Female Survivors of Sexual Abuse

Christine D. Baker

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780415139847
• eBook ISBN: 9781317725299
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

How can we treat survivors of sexual abuse more effectively?
Sexual abuse against females is a serious problem in society and there is a need for a greater understanding of the presentation and treatment of adult survivors of sexual abuse. In Female Survivors of Sexual Abuse, Christine Baker combines her clinical experience with an innovative approach to the treatment of this problem.
Female Survivors of Sexual Abuse addresses the experience of 180 female adults who were sexually abused in childhood, and provides detailed analyses and treatment approaches. The subject matter is presented in an accessible and compassionate way, imparting personal opinion and experience. It covers:
* female survivors: their stories, and the evidence
* integration, the alliance and the therapist
* the survivor's journey to recovery
* the families, disclosure and the role of the mother.
This book enables the reader to "enter" the experience of the survivors and follow their progress to recovery, while highlighting the ever-changing state of knowledge in this difficult area. It will be invaluable to practitioners and students of clinical psychology, counselling, and psychiatry.

Part I
Introduction: Survivors’ stories and the evidence

Chapter 1
Background to the book and its aims

Historical Context

To say that the writing of this book has been the most challenging, and ultimately the most satisfying project of my professional life to date, would be an understatement. The best way I can describe it is in terms of an odyssey that has encompassed all of the joys, frustrations, and despondencies, along with the isolation, personal development, and exhilaration which can be experienced having embarked on a journey in uncertain but rich terrain. More than a decade ago, as a clinical psychologist working in a teaching hospital in west London and having recently completed my training, I had barely given the issue of childhood sexual abuse (CSA) much thought. In retrospect, it seems to me now as though it was a fact of life that people, both professional and lay, were aware of but for some reason had not yet entered their consciousness to a great degree.

Knowing what I know today, having treated hundreds of female survivors of CSA, and having researched the topic in great depth, I can only be amazed that even as recently as fifteen years ago, how low down on society’s agenda was the silent suffering of people who as children had experienced the ultimate betrayal. My personal view is that at long last the issue of CSA is now firmly embedded in our consciousness but it is also my belief that it continues to be a complex topic that gives rise to a host of competing and emotive attitudes, which, in recent times, have heralded an unprecedented level of interest in the topic in many quarters of society. As professionals, we are currently undergoing a much awaited period of development in terms of our knowledge and understanding of the extent of CSA, and most importantly of the validation of survivors’ experience. I believe that we owe a great deal to the pioneers, researchers, and clinicians of the early and mid-1980s—such as Finkelhor, Courtois, and Jehu—who put the topic of CSA on the map, so to speak, of academic enquiry and clinical awareness. As a result, over the past decade, survivors of CSA have finally been encouraged to have a voice and begin their journey of validation and recovery. Indeed, Finkelhor and Browne’s (1985, 1986) proposed traumagenic model to explain the long-term effect of sexual abuse was a significant contribution in our initial attempts to conceptualise the impact of CSA and so begin to understand the nature of the suffering of survivors.

The historical context of the impetus and route that led to the writing of this book began with my interest in sexual dysfunction and the difficulties that led to sexual dissatisfaction. The initial interest in male sexuality (Baker and de Silva, 1988; Baker, 1993) inevitably encompassed female sexuality and its discontents (Baker, 1992). Indeed, as a basic grade clinical psychologist I realised that I was developing a keen interest in understanding female sexuality and I was fortunate to work in a hospital setting that allowed me to see women who were referred from a variety of medical, surgical, psychiatric, and therapeutic sources. Very soon, I became aware of the frequency with which many of the women who were complaining of sexual dissatisfaction were also reporting experiences of childhood sexual abuse. I was also made rudely aware that apart from the reassurance and support I could provide to these women, I was ill-equipped and lacking in the necessary knowledge with which to guide and inform them. I experienced both a profound sense of responsibility as well as a pressing professional and academic need to create a path that was to lead to the establishment, in Jersey, of a specialist service for survivors of sexual abuse, which ran concurrently with my own continual learning and development in the area of CSA.

Aims

There are two central aims to this book, both of which are of equal importance and can best be subsumed under the rubric of "validating the experience of female survivors of CSA". Very frequent remarks that survivors make relate to their pain and anger at not having been believed when they disclosed their abuse as children, or when they were met with their families’ ambivalence as adults. For those who did not have the resources or ability to disclose their abuse, their pain is about the lack of protection and detection either from their mothers, or society, and at times, both.

I have been asked whether there was a particular reason why I have omitted the experience of male survivors, and the simple answer is that the women who have presented for treatment have far exceeded in number their male counterparts. Indeed, the relatively few male survivors of CSA whom I have treated leads me to believe that this is an area that requires urgent attention, not least in understanding the reasons for which men may be reluctant to come forward, their individual ways of coping with the abuse, and the types of long-term effects they experience.

