Understanding Child Abuse Crisis Counseling

Dr. Laura Tanzini

When one surveys the plethora of published statistics pertaining to sexual abuse in the United States, the fact that sexual assault has decreased by more than sixty percent since 1993 is incredibly encouraging (Rape, Abuse & Incest National Network, 2007). Tragically, this feeling of uplifted spirit is momentary, only lasting until one understands that the reality remains that approximately every two minutes someone in the U.S. is sexually assaulted (Rape, Abuse & Incest National Network, 2007). This staggering realization that this is sixty percent less than it was seventeen years ago should cause all of those who learn this information to be moved to action in educating the public about sexual abuse, to lead to further prevention, in hopes of complete eradication of this societal epidemic.

Sexual abuse and assault is any type of sexual activity that one does not agree to including, but not restricted to: voyeurism, exhibitionism, inappropriate touching, sexual harassment, vaginal, anal or oral penetration, sexual intercourse that one says no to, rape, attempted rape, incest, and child molestation. Sexual abuse can be verbal, visual, or anything that forces a person to join in unwanted sexual contact or attention. Sexual abuse can happen anywhere, whether it is in a public setting, in an isolated location, on a date, or in one’s own home. The aggressor/offender can be a former boy/girlfriend, a family member, an acquaintance, or a stranger. Regardless of the location of the assault and the relationship one has with the offender, violence is alwayswrong. The abused person is not at fault for the attack and is not responsible for the violent behavior of someone else, but rather needs to seek help from family, friends, or community organizations for support, counseling, and medical attention. (WebMD, 2010). The range of forms of sexual abuse makes it difficult to assign a succinct definition, and sources such as RAINN: Rape, Abuse & Incest National Network list and define at least fourteen individual types in an attempt to include the wide range of age and gender relationships between the offender and the victim.

Understanding Perceptions Related to Sexual Abuse

It is not uncommon for the general population to limit their perception of sexual abuse to effecting women only, but this categorization causes men and children to be an afterthought, which is harmful to the physical, mental, and emotional healing of survivors of sexual assault and abuse. No one should be ignored, overlooked, or forgotten. One in six women, and one in thirty-three men will be sexually assaulted in their lifetime (Rape, Abuse & Incest National Network, 2007) and one in four girls and one in six boys will be sexually molested before the age of eighteen (The National Center For Victims of Crime, 2004). One out of every six American women, or 17.7 million, has been victims of attempted or completed rape (Rape, Abuse, & Incest National Network, 2007). Ninety percent of rape victims are women, and eighty percent of all victims are white (Rape, Abuse, & Incest National Network, 2007). The statistics of victimized children are almost as high as those of adult women, showing that fifteen percent of the total number of sexual assault and rape victims are under the age of twelve (Rape, Abuse, & Incest National Network, 2007). In 2002 there were 1,800,000 referrals made alleging child abuse, of these 896,000 were actual cases of abuse (Slesnick, Bartle-Haring, & Gangamma, 2006). Of these children, forty-four percent are under the age of eighteen, making the ages of twelve to thirty-four the highest risk years for sexual abuse in the United States (Rape, Abuse, & Incest National Network, 2007). The percentage of girls (as young as five years old) who report they have been sexually abused exceeds boys by as much as seven percent, and of all child victims, ninety-three percent know their attacker (Rape, Abuse, & Incest National Network, 2007). Approximately thirty-four percent of attackers are family members, and fifty-nine percent are acquaintances, leaving the small minority of stranger perpetrators at seven percent of total attacks on children (Rape, Abuse, & Incest National Network, 2007).

Understanding The Risks Related to Sexual Abuse

Understanding that the risk of sexual abuse is much greater within one’s circle of friends and family causes some fear of being attacked by a complete stranger to subside. However, one’s awareness, alertness, and preparation should not be diminished by this information. People need to increase the conversation about sexual abuse in this country to encourage those who are suffering or have suffered to come forward and receive much needed support and help. The 248,300 victims of rape, attempted rape, or sexual assault in 2007 does not include victims twelve years old or younger; this number is, and should be to everyone, completely unacceptable (Rape, Abuse, & Incest National Network, 2007). In the time it takes to brush one’s teeth, a loved one, friend, or complete stranger has victimized another individual. In actuality, this estimation is far below the reality, an estimated sixty percent of sexual assaults are left unreported, making sexual abuse one of the most under reported crimes in the United States (Rape, Abuse, & Incest National Network, 2007). This is a travesty, not only for the education of the public surrounding this epidemic, but most importantly in providing those who have been so unjustly abused with the appropriate treatment and support.

