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A
Abuser. See Sexual abuser
Abusive relationship, signs of, 21–23. See also Child sexual abuse (CSA)
Acceptance and commitment therapy (ACT), 174–175
Adolescence, disclosure and, 60–62
Adults, child’s trust in, 9
Alexander, Kat, 209
American Psychiatric Association CSA definition of, 9–10
and nonrecognition of complex PTSD, 186
Anger
validating feelings of, 184
Anonymity, loss of, 97
Assessment, by therapist, 162–167
Association for Cognitive and Behavioral Therapies (ABCT), 171
Attachment problems, CSA history and, 141
Awareness, disruptions of, 183–184
in PTSD, 151
B
Behavioral control, CSA history and, 142
Behaviors, risky, self-harming and, 158–159
Biological problems, CSA history and, 141
Borderline personality disorder (BPD), 2
Boston Area Rape Crisis Center, 176
increased internal distress and, 63–68
reasons for, 63
reasons preventing, 59
See also Disclosure; Disclosure aftermath
Bystander awareness, teaching, 211
C
Catholic schools (Boston), CSA prevention program of, 209
Chicago Children’s Advocacy Center, 207
Child Abuse Prevention and Treatment Act (CAPTA), 102
Child protective services, and mandated reports of CSA, 104–106
Child sexual abuse (CSA)
acute stress response and, 50–51
adult lack of awareness and, 46–47
advances in understanding and treatment of, 186–187
assessment after reporting of, 113–114
behavioral indications of, 80–81
borderline personality disorder and, 2
disbelief about, 13
epidemic proportions of, 205–207
and family/friend desires for retribution, 119–120
forms of, 10
lasting effects of, 53
legal issues and. See Legal issues
mandated reporting rules and, 9, 101–113
versus “normal” childhood angst, 67–68
and peers as confidants, 62–63
prevention of. See Prevention/education
PTSD and, 2. See also Posttraumatic stress disorder
and questioning without corroborating evidence, 82
recovery from. See Recovery
red flags for, 68
revelation of, 5
risk factors for targeting, 14
silence and, 5
societal messages and, 210–211
suspected, steps to take in, 69–77
symptoms following disclosure, 128–129
symptoms following end of, 50–51
treatment path for, 149. See also Professional help
understanding versus outrunning impacts of, 170
Child Sexual Abuse: A Social Justice Prevention Model, 207
Childhood trauma, characteristics related to, 51
Circles of Safety for Higher Education, 207
Clergy abuse, 36
Cognitive difficulties, CSA history and, 142
Cognitive processing therapy (CPT), 173
Cognitive restructuring, 171
Cognitive-behavioral therapy (CBT), for PTSD, 170, 173–175
Committee for Children’s Talking About Touching program, 209
Community-based CSA initiatives and organizations, 213–215
Comprehensive Sexual Abuse Prevention Education Act (CSAPEA), 213–214
Counseling, strength-based wellness, 197. See also Professional help; Psychotherapy
Courage to Heal, The (Bass & Davis), 190
Criminal charges
variations in state guidelines for, 108
victim and family wishes and, 109–112
Cutting, by child victim, 152–155
D
Depression, CSA history and, 140
Dialectical behavior therapy (DBT), 144, 164–165, 167, 178, 181–182
commitment strategies and, 169
as first-phase treatment, 168–171
Dialogue, open, during recovery, 129
Disclosure
abuser’s interference with, 59–60
anticipating fallout from, 76–77
child’s emotional state preceding, 75
school-based prevention programs and, 210
tentative, responding to, 83–84
and adjustment to new normal, 118–119, 128
behavioral changes during, 139
child’s adjustments during, 130–131
child’s vulnerability and, 93–94
emotional turmoil during, 136–138
guidelines for talking with child, 98
internal distress signals during, 150
