Beginning to tap into the growing area of Child Abuse: Emotional Abuse will be first of the list of (hidden) moments which more of our children are being exposed to. Although it it is a part of the much wider ecosystem that is concerning aging & recent surviving-victims of child sexual abuse (in their younger years), the lifelong results are only beginning to be realised. Following are links to some articles, discussing things from supporting children and young people, defining ECA, why kids need to escape family violence & to cutting off contact:
While some of these readings may cause tensions, it’s best to stop reading – get your mind onto something relaxing – coming back to the remaining (when you can). We’ll try to work on providing Spoken-text versions of our Article’s, as concentration + PTSD + CSA may be connected.
Australia’s National Redress Scheme | RSS Redress Support Services continues to offer Counselling, amongst its services. While some Surviving-Victims may have received other amounts from NRS, including Redress + Apologies – Counselling is a worthwhile external service for CSA victims, their family-friends & other community members. I’m finally bringing a Support Worker into these NRS Sessions, which is dealing with many (hidden) secrets! RSS offer face-to-face, online and telephone support.
Still wondering why our emotions was chosen as the 1st topic? Our emotions reveal so much of our true nature, which power and control try to manipulate. If nothing can be seen as wrong, nothing can be proven – right? Through focus on parts of our emotions, there is still a huge focus on ‘unpacking the box of mysteries’. As such, this post can be our beginning of each of our related matters. These emotional abuse posts go on further …
Content warning: This page contains information that readers may find confronting or distressing.
Help is available if you or someone you know has experienced or is at risk of child sexual abuse. Our Get support page has a list of dedicated services if you need help or support. For information on reporting child safety concerns, visit our Make a report page.
If you or a child are in immediate danger, call Triple Zero (000).
In order to keep children and young people safe, it is important to understand what grooming is and how to prevent it. The term ‘grooming’ refers to behaviours that manipulate and control a child, as well as their family, kin and carers, other support networks, or organisations in order to perpetrate child sexual abuse.
The intent of grooming is to:
gain access to the child or young person to perpetrate child sexual abuse
obtain sexual material of the child or young person
obtain the child or young person’s trust and/or compliance
maintain the child or young person’s silence, and/or
Grooming can occur online or in-person. Online child grooming is the process of establishing and building a relationship with a child or young person while online, to facilitate sexual abuse that is either physical (in person) or online.2This is achieved through the internet or other technologies such as phones, social media, gaming, chat and messaging apps.
Online grooming may involve perpetrators encouraging children and young people to engage in sexual activity or to send the perpetrator sexually explicit material. It may lead to perpetrators meeting the child or young person in person or blackmailing them to self-produce explicit materials. To evade detection while grooming children and young people, perpetrators may also convince them to use different online platforms, including those using encrypted technologies.3 Encrypted technologies are used to protect data from being stolen, changed, or compromised by scrambling data into a secret code that hides the information’s true meaning. Only a unique digital key can unlock the secret code.
Socialising online is a great way for children and young people to build friendships and have fun, but it is important to ensure online technologies are being used in a way that keeps children and young people safe. You can find resources about how to stay safe online on the eSafety website- external site.
How grooming occurs
Child sexual abuse and grooming can occur within families, by other people the child or young person knows or does not know, in organisations, and online. Behaviours related to grooming are not necessarily explicitly sexual, directly abusive or criminal, and may be consistent with behaviours or activities in non-abusive relationships. They can often be difficult to identify and may only be recognised in hindsight. In these cases, the main difference between acceptable behaviours and grooming behaviours is the motivation behind them.4
Grooming of a child or young person, online or in-person, may include:
building their trust, sometimes through special attention or gifts
treating them like an adult to make them feel different and special
gaining the trust of their parents, family or carers
isolating them from supportive and protective family and friends
coercing them, including through threats, stalking and asking them to keep secrets
manipulating them to blame themselves for the situation
encouraging them to produce child sexual abuse imagery or enticing them to participate in sexualised virtual chats
non-sexual touching of the child or young person that develops into sexual behaviour over time.
Signs of grooming
Being aware of the signs of grooming can help protect children and young people from child sexual abuse. A child or young person may show signs of being a victim of grooming in different ways. They may show all or some of the following signs:
developing an unusually close connection with an older person
having gifts or money from new friends that they cannot account for
being very secretive about their phone, internet or social media use
going missing for long periods of time
appearing extremely tired, including at school
being dishonest about who they have been with and where they have been
assuming a new name, having false identification, a stolen passport or driver licence, or a new phone
being collected from school by an older or new friend.5
How to prevent grooming
Teaching children and young people what is appropriate and inappropriate contact (both online and offline), and encouraging open and honest communication, without shame or stigma, will help to better protect them. This includes supporting children and young people to:
understand safe and unsafe behaviours and situations, including being able to identify early warning signs and their body’s natural reactions when they feel unsafe, worried, or scared. These may include feeling butterflies, and having sweaty palms and a racing pulse
practice safe online behaviour, including deleting and blocking requests and messages from people they don’t know, and reviewing and updating privacy settings
know what to do and who to talk to if something feels uncomfortable, as well as what support services are available if they are unsure or if something has happened
say no to requests to engage in unsafe behaviours or sexual advances
block unsafe users, make a complaint to social media companies and report online grooming
understand body boundaries, respectful relationships and consent
feel safe and protected when disclosing what is happening to them.
What to do about suspected grooming
Your child may not understand they are being groomed, and may not tell you that they are being groomed directly. It is important to understand the signs of grooming and talk to your child if you notice changes in their behaviour and suspect something isn’t right.
If you suspect a child or young person is being groomed or is at risk of being groomed, contact your relevant state or territory child protection agency. Visit our Make a report page to find out more.
Our Get support page provides a list of dedicated support and assistance services.
eSafety- external site is Australia’s national independent regulator and educator for online safety. It provides tools and resources for parents- external site and carers to help keep children safe online, including access to free webinars. Issues covered include:
When the hidden-denied reasons behind your childhood of multifaceted #childsexualabuse becomes known more clearly, what’s holding you back from responding alike “the reason I’ve grown so f-ed up, is due to your f-ing parent-church-school-club you took me through”?! #nrs💣
Photo-Illustration: by The Cut; Photos: Getty Images
Esther Perel is a psychotherapist, a best-selling author, and the host of the podcast Where Should We Begin? — she’s also a leading expert on contemporary relationships. Every other week on the show, Perel plays a voice-mail from a listener who has reached out with a specific problem, then returns their call to offer advice. This column is adapted from the podcast transcript — the show is now part of the Vox Media Podcast Network — and you can listen and follow for free on Apple podcasts or wherever you listen.
Simply put, I can’t tell if I’m being gaslit and this is having a very negative effect on my well-being, or if I’m just an overly sensitive person.
Anytime I put up a boundary, my partner freaks out and makes a huge deal, telling me I’m being insensitive to him. He has a big personality, is very quick-thinking and articulate, while I often find it hard to communicate. The arguments are very dramatic and intense and he never lets things go no matter how much I ask him to give me a break. He reminds me during these arguments that I’m ruining the relationship. We broke up over these arguments a few months ago, only to get back together after he assured me they wouldn’t continue.
The Phone Call
Esther Perel: So, you wrote the question, but if you could ask it to me again as we speak today?
A newsletter about modern family life by Kathryn Jezer-Morton.
Caller: I am wondering if I’m being gaslit by my partner or if it’s a case that I’m just being overly sensitive. I feel that I get certain treatment, when we’re alone, that feels very hidden, but in speaking to him, he says I’m overly sensitive, that I’m overly boundaried and that, actually, it’s more that I’m treating him badly, and he gets angry at me for me being bad. And he admits that sometimes his behavior isn’t great and he’s working on it. And he’s worked a lot on it. I just have no idea if I’m basically a bad person and if I’m treating him like crap and not being sensitive to him, because that’s what it sounds like.