The shame that victims of sexual abuse feel undoubtedly effects the report rate of sexual abuse in this country, and the possibility that victims feel it is worthless to report the abuse because of the shortcomings of the legal system, it is a great likelihood for their reluctance to come forward. Those children who do not receive treatment from molestation are much more likely to suffer emotional problems than those who do receive treatment (Garnefski & Arens, 1998). Girls are much more likely to internalize the abuse while boys are more likely to externalize the abuse. Boys often display more aggressive behaviors while girls often have difficulties with eating disorders, suicide and alcohol consumption.

When a person who has been molested does come to therapy, it is usually due to having some difficulty in their life often leading back to the molestation. They often have problems in relationships and trusting others or even themselves depending on how the abuse took place. Many abuse victims are in crisis and suffer from anxiety and/or depression. In fact, there are some consistent symptoms that child abuse victims experience and they include safety, secrecy, and shame. The interaction that occurs between a therapist and a client should build trust so the patient feels safe. Safety is of great concern for those who have been abused. In many cases, the very person who was supposed to love and protect them did the opposite and violated them. The therapeutic relationship can help the person to feel safe through appropriate boundaries and trust.

Understanding Therapy Related to Sexual Abuse

When a client comes to therapy and they have never talked about the abuse, it is important for them to do so. They need to tell the story and break the silence. The silence holds the power of the abuse and once released the healing can begin. Storytelling also helps the therapist to normalize the feeling around the abuse. If the client has not talked to any person about what happened they do not know or understand the common feelings that occur with a person who has been abused. People who have been abused often feel deep shame about the abuse that manifests from the actual event and how their body responded to the abuse. Many people who have been abused report that their bodies responded in some way to the abuse and that leads to deep shame. When they talk about the abuse, the therapist can normalize the feelings for them. In the beginning of therapy, and through the storytelling segment, the therapist needs to be very aware of the patient’s ego strength. Ego strength is important for a person to be able to cope with the memories and the feelings that will arise from the storytelling.

Much of the therapy will be centered on cognitive restructuring, challenging beliefs, and forming new coping skills. Experiencing the feelings of the abuse, the abuser, and any involvement from non-protective guardians will lead to higher self-esteem. Treatment approaches may include emotional, cognitive, behavioral, and experiential therapy leading to resolution of the abuse. If a client is in crisis and there is no resolution with therapy, medication may be an option if the client is suicidal and has low ego strength.

Spirituality’s Role in Sexual Abuse Therapy

After dealing with many of the cognitive and emotional issues, it is important to treat the harm that has been caused in the victim’s spiritual life. One of, if not, the most important questions that survivor’s of sexual abuse often wrestle with is, “Why me?” Among those who are in a healthcare and/or counseling profession, there is much temptation to either answer the question for the patient or altogether avoid it because of its deeply rooted spiritual nature. In this research we have discovered that healing cannot begin until the patient feels safe and furthermore, that s/he understands that the abuse was not their fault. Additionally, “Why me?” is a question that cannot be ignored. However, counselors do not need to feel pressured to give a direct answer because the fact is that a universal answer does not exist for such a question. When a sufferer asks, “Why me?” s/he is trying to understand their suffering in light of the tension between good and evil in the world. One method that can be implemented is guiding a patient through their understanding of God’s presence in the midst of their suffering. For counselors to best explore that spiritual dimension, it is advisable to understand the various responses to suffering. This is to say, acknowledge and be sensitive to a patient’s unexplored or unspoken theodicy. According to Merriam-Webster’s dictionary, theodicy is defined as the “defense of God’s goodness and omnipotence in view of the existence of evil (Merriam Webster, 2010).

Throughout the years, many scholars have written many books that have presented our world with a wide spectrum of responses to suffering (i.e., theodicies). Among the most recognized theodicies are: Perfect Plan (Joni Eareckson Tada), Free Will Defense (Augustine & Alvin Platinga), Soul-making(John Hick & Ireneus), Openness (Gregory Boyd), Luciferous (Ellen G. White), Finite God (Harold Kushner), Protest (Fyodor Dostoyevsky & Albert Camus), Victory of God (David Bentley Hart), and Goodness of God (Marilyn McCord Adams) (Loma Linda University, 2010). Dr. Richard Rice, professor at the School of Religion at Loma Linda University offers the following brief descriptions of the above mentioned theodicies:

