Lorraine E. Fox
Abstract: Research and clinical experience indicate that the effects of sexual abuse can be both profound and long-term, sometimes affecting the quality of life for the victim/survivor forever. While the therapeutic benefits of traditional clinical interventions are well documented, it is important that direct caregivers also recognize that they have much to offer child victims in terms of supportive and healing relationships and interventions. Using the Redl model of life-space interventions, the author details specific areas of trauma that can be positively influenced by conscious, intentional, therapeutic day- to-day interactions and interventions by adults in the child/youthís immediate environment. These potential healing agents include child care workers, support staff foster parents, school personnel, volunteers, and family members.
There are a variety of interventions by a variety of people in different helping positions that can be effective in providing comfort, soothing, new learning and eventual healing for the wounds of abuse. Therapists, direct service child care workers, recreational workers, foster parents, cooks, maintenance personnel, and volunteers each have something significant to contribute to the successful adaptation to life for hurt and hurting children and youth. No contribution is to be seen as "better" or more useful. Working as a team committed to the growth and healing of our wounded young people, we strive together to fill the gaps of love and care, and to teach coping skills that enable a successful and fulfilling life.
Fritz Redl, a pioneer in the elevation of para-professional roles to that of critical importance in the therapeutic life of children, initially coined the notion of "exploiting daily life events" for the restoration of wholeness to fractured, fragmented and vulnerable youngsters (Garfat, 1987; Redl, 1966; Redl & Wineman, 1952). Professional child care literature reveals a strong commitment to utilize the daily routines of group living, such as meals and food (Rose, 1988), chores (Editorial Board, 1992), bedtimes (Augustin, 1984), and the like. We would like to explore specific events and interactions that may occur during the course of a day that can be "exploited" for healing purposes in the lives of sexually traumatized children and youth.
First, let us briefly review some of the traumatic aspects of sexual abuse that have the potential to cause distortion and deep wounds, and that pose a risk to successful adjustment.
Sexual abuse, of course, involves sex. It is a very specific form of abuse with very specific implications. The discomfort of many with the very nature of this form of abuse is conveyed by the common substitution of non-sexual words, such as "molest," to describe it. It is abuse, of course, because it is sex that is unwanted, non-mutual (forceful or coercive), and something for which young children are not physically, mentally, or emotionally prepared. The result of this aspect of the abuse is often referred to as "traumatic sexualization." Workers with sexually abused children/youth should never be surprised or dismayed when part of the abuse trauma is acted out sexually. We know that when children are victimized by violence, there is a tendency to re-enact the violent situation in an attempt to master an event over which they were powerless (Cameron, 1994). Victims of school-yard shootings can be predicted to play "gunman" for a while after the event. And, of course, they insist that they take turns being the gunman. Using this knowledge, it can be reasonably predicted that victims of terrifying sexual abuse will attempt to gain mastery by engaging in various sexual behaviours and activities. It is not "treatment" to punish such activity. The therapeutic response will be to "exploit" such events to help with the working out, the mastery.
An additional sexual trauma results from the very way kids are "set up" for abuse. Adults do not begin to molest by grabbing a child's genitals, but by offering initial physical contact that is experienced as affection. Before turning sexual, the contact consists of benign touch: sitting on someoneís lap, having your back rubbed, snuggling, an arm around the shoulder, or a pat on the thigh. As this contact graduates to sexual intrusiveness, the child becomes confused and is often not even clear about when things changed from "OK" to "not-OK." This confusion is often manifest in touching interactions between abused children/youth and adults who engage with them. How many workers have had a child hug them in a way that felt uncomfortable? How often has a child kissed us on the lips rather than the cheek? Sometimes we have become gradually uneasy as a benign touch from a child turned to touch that had sexual tones. Confusion between sex and affection also results in a variety of symptomatic interactions between child and child, where innocent play turns to sex play, or age-appropriate play promotes sudden rage as memories are triggered. Responses from adults to these events have potential either for further confusion as a result of a harsh response, or for re-education in an area where faulty notions have been formed.
A traumatic component of all abuse is the "powerlessness" experienced by the child, as he or she experiences his or her complete inability to influence the behavior of the hurting adult(s).1 There is now an abundance of research and longitudinal study that illuminates the life-long effect of such experiences. When powerlessness is introjected, made part of the belief system and adaptation of an individual, we have the frightening phenomenon of "learned helplessness" (Seligman, 1973, 1975). When there is a compensatory reaction to this powerlessness, we find the equally frightening adaptation where the young person begins confusing "power" with "control," and we find the victim now the victimizer; the hurt, now the hurting; the scared now the scary (Groth, 1979; Hunter, 1990).
