Moving On After Childhood Sexual Abuse

Understanding the Effects and Preparing for Therapy

Jonathan Willows

• Publisher: Routledge
• Year: 2008
• Print ISBN: 9780415424820
• eBook ISBN: 9781134095582
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This self-help guide allows those who have experienced childhood sexual abuse to consider the impact that it has had on their adult lives from a new perspective, helping them to understand the effects, and prepare for therapy.

Based on known reactions to physical and emotional trauma, the book explains how a broad range of difficulties in adulthood can result from sexual abuse in childhood. The reader is invited to think about how psychological therapy can be particularly helpful in reducing these difficulties and promoting change. Ground rules for therapy are provided, as well as guidance on how to get the most from the therapy process.

Moving On After Childhood Sexual Abuse provides a clear explanation of the developmental effects of childhood sexual abuse as well as the role of psychological therapy. This book will therefore assist the reader in making informed decisions about seeking treatment and setting personal goals for therapy, as well as appreciating the demands involved in the process of change.

Part I
Childhood sexual abuse: an introduction and overview

1 Introduction: about this book and how to use it

This book is intended for anyone who has suffered sexual abuse as a child or adolescent. If this is something you have experienced, then this book will help you to consider some of the possible links between events in your past and some of the difficulties you may have as an adult. Furthermore, if you are thinking about going into therapy, this book is specifically intended to help you make informed decisions about what is most likely to help you. Thinking about this in advance, and considering the options, will help you get the most from therapy if you decide to proceed.

In order to decide what is right for you, it is important to have good information. This book provides it in a number of ways. Firstly, sexual abuse will be clearly defined. Then you will be provided with an overview of child development. This will help you to go on to think about what can happen when child development is disrupted by events such as sexual abuse. Then we will consider how adults continue to develop throughout their lives. At regular points you will be asked to stop and think about what you have read and about how it applies to you as a unique individual.

If you are considering going into therapy, several different types of psychological therapy will be described to help you to decide what is right for you. Making sure you have a good understanding of therapy and what is expected of you as a client is a good way to ‘prepare’ for therapy. Taking the time to complete the exercises at the end of the sections will also help you to get started on the road to change.

The book is presented in Parts I–IV, each of which is broken down into a number of chapters.

Part I provides a definition of sexual abuse and summarises its impact upon both child and adult development. This provides the starting point for considering how certain problems related to childhood sexual abuse can have a knock-on effect in other areas in one’s life. This relationship will be explored in more detail later in the book, and we will see how psychological therapy can help to make positive changes.

Part II is about child development. It goes into more detail by exploring the many ways in which abusive experiences in childhood can affect growth and development. It describes some of the signs and symptoms that tell us, early on, that something is wrong. We will also continue to explore the idea that difficulties in childhood can build up over time and lead to additional difficulties in adulthood.

Part III is about adult development. It provides more information about the possible links between problems in childhood and related difficulties in adulthood. By drawing out the links between childhood trauma and the symptoms that occur in adults, some of these problems can be seen as normal reactions to abnormal circumstances. When people suffer extreme stress and are hurt, scared and confused, it can affect them in profound ways. The traumatic aspects of childhood sexual abuse are described here and the ongoing after-effects are explained. Having an explanation for how one feels can be a very important support in its own right. However, it is important to remember that the relationship between childhood sexual abuse and difficulties in adult life is not always straightforward. As discussed in more depth, not everyone who has been abused develops the same issues. Equally, not everyone who experiences the difficulties described has been abused. Some people remember very clearly what happened to them, others have an idea that ‘something happened’—this does not prove that it did. In Part III, we will proceed with caution so that any conclusions you reach are based on sound judgement and real memories.

Part IV is all about therapy. It describes some of the more popular and readily available types of psychological therapy. There are some very important general issues to consider before going into therapy of any kind, and they are also described in detail here. This information will help you to make informed decisions about the type of therapy and the type of therapist most likely to help you. It should also help you to consider when the time is right to go ahead with therapy.