The first aim has been to impart to other professionals the wealth of knowledge I have gained as a clinician who has treated hundreds of female survivors of CSA in the past decade. I sincerely hope that this book will succeed in offering guidance and valuable insights to those in training or contemplating work with survivors of CSA, be they psychologists, social workers, counsellors, or those working in many of the vital voluntary or charitable organisations. For those who already have expertise in the treatment of CSA, or who have an academic interest in women’s issues, the extended case studies in the book will hopefully provide additional insights or, indeed, motivate further practice, research, or critique.

The second aim has been to provoke further interest in the area of CSA, which, in my opinion, is still in its infancy. The many changes that have occurred in the past decade, in terms of our knowledge and the increased profile of the topic, confirm that we have still a long way to go before we can claim to understand fully what it means to have been sexually abused. For example, we have yet to subject the experience of those who have suffered minimal effects as a result of CSA to scientific enquiry, both in terms of prevalence and individual differences. Another area that requires attention, urgently, relates to paedophiles and child sex offenders. The existing work is in its early stages, as is the evaluation of the nature of perpetrators. As regards the latter, I refer to the relationship of the perpetrator to the survivor. Although there is general consensus that most CSA is perpetrated by men (see Chapter 15), and also that most perpetrators are likely to be a family member (see Chapters 2, 4, and 13), there continues to be conflicting information about their relationship to the survivors. In the UK, for example, figures published in a survey by the NSPCC (1990) suggested that 25 per cent of all CSA was committed by natural fathers. Interestingly, the NSPCC’s figures from a similar survey in 2000 were reported in a rather sensational article in The Independent on Sunday (19 November 2000), in which brothers and stepbrothers were focused on as being the main culprits of CSA, accounting for almost 40 per cent of all attempted CSA. Consistent with the earlier findings, natural fathers were responsible for just over 20 per cent of all CSA. Clearly, there is a great deal more we need to learn about the relationship of perpetrators to the children they abuse, particularly because the picture is further complicated by the suggestion that in the clinical setting survivors frequently report abuse by fathers and step fathers (see Chapter 4).

Style

In order to succeed in fulfilling the above aims I considered that it would be important to create a "different" kind of book and I was aware that I was taking a risk in doing so. In other words, I wanted to ensure that the reader could access with ease and, hopefully, interest, the richness of the context within which survivors achieved their freedom from the experience of CSA. In the event, this did not prove difficult because, from the moment of its conception, six years ago, the book naturally evolved from being a dry academic text to one, which, I would like to believe, imparts the human and powerful dynamics of the therapist–client relationship. Indeed, I can now assert that it would have gone against my integrity to present this book in any other way.

So what makes this book so different? First, it is written in the first person which is not a usual mode of writing in academic texts. The reason for this is to minimise the dichotomy between therapist and client and to maximise the human and interactive element that was in process during the writing of the book. Secondly, the book contains personal information about myself which relates to my own development and growth during the course of treating the women who came to me for help, and also during the preparation of the manuscript. There are a few reasons why I chose to include this. I wanted to express the humbling effect that working with very brave women had on me, and so it seemed to go against the grain to elevate myself to the position of a detached and all-knowing observer. I also wanted to share, in the best way I knew, the degree of respect and gratitude I have for these women, who not only allowed me the privilege of sharing their experience but who also contributed to my own growth.

A further distinguishing mark of this book is the manner in which I have treated the three case studies in Chapters 9, 10, and 11. These chapters are for me the core and heart of the book because it was my primary aim to validate the experience of the female survivors. I wished to distance myself from a reductionist model that presents a clinical case as an exhibit of "how it is done". What I have learned is that nothing in this life is simple and, therefore, it was important to create the best medium within which to allow the reader to appreciate the complexity of survivors’ experience and their journey to recovery. With this in mind, I have integrated both a narrative as well as an analytic approach to the description, conceptualisation, formulation, and treatment issues of each case study. I have also made every effort to convey the interactive nature of the intervention approaches in the hope that my arguments on the therapist’s characteristics in Chapter 7 would be clearly illustrated.

Structure of the Book and How to Use It

The chapters in this book are presented in such a manner as to render it a versatile text that can be used in different ways. For the more advanced and experienced practitioner in the area of CSA, the book may be used as an informative text that can be referred to according to individual interest in any of the topics I have covered. It can also be a reference text for anyone involved in academic study or research.

For those who are just embarking on the study of CSA, the book follows a logical progression, beginning with the first of five parts. Part I comprises five chapters, and the aim here is to present a coherent background as an introduction to the parts that follow. Chapter 2 ("Fact and fiction") is divided into two sections, with the first providing an initial acquaintance to the three women—Victoria, Rose, and Florence—whose journey to recovery is addressed later in the book. Their verbal report represents a powerful and emphatic start into the personal meaning of CSA, and I deliberately refrained from providing immediate formulations and conceptualisations. This was done in order to maximise the reader’s appreciation of the chapters that follow and to prepare the ground for the in-depth focus of each individual case in Chapters 9, 10, and 11. The second part of Chapter 2, which deals with the media, was included in order to illustrate the part it has to play in terms of its potentially positive as well as negative effects on survivors of CSA.