Esther: So, tell me something — let’s just go a bit back. How did you come to formulate the question the way you do? What is the history of your relationship that led you to this question, “Am I being gaslit or am I overly sensitive?”
Caller: So, he has a tendency — for example, over New Year’s, we went away together, we were in the car and I wasn’t feeling well, and he just kept on shouting at me that I wasn’t being nice to him. And he was shouting at me. And originally, I thought he was joking. And I was like, “Yeah, I know I am.” But I was quite premenstrual at the time, or I was menstruating and I felt awful, so I was just a bit of a curmudgeon.
And I was like, “Yeah, I know. I feel bad. Just let me feel bad.” And he just kept on shouting, “You’re not being nice to me! You’re not being nice to me! Ooh!” And we were literally going to our friend’s doorstep, and he just left me there and just acted like everything was perfectly normal. And it seems to often be, as well with social settings, that we’ll be going out and he’ll do something to pull the rug out from underneath me and be like, “What’s your problem?”
Another example is, I was at therapy, and I came back and I wasn’t feeling particularly great. We had been talking about boundaries, because I do have concerns that my boundaries aren’t very good and it’s something that I work on.
Esther: What do you mean by that? That’s a big statement.
Caller: Yeah. So, I know that I don’t necessarily know how to put up boundaries. I was in a job before where, basically, I worked myself to a state of very poor health, and a lot of that had to do with working with someone who wouldn’t let me say no. So, no matter how much I was like, “I’m not available,” they just kept on pushing me.
Also, that particular industry, in that particular job, there was a real need for me. There was nobody else to do the job. I had to travel and move, and I was exhausted, but because there was such a need for me, I felt I didn’t have a choice. I let myself just get torn into that and away from my life and away from the people that I care about. And eventually, I got to a point where I completely burnt out.
Esther: And you are telling me this also because in some way something parallel is happening between you and your boyfriend? Caller: Yeah, exactly.
Esther: Right? You are on the verge of burnout. If I ask you — because you say, am I being gaslit or am I overly sensitive, which of course is what people who are gaslit often end up feeling is that they are being overly sensitive, that they are not clear, that they’re doubting themselves, that they’re confused, that they no longer trust their own sanity — you went to look for the definition of what being gaslit means?
Caller: I definitely looked it up at some point, but I don’t quite remember it at this moment.
Esther: Right. So, without even defining the term, if you are telling me, “I’m in a relationship where I don’t trust that what I think has validity. I find myself often saying I feel something and then I’m being blamed for the very thing that I just uttered. The blame is constantly shifting. I am accused of being the gaslighter, and then I end up completely confused, and it makes me question the situation.” It’s like what we call in my field, projective identification, “You are telling me that I’m doing to you what you’re exactly doing to me,” and I distrust myself. I begin to question my mental health because you keep telling me that my mental health is not steady, or something happens and you tell me that’s not what happened, or that “It is your fault” if it happened, or that “I’m doing these things and I’m saying these mean things because I actually am trying to help you,” or that “It’s not such a big deal. So what if you’re menstruating? That shouldn’t explain why you’re treating me the way you are,” or that “You are overthinking it,” or that “When I’m mean, I was just joking,” or that “You’re too emotional.”
These are seven common gaslighting phrases. If any of these are continuously occurring to you or if you simply, even without that, say, “I am constantly questioning myself, I’m constantly doubting myself, I’m constantly in a state of confusion,” et cetera, et cetera, then the answer to your question doesn’t really matter. What you know is that this is not a good situation.
Caller: But that’s the thing is … I don’t know.
Esther: Now you’re going to give me the other side, “But we also have nice times. But when I’m about to pull away, he apologizes profusely and he promises that he will change, that he’s working on it and that this will never be happening again,” until two hours later.
Esther: Now, you’re going to seesaw back and forth in the ambivalence, “Here are all these things, but maybe what if he what says has validity and is true?”
Esther: “And maybe I am indeed so insecure, and maybe I do indeed have a problem with boundaries, which, of course, I’m having with him too. So, in the end, maybe he knows me better than I know myself.”
Esther: And when I say, “I’m hungry,” he says, “No, you’re not really hungry. You shouldn’t be hungry right now.” And I’m beginning to wonder, “Well, maybe then I’m not hungry.”
Caller: Yeah, that’s literally what happens. I’ll be like, “Oh, let’s get some food,” and he’ll be like, “No, no.” I’m like, “Well, I’m, I need something.” And I’ll end up getting a protein bar, something to tide me over until we’re eating, and then he’ll be like, “Oh, yeah, by the way, while you went into the shop to get a protein bar, I got a chicken sandwich.” Then, I’m just like, “What?” Yeah, it comes from everywhere. It feels very controlling.
Esther: It’s either reality manipulation, scapegoating, coercion, or straight-up lying. Those are probably four of the main gaslighting tactics. Shifting blames would be another. And the interesting thing, as I listen to you, is, you have the answer to your question every time you give me another example to reinforce that you actually know what’s happening.
Caller: But the thing is that he has shown me, in so many ways, that he does love me and … We have, honestly, the best time. He’s my best friend in the world. I don’t know how to lose him. And that’s the thing is, I see him as a really good person, as a really kind and warm and friendly… And if you see him with his friends, he is incredible, incredible. It’s so confusing. Exactly, again. But then he turns around and does that to me.
Esther: Now, a question I would ask him is, “Who did this to you and nobody stopped them? Who did you see do this in your family and nobody stopped them?”
Caller: I feel that would be really hard for him. And I would be worried about, not challenging, I think, for him, something like that would be —
Esther: But do you know?
Caller: I’d imagine I have an idea.
Esther: That’s my question. He may be a wonderful friend, but that does not dictate how he’s going to be with his girlfriends. Those two things don’t necessarily always go in sync. I would ask him, where did he learn this, and who did he see do this, and who never stopped it? And I would then ask you this parallel question — this of course is not a question you’re going to ask him, but I’m asking that to you because you probably know him … how long are you together?
Caller: Two years.
Esther: Okay. Then, I’m going to ask you, who did you see in such a dynamic? Where did you learn not to be able to say no? Because this is not about “Am I being gaslit or am I being overly sensitive?” Without defining, without focusing just on these two terms, you’ve described the reality. Then, you say, “But he loves me,” and that may very much be the case as well. But he also needs to control you, but he’s also intensely insecure and therefore he needs you to be one down, but he also has a hard time hearing you say “I’m hungry” without instantly denying it or defying you or qualifying it or deciding if you have a right to be hungry at this moment or not because he knows better than you what your stomach needs.
So, regardless of how much he loves you, he still would need to learn to differentiate and to be able to let you have an experience, and respond caringly and compassionately to it without having to decide if your experience is valid or not before he decides how he wants to respond because he’s the master and the judge.
Caller: Oh my God, yeah. That is qualifying my experience. That’s it. It’s like every single experience I have, all of my friendships, all of my work, it’s being qualified. That’s exactly it, and being like, “You’re doing this right and you’re doing that wrong.” It’s like being stuck in a box. And the thing is that I know that I am brilliant and I have beautiful friendships and I was excellent at that job and I’m excellent at most things that you put in front of me, and I feel that really deeply.
I know what I’m doing, and I care about myself, and I’ve had to do a lot of work on myself, and I’m continuing to learn, and I’m conscious of where I go up and where I go down, but …
Esther: And if you had a friend, since you have very good friends, if one of your friends was in a situation that is similar to yours, what would you say?
Caller: Just step away. It’s just not that easy. We’re completely entwined in each other’s lives as well.
Esther: And then, what would you say to your friend who says, “It’s not that easy. We’ve got our lives completely intertwined with each other. I have invested two years of my life here. I know he loves me, but I’m being obliterated, I’m losing my mind, I’m continuously put in a situation where I have to doubt myself”?
Caller: Yeah, I’d be like, “I’ll take care of you.” I don’t know.
Esther: Have you spoken with your friends?
