Well this is good news to end the week. 400 reads on Researchgate and 204 downloads on the White Rose ethesis site! Whilst I’ve been busy with homeschooling and lockdowns people have been reading my work. 😃 There’s much more in the pipeline that I will share as soon as I can.
In the meantime you can read my work here and if you have already thank you so much! The title is a quote from an artist Käthe Kollwitz that really resonated with me. I want my research to change things for the better so people reading it is wonderful.
This is a copy of the response I submitted to the government’s recent call for evidence. If you want this as a .pdf you can download it here.
About the Research
This submission is based upon Wellcome Trust funded research involving 140 adult survey respondents and 21 detailed interviews, in which participants were asked what helped and hindered their recovery from childhood sexual abuse (CSA). Most respondents were from the UK (82%) aged between 18-70 and included 6% responses from ethnic minorities. The survey respondents were 85% female, 14% male and 1 trans. 8% were disabled when abused. 20% had experienced child sexual exploitation (CSE) and 19% were not sure (possibly being too young to comprehend). 49% were abused by a family member, 42% by an acquaintance and 9% a stranger. 67% of survey respondents had reported the crime to police and 33% had not. This submission will explain what worked well for the respondents, what did not work well and what needs to change.
Victim, Survivor or me?
There was no consensus about terminology used to describe people who have experienced abuse. Some actively chose the words victim or survivor but others did not like being defined by what had happened to them.
Recovery or Recovering?
Recovering is ‘the shift from being a big bundle of trauma with just a bit of person on the side, to a person with an amount of trauma on the side’
There was agreement that people did not like the term ‘recovery’ because it suggested an end point, whereas ‘recovering’ acknowledged lifelong consequences, encompassed the idea of ongoing effort and did not exclude anyone. You are not always recovered but you can always be recovering.
What Hinders Recovering
Under Funded Services
‘10 weeks here and there with the NHS or a charity meant that you felt as if you were jumping from life raft to life raft.’
76% viewed talking therapies as a positive influence upon recovering but there were many examples given where people struggled to access professional support, particularly longer-term help.
Poor Responses from Professionals and Others
‘After I took an overdose the doctors and nurses said I was an attention seeker’
The overwhelming message from participants was that was that their abuse was compounded by the way individuals and the wider community responded to it. 46% of survey respondents said that the main factor affecting their recovery were the stigma and stereotypes around abuse. Most participants in this research reported poor reactions when they spoke about it, including some extremely bad reactions from close family members. A poor response can silence people and prevent them from reporting the crime, accessing services and results in a lack of awareness about the effects of abuse. Thus, stigma and stereotyping enable abuse.
What Helps Recovering
In many ways, recovering is the opposite of being abused. It is about reclaiming rights, voice, choices and bodily autonomy.
Every Disclosure is Important
‘[My GP] got up from behind her desk and she knelt on the floor with me and she held my hand, talked to me and calmed me down and told me exactly what she was going to do.’
Talking about abuse is hard, and disclosure is not a single event but a multiple one. Kindness is vital. A warm, understanding, caring and non-judgemental response validates their courage. Participants talked about important interactions with professionals that changed their lives for the better. These were characterised by clear, respectful communication which took them seriously. Because the initial response is crucial, all health, care and educational professionals need to be trained in supporting those who’ve experienced CSA
A Strengths-Based Approach
Abuse involves denying the child the right to choose. Recovering is most effective when the individual makes their own choices. Denying the right to choose or infantalising the individual echoes the abuser’s actions and can be damaging. Mapping the individual’s strengths, likes and dislikes then building on them will empower them in their recovering.
‘I haven’t really felt safe to be open about what happened to me very much.’
Safety is vital for recovering, not just in the therapist’s room but in the individual’s life. Many people who have experienced abuse do not feel safe and this need to be addressed. However, some people really are not safe. Some participants reported that they became involved in abusive relationships in adulthood, others were bullied or harassed at home or work. Being safe is the bedrock of recovering. It is hard to focus on recovering when you are not safe.
