Therapy Notes

What is Sexual Abuse? I often hear people refer to sexual abuse in many different ways. In fact, just a couple of weeks ago, the Arizona’s Association for the Treatment of Sexual Abusers (AzATSA)put on a conference in Phoenix, Arizona, with leading trauma and sexual assault expert, Lucy Berliner, MSW, Director of Harborview Center for Sexual Assault & Traumatic Stress. As the president of AzATSA I got to spend some time with Lucy. We were talking about sexual trauma and she told me that she defines sexual abuse as sexual assault. She said that when we refer to children we tend to call it “sexual abuse” but when we refer to adults we tend to define it as “sexual assault”, but why? I thought this was excellent point and it got me to thinking again about how we define sexual abuse.

According to American Academy of Child and Adolescent Psychiatry

Sexual abuse of children refers to sexual behavior between a child and an adult or between two children when one of them is significantly older or uses coercion. The perpetrator and the victim may be of the same or the opposite sex. The sexual behaviors include touching breasts, buttocks, and genitals, whether the victim is undressed or dressed, exhibitionism, fellatio, cunnilingus, and penetration of the vagina or anus with sexual organs or objects. Exposure to pornographic material is also sexually abusive to children. It is important to consider developmental factors in assessing whether sexual behavior between two children is abusive or normative.

But there are many forms of sexual abuse. According to a national expert on sexual abuse, Adena Bank Lees, LCSW, covert sexual abuse is

The process where a child is used to meet the emotional sexual needs of a trusted adult authority figure or other person, i.e., surrogate spouse, emotional mistress, voyeured, exhibited in front of, witness/spectator of someone else’s sexual violation, exposed to pornography.

And according to Wikipedia

Child sexual abuse is a form of child abuse in which a child is abused for the sexual gratification of an adult or older adolescent. In addition to direct sexual contact, child sexual abuse also occurs when an adult indecently exposes their genitalia to a child, asks or pressures a child to engage in sexual activities, displays pornography to a child, or uses a child to produce child pornography.

And according to Rape Abuse Incest National Network (RAINN), www.rainn.org they list over fifteen different definitions of sexual assault, rape and sexual violence. They define sexual assault as

unwanted sexual contact that stops short of rape or attempted rape. This includes sexual touching and fondling.

RAINN states that rape is

forced sexual intercourse, including vaginal, anal, or oral penetration. Penetration may be by a body part or an object.

RAINN does an excellent job of sorting through definitions and assisting people in understanding sexual trauma. There are also legal definitions of sexual abuse and assault which may vary from state to state.

What is clear is that we may never have one definition of sexual abuse. I think many of us who are working in the field of sexual abuse, prevention and treatment are beginning to refer to it as sexual trauma, which is another topic all together…

Coming to therapy is a little daunting to many of us. As a therapist, I am constantly aware of how difficult it can be to enter into the commitment of therapy. And while main stream media has popularized the idea of therapy and we watch characters like Tony Soprano going to therapy, the idea of going to see a stranger, telling them all of our negative thoughts and feelings and actually having to work on our issues can be very overwhelming and scary.

I often tell my clients that going to therapy is like looking in the mirror: you get to see the good, the bad and the ugly. While most of us know exactly what the bad is (you know all those repetitive thoughts, negative self talk, the fights with our significant others, the drinking too much, and bad relationships we keep getting into) and we are afraid to admit the ugly (any self harming thoughts or behaviors, thoughts of hurting others, sexual thoughts and behaviors and abusing drugs and alcohol) we often are completely unaware of the good. The good are skills, strengths, abilities that you may be unaware of or may be having difficulty seeing. Therapy helps clients to identify what is positive in their lives, what positive attributes they have, and to accentuate the positive feelings they have. So while what generally brings us to therapy are those dark thoughts, what we tend to discover as we continue on in treatment are the positive within us.

We often see the most distorted images of ourselves.  And coming to therapy can correct those distortions bringing us closer to a more realistic image.  To work on the distorted images we initially start with correcting the distorted thoughts.  I ask clients to challenge their distorted thinking by asking themselves “Where is the evidence that I am ____?  Sometimes clients will ask me what if I AM ugly, fat, mean, etc.  I always tell them I have no problem if that is reality.  If the thinking isn’t distorted we look at it too but we don’t need to correct the thinking.

As I tackle the negative thinking I also have to assign affirmations.  Now those of you who are old enough remember a spoof that SNL did called “Daily Affirmations with Stuart Smalley”

“I’m good enough, “I’m smart enough and doggone it people like me.”