To be sexually abused is to be betrayed; and to be betrayed is to forever be unsure of who can be trusted. Average children are taught by their parents to fear strangers: donít open the door if you donít recognize the person; donít get into a car if the person is a stranger. Things become clear: if I know you, youíre safe; if I don't, I become afraid. Young, and even older, children have a natural recoiling response when meeting new people; hanging onto daddyís hand, hiding behind momís skirt, backing up and giving clear evidence of wanting out even when being perfectly polite in the greeting. But what if the person who hurt you is someone you were close to? What do you learn about safety if you, in the past, allowed yourself to relax with someone who was nice to you, who offered you friendship and affection, and then gave you sex and terror? Whoís to be trusted now? It is crucial that direct service caretakers learn to both expect and understand what may seem like a rejection from a child or adolescent, just when "things seemed to be going so well." A youngster may run away, ask for a new worker, or just turn strange. This will most likely stem from a deep terror of trusting, based on past experience. The young person will need patience, a stance of acceptance, and an "open arms" policy, allowing them to react to the terror, and then come back to learn that this relationship will not exploit their trust. Too often we find individuals and programs closing the door on those who seem to reject us, rather than making the commitment to hang in with them. Not only is this sad, but terribly unfair.
To be sexually abused is to be incredibly lonely. It is impossible to believe that this could be happening to anyone else. You are told not only not to tell, but that awful things will happen to you if you do tell. You gradually learn to feel "safe" when you are being deceitful; telling the truth will cause terrible things to happen to you or your family, and your molester, about whom you are usually very ambivalent. (While not usually ambivalent about wanting the sex to stop, many children are quite ambivalent about their feelings toward the person who is abusing them.) Better to be quiet, or to lie. Truth begins to equal danger. You develop a habit pattern of saying little: "OK," "not much," "nothing." Or you learn to use sounds instead of words, grunting in response to questions, using gestures. Perhaps you learn to employ "empty speech": lots of words with no substance or meaning, which sounds like youíre sharing, but youíre not really saying anything. Or, you just learn to lie: Say you had fun; lie about where you went, why you were late, what you did. Whatever you do, donít give it away. You become very adept at covering up whatís happening. "Good boy/girl," says the molester. "Good girl/boy," implies the parent of the child who really doesnít want to know. Over what period of time was the child/youth in your care sexually molested? A year, two years, more? Count the days. Three years of keeping a secret equals more than a thousand days of practice in deception. A thousand days of profound loneliness. The secret becomes as painful as the sex. How cruel to "punish" kids for lying, when that is the only safety they've known until now.
There was a recent incident in a residential treatment centre in the authorís state where a resident successfully committed suicide in the facility by hanging himself. While investigating the death, it was learned that while the young person did not share his intention with any adult staff, he did, in fact, confide in a number of his peers. Not one child said a word, until it was too late. Why? Not for any malicious reasons, but because collections of abused children/youth are, unfortunately, entirely comfortable with secrets, and very fearful of the consequences of truth. How urgent that we keep this in mind while attempting to provide safety for our vulnerable residents.
Lack of protection
It takes more than an "offender" for a child to be abused. Perhaps we have become overly focused on those who overtly hurt our children. If we can step into the experience of an abused child, we realize that abuse requires more than someone hurting you; it also requires a non-protector. No one can hurt you if someone protects you. When you lie or stand there, feeling or being forced to let someone touch you, being forced to touch sexual parts of an adult, bleeding from being penetrated, gagging from feeling suffocated, you wonder not only why someone is doing this to you, but why someone isnít stopping it! How can they go on pretending itís not happening? Why canít they see behind my feeble lies? Why canít they see and feel my pain and fear?
There are more traumatic components to sexual abuse, but letís focus on how events in the daily "life-space" present opportunities to be helpful with these.
There are a myriad of daily activities that can prompt a symptomatic response to real or perceived sexual stimuli for sexually abused children/youth: Sharing a bathroom, showering/bathing, dressing, gym class, contact playing, adult affection, bedtime. Letís hone our observation skills to see and hear what our youngsters are telling us (usually with behaviour rather than words). Do we need to be more sensitive with regard to providing privacy for children for bathroom activities? Can we "read" the unnecessary layers of clothing as a signal that the young person does not feel safe, and does not feel able to protect him or herself without clothing used as armor? Can we give them comfort and reassurance at night: a night-light, a roommate, some music to listen to while falling asleep, awake staff, permission to sleep in clothes if too scared to put on pajamas?
