a better understanding of the impact of abuse, mental health professionals hoped to be better able to help victims cope with and recover from these damaging crimes.

The problem is that today, after more than twenty-five years, predictions based on the trauma model have not proved accurate. There appears to be no direct, linear relationship between the severity of the abuse and the psychosocial difficulties victims experience in adulthood. Worst of all, we have developed no clearly effective treatments for sexual abuse victims. They continue to suffer from psychological and social problems in the aftermath of their abuse, and mental health professionals still have not reached a consensus as to exactly why or what precisely to do to help them recover.

A growing number of scholars in the sexual abuse field are coming to agree that understanding how and why sexual abuse damages victims probably has little to do with the actual abuse and a lot to do with what happens in its aftermath. Tracking the consequences of early events through developmental, cognitive, and behavioral pathways may prove more fruitful than continuing the restrictive focus on the severity and nature of event-specific trauma. I believe that the victims themselves have always known this.

Early on in my career, I did not have a lot of experience interviewing sexual abuse victims. I had, however, a lot of experience interviewing victims of other kinds of horrible experiences (motor vehicle accidents, combat, natural disasters, abductions), and I had asked these subjects to rate how traumatic the events were at the time.

By the end of the study, the data was clear. Although sexual abuse was not a particularly awful experience for many victims when it happened, looking back on it, from their perspective as adults, it was awful—ratings of shock, horror, disgust, and even fear were all high.

According to victims, they did not experience the abuse as awful when it happened because most simply did not understand clearly the meaning or significance of the sexual behaviors they were engaging in. That being said, at some point later on in life, they do. Over time, the “cloak of innocence lifted,” as one victim described it. Victims reconceptualized the formerly “confusing and weird experiences” and understood them for what they were—sexual in nature and clearly wrong. Only at this point—when the sexual abuse is fully apprehended—does it begin to damage victims.

Shame

Today, victims need to hear the truth. This requires us all to highlight publicly the true dynamics of sexual abuse—to expose the painful reality that most victims care for and trust the perpetrator (before, and sometimes during and after, they are abused), that they do not really understand the nature of what is being asked of them, that they feel they are receiving love and attention, that it does not hurt and sometimes feels good, and that, for all these reasons, participation is common.

Once exposed to the truth about how victims feel and behave during sexual abuse, victims need to hear, loudly and clearly, why they were not at fault. We cannot accomplish this with platitudes or blanket statements like “You were not to blame” or “It was done against your will.” They consented not because they were forced to but because they did not understand enough not to. And victims need to know that this is normal.

In short, in order to help victims feel less stigmatized in the aftermath of sexual abuse, we must all communicate that they were helpless victims—not, as the trauma model portrays them, literally helpless but metaphorically helpless, victims of their own level of development.

This information needs to be highlighted in the form of prevention campaigns, books, websites, and other culturally accessible outlets. Until that happens, victims will continue to feel alone, guilty, and ashamed.

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