As silly as it may be affirmations work but here is the trick – you cannot lie to yourself.  So while you may want to say “I like myself” if that isn’t true it won’t work.  So you’ve got to start with affirmations you believe in otherwise they won’t work.

So good luck and have fun looking into the mirror!

Although some of you are just welcoming yourselves to the world of twitter (even though there still may be some of you who have no idea what twitter is – thank goodness I’m not the only one), I am welcoming you to my blog!  Why a blog?  I wanted a place to share some of my musings, commentary, and a place to record some of my ideas.

I am a licensed clinical social worker specializing in the field of sexual abuse and trauma.  I have worked in this area for over fifteen years starting with female adult survivors of sexual abuse and sexual assault.  I have dedicated much of my work to the specialties of sexual abuse, incest, perpetration and sexual acting out.  I also have extensive experience working with depression, anxiety, trauma, addictions, anger, violence and abuse.

This blog will focus on my thoughts regarding psychology & social work,  treatment, psychotherapy,  and my specialty of sexual abuse.  It will also explore other areas of interests for me such as spirituality, addictions, sexuality, sexual offending, forensics and relationships.  I may also from time to time venture off topic to discuss other varied interests.

What is normal sexual behavior in children?

I don’t know how many parents have asked me, “How do I know what is normal sexual behavior in my children?” or “What did I miss?” or “How did I not notice that something was wrong?” It is so hard for parents to know today what normal sexual behavior is when navigating through the sexualized media and the over sexualized public figures that all of our children seem to idolize. And if your child has acted sexually inappropriate, many parents struggle to understand this behavior and often blame themselves.

For most children they develop sexual behaviors in much the same ways they develop other non-sexual behaviors. In other words, it is through normal exploration, an information gathering process as they begin to discover their bodies, act out different roles and sexual behaviors. However, it should be noted that all exploration should be with same age children and should not be confused with sexual abuse. It is important to understand what is normal and what is not normal sexual behavior in children and adolescents. It is also important to talk with your child and let them know what acceptable behavior is and what is not acceptable.

What is typically seen in normal sexual behavior in children (under age 10)?

• Looking and touching same aged children’s bodies (i.e. playing doctor)
• Exploring gender roles (i.e. playing house)
• Touching and rubbing of own genitals
• Curiosity about sexual things and sexual talk
• Curiosity about others’ bodies and genitals
• Interest in how people make babies
• Curiosity about urinating, defecating and other bodily functions
• Talking/asking about their own genitals
• Looking at others genitals

Adolescent Sexuality (ages 10 – 18)

Puberty brings increased interest in sex. This is the time that you will generally see more sexual behavior. In addition to the above behaviors of younger children you will also see:

• Masturbation – almost all boys masturbate and many girls begin to masturbate at the onset of adolescence.
• Voyeuristic behavior may occur in the form of viewing pornography or looking at others.
• About half of all boys and a third of all girls have sexual contact with same aged peers in early adolescence. They may begin with kissing and touching and eventually evolve to sexual intercourse.
• Increased interest in opposite sex or same sex peers.

What are behaviors that are of concern and require professional intervention?

• Sexual knowledge beyond biological/developmental age
• Public masturbation after being told it is not ok and consequenced
• Continually talks about sex
• Wants to play games with younger children such as doctor or house
• Draws people having sexual intercourse
• Asks people to take off their clothes
• Touching of genitals of adults either through force or manipulation
• Talking or acting in over-sexualized way
• Touching of genitals of other children through force or manipulation
• Extreme fear of having someone observing them undress
• Hurting of one’s own genitals or rectum
• Sexual behaviors or contact with animals
• Forcing or manipulating others to touch their genitals
• Forcing or manipulating others to show their genitals
• Exposing their genitals after being told it is not ok and consequenced
• Hates their own genitals
• Hates their own gender/sex
• Refuses to leave people alone when they are in the bathroom
• Smearing of feces or urinating purposely in areas outside the bathroom
• “Humping” the furniture, animals or other children
• Forcing or manipulating others to have sex
• Inability to stop themselves from engaging in sexual behaviors

If you see any of the above behaviors, you should seek out professional help. Or if you are experiencing any of the above behaviors or have feelings of wanting to do these behaviors, please contact a professional.

References:
Johnson, Toni Cavanaugh, (1996). Understanding Children’s Sexual Behaviors: What’s Natural and Healthy: New Harbinger Publications: South Pasadena, CA.