Caller: Yeah, a bit. I don’t like to speak badly about him because they all know him. So I want to honor the relationship, in a way. I’ve spoken to my sister a bit.
Esther: And has anybody said, “Keep going”?
Caller: Yeah. Then, I had one friend who had flagged it early, and when she flagged it, that was also the time, literally the same day when I had the breakdown for work, or the day that I literally just heard from my doctor being like, “You can’t do that job anymore.” And I was not sleeping through the night.
And I was literally talking to him about it, and he was like, “Well, I’m thinking about maybe we should break up.” So, he, nearly always, when I’m at a level of peak stress, he’ll put something else on top. Then I never went back to work after that.
Esther: So, if you are struggling with something, he will trump you? If you bring up a feeling, he’ll bring up another one that he thinks, in that moment, is more important than the one you just brought up?
Caller: Yeah, every single time. So when I was talking about that boundaries thing, he flipped. When I was back from the therapist and I was just literally standing in the kitchen being, “I just need to eat some dinner.” So I was like, “Right, I’m just going to make myself some food. I’m gonna take care of myself, I’m gonna nourish my body.”
And I was like, “Okay, I just need … I’m a bit weird right now, I just need a little bit of space because I,” blah, blah, blah. Then, he started at me, and I was like, “No, I can’t handle this right now. I’ve explained the fact that I’m feeling very vulnerable. I’m just like letting you know that.” And he was in a great mood when I came in, and then, suddenly, he turned, and then he started shouting at me and shouting at me, and I was like, “Stop shouting at me.”
Then he freaked out about me not understanding what a boundary was, me turning my boundaries against him. Then we had this long discussion about what qualifies shouting or not, and then we literally got into the depths of what the semiotics of the word shouting is to both of us. Then he made me say that he hadn’t been shouting at me in terms of the way that he understands the word “shouting.”
Esther: So, you covered all four, right?
Esther: You covered the coercive strategies, you covered the shifting of the blame, you covered the questioning of your reality, you covered the manipulation, the disqualifying. So, you’ve answered your question.
Esther: What has made it so difficult for you to know that you have to go or to act on it? Where does your challenge come from in terms of saying no, in terms of saying, “This is what I know I need to do, and I’ll deal with the consequences. In fact, I’ll be liberated. I’ll suddenly realize how much I’ve been hijacked and what kind of a hostage situation this has been. And I will be able to, once again, liberate myself with my friends, and then my friends are going to start telling me how they had noticed it, that and the other, and I’m going to say, ‘How come you never told me?’ And they’ll tell me, ‘We kept trying to tell you but you couldn’t hear it because you were completely enveloped in this saga.’”
Caller: Yeah, it’s bizarre. I know that you’re right, I know that.
Esther: You are brilliant. You’ve answered your questions. You have your answer. This is not a question of discernment, this is a question of, you’ve tried it before, you may try it again, he’s going to beg you, he’s going to plead with you, he’s going to be his best self for half an hour, and he may be a perfectly good, kind person, but he’s got some things to deal with if he’s going to be in a relationship.
Esther: And so do you.
Caller: Yeah. Well, yeah, I think that’s the thing — if I’ve tried so hard, and I’m 35, I’ve been in enough relationships, and he genuinely has worked a lot on himself, and I can see how he’s come along in a big way.
Esther: Do you know what?
Esther: I don’t know what you mean, because every example you’ve given shows me somebody who has very little ability to see what he does. And, of course, for any gaslighter there must be a person that is letting themselves be gaslit. These two go together.
Esther: But there hasn’t been a situation where you describe him saying, “I realize, I notice, I take responsibility, I’m sorry, I was projecting, I was dumping.”
Caller: Well, he has done that.
Esther: When? When you leave?
Caller: No. We do talk after these things happen. I’ve been listening to you forever. I never knew that he knew about you, and he sent me something, one of your YouTube videos about when couples get to an impasse, and he was like, “Let’s look at this and let’s talk about this based on the tools that are there.” And I really appreciate that.
I can see him trying. But the thing is, we’re actually at a point right now where we’re not really speaking, and I asked for the keys back for my flat after everything that happened that I’ve been talking about recently. It was too much.
Esther: That piece of your excusing him and analyzing and justifying and excusing his behavior is part of the gaslit cycle.
Esther: “He’s doing this but he doesn’t really mean to do this, he feels bad about it afterwards, and so, now, I need to make him feel better about him making me feel bad.”
Caller: Yeah, yes. Yes.
Esther: This is twisted.
Caller: Completely twisted. Because I was on the phone to him yesterday. I wanted to let him know that I was going to be speaking to you because I thought that that was respectful. I also was like, “Look, in the long run, I feel we’ve been running on what I want. I just want to know what you want.” Then, of course, it came back around to how much all of his friends told him that he’s great, and then I, of course, was like, “Well, you’re a great person, and I want you to know that you’re a good person.” And I do think that, but it still comes around to having this treatment, and I still seem to be the person going to him telling him that he’s good, and then I’m the bad guy again.
Esther: And does that come from him as well, “You’re a wonderful person”?
Caller: No. I get, “You’re a lovely person.”
Esther: “You’re a lovely person,” okay. If you are indeed such close friends, and if he’s indeed such a wonderful person, then you may want to find this relational structure that will actually highlight that. Being his friend may give you much more of the wonderful qualities that he has than being his girlfriend.
Caller: Yeah, that’s true.
Esther: At least for right now. So, he can stay in your life. It’s not clear that he will. Generally, when that dynamic occurs, it’s more common that the person will be more vindictive and not want anything to do with you. They’ll try, they’ll come back, they’ll come back until they finally realize that maybe they’re not going to get what they want, and then they’ll say, “Fuck you.”
But if he does stay, have him in your life, but have him in the structure of a relationship that gives you access to the best qualities that he has. If he’s such a wonderful friend, be a friend.
Caller: But I love him.
Esther: That is a wonderful thing, but that doesn’t mean you need to make a life in that dynamic.
Esther: It doesn’t change if people don’t actively take ownership over what they do to create this kind of dynamic, and that means you and him.
Caller: Yeah. One of the reasons that I contacted you is, I know that I’m autonomous in this relationship, but it’s really hard to admit that I’ve let somebody walk all over me and that I haven’t been strong enough to tell them to piss off. It makes me question myself so much more.
Esther: Which is one of the reasons why these dynamics sometimes go on for a long time, because he has his denial. His denial is to shift the blame on you. But you have your denial, which is, “This isn’t really happening. I could walk away at any time. I am a strong woman, I am autonomous. Nobody tells me what to do.” But in fact, that’s not what’s happening. So, it’s one denial meeting another denial, so to speak.
Caller: Yeah. I hear you.
Esther: And what you just said, “But I love him,” so what? I hear you, it’s a deep feeling, but the question remains, and what do you want to do? That your feelings of love are mired into a relationship that is ultimately going to make you lose your entire sense of yourself.
Esther: So, you will continue to say, “I love him,” but the “I” will have dissolved in the process.
It’s not easy. You’re going to surround yourself with friends, and you’re going to have to be honest with your friends and let them know what’s going on, not by blaming him, but by telling them that you found yourself in a relationship where instead of increasingly becoming bolder and stronger and more recognized, it’s all the reverse that is happening.
And that’s not because of what he does only. If, on the other end, you say, “I want to do some couples work and I want us to both go and deal with this dynamic,” go ahead. It won’t change alone. Somebody has to see this in action to be able to intervene. Each of you will make perfect sense when you talk alone to your own respective therapists.
Caller: Yeah. Couples counseling is on the cards right now. We’ve seen a couples counselor before and it didn’t … she wasn’t great. And my concern is that he’s going to charm them, and he is not going to show the truth of the dynamic when there’s another person present.
Esther: Then, you’ll put that on the table too.
Esther: A good clinician sees the invisible and sometimes hears the inaudible.
Caller: Thank goodness for you, and thank goodness for this phone call, It’s just like clearing the clouds from my brain.
