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Article Excerpt
How does child sexual abuse (CSA) come to an end? This research question originated in the experience of working with adult female CSA victims in clinical practice. Several CSA victims said the abuse came to an end when they started saying "no" to their perpetrator. But was it really that simple? Can a single word put an end to severe sexual abuse, and, if so, under which circumstances may this hold true? Research regarding this phenomenon seems more or less absent in the scientific literature. For this reason a qualitative study of CSA victims was undertaken.
This qualitative study can contribute to our knowledge of how CSA victims structure their reality, how reality is shaped and maintained by the victims. Our studies aim at identifying which factors CSA victims attribute to the termination of the abuse. The purpose of the in-depth interviews is thus to contribute to the body of knowledge on how CSA victims perceive, describe, experience, and interpret their experiences. The informants in this study do not constitute a representative sample. The purpose of the study is, however, to contribute to the knowledge of how CSA victims perceive and create their realities, and not to estimate means. At the same time there is always the question of another type of representativity, namely, generalizability, which is different from statistical representativity. A qualitative study makes it possible to discuss how social realities are formed and maintained in people. By interviewing them we are able to elucidate how people reflect upon and understand the experiences they make. The purpose of the interview study is to present the ways different CSA victims understand themselves, interpret what happens to them, and create meanings. The research questions in this article are the following: From the perspective of the subjects' narratives, how is abuse terminated? What causes the termination of abuse, and how do the subjects perceive their own role in the termination process? Does the feeling of being in a situation of abuse terminate when the sexual abuse ends?
Finkelhor (1994) defines CSA as follows: (1) sexual activity where a child is present, and (2) an abusive situation. Incest refers to sexual contact between close family members in a down-pointing or horizontal line, or between an adult in a parent relation and a child (Norman, 1993, p. 16).
Finkelhor and Browne (1985) have developed a conceptual framework for understanding the phenomenon of sexual abuse and the consequences it may have for the abused individual. This theory is called the traumatogenic/ dynamic model of sexual abuse and consists of four dimensions: traumatic sexualization, betrayal, powerlessness, and stigmatization. The model suggests that trauma is created through changes in the child's cognitive and emotional system. This leads to a disturbance in the child's self-concept/identity, worldview, and affective capacities. Several negative consequences are associated with childhood sexual abuse, and researchers seem to agree that exposure to sexual abuse increases the risk of psychopathology at some point later in life (Nurcombe, 2000).
Antonovsky (1993) underlines that a well-functioning human being is recognized by an ability to create meaning and coherence in life, even when exposed to trauma and stress. Studies show that victims of CSA who developed adaptation problems also developed different meaning constructions compared with normally functioning individuals (e.g., Leahy, Tenenbaum, & Preety, 2003). If the victim attributes the sexual abuse only to their own personal traits or characteristics, this can lead to poorer mental functioning (Feiring, Taska, & Lewis, 2002). Qualitative studies that seek the victims' narratives, or life stories, may therefore be important in the attempt to acquire greater understanding of the causes and consequences of childhood sexual abuse.
James, Liem, and O'Toole (1997) investigated the causes of resilience in a group of participants. Women who considered themselves powerful in regards to their career and personal relationships also perceived themselves as the mentally healthiest. Leahy et al. (2003) claim that the main problem arising after CSA stems from a change in the locus of control: Instead of blaming the adult for what has happened, the child blames himself or herself. The bonding that develops between the victim and the offender has a traumatic quality and can lead to poorer mental functioning later in life. The narratives of the nonclinical group in this study contained a wider set of meaning constructions in regard to the abuse. Perrott, Morris, Martin, and Romans (1998) found that female incest victims who managed to reformulate the abuse experience displayed fewer psychological symptoms than those who did not do this. In a similar study, Himelein and McElrath (1996) found that coping strategies were associated with resilience: Disclosing and talking about the abuse, minimizing the abuse, reformulating the incidents, and disengaging from speculations regarding the abuse.
Crisma, Bascelli, Paci, and Romito (2004) found factors obstructing disclosure to be shame, fear of not being believed, and fear of creating difficulties for family members. The authors found that in half of the instances the abuse was ended by mere coincidence, for instance, when the perpetrator moved or died. Some of the adolescents had put a stop to the abuse themselves, while other received help and support from family members. This was the only qualitative study referring to the termination of sexual abuse in our review. Svedin, Back, and Srderback (2002) interviewed 38 female victims of incest (18 children and adolescents and 20 adults). They found that the subjects' family environments were characterized by loneliness and a lack of proximity, predictability, and organization. Growing up in an environment such as this might increase the risk of being a subject of sexual abuse. In addition, one can argue that other family members might be prohibited from putting a stop to the abuse. Qualitative studies on CSA support and elaborate quantitative research findings. They also put emphasis on the importance of the individuals' perception of reality in terms of the quality of mental health development after CSA.
Theoretical Framework
Cole and Putnam (1992) claim that much of the research on sexual abuse has been carried out in a contextual vacuum. It is our view that psychological theories of the self can contribute to the understanding of the underlying mechanisms and processes that may create adaptation difficulties after CSA. This is in accordance with the studies of Cole and Putnam (1992) and Finklehor and Browne (1985). Banyard (2003) claims research on sexual abuse must address the fact that people's mental health is a dynamic and developing process and that researchers must seek alternative ways of measuring health. Theory on the self can help achieve both these aims. In addition, research on consequences after CSA shows that victims struggle with feelings tied to emotional regulation and identity concepts (Feiring et al., 2002; James et al., 1997; Kendall-Tackett, Williams, & Finkelhor, 1993; Kinzl & Biebl, 1992; Leahy et al., 2003; Peleikis, Mykletun, & Dahl, 2004; Rumstein-McKean & Hunsley, 2001). Findings such as these substantiate theories that focus on the significance of how interactions in close relationships during childhood affect identity development.
A newborn child, motivated by an innate need for protection and safety, needs to forge emotional bonds. The primary care provider is intended to function as a secure base from which the child can explore the world and return to be cared for and supported. The mental representation of the interaction between a child and a parent has been given the theoretical term internal working model (Bowlby, 1980, 1988). If the carer is sensitive to the child's needs and available and responsive in a consequent and empathic way, the interaction is considered to be of good quality. Unhealthy interaction is recognized by a caregiver who responds neither consequently nor empathically, and who is unavailable when the child seeks comfort and protection (Bowlby, 1988). The working model that the child develops during the first year of life seems to last throughout adolescence and adulthood (Bowlby, 1980; Egeland, Jacobvitz, & Stroufe, 1988), and is therefore a decisive determinant in terms of how people relate to others and define their personality and self-image.
Similarly to Bowlby (1980, 1988), Fonagy et al. (2004) believe that children develop in a social context, and that the self is a product of social interaction. They also believe that self-organization and self-construction are closely linked to what is called affective regulation. To have a sense of self, Fonagy claims, one needs to be in touch with and comprehend one's emotional reactions. Through the process of recognizing and regulating emotions, one gains a sense of being an agent for oneself. Emotional regulation gives the self both meaning and the power to act, and it is an...
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