What supports sexual abuse disclosure?

In 2011, I had the privilege of delivering the annual lecture sponsored by the Tulir Centre for the Prevention and Healing of Child Sexual Abuse. They are located in Chennai, India. I was speaking on the sexual abuse by a sibling or juvenile. An individual in the audience found it hard to believe that the majority of victims are not disclosing the abuse almost immediately after it happens. I was reminded of this upon reading a newly published study in the Journal of Interpersonal Violence. McElvaney, Greene & Hogan have raised a number of very fascinating points. The article is well worth a read including their literature review in the introduction.

These researchers helped to identify that there may be a difference in the data from studies that have been done on a prosecution sample (where there has been disclosure in some way) and in studies where there has not been the involvement of the criminal justice system. They note that in research studies, there is a substantial group who has never told prior to being asked in the study - this ranged from 19% up to 47%. Silence is real.

The longer the delay in telling, the harder it may be to seek help. Further, given the link between child sexual abuse and subsequent traumatization through sexual assault and abuse, it may be even harder as trauma builds upon trauma.  There are many barriers to disclosure which the authors identify including shame, guilt, the risk to the family or the perpetrator and fear of reactions by others. I was particularly interested in the notion of the victim needed to weigh the consequences of a disclosure creating a pressure cooker effect - the wish to tell and the wish to keep it secret. This is a wonderful insight that serves as a useful reminder that disclosure is often an extremely challenging decision.

These authors found 5 themes from they qualitative research with both victims and parents:

1. The fear of not being believed although those fears often turned out to be unfounded once the disclosure was made;
2. Being asked is a way in which disclosure occurs.There were also those in the study who felt that someone (an adult) must have known it was happening;
3. Shame and Self Blame was another theme;
4. Fear and concerns for self and others - for example the fear that a disclosure would break up the family or that the victim would be unsafe or get int trouble; and
5. Peer influence in that first disclosures often happened to a peer.

There is a need to be aware of these barriers when working with those who may have been abused. As the researchers noted, many parents were "incredulous" when the child disclosed. It was not something that was meant to happen in their own family. 

A child who has yet to disclose may have some or all of these barriers in place - each one of them being quite powerful in and of themselves. Imagine the impact of several at once.

In my own work, I have seen time and time again, various disclosures simply because I have asked. This research affirms that. 

An already hurt and wounded child does not want to spread the pain - hurt the family; cause a family member to be gone; create more vulnerability as well as the fear of retaliation. One feature that may be useful in creating disclosure, beyond creating safety for the child, is to ensure that the perpetrator does not hurt others. Thus, disclosure can protect siblings or other children. This seemed to matter. But, of course, little will occur if the child believes that disclosure will create a further lack of safety.

Reference:

McElvaney, R., Greene, S. & Hogan, D. (2013). To tell or not to tell? Factors influencing young people's informal disclosures of child sexual abuse. Journal of Interpersonal Violence, published online 27 November 2013. http://dx.doi.org//10.1177/0886260513506281 

Rape Victim in India is an inter personal violence issue worldwide

As the world media focuses on the death of the woman in India who was gang raped, they may focus on two themes - the outrage in India which is leading to large scale public demonstrations and on the charges against the alleged assailants which may lead to the death penalty.

One hopes that the many protests will, however, cause a larger discussion about the role of sexual abuse in India. I have done some volunteer work there around the issues of child protection and sexual abuse. The official statistics in India are that 53% of children will be sexually abused. This may be the biggest story that should now become the focus of attention. It is a discussion of what has become too normal. Challenging the status quo such that sexual abuse of any person in India should be seen as wrong. This is an opportunity to bring to the national stage this very large discussion.

It is also a discussion of the remarkably few resources that exist in India to heal. I am impressed with the organizations that do exist such as the Tulir Centre for Prevention and Healing of Sexual Abuse located in Chennai. But they do not have the supports they need. Indeed, I am advised that there is a real shortage of skilled therapists to help with those who have been abused and those that abuse. Creative approaches are needed (An example is the wonderful ideas of Vikram Patel which can be hear in his TedTalk.

But there should be no nation that sits in judgment of India. For interpersonal violence is an international concern. We need only look at Sandy Hook in the United States where a shooter in a rampage killed children and adults. Then there is Amanda Todd who committed suicide after taunting bullying. Or how about Phoenix Sinclair, the Aboriginal child in Canada who died at parental hands? The point is, that this sexual assault in India should be seen as an incident of world wide inter personal violence that needs to be addressed by all of us.

Maybe abstinence sex education is harmful

There has been a movement in the religious right to push teenagers to commit to sexual abstinence. Per se, that does not seem like a negative thing. Trying to ensure that teenagers do not find themselves in unwanted parenthood or having to face decisions about what to do with an unwanted pregnancy seem like worthy goals.

Regrettably, that same movement would have abstinence education replace other forms of sexual education. I got to think about this after two recent experiences. The first was reading the 2005 book by Lisa Aronson Fontes, Child abuse and culture. She made reference to a doctoral dissertation by McDonald in 2004 which noted that most sex education occurs in adolescence which is after most victims of sexual abuse have been victimized. Fontes cogently points out that this further shames the victim who did not engage in sexual behavior by choice – but by coercion and force. What then are they to make of statements that they must save themselves for marriage and commit to abstinence? They are already sexually involved because of the abuse.

The second event was meeting with the Tulir Centre for Prevention and Healing of Sexual Abuse . Located in Chennai, India they talk about how victims are often quite young and clearly before they can receive sex education. Indeed, in many cases, they are not in a position to even understand what consent is about.

Sex education that offers children and teenagers information on choices but also helps victims to separate forced sex from sex by choice can help to prevent the unwanted pregnancies. These in turn can add to the children involved in child protection systems – but so too can rapes and molestation. Sex education should add to the efforts to prevent and heal sexual abuse and trauma. It should not be a way in which victims are then re-victimized.