Esther: Look, I’m going to ask the question again, and then we are going to say good-bye. But it is the question that you didn’t answer, which is, where does your challenge come from? Because you couldn’t say, “Saying no is difficult for me, so I found a person with whom I can practice that muscle.” These things are a mindfuck.
Esther: But you may want to say, “I wanna practice my no, and I found the best place to do so because here is a person who doesn’t hear any of them. So, I practice boundaries with somebody who doesn’t respect any of them or sees them all as an attack on him or sees them as a weakness of mine, but they’re all qualified.”
Or you may say, “That doesn’t have to be the way I’m looking for a relationship.” I know you’re 35 and I know that you love him and I know that you think you’ve had your share, but maybe that should bring you also a level of awareness that says, “Is this how I want to live?”
Caller: But I think that’s the thing, it’s, I don’t know how I’ll have a healthy and wholesome relationship. I just keep on seeming to get battered or something.
Esther: “Why do I, a smart, accomplished, professional, insightful, autonomous woman, find myself in relationships with men where I end up in this kind of battered position?” That is a very powerful question.
Esther: “And how do I learn to see it sooner rather than later?”
Esther: “And how do I say, ‘I’m breaking the cycle,’ and then act on it?” Is this a good place to stop?
Caller: In my head, I’m only just beginning.
Esther: Because I’m leaving you with some big questions rather than slap answers, because you have the answer. To the question that you came with, you know the answer before you came. To what is the cycle that you are repeating, we didn’t get to, but we suspect there is one because this is not your first time. Different melodies for the same dance.
If we were seeing each other regularly, this would be the moment where I say, “To be continued.” But it will be continued, but without me. But I’m inviting you to take this and do something with it.
This form of PTSD results from repeated, prolonged trauma. Experts often use a multipronged approach to treat it. C-PTSD may be familiar to many a surviving-victim of CSA!
BY MATTHEW TULL, PHD MEDICALLY REVIEWED BY IVY KWONG, LMFT
Complex post-traumatic stress disorder (sometimes called complex PTSD or C-PTSD) is an anxiety condition that involves many of the same symptoms of PTSD, along with other symptoms.
First recognized as a condition that affects war veterans, post-traumatic stress disorder can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse.
When the underlying trauma is repeated and ongoing, though, some mental health professionals consider it C-PTSD.
The condition has gained attention in the years since it was first described in the late 1980s. However, it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the tool that mental health professionals use to diagnose mental health conditions.
PTSD vs. C-PTSD
PTSD and C-PTSD are a result of something deeply traumatic happening and can cause flashbacks, nightmares, and insomnia. Both conditions can also make you feel intensely afraid and unsafe even though the danger has passed. Despite these similarities, though, there are key differences, according to some experts.
The main difference is the frequency of the trauma. While PTSD is triggered by a single traumatic event, C-PTSD is caused by long-lasting trauma that continues or repeats for months, even years (commonly referred to as “complex trauma”). Another difference: C-PTSD is typically the result of childhood trauma.
The harmful effects of oppression and racism can add layers to the complex trauma—particularly if the justice system is involved.
The psychological and developmental impacts of complex trauma early in life are often more severe than a single traumatic experience—so different, in fact, that many experts believe that the PTSD diagnostic criteria don’t adequately describe the wide-ranging, long-lasting consequences of C-PTSD.
● Caused by long-term, repeated trauma
● Typically arises from childhood experiences
● Often occurs in those who have endured racism and oppression
● Usually more severe than PTSD
● Caused by a single event
● Can result from trauma experienced at any age
● Usually milder than C-PTSD
Symptoms of C-PTSD
In addition to all of the core symptoms of PTSD—reexperiencing, avoidance, and hyperarousal—C-PTSD symptoms generally also include:
DIFFICULTY CONTROLLING EMOTIONS. It’s common for someone suffering from C-PTSD to lose control over their emotions, which can manifest as explosive anger, persistent sadness, depression, and suicidal thoughts.
NEGATIVE SELF-VIEW. C-PTSD can cause a person to view themselves in a negative light. They may feel helpless, guilty, or ashamed. They often have a sense of being completely different from others.
TROUBLE WITH RELATIONSHIPS. People with C-PTSD may avoid relationships or develop unhealthy relationships because that is what they knew in the past.
DETACHMENT FROM THE TRAUMA. A person may disconnect from themselves (depersonalization) and the world around them (derealization). Some people might even forget their trauma.
LOSS OF BELIEFS AND FAITH. Another symptom can be losing core beliefs, values, religious faith, or hope in the world and other people.
All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of life.
Making a Diagnosis
Although C-PTSD comes with its own set of symptoms, some believe the condition is too similar to PTSD (and other trauma-related conditions) to warrant a separate diagnosis. As a result, the DSM-5 lumps symptoms of C-PTSD together with PTSD. Therefore it isn’t officially recognized by the American Psychiatric Association.
Many mental health professionals recognize C-PTSD as a separate condition, because the traditional symptoms of PTSD do not fully capture some of the unique characteristics shown in people who experienced repeat trauma.
In 2018, the World Health Organization made the decision to include C-PTSD as its own separate diagnosis in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems.
Because the condition is relatively new, doctors may make a diagnosis of PTSD instead of C-PTSD. Since there is not a specific test to determine the difference between PTSD and C-PTSD, you should keep track of the symptoms you have experienced so that you can describe them to your doctor.
Treatment for the two conditions is similar, but you may want to discuss some of your additional symptoms of complex trauma so your doctor or therapist can also address them.
C-PTSD can also share signs and symptoms with borderline personality disorder (BPD). Although BPD doesn’t always have its roots in trauma, this is often the case. In fact, some researchers and psychologists advocate for putting BPD under the umbrella of C-PTSD in future editions of the DSM to acknowledge the link to trauma, foster a better understanding of BPD, and help people with BPD face less stigma.
Identifying the Cause
C-PTSD is believed to be caused by severe, repetitive abuse over a long period of time. The abuse often occurs at vulnerable times in a person’s life—such as early childhood or adolescence—and can create lifelong challenges.
Traumatic stress can have a number of effects on the brain. Research suggests that trauma is associated with lasting changes in key areas of the brain including the amygdala, hippocampus, and prefrontal cortex.
The types of long-term traumatic events that can lead to C-PTSD include the following: child abuse, neglect, or abandonment; domestic violence; genocide; childhood soldiering; torture; and slavery.
In these types of trauma, a victim is under the control of another person and does not have the ability to easily escape.
The Latest Treatment
Because the DSM-5 does not currently provide specific diagnostic criteria for C-PTSD, it’s possible to be diagnosed with PTSD when C-PTSD may be a more accurate assessment of your symptoms. Despite the complexity and severity of the disorder, C-PTSD can be treated with many of the same strategies as PTSD, including:
Medications may help reduce symptoms of C-PTSD, such as anxiety or depression. They are especially helpful when used in combination with psychotherapy. Antidepressants including Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline) are often used to treat C-PTSD.
Psychotherapy for C-PTSD focuses on identifying traumatic memories and negative thought patterns, replacing them with more realistic and positive ones, and learning to cope more adaptively to the impact of your trauma.
One type of psychotherapy that may be used to treat both PTSD and complex PTSD is known as eye movement desensitization and reprocessing (EMDR). This approach uses eye movements guided by the therapist to process and reframe traumatic memories. Over time, this process is supposed to reduce the negative feelings associated with the traumatic memory.
Coping With C-PTSD
Treatments for complex PTSD can take time, so it is important to find ways to manage and cope with the symptoms of the condition. Some strategies that may help you manage your recovery:
FIND SUPPORT. Like PTSD, C-PTSD often leads people to withdraw from friends and family. However, having a strong social support network is important for mental well-being. When you are feeling overwhelmed, angry, anxious, or fearful, reach out to a trusted friend or family member.
Research has found that writing in a journal can be helpful in managing PTSD symptoms and decreases symptoms of flashbacks, intrusive thoughts, and nightmares.
