Child Sexual Abuse Accommodation Syndrome

1. Child Sexual Abuse Accommodation Syndrome Dr. Michelle S. Zuckerman Psy, D. Director of mental Health SERVICES Dorothy B. hersh-Regional Diagnostic treatment Center Saint Peters university hospital MZUCKERMAN@SAINTPETERSUH.COM Dr. Karen A. Owen Jimenez Psy, D. BILINGUAL PSYCHOLOGIST Dorothy B. hersh-Regional Diagnostic treatment Center Saint Peters university hospital VENKOWENS@SAINTPETERSUH.COM

4. CHILD SEXUAL ABUSE • MAGNITUDE • DEFINITION • DYNAMICS

5. MAGNITUDE

6. MAGNITUDE

7. DEFINITION OF SEXUAL ABUSE Sexual Abuse • Any act occurring between people who are at different developmental stages which is for the sexual gratification of the person at the more advanced developmental state (Coulborn-Faller, 1988) • Consent is not or cannot be given (Finkelhor, 1979)

8. Types of Abuse • NONCONTACT SEXUAL ABUSE • Sexy talk • Exposure – showing genitals • Voyeurism – attempting to observe victim • Cyber sex • Instructing child to take off clothes or engage in sex with another child

9. Sexual Contact • Any touching of intimate body parts – including breasts, vagina, penis, anal area, buttocks and anus. • Includes perpetrator touching victim or having victim touch perpetrator or mutual touching. • Can take place over and under clothing • Frottage – rubbing intimate parts against victim’s body or clothing

10. Oral Genital Contact • Perpetrator licks, kisses, sucks or bites victim’s genitals • Perpetrator induces victim to have oral contact with his or her genitals • “Daddy made me kiss his wiener” • “He put his pee pee in my mouth”

11. Sexual Penetration • Intrusion into an orifice • Digital Penetration – finger in vagina, or anus; can be a precursor to vaginal or anal penetration • Penetration with objects- vibrator, dildo • Genital Intercourse – penis in vagina • Anal Intercourse – penis in anus – more common with male victims

12. Sexual Exploitation • Does not generally include physical contact • Person responsible for the child may be involved for financial gain • Child pornography – taking photos of children • Child Prostitution- typically late latency aged or adolescent children; often runaways

13. Interfamilial vs. Extrafamilal Sexual Abuse • Intrafamilial includes blood as well as marriage relationships i.e., stepparents or live-in partners. • Extrafamilial typically involves sexual contact with either a stranger or a person known to the family, but not in the household or related by blood or marriage.

14. MYTHS ABOUT SEXUAL ABUSE • Children • Children are mostly sexually abused by strangers • When a child is sexually assaulted, they tell right away • S/he will have no memory • The child is “damaged” and will inevitably become emotional disturbed • Boys are not abused very often • PARENTS • With positive parenting, no harm can come to their child • They can protect them • They will be able to tell if something were wrong • The child would disclose to the parent • A supportive parent believes immediately • OFFENDERS • One can recognize a pedophile or child abuser

15. TRAUMAGENIC DYNAMICS • 1. TRAUMATIC SEXUALIZATION • 2. BETRAYAL • 3. POWERLESSNESS • 4. STIGMATIZATION • DAVID FINKELHOR, PhD & ANGELA BROWNE, PhD (1985).

16. TRAUMATIC SEXUALIZTION Child ADULT AVERSION TO SEX NEGATIVE PERCEPTION OF BODY HIGHER RISK OF VICTIMIZATION SEXUAL IDENTITY • SEXUALITY IS SHAPED • CONFUSION • REPRETOIRE CHANGED

17. BETRAYAL child ADULT DISTRUST DEPRESSION HOSTILITY AND ANGER • TRUST • GRIEF/DEPRESSION • DISBELIEVED, BLAMED OR OSTRACIZED

18. POWERLESSNESS CHILD ADULT ANXIETY PANIC ATTACKS SOMATIC PROBLEMS DESPAIR SUICIDAL • WILL, DESIRES AND SENSE OF EFFICACY IS DISREGARDED • MANIPULATED • TRAPPED

19. STIGMATIZATION CHILD ADULT GUILT & SHAME NEGATIVE PERCEPTION FROM OTHERS • ISOLATED • GUILT & SHAME • LOW SELF-ESTEEM

