Parenting Skills For Adult Survivors of Childhood Sexual Abuse

1. RACHEL C. FREEMAN, LCSW
SEXUAL ASSAULT CENTER
DECEMBER 2013
Parenting Skills for Adult Survivors of Childhood Sexual Abuse: Engaging, Empowering and Equipping Survivors as Parents

2. Thriving…
I was forced to enter the basement of my soul and look directly at what was hidden there, to choose, in the face of it all, not death but life.”
~ Henri Nouwen

3. Facts About Sexual Abuse
1 in 4 girls and 1 in 6 boys will be sexually abused before the age of 18 1
1 in every 6 women will be sexually assaulted at some point in her lifetime 2
In approximately ¾ of child sexual abuse cases, the offender is someone known to the victim 3
Approximately 2.78 million men have been victimized by rape or sexual assault 4
Child sexual abuse is a major life trauma for entire families, not just the child

5. More Statistics
Victims of sexual assault are:
3 times more likely to suffer from depression
6 times more likely to suffer from Post-Traumatic Stress Disorder
13 times more likely to abuse alcohol
26 times more likely to abuse drugs
4 times more likely to contemplate suicide 5

7. Long Term Effects of Sexual Abuse
Feelings of guilt and shame
 Feeling different or alone
Sadness
Confusion
Anger
Low Self-Esteem
Dissociation
Fear
Hatred
Depression
Promiscuity
Eating Disorders
Body Image issues
Anxieties
Changes in lifestyle
Turning to violence
Substance Abuse
 Self Injurious Behavior
Post-Traumatic Stress Disorder (PTSD)
Rape Trauma Syndrome (RTS)

8. Effects of Sexual Abuse (cont.)
Intrusive thoughts
Viewing sex as obligation
Seeing sex as a means to exert power
Confusing sex and love
Rigid boundaries or lack of boundaries
Difficulty forming close relationships
Trust issues/intimacy issues
Sexual/relationship dysfunctions
Difficulty with authority figures
Vague or no recollection of early years or periods surrounding sexual abuse
Sexual/relationship dysfunctions
Somatic or Psycho-somatic symptoms including long- term physical ailments

9. Physical Effects of Sexual Assault Research shows that survivors of sexual abuse have more medical problems, somatization issues, high-risk behaviors, family physician visits, hospitalizations and surgeries, compared to individuals who have not been sexually abused.
Long term genital or anal discomfort with no medical cause
Headaches
Stomach aches
Dissociation
Fibromyalgia
Asthma
Chronic Fatigue Syndrome
Irritable Bowl Syndrome
Bladder/Kidney infections
Reproductive system damage
Sexual dysfunction
Acne

10. Why work with Non-Offending Caregivers?
The best prognosis for healing for a sexually abused child is when they are believed and supported
To enhance the opportunities for recovery for the child victim; children who are believed and supported by their families develop fewer negative repercussions from the abuse
To increase safety for the child victim and other children
To increase positive parenting skills and familial relationships

11. Treatment Goals for Non- Offending Parents/Caregivers
1.To increase knowledge of the dynamics and effects of childhood sexual abuse, including sexual behaviors in children, responding to a disclosure of sexual abuse, and aiding children in learning appropriate boundaries and safety skills.
2.To increase the knowledge and utilization of positive anger management, coping, relaxation and grounding skills to aid in dealing with the child’s symptoms of childhood sexual abuse and with their own reaction to the sexual abuse of the child.
3.To decrease the belief that the child contributed to or was responsible for the abuse and/or decrease feelings of guilt and shame regarding the inability to protect the child from abuse.

12. Treatment Goals for Adult Survivors
Safety planning
Psycho-education
Feelings identification and affect regulation
Increase relaxation skills; stress management
Cognitive processing and Cognitive coping
Increase Self-Esteem / Positive Sense of Self
Increase Healthy Relationships and Trust
Create a coherent trauma narrative

13. Safety Planning
Support system
Assess for past and current suicidal ideations or attempts
Create Safety Plan
Examples
Make Safety planning on-going

17. Psycho-Education
What is sexual abuse?
Offenders and Grooming
Common reactions and effects of childhood sexual abuse
Coping Skills
Boundaries
Survivor’s Journey6 or Sexual Abuse Game (from Paper Dolls and Paper Airplanes)7
Barriers to healing

18. What is CSA & Who Offends?
CSA usually happens gradually and over time but can increase in severity and duration
Children are most often sexually abused by someone they know and trust. Approximately 3/4 of reported cases of child sexual abuse are committed by family members or other individuals who are considered part of the victim’s “circle of trust.” (NCTSN.org)
Sexual assault is a crime to express power and control. Sexual assault is not about the need for sex. Power, not sex, is the motivation behind sexual assaults.