PRACTICE MINDFULNESS: C-PTSD can lead to feelings of stress, anxiety, and depression. Mindfulness is a strategy that can help you become more aware of what you are feeling in the moment and combat feelings of distress. This practice involves learning different ways to tune into your body and focus on staying in the present moment.
WRITE DOWN YOUR THOUGHTS: Research has found that writing in a journal can be a useful tool for managing PTSD symptoms; it decreases symptoms including flashbacks, intrusive thoughts, and nightmares.
Keeping a journal can be a handy way to track symptoms so that you can later discuss them with your therapist.
Support groups and self-help books can also be helpful when dealing with complex PTSD. Two recommended books that address this topic are The Body Keeps the Score by Bessel van der Kolk, MD, and Complex PTSD: From Surviving to Thriving by Pete Walker.
It can feel overwhelming if you or someone you care about has been exposed to repeated trauma and is struggling to cope. But remember that it’s important to seek help from a therapist who is experienced treating PTSD.
You might also want to contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357; they can provide information on support and treatment facilities in your area.
In addition, you can do a search online to locate mental health providers in your area who specialize in PTSD. The bottom line? You don’t have to go it alone.
Guys – an online support group that SAMSN are running, in case you are interested. I got info on it through an email from another Counsellor (BlueKnot)! Absolutely no pressure to join, It’s just in case it’s something you’re interested in… (6pm-8pm may be Daylight Savings time, which we’ll check on before then)
Mon 21st Feb is in just over 1 & 1/2 wks away. This should be a wonderful chance for you guys! You’re definitely not alone.
Professor Jill Astbury MAPS, College of Arts, Victoria University
All forms of child sexual abuse (CSA) are a profound violation of the human rights of children. CSA is a crime under Australian law and an extreme transgression of trust, duty of care and power by perpetrators. The rights violations that define CSA are critically connected to the deleterious behavioural and psychological health consequences that ensue. This article examines the long-term effects of CSA on mental health and the determinants of these outcomes, in order to identify opportunities to ameliorate the profound psychological impacts of CSA on the lives of many victims/survivors. The article is based on a literature review commissioned to inform the APS response to the Royal Commission into Institutional Responses to Child Sexual Abuse, which was established in 2013 by the Gillard Government.
Prevalence of child sexual abuse
Rates of CSA are difficult to gauge accurately given the clandestine, sensitive and criminal nature of the sexual abuse to which children are exposed. Perpetrators of CSA are often close to the victim, such as fathers, uncles, teachers, caregivers and other trusted members of the community (Finkelhor, Hammer & Sedlak, 2008). CSA often goes undisclosed and unreported to professionals or adults for many complex reasons, including fear of punishment and retaliation by the perpetrator, as well as the stigma and shame associated with this type of abuse (Priebe & Svedin, 2008).
A global meta-analysis of child sexual abuse prevalence figures found self-reported CSA ranged from 164-197 in every 1,000 girls and 66-88 per 1,000 boys (Stoltenborgh, van Ijzendoorn, Euser, & Bakermans-Kranenburg, 2011). In Australia, Fleming (1997) used a community sample of 710 women randomly selected from the Australian electoral roll and found that 20 per cent of the sample reported experiencing CSA involving contact. Another national survey involving both men and women (Najman, Dunne, Purdie, Boyle, & Coxeter, 2005) reported a higher prevalence of CSA, with more than one third of women and approximately one sixth of men reporting a history of CSA. A more recent study in Victoria (Moore et al., 2010) reported a prevalence rate of 17 per cent for any type of CSA for girls and seven per cent for boys when they took part in the study during adolescence. Both Australian studies involving community samples of women or girls and men or boys indicate that girls are two or more times more likely to experience CSA than boys.
Long-term mental health consequences
A significant body of research has demonstrated that the experience of CSA can exert long-lasting effects on brain development, psychological and social functioning, self-esteem, mental health, personality, sleep, health risk behaviours including substance use, self-harm and life expectancy. CSA often co-occurs with physical and emotional abuse and other negative and stressful childhood experiences that independently predict poor mental and physical health outcomes in adult life.
Nevertheless, the research literature indicates that when other predictors of poor adult mental health are statistically controlled, CSA remains a powerful determinant of psychological disorder in adult life (Kendler et al., 2000). Strong evidence from twin studies indicates that a causal relationship exists between CSA and subsequent mental disorders. Twin studies necessarily control for genetic and family environment factors and a number since 2000 have documented significant associations between CSA, depression, panic disorder, alcohol abuse/dependence, drug abuse/dependence, suicide attempts and completed suicides.
A systematic review and meta-analysis of studies published between 1980 and 2008 (Chen et al., 2010) found that a history of sexual abuse including child sexual abuse was related to significantly increased odds of a lifetime diagnosis of several different psychiatric disorders, including anxiety disorders, depression, eating disorders, posttraumatic stress disorder (PTSD), sleep disorders and suicide. A particularly strong link between CSA and subsequent PTSD has been found.
Although the diagnosis of PTSD may be appropriate for those who have been exposed to relatively circumscribed CSA, Herman (1992) argued more than two decades ago that this diagnosis does not adequately capture the psychological responses of people who are repeatedly traumatised over a long period of time, experience subsequent re-victimisation in adolescence or adult life and typically display multiple symptoms of psychological distress and high levels of psychiatric co-morbidity. For survivors of this kind of CSA, Herman (1992) proposed the expanded diagnostic concept of complex PTSD on the grounds that it was better able to accurately capture the complex psychological sequelae of prolonged, repeated trauma.
Risk of suicide: Australian research
Survivors of CSA face a significantly increased risk of suicide and a higher prevalence of suicide attempts and ideation. An Australian follow-up study (Plunkett et al., 2001) of young people who had experienced CSA compared with those who had not, reported that those with a CSA history had a suicide rate 10.7-13.0 times the national rate. Furthermore, 32 per cent of those sexually abused as children had attempted suicide and 43 per cent had thought about suicide. None of the non-abused participants had completed suicide.
A more recent Australian study confirms and extends this finding. Cutajar and colleagues (2010) conducted a cohort study of 2,759 victims of CSA by linking forensic records from the Victorian Institute of Forensic Medicine between 1964 and 1995 to coronial records up to 44 years later. They found that female sexual abuse victims had 40 times higher risk of suicide and 88 times higher risk of fatal overdose than the rates in the general population. Interestingly these rates were even higher than those for males, in contrast to the usual gender pattern for suicide. The respective rates for males were 14 times and 38 times higher than those in the general population.
Determinants of long-term mental health outcomes
While victims/survivors of CSA face greatly increased risks of poor mental health in adult life, a significant minority do not go on to develop psychological disorders (Saunders, Kilpatrick, Hanson, Resnick, & Walker, 1999). Broadly, two approaches to explaining this finding have informed research: differences in the nature of the abuse that has taken place; and post-abuse factors that positively mediate or intervene in the development of negative long-term mental health outcomes.
Nature of the sexual abuse
The likelihood of experiencing severe, negative mental health outcomes in adult life as the result of CSA is increased by several abuse-specific characteristics. Large scale epidemiological studies have consistently documented that forced penetrative sex, multiple perpetrators, abuse by a relative, and a long duration of CSA (e.g., more than a year) predict more severe psychiatric disturbance and a higher likelihood of being an in-patient in a psychiatric facility in adult life.
More than 20 years ago, Pribor and Dinwiddie (1992) investigated different types of CSA of increasing severity and found that incest victims had a significantly increased lifetime prevalence rate for seven psychological disorders including agoraphobia, alcohol abuse or dependence, depression, panic disorder, PTSD, simple phobia and social phobia. Bulik, Prescott and Kendler (2001) also confirmed that a higher risk for the development of psychiatric and substance use disorders was associated with certain characteristics of the abuse, including attempted or completed intercourse, the use of force or threats and abuse by a relative. More severe and chronic abuse which starts at an early age has also been reported to increase the risk of developing symptoms of dissociation.