A number of people drop out of therapy early on. This can be for any number of reasons, including a lack of information about the different types of psychological therapy and how they work. Sometimes unrealistic expectations can get in the way, and sometimes it is just ‘bad timing’. Others drop out because they are not prepared for the demands of therapy and for the amount of emotional work involved. Dropping out can be a disheartening experience and can undermine your hope for the future. Having sound information about what therapy involves can help you to avoid this. As an aid to this, some of the technical terms and jargon that are used in describing psychological therapy are also explained along the way. More importantly, Part IV also gives you some essential ‘ground rules’ for making sure that you get the most from therapy. These apply both to your therapist and to you as a client. They will help to ensure that you find your way to professionally accredited therapists who work in a way that is most likely to suit you. The ground rules are also there to help you to prepare for therapy by being mindful of the hard work and some of the potential pitfalls involved.

At frequent intervals throughout the book you will also find suggestions and prompts about how you can begin the process of thinking through what you want to get from therapy in more detail. You will also be encouraged to reflect on how you feel the information in each Part applies to you as an individual. By working through the book in this way you will be starting off the process of change and giving yourself a better chance of benefiting from therapy in the long run.

As you go through the book you may, of course, decide not to enter therapy at all or to put the idea to one side for the time being. It is better to use the information here to make an informed decision rather than just avoid ‘change’ because of fear or misinformation. Of course, it is also important to recognise that there are many other paths to achieving change and well-being besides psychological therapy.

Finally, the Further Information, Links and Contacts section at the back of the book provides signposts to various useful organisations and sources of information. This is followed by a list of references. The references are not ‘essential’ reading. They are simply there if you wish to find out more about something that has caught your attention along the way.

Throughout the book there are numerous case histories and examples. They are presented to help bring some of the ideas and theories to life. They also emphasise how broad and how varied some of the difficulties caused by childhood sexual abuse can be and how different stories can unfold. However, the examples will only reflect the experiences of some readers. Because everyone is an individual, it is also certainly not the case that ‘one size fits all’ when it comes to therapy or to getting over past events. The aim of this book is to help you to think carefully about what is right for you as an individual before going ahead.

A note of caution—how has childhood sexual abuse affected your life?

Throughout this book you will find descriptions of many different kinds of symptoms and psychological difficulties that can affect both children and adults. It is very important to recognise that each of them has many possible causes. Childhood sexual abuse is only one possible cause. Furthermore, in many cases, childhood sexual abuse is one difficulty amongst several others in a person’s life. It is very important, therefore, to be as clear as you can about the impact that childhood sexual abuse has had upon you.

Generally speaking, there are three broad categories of people seeking therapy for the kinds of difficulties described in this book and who also believe that childhood sexual abuse has affected them:

• People who can clearly remember abuse happening to them and who feel sure that this has been a major factor in contributing to their difficulties as adults.
• People who can clearly remember abuse happening to them but who also recognise that this was one of several problems that have continued to affect them.
• People who do not remember being abused but who either believe it did happen to them or that it provides an ‘explanation’ for their current difficulties.

People in the first two groups will benefit from reading through this book and may well benefit from therapy aimed at alleviating some of the long-term effects of childhood sexual abuse. Of course, for those in the second group, this may be as part of a range of treatments for other difficulties.

People in the third category should proceed with a great deal of caution and are advised to begin by having a discussion with a mental health professional or their GP before assuming that childhood sexual abuse is at the root of their difficulties. If there are no clear memories, then it can be extremely difficult to prove that anything happened and it is very unwise to proceed on the basis that the memories will somehow be ‘recovered’ along the way.

There has been an ongoing debate about the validity of recovered memories and about a condition known as False Memory Syndrome (Merskey 1996; Gardner 2004). Some groups in this debate are convinced that memories recovered in therapy (or elsewhere) are false and are the result of leading questions and suggestions by unethical or unskilled therapists. Another group insists that disturbing memories can be repressed for many years and that it is not surprising that people going through therapy sometimes remember a lot more about their past. Of course, proving that what has been ‘remembered’ actually happened is a different thing altogether and when recovered memories are presented as evidence in a legal setting the situation can become very complex.

A reasonable ‘middle ground’ (Dobson and Prout 1998) is to assume that it is possible that some people in therapy, perhaps as the result of undue prompting by a therapist who has jumped to conclusions, will experience ‘memories’ that do not actually represent what really happened to them. It is also possible that some people in therapy may remember things that actually happened to them even though they had not been able to recall them over the course of many years. For the vast majority, therapy around childhood sexual abuse will focus on clearly remembered events and, as a general rule, it is wise only to proceed if the memories are clear and evident. Of course, it is possible to work on the difficulty of ‘not knowing’, but this is very different from trying to look for proof of something that you cannot remember.

