some considerations for therapy with Childhood Sexual Abuse clients

1. CSA and pre-counselling
considerations
By AA MacKenzie

2. Child Abuse
Umbrella term for various forms of ill-treatment
of children by caregivers.
Five main forms:
•
•
•
•
•
Spiritual abuse
Physical abuse
Emotional/Psychological abuse
Neglect
Sexual abuse
National Statistics:
Approx. 107,000 national reports in 1999-2000 and 40-50%
of reports confirmed child abuse cases.

3. Confirmed cases were:
• 35% physical abuse
• 29% neglect
• 27% sexual abuse
• 10% emotional abuse
Aboriginal children have higher rates of both sexual
abuse and neglect.
National Child Protection Clearinghouse - AIFS

4. Spiritual abuse
Psychology almost never recognises the
spiritual basis of child development, but this
was important to Biblical writers.
• Psalm 78:1-8 emphasises that children should
receive spiritual instruction so they will put their
faith in God and not become stubborn or
rebellious.
• Scriptures clearly teach that Biblical education is
beneficial to children; its absence is surely
harmful.

5. Physical abuse
• Non-accidental injury
• Physical assault such as beatings, burnings,
bruising, shaking
• Inappropriate/excessive physical discipline
Ephesians 4:31 says to
“put away from you all bitterness, rage and
anger, brawling and slander, along with every
form of malice.”

6. Emotional/Psychological abuse
• Instability in home ie: family pressures,
domestic violence
• Punished unrealistically, or not punished at all
• Deprived of love, warmth and attention or shown
love spasmodically
• Humiliated persistently, criticised excessively
verbal condemnation
Colossians 3:11 says
“fathers do not provoke your children, or they may lose heart.”

7. Neglect
Failure to provide a level of care that meets
a child’s physical and emotional needs:
• Inadequate food/fluids, clothing, hygienic
living conditions
• Inadequate supervision, failure to ensure
safety
• Abandonment / desertion
• Educational and/or medical neglect
Psalms 27:10 says
“Though my Father and Mother forsake me, the Lord
will take me up.”

8. Sexual Abuse
• Includes exhibitionism, fondling of sex organs
of a minor
• Forced intercourse, rape, incest
• The use of children in the sex industry
Ephesians 5:3 says
“...among you there must not be even a hint of sexual
immorality, or any kind of impurity, or of greed,
because these are improper for God’s holy people.”

9. Pre-Counselling
Considerations
Child Sexual Abuse
VICTIMS

10. Considerations
• 50% of victims do not remember the abuse until years
after it has occurred. Usually something in adulthood
will trigger the memory.
• Victims hold a distorted belief that they are
responsible for the abuse perpetrated against them. This
results in feelings of extreme shame and self-blame.
• Numerous studies have discussed a direct relationship
between CSA and adolescent/adult prostitution -- 76 to
90 % of prostitutes have a history of CSA, the most
common form being incest.
L.W. Carson, “Child Sex Abuse” (1988)

11. Considerations
• In Australia mandatory reporting requirements exist
but vary by State (see handout).
• Queensland doctors are required under the Health Act
1937 to report all cases of suspected “maltreatment”.
• Queensland Education Policy requires school
principals to report suspected child abuse cases to
appropriate authorities. Teachers to report through
principals (not legislated).
• Privacy of Information Act prevails in counselling
situations - up to counsellor & counselee whether to
report
Australian Institute of Health & Welfare (1999)

12. Long-Term Effects
Latent Adult CSA
VICTIM

13. Common responses in many survivors:
Feelings of extremely low self-esteem or selfhatred --- extreme is self-mutilation.
• Trust can be next to impossible under many
circumstances.
• Re-experience the sexual abuse as if it were
occurring at that moment - “flashbacks”.
• Frequent sleep disturbances and nightmares.
• Alcoholism & drug abuse.
• Suicide
B.C. Ministry of Health, Child and Youth Mental Health Services, 1990

14. Common responses (continued):
Frequently find themselves in abusive, dangerous
situations or relationships as adults.
• Continue to be abused by family, caregivers
and professionals.
• Repression and disassociation to escape the
painful memories.
• When the abuse is severe, `splitting' can
become the only means of escape - multiple
personalities.
B.C. Ministry of Health, Child and Youth Mental Health Services, 1990

15. Eschatological Insights

16. Insights
“Psychotherapy and counselling (which includes
listening, support, prayer, admonition, Scripture,
meditation, encouragement, reflection, advice,
confession, questioning, interpretation, evaluation,
explanation, teaching, informing, empathy, verbalising
feelings, unconditional love, trust, authenticity) is a
powerful instrument that the H.S. is able to utilise.”
G. R. Collins, “Biblical Basis for Christian
Counselling” (1993)

17. Insights (continued)
• The therapeutic process can best facilitate the Spirit’s
work by having an eschatological orientation.
• From an eschatological perspective, latent victim is
not captive to their emotions, only able to return abuse
for abuse.
• Instead, they can forgive because they are able to
envision abuser as God does and see themselves whole
in Christ.
G. R. Collins, “Biblical Basis for Christian
Counselling” (1993)

18. Challenge to Christian Counsellors
• To enable people to see their problems more clearly.
• To assist them to live their lives in light about what is
certain in the future.
• To provide a firm basis on which the victim can
rebuild their lives.
G. R. Collins, “Biblical Basis for Christian
Counselling” (1993)

19. Biblical & Theological Insights

20. Jeremiah 29:11, Ephesians 1: 11
Deviation from God’s perfect plans for
human beings is destructive. Sexual
deviancy (rape, incest, abuse) is selfcentred, and often expresses a desire to
manipulate, control, or hurt another
person.
In every case, fornication is presented
as behaviour opposed to the plan and
will of God.

21. Matthew 5:28
To lust (want what is wrong sexually) is
as evil as doing what is wrong sexually.
This is sinful thinking.
CSA leaves at least two people abused.
According to Jesus, this is unequivocally,
morally and ethically reprehensible.

22. 1 Corinthians 6 - 7
A person who cannot resist sexual
temptation is not free. They are caught
in the strangling hold of uncontrolled
impulses.
Therefore, sex outside of a covenant
relationship restricts freedom.

23. 1 Corinthians 6: 13, 18
Sexual sin is something that affects the
body. “All other sins a man commits
outside the body, but he who sins
sexually sins against the body.”
Paul implores us to “flee from sexual
immorality.”

24. Proverbs 5: 1-8; 1 Corinthians 6: 9,10;
1 Thessalonians 4: 3; Ephesians 5: 3-7;
Colossians 3: 5,6.
The Bible warns us repeatedly of the
enslaving influence of inappropriate
sexual behaviour.
Immoral sex hinders the potential
oneness that can come within marriage.

25. Ephesians 6: 10-13
Christians are in a spiritual battle
against the forces of evil.
Our “Achilles heal” is often sexual
temptation and it is here the attack
often comes.
We fail at times to rely on the protective
power of the H.S.