Post-abuse mediating factors
Certain factors, both negative and positive, are likely to intervene after CSA has taken place and to mediate adult mental health outcomes.
Coping strategies Specific coping strategies used by survivors can positively or negatively predict long-term psychological outcomes. Overall, positive, constructive coping strategies such as expressing feelings and making efforts to improve the situation are associated with better adjustment (Runtz & Schallow, 1997; Tremblay, Hebert, & Piche, 1999), and negative coping strategies, including engaging in self-destructive or avoidant behaviours, with worse adjustment (Merrill, Thomsen, Sinclair, Gold, & Miller, 2001). However, the coping strategies used by survivors are contingent to some degree on the availability of social or material resources over which children have little or no control.
In addition, the number of negative or maladaptive coping strategies used is predictive of the likelihood of sexual re-victimisation in adulthood (Filipas & Ullman, 2006). This strongly indicates that the link between CSA, negative coping strategies and adverse adult psychological outcomes is strengthened by sexual re-victimisation. Several studies have confirmed this relationship.
Re-victimisation CSA is associated with an increased risk of subsequent violent victimisation including intimate partner violence and sexual violence in adolescence and adulthood (see, for example, Classen, Palesh, & Aggarwal, 2005). Sexual re-victimisation involving rape or other types of sexual abuse/assault poses a potent risk for worse psychological health in adult life. A number of studies have confirmed that women who are sexually re-victimised compared with their non-revictimised counterparts have more severe symptoms of psychological distress in adulthood.
Social support and reaction to disclosure Historically, the role of social support and other societal and cultural factors in determining survivors’ responses to CSA has been under-explored in comparison with the heavy focus on the survivor’s role in responding to sexual trauma. Increased interest in the contribution of social support and other sociocultural factors has prompted increased investigation into the social contextual factors that can mediate adult outcomes following childhood violence, many of which are associated with the reactions to disclosure.
Delay in the disclosure of CSA is linked inevitably with other delays, all of which are harmful to the child. These include delay in putting in place adequate means to protect the child from further victimisation, delay in the child receiving meaningful assistance including necessary psychological and physical health care, and delay in redress and justice for the victim. Without disclosure, negative health outcomes are more likely to proliferate and compound. Conversely, disclosure within one month of sexual assault occurring is associated with a significantly lower risk of subsequent psychosocial difficulties in adult life including lower rates of PTSD and major depressive episodes (Ruggiero et al., 2004).
Yet experiences of disclosure are not uniform and whether they are positive or negative depends on the reactions of the person to whom the CSA is disclosed. Unfortunately, negative reactions to disclosure are common, constitute secondary traumatisation and are associated with poorer adult psychological outcomes (Ullman, 2007). Such reactions include not being believed, being blamed and judged, or punished and not supported, all of which can compound the impact of the original abuse and further increase the risk of psychological distress including increased symptoms of PTSD, particularly when the perpetrator is a relative.
Specific characteristics of disclosure appear to be protective against the development of psychiatric disorders. This finding highlights the importance of social support in concert with effective action by the person in whom the child confides. The degree to which someone is affected is likely to reflect various indicators of the severity of the abuse as well as countervailing protective factors such as the strength of family relationships and the survivor’s self-esteem. One such factor is a warm and supportive relationship with a non-offending parent, which is strongly associated with resilience following CSA and lower levels of abuse-related stress.
Implications for psychological training and practice
The research outlined above shows conclusively that CSA is associated with multiple adverse psychological outcomes, although such outcomes are not inevitable. The identified mediating or intervening factors that increase or decrease the risk of developing psychological disorders as a result of CSA have important implications for psychological training and for the practising psychologists who work with survivors of CSA.
Training on CSA
It is a matter of grave concern that the issue of CSA has been neglected in psychology training. When psychologists lack appropriate knowledge and skills to work with survivors they put both their clients and themselves at risk and can cause unintended harm. Training on CSA is urgently needed in psychology programs to disseminate evidence to students on the protean psychological consequences of CSA as well as the skills necessary to carry out the demanding mental and emotional work of treating survivors. Survivors can have chronic, complex problems in many areas of functioning and psychological disorders can overlap with physical health problems, including pain syndromes and high risk health behaviours such as alcohol, tobacco and drug use. Careful long-term psychological care is often necessary. As survivors may seek help from a range of psychologists, it is important that all psychologists are educated about the magnitude and psychological consequences of CSA.
Apart from acquiring more in-depth knowledge of the emotional effects of CSA and experience in trauma-related interventions, postgraduate courses should prepare practitioners for how exposure to their clients’ traumatic material can traumatise them as well. To remain psychologically healthy while working with survivors of CSA, psychologists need to be able to recognise symptoms of secondary traumatic stress and develop self-care strategies and support systems that will help them to manage the stress related to working with CSA survivors.
Most practising psychologists today who work with survivors have acquired their knowledge and skills ‘on the job’ post-graduation or as a result of their own initiative by attending workshops delivered by specialists in the field. An unknown number of registered psychologists may have no training on CSA and a more systematic continuing education program should be available and accessible so that all psychologists are equipped, at the very least, to ‘do no harm’ to the clients who have experienced CSA.
Implications for psychological practice
Knowing how to facilitate disclosure and take a comprehensive trauma history is an essential first step in developing a treatment plan for survivors of CSA. How a psychologist responds to a client’s disclosure will have an enormous impact on whether a survivor continues or abruptly terminates treatment. Any hint of disbelief, blame or judgment is likely to fracture the client’s fragile hope that she or he will be believed and that it is safe to undertake the painful task of working through the original abuse and its aftermath. If the response to a disclosure is negative it may be years before a survivor is willing to try again, and in the meantime the psychological burden of the abuse and its effects can proliferate. The effort to remain silent and keep the abuse hidden is extremely isolating and cuts off access to potential avenues of psychosocial support.
It would be a mistake for psychologists to assume, for example, that knowing about prolonged exposure therapy for the treatment of PTSD, would, by itself, be sufficient to offer effective treatment to survivors. Beyond the symptoms of traumatic stress associated with CSA, survivors often struggle with many other pressing concerns. These often relate to the deep betrayal of trust by the adult/s with a duty of care towards them as children. This betrayal can prompt persistent negative self-perceptions, difficulties in trusting others and their own judgement, and abiding feelings of shame and intrinsic ‘unloveability’ that contribute to insecure, unsatisfying relationships in adult life. These same issues can impinge on the client-psychologist interaction, making it challenging to establish a robust therapeutic alliance or maintain appropriate boundaries.
CSA does not result in a single disorder such as depression, treatable within the 10 sessions supported under the Better Access to Mental Health Care initiative. The chronicity and complexity of the disorders stemming from CSA require much longer term mental health care. The current system under Medicare is very poorly suited to meeting the mental health care needs of perhaps the most numerous and psychologically vulnerable group in society – CSA survivors.
The Royal Commission has provided a timely opportunity to closely examine the enduring, deleterious and multi-faceted impacts of CSA on survivors, how institutions in which abuse took place failed to intervene and the kind of assistance survivors believe will be most helpful in healing from their traumatic experiences. Psychology has much to contribute to this process and to ensure that the best available psychological evidence is put forward to address the profoundly disturbing phenomenon of child sexual abuse.