Chapter 3 provides the historical background to the development of empirical work in the area of CSA and will highlight the relative recency of such work, as well as the difficulties encountered when attempting to define and measure the prevalence of CSA. Chapter 4 sets out the context of my own work and observations based on 180 female survivors of CSA. For ease of reference, I have included in the form of tables the breakdown of relevant variables related to both the demographic characteristics of the survivors as well as the abuse. The latter are summaries of the descriptive relevant statistics that may help the reader to gain an overall view of the general profile of a group of survivors who were referred for psychological treatment. The last chapter in Part I provides an in-depth discussion of the long-term effects of CSA. The information in this chapter aims to provide the reader with the understanding and insights that have been proposed so far, and will help to provide the necessary background for the formulations that follow in Part III of the book.

Part II paves the way for Part III, which is the central core of the book. Chapter 6 introduces the importance of model integration when treating survivors of CSA and discusses the reasons for this. In this chapter, I also make a case for the importance of the therapeutic relationship as being the one constant and dynamic factor in the development of a therapeutic alliance. I argue that the latter is the main vehicle towards positive change and I also explain why this is particularly vital when treating survivors of sexual abuse. Chapter 7 extends this discussion to examine the therapist’s characteristics, and it is here that I reveal personal information about myself. Indeed, it is here that I pay my tribute to the clients whom I have had the privilege to treat, in terms of the development I have undergone, which has in turn affected my therapeutic practice.

I have already anticipated a possible criticism that Chapters 7 and to some extent 6 are idiosyncratic, given their personal nature. I would argue, however, as already mentioned earlier in this introduction, that this was the only way I could conceive of putting together a book that would be an honest and humble account, and also one that would be able to provide the important insights that I have gained during a decade’s work with hundreds of women who have been sexually abused.

Part III comprises four chapters. Chapter 8 provides an introduction to the three-stage working model that I adopt when treating survivors. This is an extension of the previous two chapters and illustrates the model integration process. As I have already indicated, Chapters 9, 10, and 11 represent the main focus of the book, in which Victoria, Rose, and Florence are given extended attention. Here the reader can consolidate the information gained so far and can follow "in action", so to speak, each individual story from initial introduction to therapy, until final resolution of their abuse and eventual growth and independence. In the Appendix at the end of the book, the interested reader will find a list of relevant reading for the therapeutic techniques and conceptualisations that are discussed in the treatment of the three women.

I have dedicated Part IV to an examination of the families of origin of survivors of CSA. There is now growing consensus that the family of origin, and in particular mothers, have a crucial part to play both in the onset of CSA and the degree of long-term effects survivors are likely to experience. In Chapter 12 I accord particular attention to mothers and I would like to issue a warning from the outset that this may prove to be a sensitive area of discussion. However, I would also like to reassure the reader that I had no particular wish to downgrade mothers, my primary motivation being to express the experience of the women whom I have seen. Indeed, if anything, mothers have been portrayed as being powerful and very influential in either helping or hindering their daughters’ recovery.

Finally, Part V concludes with two chapters that highlight the ever changing nature and degree of knowledge we are acquiring in the study of CSA. Books written on the treatment of sexual abuse in the 1980s or even the early 1990s will not have included the issue of false memory, or the treatment of child sex offenders. In Chapter 14 the reader will be able to follow a summary of the recovered/false memory debate, which became established by 1995. In Chapter 15 the closing remarks for the book attempt to address survivors’ repeated questions about why people abuse children and what can be done about this. A case will be made for the fact that responsibility for the prevention of CSA lies primarily with society as a whole and, of course, the family.

Chapter 2
Fact and fiction

A Trilogy: The Stories of Three Women

Victoria

I have very mixed-up feelings about my childhood, but worst of all I feel very bad about myself. To the outside world I appear to be confident, together, and the person people feel they can come to and confide their problems. Inside, I often see an ugly, sad person who is unable to sustain relationships or ever feel properly loved. If people say they care for or love me, I think they have ulterior motives and I generally find it very difficult to trust anyone. I feel especially guilty when I look at what I have achieved and think that maybe I am making a fuss about nothing, because so much time has passed since I left my house, my family, and all other connections with the first eighteen years of my life.

I don’t remember very much of the first five years of my life. I suppose my first memory is of my brother being brought to the house with my mother and father from the hospital where he was born. I remember thinking tha...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Illustrations
• Acknowledgements
• Foreword
• PART I Introduction: Survivors' stories and the evidence
• PART II Integration, the alliance, and the therapist
• PART III The survivors' journey to recovery
• PART IV The families, disclosure, and the role of the mother
• PART V Further considerations
• Epilogue
• Appendix: Recommended reading for treatment issues raised in Chapters 9, 10, and 11
• Notes
• Bibliography
• Index