Are we talking about sex? Sexually abused children have trouble with sex! We are now able to correct their distortions and misinformation. We can give them education and re-education. Are there books to read? Are they accessible? Do we have regular conversations about sex and how it is supposed to be, and about how hard it is to have it introduced into young lives before nature intended? When sexual remarks are made at the dinner table, do we hush the child(ren), or do we postpone the discussion until after dinner, but schedule a time to talk about what was brought up? Have staff told kids explicitly that they are open to questions about sex? We want to monitor our responses to their sexual behaviour (talk or activity) to be sure we are not causing shame about something the child had no control over. Sexual talk, and sexual activity, provide wonderful opportunities for us to interact with kids about a part of their life that they cannot deal with alone. They have questions and wonder if anyone has answers. Of course we donít always have good answers, but we can always be clear that we are not hiding anything from them, leaving them to imagine what might have happened to them. We donít want to leave our immature young minds on their own to figure out whatís happened to them: and if we donít help, they will. The author can assure you that there is an inverse relationship between sexual activity and verbalization: the less adults are willing to talk, the more kids will sort out and act out their concerns behaviourally.2
Staff and other helping adults are in a wonderful position to use their own experiences and interactions with youth to help them gain insight and sort through their confusion. We can use uncomfortable touch to teach exactly what makes it uncomfortable, and why, and to provide guidance about more acceptable physical interaction. We can use activity between peers to try to understand the meaning of the activity for the children. If we can find out what they were trying to understand or solve with the sexual interaction, we can help them do so more appropriatelyĒ with us. Staff can use displays of affection between them, which invariably produce hoots of innuendo, to discuss differences between sexual and affectionate touch. (This, of course, implies that we have done work on the treatment team to ensure that they have developed positive enough feelings between the members that displays of affection - back rubs, hugs, and so on - are likely!)
Another very challenging aspect of interventions with sexual behaviour is the opportunity to join the struggle experienced by same-sex abused youth. In my work with organizations, I have found this probably the most "loaded" issue for staff to deal with. Literature on sexual abuse reveals that, as far as we know from reported cases, offenders are more often men, whether the child-victim is male or female. This presents specific trauma for male victims abused by men, since many questions and fears arise with regard to the effects of same-sex abuse on sexual development. Specifically, boys (usually) must resolve two very complex - and controversial - issues: resolving their sexual identity as well as their sexual orientation. It is important to distinguish between these two processes, because they are quite separate, although many cultural stereotypes cause them to seem fused. (Gay men do not, because they are gay, feel and act like women. Lesbians do not, because they are gay, feel and act like men.)
Sexual identity has to do with oneís comfort and acceptance with oneís maleness or femaleness. Because of many cultural roles, some boys see victimization as a "girl" problem, and thus have difficulty living with their former inability to control abusive situations, especially sexual ones, which are often not overtly forceful. This discomfort sometimes causes post-pubertal and adolescent boys to become estranged and alienated from their vulnerable small-boy past, and to thus risk losing "empathy" for others who are hurt. Adults can be very helpful in re-framing the abuse as a crime of adults against children, which is not sex-specific. We can also try to keep them in touch with the realistic reasons for their compliance: smallness in size, vulnerability to the relationship, and conformity to the expectation of obedience. A very simple, practical intervention with some boys is to simply take them to a school or play yard and show them small boys - to give permission, as it were, for their past behaviour. It is crucial that our male victims not lose touch with their vulnerable self, for an unfortunate characteristic of many abusers is lack of "empathy" for their victims, which stems from lack of empathy for themselves.
Sexual orientation is a separate developmental process, and has to do with the development of an emotional and sexual feeling for oneís own sex. In our "homophobic" society this can lead to an incredibly lonely, and sometimes dangerous, journey for teens as they try to understand themselves. Perhaps a teen girlís only experience with intercourse was during the abuse, which she hated; she then might wonder if she doesnít like men. Perhaps a young boy had some sexual pleasure during the abuse, although the context was miserable, leading him to wonder if heís gay. Some same-sex molested youth come to believe that they - ve been "made" a homosexual by the abuser. The rate of suicide for gay youth is frightening; and suicide is a result of loneliness and hopelessness. We owe our abused youth relationships in which they can sort out their questions and feelings without recrimination and condemnation.
Feelings of powerlessness
We can study the daily behaviour of children in our care to see how they are struggling with their anger about having been powerless to influence adult behaviour. Are they showing us that they are becoming comfortable (i.e., used to) being victims. Do they turn to others to solve their problems? Are they allowing themselves to be scapegoated? Who are they dating and how do they allow themselves to be treated? Are they, rather, showing us that they are reacting to their victimization by identifying with the aggressor, believing that it is better to "give it" than to "get it"? Are they beginning to feel "powerful" when they are controlling others?