Participants reported that the most important factor that both helped and hindered recovering was other people. Supportive friends, partners, professionals and communities were very important. Finding those avenues for support is vital for recovering.
Nearly three quarters found creative activities helped, such as art, reading, writing, gardening, design, poetry and gaming. It can be any activity as long as it is challenging but achievable, absorbing and fun. This creates a mental state called flow (Csikszentmihalyi, 2002). During flow you feel less anxious, in control and safer. These benefits can carry over into everyday life.
Abuse creates a mental severance between body and mind, so the body is an important area where recovering is created and expressed. Nearly half of the people who filled in the survey said they found touch and movement helped, such as sport, yoga, massage, walking and dance. These activities bring many benefits, including creating flow, releasing emotions and creating a feeling of safety.
There needs to be an overarching effort to change the dialogue around CSA/CSE. Victim blaming and stigmatisation means that people are reluctant to disclose abuse because of the very real prospect of being rejected and disbelieved. This benefits perpetrators. Secondly the image of perpetrators as evil monsters, whilst illustrating people’s understandable horror of such abuse, results in individuals being reluctant to accept that their relative, partner, friend or colleague could be a perpetrator. This again benefits perpetrators.
Trauma Informed Responses
Evidence shows that the majority of people who have experienced child sexual abuse have some form of traumatic disorder (Maikovich et al., 2009). Complex Post-Traumatic Stress Disorder (cPTSD) triggers can cause extreme anxiety or fear and thus affects the individual’s ability to engage with services or give evidence in court. Taking a trauma-based approach is essential for professionals helping people who have been abused. Anyone likely to hear such disclosures should be trained in sensitive, trauma informed responses.
Individuals approaching services should be tested for cPTSD (by the NHS) as a matter of course and individuals approaching other services should be treated as though they have cPTSD, in the absence of such an assessment. In practice, this means understanding the individual’s needs and requirements and making all possible attempts to accommodate them. Furthermore,cPTSD and the effects of cPTSD should not invalidate an individual’s credibility in criminal cases but in fact be seen as evidence of trauma.
Improved Support Services
Many children who are abused live in families where other issues (addiction, domestic violence, mental health issues) are ongoing. Proper social care and support will benefit those children, their family and may prevent or limit abuse. As adults, people who have experienced abuse may require long term therapy and support to recover from addictions and/or eating disorders. This research suggests that taking a strengths-based approach will be most effective.
Csikszentmihalyi, M. (2002). Flow: The Classic Work on how to achieve Happiness (2nd ed.). Random House, London.
Cunnington, C. (2020) Adults recovering from Childhood Sexual Abuse: A Salutogenic Approach. PhD Thesis.University of Sheffield, Sheffield.
Maikovich, A.K., Koenen, K.C. & Jaffee, S.R., (2009). Posttraumatic Stress Symptoms and Trajecturies in Child Sexual Abuse Victims: An Analysis of Sex Differences Using the National Survey of Child and Adolescent Well-Being. J Abnorm Child Psychol, 37, pp.727–737.
For anyone feeling alone this Christmas (whether you are with people or not!) Survivor Voices for people affected by abuse have a private Facebook group and an online support group. Check out the link for more information. https://survivorsvoices.org/support/
Most people think child abuse is wrong. We are horrified by it, instinctively revolted. Because of this we find it easier to think that the people abusing children are different from us in some way; a different class, race or ethnicity, followers of another religion or belief. As Lewis Coser argued back in 1969 we tend to see the world as ‘us’ (our community’ and ‘them’ (everyone else). The problem is that we find it much easier to blame ‘them’ than ‘us.’
However, when you ask people who have been abused they overwhelming report that the person or people who abused them was very close to their family, often in their family. Research suggests that the majority are often acquaintances, although familial abuse is also a very large percentage. However, most studies agree than strangers are the perpetrators only in a small minority of cases.