20. Events after the Disclosure • For some victims, events that happen following the sexual abuse can be almost as damaging as the abuse itself. These children may be doubly traumatized by: • Telling and not being believed or protected • Being removed from their home • Being told by other adults to keep secrets • Being accused of betrayal by their family • Being returned to the home without protection, allowing the abuse to continue • Having to testify against someone they love

21. Feelings Associated With Sexual Abuse • Anger • Depression • Shame & Guilt • Confusion • Scared • Alone

22. Victims May Feel That • Bodies are not their own to control • Love or caring has to be paid for in some way • Adults cannot be trusted • World is not a safe place • Childhood is over • They are to blame for the abuse • The perpetrator, most likely, is willing to lie about what happened • Nothing will help them in court

23. Why Don’t Children Tell Sooner • Many children wait months or years before disclosing that they have been sexually abused • May have thought that he/she would not be believed • Child feared they would get in trouble • Embarrassing • Does not want to get the person in trouble • Fear family member(s) would be hurt if they told

24. Why Do Children Go Along With the Abuse • Children are raised to be nice, to be courteous and polite. They have natural trust and affection for others. • They are vulnerable to adults • Powerlessness of children • The child often knows the offender • Grooming

25. Relevance of Culture in the Intervention with a client

26. Ecosystemic Framework • People who are affected by child abuse are nestled in a variety of social and material domains that are highly interconnected and interactive (Fontes, 1993) • Bronfenbrenner (1979) describes various levels in the ecological system as a kind to Russian nesting dolls. It serves to highlights the importance of ethnic culture and the social service systems. • Individual Child – Genetic makeup, individual experience and developmental level • Child’s Home and Family • Ethnic Culture – Tradition, Religion, etc. • Proximal Social Systems – Neighborhood, Schools, Treatment providers and peer group • Wider Social Systems – State and national policies • Multicultural Orientation

27. Wider Social System Multicultural Orientation Home / Family Ethnic Culture Individual Proximal Social System

28. Ecosystem Framework (cont.) • It is important to consider the various circles because it provides us an idea for shaping our intervention with our client. • If we focus too narrowly, we may miss some of the contextual variables that would help us understand how to help. • This framework helps: • To remind us on the various levels that can be used to intervene with a child. • One level may not work while other could. • Helps move away from traditional western mentality / culture. • Inviting us to take into account family and community norms and concerns. • Helps understand where we fit in the child’s ecosystem. • Requires some understanding of the child’s ethnic culture before being able to get close to them.

30. What is culture? • Culture can be defined as the beliefs, values and practices shared by a group that guide thinking and acting in patterned ways: • Transmitted from person to person through direct teaching, imitation, or writing. • Guides behavior and provides framework for interpreting things in the world. Hayes & McLeod (2010)

31. Ethnic Culture • “Culture is a set of beliefs, attributes, values and standards of behavior that are passed from one generation to the next” (Abney, 2002, p. 477) • Culture defines what is a natural and expected in a given group. We all participate in multiple cultures: ethnic, national, and professional, among others. • We carry our culture with us at all times, and it has an impact on how we view and relate to people from our own and other cultures. • Ethnic cultures includes: • Language • Worldview, dress, food, styles of communication • Notions of wellness • Healing techniques • Child rearing patterns • Self-identity • Ethnic culture perspective affects the behavior we consider abusive and non-abusive.

32. Professional Culture • Professional cultures influence how we understand the world and the behaviors that seem normal, natural, and “right” to us. • The best we can hope for is to know our own backgrounds well and understand that our own views is just but one-way to see the world. • “Being aware of my own biases I can avoid acting on them rashly.” • External support from more experienced professionals, peer supervision, and teamwork can be used to monitor our own biases.

33. Generalization vs Stereotype • These two concepts are often confused because they both involve making broad statements about a group of people.  This is where the similarity ends. When we make a generalization, we are attempting to look at the behavior of many people and note similarities.  While we do this, we focus on being descriptive and not judgmental.  We are also able to modify this broad view if we encounter new examples which disprove the description we are trying to make. • Stereotypes tend to lock people into categories with the idea of limiting that group.  Stereotypes seek to make judgments rather than to describe.  Once we make stereotypes, we then are reluctant to modify them.  