19. Appropriate vs. Inappropriate Sexual Behaviors
Appropriate
Inappropriate
oHealthy sexual exploration
oPresents with an element of fun and curiosity, not harm
oLimited in duration and intensity
oInvolve shame, guilt, fear and anxiety
oContinuous problem generally worsening over time
oUnresponsive to positive redirection
oCan involve threats, bribes, coercion and/or force

20. Disclosures
Children rarely lie about sexual abuse
False reports make up only 1% to 4% of all reported cases. Of these reports, 75% are falsely reported by adults and 25% are reported by children (www.tncac.org)
There are many reasons why children may have trouble disclosing:
Fear of repercussions
They may be protecting the abuser
They don’t have the words
They don’t know it’s wrong
They are being bribed or threatened
They are afraid the abuse is their fault

21. How to Respond
Remain calm and listen
NEVER blame the child
Pay attention to body language
Reassure the child that you believe him/her
Be supportive
REPORT the disclosure
Don’t put words into the child’s mouth
Try not to make promises you can’t keep
Don’t try to figure out yourself if the allegations are true or valid

22. Talk About Safety
Avoid only teaching Stranger Danger
Remember, most offenders are known to the child
Qualities of Safe People
Safe and Unsafe Touches or Okay and Not Okay Touches
Private Body Parts
Secrets
Boundaries and Privacy
Personal Safety Skills and Assertiveness Skills

23. Feelings Identification
Before survivors are ever able to talk about their deep hurts, we have to first help them learn how to handle intense emotions.
One of the first things we must do is help survivors address, connect with, and identify their feelings
Feelings Box
Masks
Where Do I Feel?

25. Normalization for NOPS
Parents may display any or all the following
behaviors. Responses may vary, depending
on who the alleged perpetrator is:
oAnger
oConfusion
oOverwhelmed, Anxious
oDisbelief, Refusal to Acknowledge/Denial, Shock
oFear
oGuilt, Shame
oInadequacy
oSadness, Depression

26. How to Help your Child
Maintain contact with teachers about concerns and observations
Listen to the child’s stories and be supportive
Contact a therapist or case worker with specific questions
Teach personal safety
Use care when correcting behavior
Offer alternative choices or redirect inappropriate behavior

27. Relaxation and Stress Management Skills
Deep breathing
Meditation, prayer
Progressive Muscle Relaxation
Exercise
Yoga
Music
Self-Care Calendars
Positive Anger Management Skills

28. How to Take Care of Yourself (so you can take care of your child)
Positive coping skills
Parenting time outs
Self-care activities
Individual or Group therapy
Talk about feelings about the abuse
Positive outlet for anger
Utilize support system
Reminders that your child is still the same child
Address personal trauma history, if applicable
Reassurance that there is hope and healing

29. Cognitive Coping and Cognitive Processing
Cognitive Triangle What I Think? What Did I Do?
Intrusive Thoughts
Automatic Thoughts
Thought Records
Journaling
Reframing Negative
Cognitions
How Do I Feel?

30. Why Didn’t My Child Tell Me?
oSmall children may not have an accurate understanding of what happened or the right words to use
oThey’re afraid of getting in trouble or that it is their fault
o They do not know who to tell
o They may be trying to protect their abuser or someone else
oThey are threatened or bribed
o It may be the only attention or physical affection they are receiving
oThey do not know it is wrong
oThey thought they did tell

31. Why Do Some Children Tell?
The child has received sexual abuse prevention training and knows what to do
The child feels safe with a certain adult and feels safe to disclose
Physical problems lead to a medical exam
The sexual abuse escalates in frequency and/or behavior and alarms the child
Child’s sibling is at the age the abuse started and child is worried about sibling’s safety
Remember: Sexual abuse is never the fault or responsibility of a child

32. How Do I Protect My Children?
Positive Parenting:
Give each child responsibilities
Allow children to make choices
Show appreciation
Treat mistakes positively
Validate each child’s feelings
Be a good listener
Spend time with each child
Focus on Safety:
Know where your children are when they aren’t with you
Teach safety skills