In my research 89 (49%) of respondents experienced familial abuse, 75 (42%) acquaintance and 16 (9%) abuse by strangers. For people who described their abusers as acquaintances the majority met them through their family, followed by neighbours, education and religion.
Thus, from the responses, which agrees with other research, it appears that perpetrators are not different; they are people integral to our community life. They are very likely to be known and, potentially, respected by the family. The relationship of perpetrator to victim is important, because abuse by trusted perpetrators has been demonstrated to be associated with more severe mental health symptoms. It can also affect how families respond to finding out about the abuse.
The media focusses on stories that are unusual, not the every day horror that occurs in family homes around the world. I am glad that people are, in the main, against abuse but I would suggest that focussing on the unusual, or the clearly not true, means that we ignore or are blinded to the abuse occurring in our street. It’s easier to believe that ‘other people’ abuse children rather than our friends or relatives but the evidence suggests the opposite.
‘everybody knew…you knew that they knew and that it was my fault’ Lynne
Abuse exists and thrives in silence. Indeed, in most cases, it depends it. That silence can extend across the entire life of those affected. Many people who have experienced CSA will try to disclose the crime, but evidence suggests that the response may well not be positive. Children are socialised into being victims of CSA and into protecting abusers by keeping it secret. Then the perpetrator, family members and wider society reinforce this secrecy through techniques of neutralisation.
The theory of neutralisation was proposed by Sykes and Matza in 1957. It was developed to explain how teenagers became delinquents despite societal pressure to conform. Following on from this, it has been applied to many deviant behaviours, including paedophilia. The theory lists five rationalisations used by individuals or groups to overcome objections to deviant behaviour: denial of responsibility, denial of harm, victim blaming, questioning or blaming authority and, finally, arguing that the individual should be loyal to the group.
What I found out is that, as expected, perpetrators of abuse use these arguments to justify what they do (‘it doesn’t cause any harm,’ ‘they wanted it,’ ‘they won’t remember it’ etc). More surprisingly, when people started talking about the abuse that they had experienced these neutralisation techniques were also utilised by their family, friends and professionals (‘it was just experimentation,’ ‘why didn’t you tell anyone straight away?,’ ‘what did you do to make this happen?’, ‘you’ve brought shame on the family.’ etc). Such responses create shame in the victim and silence them.
Silence and shame are fundamental to the experience of CSA and, therefore, of recovering from it. When asked what hinders recovering, the most common answers were ‘family’, ‘understanding’ and ‘support’. It is crucial to note that the actual effects of abuse, such as depression or anxiety, were not mentioned so frequently. This indicates that human interactions, particularly with those closest to us can significantly mould the experience of CSA and recovering from it.
‘I wish that there had been people that I could have gone to, not necessarily when it was happening because I was terrified of them finding out but afterward to have to have people I could go to who didn’t see me as dirty, or soiled or broken or unworthy or any of things I thought about myself that were reinforced by family members (pause) to have someone say to me ‘no you weren’t the one, it wasn’t your fault and we love you.’’ Ruth
Sykes, G. M. and Matza, D. (1957) ‘Techniques of Neutralization: A Theory of Delinquency’, American Sociological Review, 22(6), pp. 664–670.
When I started my PhD I wanted my research primarily to be aimed at people who had experienced childhood sexual abuse. This was because so much previous research was created for professionals. However, the data I gathered does have implications for all sorts of professionals; people working in the law, health, social work, community and voluntary sectors. I have created a handout that you can download here.
The main messages are:
1) Be kind. Participants talked about important interactions with professionals that really changed their lives for the better. It is an opportunity for you to positively impact someone’s life.
2) Be trauma and chronic post traumatic stress disorder (cPTSD) aware. Research suggests that up to 85% of adults who experienced childhood sexual abuse suffer from cPTSD. So it makes sense to assume that people have it, rather than that they do not.