police and criminal charges and, 106–113
worsening distress and, 115–125
Dissociation
of child victims, 37
CSA history and, 141
in PTSD, 151
Double-self, Herman’s concept of, 38
Doyle, Daniel
arrest, guilty plea, trial, and sentencing of, 109–113, 117–125, 136
development of Kayla’s relationship with, 9, 14–19, 26–27
and grooming of family, 12–13, 24–26, 60, 69–70
incarceration and post-incarceration restrictions of, 206
and Kayla’s disclosure, 58–89, 64–65, 86–90, 94, 96–97, 105–106
and sexual abuse of Kayla, 27–43, 48, 54–58
E
EMDR International Association, 174
Emotional regulation
CSA history and, 141
preceding disclosure, 75
problems with, 183
in PTSD, 151
Evidence, corroborating, 82
Exposure-based treatments for PTSD, 171–173
Eye movement desensitization and reprocessing therapy (EMDR), 170, 174
F
Family
and desire for retribution, 119–120
and effects of disclosure, 112–113
grooming of, 12–13, 22–26, 60, 69–70
promoting stability of, 185–186
role in recovery, 177
See also Parents/caregivers
Family counseling, Kayla’s recommendation for, 195–196
Family structure, as risk factor for CSA, 14
Fears, trauma-specific, 51
Feelings
validation of, 184
Feminist movement, impact on CSA, 1
Fighting Back, goals and beneficiaries of, 4–6
G
Gender, as risk factor for CSA, 14
GenerationFIVE, 217
Girls, empowerment of, 211
family and, 12–13, 22–26, 60, 69–70
lack of education about, 204
learning about, 12
parental/caregiver recognition of, 22–23
teaching warning signs of, 212
Guilt
feelings of, 127
validating feelings of, 184
H
Harrison, Kayla
advocacy work of, 199–203, 209, 215–218
journal entries of
after disclosure, 92–93, 94–95, 109–112
after restraining order hearing, 127
after seeking professional help, 148, 150, 152–153, 156–160, 176–179
breaking silence and, 58–59, 61–62
during disclosure aftermath, 105, 106, 115–120, 122–125
in early stages of abuse, 7–9, 15–16, 18–29
and maintaining silence, 30–35, 43, 48
and reconciliation of good/bad, right/wrong, 38–40
during recovery, 127, 131–134, 136–137, 146
reexamination of, 178
during transition from victim to survivor, 180–182, 187, 189–200
mother’s concerns and, 25, 56, 60–63, 69–70, 73, 78
mother’s reactions to disclosure, 89, 94, 105–106, 113, 118, 138, 143, 145–148, 159–160, 165–166, 176
Olympics training and, 198–199
PTSD and, 128, 143–146, 149–150, 164–165
suggestions for justice-seeking process, 96
therapist assessment of, 162–167
victimization and survival of, 4–5
Healing
Bass and Davis’s work on, 190
See also Survivor transition
Henry, Fran, 207
Hopelessness, suicidal thoughts and, 157
I
Incest
INCITE!, 217
International Society for Traumatic Stress Studies, 173
Interviewing, Kayla’s suggestions for, 96
Isolation
suicidal thoughts and, 157
J
Jenna’s Law, 209
Journaling, as coping mechanism, 188–191. See also Harrison, Kayla, journal entries of
Judicial process
Kayla’s suggestions for, 96
L
Legal issues
in disclosure aftermath, 99–113
mandated reporting rules, 9, 101–113
organizations providing information on, 228
police and criminal charges, 106, 108–113
Legislation
organizations providing information on, 228
for prevention/education of CSA, 207–208
Love, changing understanding of, 43–44
M
Mandated reporting rules, 9
child protective services and, 104–106
police and criminal charges and, 106–113
McLean Hospital, Kayla’s admission to, 149–150
Medical issues, CSA-associated, 53
Medications, in PTSD treatment, 175
Memory(ies)
in PTSD, 151
suppression of, 36
of traumatic events, 51
Monitoring, during transition to survivor, 182–186
Mood swings, suicidal thoughts and, 157
N
National Child Abuse and Neglect Data System (NCANDS), 205