33. Self-Esteem / Positive Sense of Self
Letter Writing
Collages
Self-Esteem in a Bag
Post-it Notes
Lipstick writing
“Three Open Doors” activity
5 Finger Exercise

34. Three Open Doors Activity
The survivor is asked to imagine what is on the other side of 3
doors that are partially open. The first door is the door to
their past that opens to whatever disappointments, losses,
or setbacks that they’ve experienced. These are
experiences that they may wish to put behind them. The
second door opens to the things they want to hold onto
from their past. These could be happy memories,
relationships, skills or lessons learned that they value and
wish to keep. The third door opens to their hopes and
dreams for their future. The survivor can either describe to
the therapist what is behind each door, or write, draw or
use miniatures to symbolize what is to be found on the
other side of each door.
David Crenshaw Assessment and Treatment Activities for children, adolescents and families Volume Two

35. Relationships and Trust
Family dynamics and family of origin issues
Needs of Children
Healthy vs. Unhealthy Relationships
Creating healthy relationships
Sex vs. Love
Respect
Boundaries
Assertiveness Skills

36. Trauma Narrative
Story-telling
Scrapbooking
Art
Time Line
Survivor’s Journey
The Sexual Abuse Game (Paper Dolls and Paper Airplanes 7)
T-Shirts

40. Special Considerations when working with NOPS
Some NOPS may also be survivors of sexual abuse themselves
Triggers, age of their abuse, etc.
The NOPS’ relationship with the alleged perpetrator
Non-believing or non-supportive?
Other children (non victims) in the home

41. Activities for Families
Self-Care Calendars
Positive Post-Its
Hand massages with lotion
Nail polish
Kicking it out of the Office/Paper Toss
Kindness Notes
Family Feelings Check-ins
Relaxation Exercises

42. Taken from The Self-Esteem Companion
1.Touch your thumb to your index finger and think of a time you felt really loved
2.Touch your thumb to your middle finger and think about a time you felt proud of yourself
3.Touch your thumb to your ring finger and think about a time you did something nice for someone else
4.Touch your thumb to your pinkie and think of a time when you felt really safe and happy
The 5 Finger Exercise

43. CELEBRATE!
Plan a celebration for all of the hard work the survivor has done!
Invite family / support person/people
Review accomplishments on the therapeutic journey
Tangible item for survivor to leave with—rock, letter, certificate, etc.

45. Contact Information
The Sexual Assault Center, Nashville TN
Rachel C. Freeman, LCSW
Vice President of Programs
rfreeman@sacenter.org
615-259-9055 ext. 338
www.sacenter.org
The mission of the Sexual Assault Center is to provide healing for children, adults and families affected by sexual assault and to end sexual violence through counseling, education and advocacy.

46. S.A.C. Services
Individual, Group and Family Therapy
11 Therapists on staff
Advocacy Services and Crisis Intervention
School Curriculum (Safe@Last and Be. Promoting Healthy Relationships)
Community Engagement and Outreach Presentations
24-hour Crisis Hotline 1-800-879-1999
Hospital Accompaniment
Main Line 615-259-9055

47. Citations
1.Centers for Disease Control and Prevention. (2005). Adverse Childhood Experiences Study: Data and Statistics. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Retrieved January 12, 2009 from: http://www.cdc.gov/nccdphp/ace/prevalence.htm
2.National Institute of Justice & Centers for Disease Control & Prevention. Prevalence, Incidence and Consequences of Violence Against Women Survey. 1998.
3.Finkelhor, D. & Ormrod, R. (2000). Characteristics of Crimes Against Juveniles. Juvenile Justice Bulletin. (Publication No. NCJ 179034). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
4.National Institute of Justice & Centers for Disease Control & Prevention. Prevalence, Incidence and Consequences of Violence Against Women Survey. 1998.; U.S. Department of Justice. 2003 National Crime Victimization Survey. 2003.
5.World Health Organization, 2002
6.Survivor's journey : a therapeutic game for working with survivors of sexual abuse. Charlotte, NC : Kidsrights, ©1994.
7.Crisci, G., Lay, M. & Lowenstein, L. (1998). Paper Dolls and Paper Airplanes—
8.Therapeutic exercises for sexually traumatized children. Indianapolis, IN: Kidsrights.