Clergy-perpetrated child sexual abuseIn contrast with the large evidence base amassed since the 1980s on the prevalence and health consequences of CSA occurring in the general community, minimal research was published before 2000 on CSA perpetrated by clergy or others working for institutions or organisations, and evidence remains limited in scope.There is an additional theological and spiritual dimension to clergy-perpetrated abuse that sets it apart other forms of CSA, including a spiritual and religious crisis during and after the abuse (Farrell & Taylor, 2000). CSA perpetrated by priests and other members of the clergy has been described as “a unique betrayal” (Guido, 2008) and the “ultimate deception” (Cook, 2005), and the implications of such abuse for victims are eloquently described by McMackin, Keane and Kline (2008):The sexual exploitation of a child by one who has been privileged, even anointed, as a representative of God is a sinister assault on that person’s psychosocial and spiritual well-being. The impact of such a violent betrayal is amplified when the perpetrator is sheltered and supported by a larger religious community. (p.198)Psychological consequences of clergy-perpetrated child sexual abuseClergy-perpetrated sexual abuse of children can catastrophically alter the trajectory of victims’ psychosocial, sexual and spiritual development (Fogler et al., 2008). In the US, investigation into the Catholic Church by the John Jay Research Team repeatedly identified certain psychological effects of clergy CSA in the personal testimony of survivors and family members. These included major symptoms of PTSD with co-occurring substance abuse, affective lability, relational conflicts, and a profound alteration in individual spirituality and religious practices associated with a deep sense of betrayal by the individual perpetrator and the church more broadly (John Jay College, 2004, 2006; McMackin et al., 2008).Some of these negative psychological outcomes are shared with survivors of CSA in the general population but those related to spirituality, religious practices and a sense of betrayal by the church alter the nature of the harm caused by clergy-perpetrated CSA. While a diagnosis of PTSD may be useful as a starting point in understanding and treating survivors of clergy CSA, Farrell and Taylor (2000) contend that “there are qualitative differences in [clergy-perpetrated CSA] symptomatology, which the PTSD diagnosis cannot explain” (p. 28). Such symptoms include self-blame, guilt, psychosexual disturbances, self-destructive behaviours, substance abuse, and re-victimisation. These symptoms are argued to emanate from the theological, spiritual and existential features of clergy CSA. For these reasons, Farrell and Taylor (2000) suggest that a diagnosis of complex PTSD (Herman, 1992) offers a better fit for the symptoms reported by survivors of clergy-perpetrated CSA.Preventing clergy-perpetrated child sexual abuseThe history of denial, cover up and delays in response to disclosures of clergy CSA by churches has been well documented, with their responses to perpetrators evidencing a failure to implement any effective preventative measures. To stop institutional CSA from occurring, it is critical to understand the situational indicators of such abuse so that the opportunities they afford to perpetrators to commit the crime of CSA can be identified.Parkinson and colleagues (2009) identified that having immediate and convenient access to minors were the defining characteristics that facilitated abuse. The evidence also suggests the need for parents and their children to be made much more aware of the grooming tactics used by clergy who perpetrate CSA. The John Jay College study (2006) identified the strategies that allowed the perpetrators to become close to the child they subsequently abused including being friendly with the victims’ families, giving gifts or other enticements such as taking them to sporting events or letting them drive cars, and spending a lot of time with victims.A recurrent theme in Australian victims’ accounts is how their parents’ religious beliefs and trust and reverence for members of the clergy meant that they could not conceive of the possibility that priests could sexually abuse their children and betray their own vows. Yet there is ample evidence that this trust was sadly misplaced and the same caution that would be applied to other members of society needs to be applied to the clergy.Finally, in tandem with a message from churches that there is zero tolerance for CSA, there needs to be a clear and trustworthy process in place, independent of the churches, that encourages children to disclose CSA safely and confidentially. Educational programs in all schools beginning in primary school might be one way of achieving this.Victims of clergy-perpetrated CSA need to be heard with respect and compassion, given meaningful assistance to meet their psychosocial needs, and provided with justice through those who perpetrated the abuse and those who covered it up being held fully accountable. Only then will it be possible for recovery from the immense trauma of clergy CSA and the rebuilding of shattered lives to truly begin.
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Disclaimer: Published in InPsych on October 2013. The APS aims to ensure that information published in InPsych is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in InPsych does not replace obtaining appropriate professional and/or legal advice.OCTOBER 2013 | ISSUE INDEX
“If a community values its children, it must cherish their parents” – John Bowlby, 1951
At Beacon House, we are passionate about working with networks who are supporting families at risk of breakdown, where children are identified as being ‘In Need’ or meeting criteria for child protection procedures. We also sometimes work directly with families (or their professional networks) where care proceedings have been initiated, where the parties are open in principle to supporting therapeutic intervention prior to a final hearing. Please note that this sometimes requires an extension to standard timescales, as long as this is safe for the child.
The role that we take is somewhat different from that of an independent expert; we commence every piece of work with an overarching question of “What would need to be put in place for everyone in this family to be safe, and have their needs well met?”
Our work is inspired and shaped by the pioneering writing and research of Dr Patricia Crittenden. Crittenden’s key text, ‘Raising Parents’, shines a light on attachment throughout the lifespan, and the impact of parents’ own early years and developmental experiences on their capacity to safely parent their own children.
“Supporting – cherishing – parents is central to caring for their children. Doing so makes emotional sense, functional sense, and economic sense; parents are the only resource that is never cut back. Moreover, they are the architects of society; let’s value all parents and assist those that need help”
Patricia Crittenden, 2008.
We offer three different pathways for families at risk of breakdown – all with a primary focus of meeting the emotional and psychological needs of the caregiver, and facilitating them to do the same for their children:
Case Consultation to the Allocated Social Worker
Case Consultation to the Professional Network
Parental Therapeutic Needs Assessment
Consultation to the Allocated Social Worker
Why choose this?
This option is useful when:
There are parts of a family’s situation that are difficult to understand
There are multiple significant needs, and it is difficult to know which to prioritise
Things feel ‘stuck’, or expected change is not happening
It is difficult to accurately assess risk
Aspects of the case are having a powerful impact upon the allocated worker
What is involved?
Key background reading is undertaken by the consulting Psychologist (e.g. chronology, PAMS assessment, assessments by other mental health professionals).
The Allocated Social Worker meets with the consulting Psychologist (either at one of our clinics, or the Social Worker’s usual base), and is guided through the process of developing a trauma and attachment informed, psychological formulation of the case.
The Social Worker is supported to connect with the emotional and psychological impact of the case for them, and thus, understand the ‘helping’ attachment relationship more deeply. This understanding is incorporated in to the formulation.
What happens next?
Initial recommendations are shared during the consultation session. Recommendations are likely to include:
Attachment and trauma informed strategies for working with the family
Priority needs to be addressed (i.e. those most likely to result in timely change)
How to sequence interventions
How to optimise the attachment relationship between parents and professionals
A written case formulation will be provided by the consulting Psychologist within two weeks of the consultation.
Case Consultation to the Professional Network
Why choose this?
This is a useful option when:
A case is complex, with the potential for risk of harm to children or young people is significant, and a number of different agencies are involved
There are parts of a case that are difficult to understand, and there is a lack of consensus within the professional network
There are multiple significant needs that require the input of a large number of professionals, and it is difficult to know which to prioritise
The professional network is not working as effectively together as everyone would like
Professionals, and the family, feel stuck and frustrated
Aspects of the case are having a powerful impact upon the all of the professionals involved, which may be manifesting as difficulties in relationships between professionals
What is involved?
Key background reading is undertaken by the consulting Psychologist (e.g. chronology, PAMS assessment, assessments by other mental health professionals)
The entire professional network meets with the consulting Psychologist (either at one of our clinics, or a convenient location for the network), and is guided through the process of developing a trauma and attachment informed, psychological formulation of the case.
Considerable time is dedicated to supporting the entire professional network to connect with the emotional and psychological impact of the case for each individual, and the network as a whole. The patterns of survival, defence, attachment, resilience and compassion within the team will be ‘brought to life’ in the room, and the network will be supported to observe these patterns with acceptance, curiosity and respect. This understanding is incorporated into the formulation.
What happens next?
We ask professional networks to approach these consultations with openness, honesty and self-reflection. Therefore, we do not minute or record what is shared.
In the final part of the meeting, the consulting Psychologist will facilitate the network to bring their reflections together in to a clear and concise plan for future working.
Parental Therapeutic Needs Assessment
Why choose this?