National Institutes of Juvenile Justice, perpetrator identity data and, 11
Neurosequential model of therapeutics (NMT), 174–175
Nonsuicidal self-injury (NSSI), 153–155
common types of, 154
prevalence of, 153
reasons for, 154
signs of, 154
NoVo Foundation, 207
O
OAK Foundation, 207
Offender-management initiatives, 205–209
drawbacks of, 206
Office of Child Abuse and Neglect, 102
Open dialogue
during recovery, 129
P
Parents/caregivers
and anticipating fallout from disclosure, 76–77
during child’s recovery, 176
and communicating protectiveness, 76
and communicating support for child, 74–76
and conversations with possible victim, 62, 66–67
and creating conditions for disclosure, 70–77
feelings of, 184
grooming of, 12–13, 22–26, 60, 69–70
guidelines for disclosure aftermath, 95–96
guidelines for voicing suspicions, 72, 74
postdisclosure legal issues and, 99–113
and recognition of grooming behaviors, 22–23
recommended steps for suspected abuse, 69–77
and responding to tentative disclosure, 83–84
and symptoms of CSA, 37
and talking with child after disclosure, 98
Pennsylvania Coalition Against Rape, 24–25
Perpetrators of sexual abuse. See Sexual abuser
Personal boundaries, lack of understanding of, 40–41
Physical exam, reactions to, 159–160
Position of trust, violations of, 108
Posttraumatic stress disorder (PTSD), 128
CBT effectiveness and, 170
complex, 141–142, 150–151, 186
diagnostic dilemmas of, 134–135
evidence-based treatments for, 135
features of, 52
psychotherapy options for, 167–175
short-term symptoms of, 138–139
time frame for, 139
watching for symptoms of, 131–132
Power imbalance, 35
Pregnancy, fears about, 41
Prevent Child Abuse America, 217
community-based initiatives and organizations, 213–215
Fearless Foundation and, 215–218
offender-management versus victim-focused initiatives in, 205–209
organizations working for, 217
in transition from victim to survivor, 185–186
See also Cognitive-behavioral therapy (CBT); Dialectical behavior therapy (DBT); Psychotherapy; Therapist
Prolonged exposure (PE), 171–172, 190
Protectiveness, communicating, 76
Psychiatric disorders, CSA history and, 140
Psychological disorders, possible symptoms of, 68
Psychotherapy
commitment strategies in, 169
for PTSD
cognitive approaches to, 173–175
EMDR and, 170
skills- and exposure-focused phases of, 168
Puberty, disclosure and, 60–62
Public awareness of CSA. See Prevention/education
Q
Quinn, Jenna, 209
R
Rape, statutory, 101
Rape, Abuse & Incest National Network (RAINN), 217
Recovered memory therapy, 82
after hospitalization, 175–179
feeling worse at beginning of, 128–129
and movement toward professional help, 142–147
natural, fostering process of, 187–188
open dialogue during, 129
parental support during, 95–96
and possibility of PTSD, 134–142
and shift to daily reality, 130–131
Red flags, 68
Relationships
disrupted, in PTSD, 152
trusting, support for reestablishing, 185
Religious institutions, prevention-oriented programs for, 207–208
Report It, Girl, 209
Reporting rules, mandated. See Mandated reporting rules
Resources
for legal issues, 228
for prevention/education, 223–228
Retribution, desire for, 119–120
Risky behaviors, self-harming and, 158–159
Robert Wood Johnson Foundation, 207
S
Safety
and delayed treatment, 172–173
Sandusky, Jerry, 199, 206, 209
School districts, prevention-oriented curricula for, 207–208
School-based CSA educational programs, 210–218
core components of, 212
Secrecy
about feelings of shame and self-loathing, 182–183
Self-blame/loathing, 40–41, 127, 128, 133
Self-concept, CSA history and, 142
Self-efficacy, role in recovery, 196–198
Self-esteem
recovery and, 197
Self-image
damage to, 38
feelings affecting, 184
Self-injury, 2
