Sexual abuse therapy

Sexual abuse is wrought with taboo and is therefore rarely discussed. Yet it is far more prevalent than one would imagine given how infrequently it's discussed. Many who suffer abuse live out their adult lives never disclosing the abuse to anyone, and occasionally without ever recognizing that what happened to them was abuse at all.

What constitutes sexual abuse?

This question is not as simple as it may sound. As adults trying to make sense of what happened--often what happened early in childhood--can be confounded by years or decades of fog. We are remembering as adults things that happened to us as children when our ability to make sense of the world was quite different.

While judges and lawmakers must endeavor to strictly define what constitutes abuse, in the therapy office we choose to take a broad view. The very question of deciding whether something was wrong is one worthy of collaborative exploration without simple, top-down answers.

That said, more often than not, patients we've worked with who've shared questionable experiences in their childhood too often downplay the sexual behavior of adults responsible, dismissing it as "not a big deal," or citing that it was, in fact, consensual (even when it clearly could not have been). While it is not our place to decide for you what was and was not abuse, we have some strong beliefs and principles about sex and sexual contact:

Unwanted sex, sexual play, touching, exposing, or sexually-explicit conversation is never okay, regardless of the ages of the participants.

Young children do not have the capacity to consent to sexual activity of any kind. Whether with an adult, an older child, or even a peer, young children who are coerced into sexual activity are being abused.

Adults who have sex with children, including teenagers, are almost always taking advantage of the child or teenager and are out of line. Exceptions to this are phenomenally rare, and never include an age discrepancy of more than a few years.

Regardless of age, anytime there is a difference in power, due to an authority of roles (a boss, a teacher, a babysitter), intellectual capacity, or physical ability, sex cannot be consensual.

Sex should never be a secret. If either person participating in the sexual relationship has any desire to share it, they have every right. Convincing, coercing, or threatening someone in any way to prevent them from sharing a sexual relationship is abusive.

There are, of course, other examples, and in no way should the above be confused as the sum total of experiences that might constitute abuse.

There are a number of factors that contribute to someone who experienced sexual abuse not understanding that it was abuse that took place, aside from the challenges of time and the confusion of childhood. Some children who are abused feel some sense of enjoyment; perhaps they experience physical stimulation, find elements of the secrecy and the taboo exciting, or are longing for attention, closeness, and intimacy. This is in no way is to imply that a child who is sexually abused asked to be abused or was complicit in any way. In fact, this can be the very source of confusion for many who go through such an experience.

Others who suffered abuse feel (either in their childhood or as adults) that perhaps their abuser (or abusers) must have seen something in them suggesting that they wanted to be abused or otherwise deserved it. Confusion or outside-the-mainstream sexual activities or attractions as an adult can support this erroneous belief. ("He/ she knew I was gay/ weird/ messed up and so that's why they picked me.")

Making sense of abuse is equally confounded when the abuser isn't a full-grown adult but rather a stronger, more mature peer or an older child (including perhaps a sibling). This scenario, sadly common, is not consistent with the image many have of an abusive relationship, which can cause confusion and denial.

Sexual abuse isn't okay

Even when a relationship is understood as abusive, many who were abused dismiss it as "not that big a deal." While not everyone experiences the same consequences of abuse as everyone else, and while sexual abuse is not a guarantee of pain and suffering, it does have an impact on everyone who experiences it, and it isn't, under any circumstances, "okay."

Which doesn't mean it has to ruin your life

Often therapists are guilty of reacting to sexual abuse in a manner that isn't very helpful. There is extensive research on the consequences of sexual abuse, but too often therapists relate to that research as proscriptive, meaning they insist that if sexual abuse happened, those consequences must be present. We all deal with challenging experiences in different ways. While there is no doubt much commonality exists in these experiences, this does not mean that you're lying or "doing it wrong" if you aren't suffering in the ways research says you are supposed to.

Sexual abuse is a violation of trust

Clearly the adult or older/ more powerful child who engaged in abusive behavior violated trust. Unfortunately, it is those we trust most who are in the best position to take advantage. There is also frequently a violation of trust on the part of parents, older siblings, or other caregivers who may not have been the abusers, but who perhaps knew of the abuse and didn't intervene, or would have known about the abuse had they been more present and available as caregivers. As a consequence, many who suffer abuse have profound difficulty with trust in their adult lives.

What to do now?

All adults who experienced sexual abuse as a child will, in their own way, forge their relationship to the abuse, the abuser or abusers, and to the impact it's had on their lives. While it is critical that no set formula be imposed, a number of questions frequently come up:

Do I tell my parent or parents (if not the abuser--that's another question, and an important one) about the abuse?

Do I disclose the abuse to my partner or spouse?

When, if ever, should I disclose the abuse to my siblings? My children? My close friends?

I never confronted my abuser. Should I?

I know others who were abused by the same abuser or abusers. Do I talk to them about it?

Commonly, adults who were abused struggle with difficulties in sexual relationships as adults, and may experience confusion about sexual attraction, sexual orientation, and difficulties with sexuality that can make it difficult to have a fulfilling sex life. In some cases they make choices to be with sexual and romantic partners who are abusive, and in others, forgo sexual relationships altogether. For these and many other reasons, adults who were abused as children wonder if they are "damaged," "broken," or "perverted."

Sexual abuse can impair one's ability to have trusting relationships, either romantically or among friends.

Many who believed they were at peace with their abuse experience a complicated re-emergence of difficult feelings upon becoming parents. Perhaps they see in a new light the ways in which they weren't looked out for or were left vulnerable. Many experience intense concern over their ability to protect their own children from abuse.

Choosing a therapist to help with issues related to childhood sexual abuse

When selecting a therapist, it is important to remember that while sexual abuse will no doubt be a central part of your work together, the help you need is with the totality of building your life. In this regard, choosing a therapist should include an exploration of how that therapist views the impact and support of adults who have experienced childhood sexual abuse, but should also include an exploration of how that therapist will help you create your life. While experience in treating adults who were sexually abused is a must, be wary of a clinician who seems to insist on a set path in recovering from abuse. Instead, consider working with a therapist who is both knowledgeable and open to helping you shape your own path.

Most critical is the issue of trust, which in our view needs to be built, rather than expected or assumed from the start. Therapy works best when a close relationship is built, and that effort must be given its due course. Any therapist who asks that you explore anything before a trusting environment has been created will likely undermine this building of trust.

Group therapy

While the thought of discussing sexual abuse in group therapy may seem daunting, after working closely with a therapist, this may be a tremendous option for working on the impact of the abuse, including learning how to build meaningful, close relationships. When the right environment is built, including explicit confidentiality, a therapy group is a tremendous opportunity to break out of the taboo and secrecy of abuse that can make it so powerful. Letting a caring group of others in can bring a gentle challenge to firmly held beliefs about what happened, what was right and wrong, who was to blame, and who you are in your life.