34. CULTURAL COMPETENCE A set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. (Cross, Bazron, Dennis & Issacs, 1989)

35. Cultural Humility • The culturally humble practitioner has the capacity to remain open to new ways of knowing and listening to a client with nonjudgement. (Hook et al.,2013; Tervalon &Murray-Garcia, 1998). • Cultural humility can be described as a “cultural presence” or a “way of being” with a client, which can facilitate trust and self-disclosure. (Owen, J., Tao, K.W., Drinane, J.M., Davis, D.E.,& Kune, N.F; Oct, 2015).

36. “A therapist role is to accept clients and care for the client, but not in a possessive way or in such a way as simply to satisfy the therapists own needs. It means a caring for the client as a separate person, with permission to have their own feelings and their own experiences.” (Rogers, 1957.)

37. Child Sexual Abuse Accommodation Syndrome (1983)Roland Summit, MD

38. Five Categories • Secrecy • Helplessness • Entrapment & Accommodation • Delayed, Unconvincing Disclosure • Retraction

39. Secrecy • Precondition that allows for the abuse to continue • Offending adult finds opportunities to be alone with the child, even when other people may be in the same vicinity • Offending adult provides his/her version of reality of the sexual abuse experience • “However gentle or menacing the intimidation may be, the secrecy makes it clear to the child that this is something bad and dangerous” • “Secrecy is both the source of fear and the promise of safety”

40. Secrecy • INITIATATION • INTIMIDATION • ISOLATION • DON’T TELL ANYBODY/THIS IS OUR SECRET • I WILL KILL YOU/ I WILL KILL YOUR FAMILY • I WILL GO TO JAIL/ BREAK FAMILY UP • UPSET YOUR MOTHER / I WON’T LOVE YOU • NOBODY WILL BELIEVE YOU

41. Helplessness • Children “are required to be obedient and affectionate with any adult entrusted with their care” • Majority of child victims of sexual abuse are victimized by someone with whom they have a trusting, loving relationship • “No child has equal power to say no to a parental figure or to anticipate the consequences of sexual involvement with an adult caretaker” • Given the power differential between an adult and child, the child will often “play possum” and “learn to cope silently with terrors in the night”

42. Entrapment & Accommodation • Sexual abuse is “typically not a one time occurrence” for a child within a dependent relationship • Accommodation occurs after the “child is faced with continuing helpless victimization” • A child accommodates to psychologically adapt and “achieve a sense of power and control” in order to survive • Children accommodate in various ways

43. Accommodations • SURVIVAL SKILLS…. • OVER ACHIEVERS (RESILIENCY) • SELF-INJURIES (CUTTING, BURNING) • SUICIDAL THREATS • ALCOHOL OR DRUGS • PROMISCUOUS

44. Polyvagal Theory • SOCIAL ENGAGEMENT SYSTEM • 1. ACTIVATE FIGHT/ FLIGHT RESPONSE • 2. FREEZE-FEIGN DEATH STEPHEN PORGES, PHD

45. Delayed, Unconvincing Disclosure • Majority of children do not disclose on-going sexual abuse, especially outside of their immediate family • Reasons Disclosure occurs: • Overwhelming Family Conflict • Incidental Discovery by a third party • Sensitive outreach & community education by child protective agencies • Disclosures appear unconvincing for many reasons: • The delay in the disclosure • Way in which a child discloses • Accommodation mechanisms

46. Delayed Disclosure • Scientists accept a significant percentage of children delay reporting sexual abuse • In a 2008 study, London et al found 55-69% of adults reported “that they never told anyone about the sexual abuse during childhood.”

47. Delayed Disclosure • “MISCONCEPTIONS ABOUT DELAYED REPORTING AND MAY BE CONSIDERED IN ASSESSING A WITNESS’S CREDIBILITY.” • IF A CHILD CANNOT OFFER A RATIONAL EXPLANATION EXPERT TESTIMONY MAY HELP THE JURY UNDERSTAND WITNESS’S BEHAVIOR • (2018) RABNER, C.J., writing for the Court

48. Retraction • Child experiences a negative reaction from caregivers and their community: • Not believed or supported • Blamed • Experiences consequences of the disclosure, i.e. family separation, offending parent in jail, CPS involvement • Questioned multiple times. • Cultural

49. “Never worry about numbers. Help one person at a time and always start with the person nearest you.” Mother Teresa