  1. Perfect Plan Theodicy – God directly controls everything that happens in the world, suffering included, and his plan is perfect. Otherwise he would not be sovereign Lord, and life in this world would be much worse that it is.
  2. Free Will Defense Theodicy – God gave certain creatures’ freedom and some of them those to rebel against him. Since a free act is uncaused, the responsibility for evil is theirs, not God’s. (God could not give them freedom and then determine how they used it).
  3. Soul-making Theodicy – Without challenges, the soul cannot grow. Consequently, the world we live in, with all its hazards and moral ambiguities, provides an ideal environment for character development.
  4. Openness Theodicy – Because it is God’s very nature to love, God created beings with moral freedom, respects the decisions they make, is profoundly affected by their experiences, and works for the fulfillment of his purposes for them in ways that honor their integrity.
  5. Luciferous Theodicy – Evil originated in the sinful rebellion of the highest created being and spread to humanity through the fall of Adam and Eve. God allows evil to continue in order to convince the entire on-looking universe that God’s character is one of the perfect love and infinite goodness.
  6. Finite God Theodicy – God has supreme power, but there are some things that even God cannot do. While God is involved in every aspect of the world – sustaining, caring for, and influencing it- God cannot interrupt or intervene the course of creaturely events. God cannot unilaterally cause things to happen.
  7. Protest Theodicy – Every attempt to provide a rational framework in which evil fits will fail. There is no explanation for evil that accounts for the suffering of innocent children. The very idea that there is one is offensive.
  8. Victory of God Theodicy – Evil is the result of forces at work in the world that oppose God’s purposes and God will eventually overcome them and establish his beneficent sovereignty.
  9. Goodness of God Theodicy – The goodness of God defeats horrendous evils by ultimately bringing all people into a relationship of intimacy with God in which their sufferings are viewed as occasions for positive good.

It is important to note that although some people find it easy to firmly abide by the specific arguments of any one theodicy, most people do not. An individual’s experience and life story gives them the freedom to draw from different theodicies and create one that is best suited for their lifestyle. By gaining an understanding of the concept of theodicy, a person could increase their ability to cope with their crisis by positively influencing their perspective on the assault. This is not to say that a victim is encouraged to view their assault as a positive event in their life but rather, that a fitting theodicy can reconcile the presence of God in the midst of their suffering.

Another spiritual component that is important to address in victims of sexual assault is forgiveness. The dictionary definition of forgiveness and the most popular understanding is, “ceasing to feel resentment against (an offender)(Merriam Webster, 2010). However, there is a difference between forgiving wrongs and overlooking them. Forgiveness does not mean you have to forgive or forget what happened to you, or that you have a moral obligation towards the attacker (i.e., you do not have to be friends). In his book, Forgiving our Parents Forgiving Ourselves, Dr. David Stoop writes that there is a “need to distinguish forgiveness as a decision from forgiveness as a process”. Forgiveness as a decision means choosing not to hold onto an emotional “debt” against another person. Forgiveness as a process means working through our own inner reactions until what was done to us no longer dominates us (Stoop & Mateller, 1996).

The Ritual of Release

During therapy, one of the final sessions that ends a survivor’s dependence on the therapist and encourages them to rely on themselves in order to continue to heal is known as a Ritual of Release. During this session, the individual engages in a physical demonstration of the power of forgiveness such as writing a letter to the offender and burning it, praying, washing their body, and saying “I forgive you” out loud for as many times as necessary. Rituals are concrete ways to symbolize an individual’s spiritual nature. Furthermore, they give us “something tangible to help us with the intangible nature of our relationships”. Sometimes we need physical evidence that love exists. In times when it very difficult to forget, rituals can help us remember that love is still a present reality.


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Author Bio

Dr. Laura Tanzini, DrPh, MA, MFT

Dr. Laura Tanzini is a highly educated and accomplished professional with a background in biology and psychology. She received a BS in Biology from UC Riverside, an MA in psychology from Phillips Graduate Institute, and a Doctorate in Public Health with a specialty in Lifestyle Medicine from Loma Linda University.

Dr. Laura Tanzini is a Board Certified Professional Counselor, Integrative Medicine Clinician, and PTSD Clinician. She has worked in multiple medical hospitals, mental health institutions, and inpatient eating disorder clinics. Also, Dr. Tanzini has written scholarly papers and spoken on various topics related to nutrition, stress, menopause, obesity, depression, anxiety, and human development.