It is not helpful for staff to solve problems for children/youth, because it reinforces for the child/youth that he or she canít. It is more important that adults teach problem-solving skills; that coaching is provided, not interference. When peers are having trouble with each other, work with them to solve it, but donít solve it for them.
Working through betrayal
It is important to be alert for signs of "panic" when a young person starts to feel too comfortable. They often "blow" a placement, or a relationship, when they realize they are letting their guard down and relaxing too much. It reminds them of when they did this before, and then got done in! We want to be careful not to reject a child when he or she rejects us. We want to examine our willingness to "hang on" to someone whoís too scared to stick with us right now. Can we wait for the runner to return? Can we use care before assigning a new worker? It is important to provide opportunities for betrayed young people to learn that getting close and feeling vulnerable does not always result in being "used" or hurt by someone. When a child/ youth makes an overt sexual gesture, or offers an explicit sexual favour, we can show care to respond not to the language, which is not the issue, but to the "real" question: are you interested in having sex with me? The most reassuring response is the most explicit: not "donít be silly," but "Iím not interested in having sex with children."
We want to look, also, at signs that bewilderment over trust is not causing youngsters to be careless with their personal safety. Many of our young people feel perfectly comfortable getting into a car full of strangers, letting someone they donít know hold them or take them by the hand. Great patience is needed to give good information about personal safety, while not discounting their previous experience.
Learning to live with the truth
The longer a child/young person has had to live fearing the truth, that is, discovery of their "secret," the more patient we must be with their inclination to avoid honesty. It is crucial that we not moralize this behaviour: it has nothing to do with values or morality, it had to do with their very survival, as they understood it. Punishing these children for lying serves to reinforce the notion that the truth is dangerous. Opportunities must be provided for them to try saying scary things out loud, without retribution. Obviously, this complicates interactions in group settings! We donít want to compromise our belief that "honesty is the best policy," but we also canít afford to be naive. Sexually abused children/youth have been taught something quite different. Learning to hear the "sound" of reality can take a very long time. One of our uncomfortable tasks is to examine our own interactions: are they honest? Do staff say out loud what it really is, or do we also compromise truth, rationalizing away our reasons for not confronting each other, for giving children less than complete information.
"Wimps" need not apply
Abused youngsters cannot heal or feel safe when in the care of those overwhelmed with the job! Stress junkies, step right up. The job will never get easy. The challenges never stop. Not everyone with a good heart is suited. Hire, pay, and reward those who actually enjoy the challenges of working with troubled and troubling children. Beware of getting caught in the "bar at closing time" trap when there are staff shortages: remember that people look better to us when weíre desperate than they should.
Sexually abused children are either abused by women, or not protected by women, which places a strong burden/opportunity on women to demonstrate protective skills. It is urgent that women not back off in favour of men during explosive situations. Sexually abused children have either been abused by men, or abandoned by men. Strong, nurturing, "present" men can teach new roles. It is crucial that all adults in the environment demonstrate protection skills, or we fail our mission and release young people who will produce children with no notions of how to protect them: by sticking around, by knowing whatís going on, by not allowing others to hurt or get hurt, by facing the truth. All of you "clucking mother hens" out there... go for it! What a gift to abused kids. Find out what theyíre up to. Ask questions. Be nosy. Give and get lots of information. Letís also be sure to have caring male workers who are not just biding time until they can move "up," and away from the kids. Loving and caring for kids is not a "woman thing." Kids are owed - and their future kids are owed - strong and protective men and women to keep them safe now, and to show how itís done.
Reasons for optimism
Each day, in hundreds of ways, those who attempt to "help" those who need us are provided with a multitude of opportunities. We may not know exactly what to say, and it doesnít matter. Kids will know if we have taken the trouble to understand their experience, and this can always be communicated. If we are willing to take a step in their shoes (and those shoes do hurt!), we can walk with them into new ways of looking at the world, new ways of learning to carefully trust, new ways to exercise personal power so they can be in charge of their own safety. What a wonderful way to spend a life!
1. For a more complete discussion of the effects of, and therapeutic interventions with, the experience of powerlessness for victims, see Fox,1994.
2. Solicited reports from agencies the author has worked with, who reported a sometimes dramatic decrease in covert sexual activity in response to changes in staff openness about sexuality. See also Fox, 1989.
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Garfat, T. (1987). Words that have meaning: Reflections on the words of Dr. Fritz Redl. Residential Treatment for Children & Youth, 5(2), 5-12.
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Rose, M. (1988). The function of food in a residential treatment process. Residential Treatment for Children & Youth, 6(1), 43Ė60.
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This feature: Fox, Lorraine (1995) Exploiting daily events to heal the pain of sexual abuse. Journal of Child and Youth Care. 10 (2). pp 33-42