3) Be aware of damaging discourses and don’t perpetuate them. People who have been abused are infantalised and viewed as incapable. They can also be affected by stigma, created by theories such as the ‘cycle of abuse.’
4) In many ways recovering is the opposite of being abused. It is about reclaiming rights, voice, choices and bodily autonomy. Employ the abused person’s personal strengths and those in the networks around them to assist in their recovering.
Cunnington, C. (2020) Adults recovering from Childhood Sexual Abuse: A Salutogenic Approach. PhD Thesis.University of Sheffield, Sheffield.
Johnson, D. M., Pike, J. L. and Chard, K. M. (2001) ‘Factors predicting PTSD, depression, and dissociative severity in female treatment-seeking childhood sexual abuse survivors’, Child Abuse and Neglect, 25(1), pp. 179–198.
Herman, J. L. (1992) Trauma and Recovery. New York: Basic Books.
Rodriguez, N. et al. (1996) ‘Posttraumatic stress disorder in a clinical sample of adult survivors of childhood sexual abuse’, Child Abuse and Neglect, 20(10), pp. 943–952.
Artwork: The Touch of Comfort by Carmel Couchi. Photo credit: George Eliot Hospital Chapel. Art.uk.
My research has identified four key questions for people recovering from childhood sexual abuse to consider. Some of the answers will be individual to you and it is vital that you make your own choices. After thinking of your answers to these questions you might feel that you want to take action yourself or you might want to find help and support from others to help you.
It’s not easy and everyone stumbles, but when we put more time into ourselves, and access the help we need, it’s easier to move from more negative ways of coping to more positive ones.
Recovering is a life-long process. We can’t forget, but we can keep trying to live the life we deserve. I hope these ideas help.
1.Am I safe?
Safety is vital for recovering, not just in the therapist’s room but in your life and many participants referred to it. Some told me about negative experiences in adulthood, such as abusive relationships or bullying at work, that had traumatised them further. Being safe is the bedrock of recovering. It is hard to focus on recovering when you don’t feel safe.
2. Am I heard?
Many people reported that, in general, people didn’t want them to talk about what happened to them. Friends and partners who listened without judgement were appreciated so much. A quarter of people who took part said that relationships were the most important factor in recovering.
For professionals, a warm, understanding, caring approach was really valued. Participants talked about important interactions that really changed their lives for the better. Counselling and therapy were valued by three quarters of survey respondents.
3. What do I like to do?
Abuse involves denying the child the right to choose. Recovering works best when the individual makes their own choices. Nearly three quarters found creative activities helped, such as art, reading, writing, gardening, design, poetry and gaming. It does not matter what it is as long as you love it, it is challenging but achievable, absorbing and fun. This creates a mental state called flow. During flow you feel less anxious, more in control and safer. These benefits can carry over into everyday life.
4. How can I improve myrelationship with my body?
The body is an important area where recovering is created and expressed. Abuse creates a mental severance between your body and your mind. Recovering involves making friends with your body again. Nearly half of the people who filled in my survey said they found touch and movement helped, such as sport, yoga, massage, walking and dance. These activities bring many benefits, including creating flow, releasing emotions, helping you feel safer because you are stronger and faster.
It doesn’t go into any graphic detail about abuse as it is focused on recovering but it may well be triggering for people with cPTSD. Certainly parts of it were for me but I still think it’s worth writing and, hopefully, reading. It’s written in academic language so I’m working on a two page summary that I’ll post as soon as I can.
I also want to publish a book on it that is jargon free and that’s my next task. Work has been tricky lately as I have my children at home so it’s taking much longer to do anything. I get about an hour’s quiet time a day to do anything that requires thinking so it will take me longer to do.
I was really enjoying teaching undergraduates but it looks like that won’t be available next year as Covid19 has affected the university’s finances. This is a real shame because teaching about inequalities feels like you are contributing, even if only in a small way, to ending them. Hopefully opportunities will pick up again soon.
If you want to ask me anything about the research please use the contact form on the website and I’ll get back to you as soon as I can.