The interaction between memory and emotion is also very complex and the developing research evidence continues to improve our knowledge. However, we do not know all there is to know about this relationship. Hence, it is best to proceed with caution if you are in any doubt.

How to use this book

Reading through this book should provide you with a firm foundation for going into therapy. I hope that it will also give you some strategies and ideas that will help you to get the most from therapy and from your life beyond therapy. Take your time and work through one chapter at a time and then stop and think about how what you have read applies to you. Then move on, making sure that you have a good grasp of what has gone before. By the end of the book you should have a good understanding of how your experiences have affected you as an individual and what you can do to start making positive changes. If you feel confused or unsure, then just go back and pick up the thread again. Try to resist rushing through the book or making snap decisions about therapy. Instead, it is better to take your time and to make sure that you are clear about what you want to achieve before you go ahead.

Your reactions to reading the book

Thinking, reading and talking about childhood sexual abuse is bound to be difficult for anyone. Because it can be unsettling to read about childhood sexual abuse, it is important to establish right at the start that if it becomes too upsetting then stop! Put the book down and go and do something else that you know will help you feel okay. It is not a sign of failure or weakness to accept that you are distressed—quite the opposite. Uncomfortable feelings will be stirred up. If and when this happens as you read through the book, try to notice how you feel and how that makes you want to react. If possible, write it down rather than acting on what you are feeling straight away. This will help you to begin to see how things link up, how particular thoughts and memories link to particular feelings and how those feelings link to how you behave as an individual.

If some of the things that you read about here remind you of specific things that happened to you, then your reaction is likely to be all the more powerful. For instance, you may notice some very sad feelings, or fear or anger building up. These might be difficult feelings to shake off straight away, so make sure that you put aside a time to read the book when you can relax and be free of interruptions and commitments. It is worth stating, as you go through the book, that you might become more irritable and short-tempered with the people around you, such as friends, family and colleagues. You might also notice more frequent dreams and nightmares. Some people might also experience ‘flashbacks’ or disturbing memories of the past that are so vivid that, just for a moment, it feels as if those things are actually happening again. Because of this you might also notice yourself doing more of the things that you usually do in order to try to stay calm, or ‘self-soothe’. For instance, you might feel like drinking more alcohol, smoking more cigarettes, eating more comfort food or maybe even retreating to your bed.

If the methods you have relied on to settle yourself in the past are also ‘self-destructive’, then it is important to try to replace as many as you can with something more constructive along the way. For instance, throughout the book you will find frequent reminders and encouragement to write things down, to keep a diary or just to step back and reflect on what you are feeling. Of course, it is not easy to change habits just like that, but being prepared to give these new things a go and to give them time to help can make a big difference.

Considering ‘change’

Of course, change is not easy. We all know it requires hard work and the willingness to experience pain and to explore aspects of oneself and one’s past that are uncomfortable. Because of this it may also feel like an added injustice to have to go through this process when you are filled with a sense of having been so unfairly treated as a child. This is just one reason why ‘change’ can be so difficult to achieve and an example of why psychological therapy can be so challenging.

But because people do make important changes to the way that they think, feel and behave in therapy, it is also important to think about how change will affect you and those around you. Not only might you feel resistant to change, the people around you may be just as reluctant. None of us lives in a vacuum and when we change how we behave around others they are likely to notice and to react. Hopefully, the people you have in your life now will be positive and supportive; but this is not always the case. For example, imagine someone who comes away from therapy with more confidence, improved self-esteem and more sense of how they wish to be treated by others. If this puts strain on their relationship at home, then their partner may feel they have only two choices; either adapt to the changes or else resist and try to push things back to how they were. This kind of situation can quickly bring the issue of ‘control’ in relationships to the surface. If this has been a problem in the relationship before, then progress in therapy might begin to undermine an already unstable relationship, bringing things to a head. If it feels right and safe to do so, you might want to talk some of this through with, for example, your partner so that you work things through as they go along. However, if you don’t feel safe to talk about these things, then try to bear in mind, as you go through the book, whether this aspect of yo...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Acknowledgements
• PART I Childhood sexual abuse: an introduction and overview
• PART II Childhood sexual abuse and child development
• PART III Childhood sexual abuse and adulthood
• PART IV Psychological therapy
• Further information, links and contacts
• References