suicidal thoughts and, 157
See also Nonsuicidal self-injury (NSSI)
Self-love, and reestablishing trusting relationships, 191–192
Self-perception, in PTSD, 151
Sex, child’s understanding of, 39–40
Sexual abuse of children
Sexual abuser
coercion by, 33
concern for well-being of, 128, 129, 151–152
conflicted feelings about, 184
distorted perceptions of, 184
family members as, 44
grooming behaviors of, 5, 10, 13–26
influence on family, 60
parental relationship with, 71–72
and selection of vulnerable victims, 14
as source of emotional support, 42
statistics on, 12
See Child sexual abuse (CSA); Victims of CSA
Sexual assault
statutes of limitations for, 121
Sexual Assault Awareness Month (SAAM), 208
Sexual Assault Intervention Network (S.A.I.N.), 96
Sexual behavior
nontouching, 10
risky, 158
touching, 10
Sexual relationships, and age of consent, 100–101
Sexual victimization, as adults, CSA history and, 140–141
Sexual violence, societal norms and, 210–211
validating feelings of, 184
Silence
and denial of treatment, 51–57
reasons for keeping, 35–46, 59
See also Breaking the silence; Disclosure
Societal norms, lack of understanding of, 40–41
Socioeconomic status, as risk factor for CSA, 14
Statutory rape, 101
Stop It Now!, 207
“Stranger danger,” warnings about, 1–2
Strength-based wellness counseling, 197
Suicidal thoughts, 77, 79, 132, 133, 146, 155–158
after disclosure, 152
Suicide threats, 157
Supervision, increasing level of, 74–75
during transition to survivor, 182–186
See also Family; Parents/caregivers; Psychotherapy
and advances in understanding and treatment of CSA, 186–187
and building mastery and recovery, 196–198
core beliefs/values and, 185–186
and finding and making of meaning, 198–201
and fostering of process, 187–188
and need for monitoring and support, 182–186
and reconstructing, sharing of trauma, 188–191
Survivors Network of those Abused by Priests (SNAP), 217
Suspicions
communicating about, 62, 66–67
parental, guidelines for voicing, 72, 74
T
Team-assessment approach, 114
Therapist
identifying qualifications of, 160–161
questions for, 161
Therapy, court-ordered, 96. See also Psychotherapy
Threats, by perpetrators, 18, 33–34
Tipping point. See Breaking the silence; Disclosure
Touching behaviors, 10
appropriate/inappropriate, 39–40
desensitizing of child and, 16–18
Trauma
educating parents about, 3
reconstructing and sharing, 188–191
understanding versus outrunning impacts of, 170
Trauma and Recovery (Herman), 176
Trauma memories, triggers of, 133–134
Trauma symptoms, in disclosure aftermath, 131–132
Treatment
organizations offering information on, 228–229
See also Cognitive-behavioral therapy (CBT); Dialectical behavior therapy (DBT); Psychotherapy
Trials, and victims as witnesses, 116–119
Trust
in adults, 9
position of, violations of, 108
in untrustworthy people, 35
Trusting relationships
support for reestablishing, 185
V
Victim witness advocates, 99, 117
Victim-focused initiatives, 205–209
Victims of CSA
as adults, 121
court-ordered therapy for, 96
and decision to break silence, 48–49
and desire to please, 14–16, 19
and efforts to protect family, 44–46
increased internal distress and, 63–68
Kayla’s suggestions for interviewing, 96
and normalizing the abnormal, 35–37
and parental expression of suspicions, 62
parental intuition and, 62, 66–67
perpetrator’s discrediting of, 60
reasons for maintaining silence, 35–46
and reconciliation of “good” and “bad,” 38–41
self/blame and shame of, 40–41
and support after disclosure, 95–96
and understanding of “love,” 43–44
vulnerability after disclosure, 93–94
Violence, societal norms and, 210–211
Y
Youth organizations, prevention-oriented programs for, 207–208