Empirical evidence tells us that the most powerful way to meet the emotional and psychological needs of a child is to meet the emotional and psychological needs of their caregiver. Creating a safe and secure care environment in the home has more profound and long-lasting impact than any individual therapy provision or even a number of discrete therapies.
Working alongside West Sussex County Council, we have developed a specialism in meeting the therapeutic needs of vulnerable parents. Often, parents come to us with a history of significant adversity, disruption, loss and trauma. They may have been removed from their own birth family. They may have insecure and mistrustful attachments with professional caregivers. They may find it difficult to relate openly to ‘help’, as help may feel threatening, overwhelming, or confusing.
A Parental Therapeutic Needs Assessment may be appropriate when there is a recognition that a parent’s own psychological and emotional vulnerabilities are serving to inhibit their capacity to parent their own children in the way that they would want to. We are very happy to work alongside statutory services to proactively engage parents who are anxious, ambivalent or unsure.
What is involved?
We commence all of our assessments with a professional network meeting. It is really important for parents to know that all of the professionals around them are working together in a joined-up way, and that there is an overall commitment to supporting them therapeutically. This meeting happens with the knowledge of the parent, but they would not usually be in attendance. This is an opportunity for professionals to share both their concerns and their hopes.
Following this, we would typically undertake any background reading, and meet with the parent over two to three hours to complete a clinical interview and administer psychological measures. Our aim is to develop a psychological ‘formulation’ of the parent’s difficulties, both as an adult in their own right, and as a parent. This involves developing an understanding of:
The parent’s own early years environment, early experiences of care, and developmental experiences.
The story of the parent’s key transitional stages (e.g. childhood to adolescence, adolescence to adulthood).
Understanding any significant life events, including the experience of becoming a parent.
A detailed picture of how difficulty and distress impact upon daily life, including the challenges of parenting.
The factors that seem to make things worse, or stop them from getting better.
How the parent experiences ‘help’, in the context of their own attachment pattern, and how they relate to professional caregivers.
The parent’s strengths, resources, skills and qualities.
All of this information is then brought together, underpinned by psychological theory and research evidence. We draw upon this understanding to generate our therapeutic recommendations for the parent.
What happens next?
Our assessment letter will be ready within three weeks of the last assessment appointment. This letter will include our formulation, and detailed recommendations for the type of therapeutic intervention that we think would be most helpful. We will invite the parent and allocated Social Worker to come back to meet with us face-to-face, to share our formulation and therapeutic recommendations. We usually conduct this meeting in two parts, allowing the parent to be the first person that our feedback is shared with.
Where therapeutic intervention is recommended, a phased programme will be devised, allowing the commissioning service to regularly review progress before commissioning the next phase. Please see ‘How will progress be reviewed?’
The psychological interventions that we use with vulnerable parents include:
Cognitive Analytic Therapy
Comprehensive Resource Model
Eye Movement Desensitisation and Reprocessing
Internal Family Systems Therapy
Mentalization Based Treatment
If, as part of a Parental Therapeutic Needs Assessment, it becomes clear that the parent-child relationship could be further supported by a dyadic intervention, this will form part of our recommendations. Most often, individual intervention with parents will be sequenced to take place before their child is brought into a therapeutic space with them.
How will progress be reviewed?
Therapeutic progress is something which is continually reviewed throughout the intervention. During the feedback and treatment planning meeting with the parent and Social Worker, the intervals for review will be agreed. Review can take the form of a telephone call between therapist and Social Worker, a written report, or a professional’s review meeting.
Alongside this, we have three main ways that we evaluate therapeutic progress:
During the Therapeutic Needs Assessment, the parent will be asked to fill out a number of questionnaires, which will be re-administered at the end of each piece of work.
At the start of the therapeutic intervention, the parent will be asked to identify three therapeutic goals, and scale them to show how well they feel they are achieving those goals. We will review these goals and the scaling at the end of therapy.
At the end of therapy, both parent and referrer will be asked to tell us how satisfied you feel with your experience of coming to Beacon House, and whether you feel the difficulties you have been working on have improved.
How do I make a referral?
You can request a referral form by contacting the clinic on 01444 413939. Alternatively, you can email email@example.com. Please specify which service you are requesting: case consultation, professional network case consultation, or therapeutic needs assessment and your preference of whether the work should take place from our Cuckfield or Chichester clinic. If you are unsure of the right option, please feel free to request a free of charge initial telephone conversation with Dr Laura France, Adult Services Lead, to help you to select the most appropriate service.
Your referral form and supporting documentation will be reviewed by our Adult Services Lead, who will then provide an estimate within three working days. We are usually able to commence work immediately on the receipt of a Purchase Order number. We do not have a waiting list and can usually organise the first appointment within two weeks.
Our commitment to working therapeutically with parents is rooted in our commitment to the safety, protection and well-being of children. Please see our Safeguarding Policy here.
(Please do not send Post or attend for Therapy) Registered Name Beacon House Psychological Services Ltd Registered in England and Wales. Registered Address AD5 Littlehampton Marina, Ferry Road, Littlehampton BN17 5DS Registered No: 09205920Chichester 01243 219 900Cuckfield 01444 413 939Enquiry: Message Us
1.1The Joint Select Committee (Committee) was formed to inquire into the Australian Government policy, program and legal response to the redress related recommendations of the Royal Commission into Institutional Responses to Child Sexual Abuse, including the establishment and operation of the Commonwealth Redress Scheme and ongoing support of survivors. 1.2The Committee is required to table its final report in May 2022.1.3Section 192 of the National Redress Scheme for Institutional Child Sexual Abuse Act 2018 (the Act) provides that the relevant Minister must conduct a review of the National Redress Scheme (NRS) as soon as possible after the second anniversary of NRS operation. The Committee notes that the NRS commenced 1 July 2018, and as such, the review must commence prior to 30 June 2020. 1.4Early in its deliberations, the Committee resolved that its first priority should be to review the early experience of survivors with the NRS and use their evidence to identify priority issues that should be addressed by the second anniversary review. 1.5It is the Committee’s expectation that the Minister for Families and Social Services and the Department of Social Services (DSS) accept the findings in this interim report and ensure that the matters identified are incorporated into the terms of reference and design of the second anniversary review as a matter of priority.
Objectives and Scope1.6On 2 April 2020, the Committee announced that it would table an interim report into the implementation of the NRS to reflect the evidence received so far by the Committee.11.7It remains the Committee’s intention that this report will inform the work and priorities of the legislated second anniversary review of the NRS which is to commence after 30 June 2020.1.8The Committee has resolved to finalise a second interim report before tabling its final report in May 2022.
1.9On 13 February 2020, the Committee issued a media release announcing initial public hearing program. Due to matters associated with COVID-19 on 16 March 2020, a separate media release was published noting the hearing program would continue as advised via teleconference.1.10Since the establishment of the Committee, six public hearings have been held. Transcripts can be found on the Committee website and a list of witnesses that appeared is at Appendix A.1.11The Committee invited submissions to be received by 29 May 2020, noting that submissions could be received after that date. The Committee also informed people that confidential and name withheld submissions would also be received. To date the Committee has received 20 submissions, which are listed at Appendix B.
1.12Chapter 1 details the scope of the activities conducted to undertake the interim report and includes discussion of the Committees aims for the interim report. 1.13Chapter 2 provides a background to the development of the NRS, and discusses how the government has implemented the recommendations of the Royal Commission into Institutional Child Sexual Abuse. Consideration of previous parliamentary committee findings is also included in this section. 1.14Chapter 3 examines the NRS application process. The three components of an offer of redress including monetary payment, counselling services and direct personal responses are also examined.1.15Chapter 4 considers NRS participation and examines factors that may be influencing a survivor’s decision on whether to apply for redress through the NRS. The number and rate of institutions joining the NRS is also discussed. 1.16Chapter 5 discusses the appropriateness of funder of last resort provisions within the Act.1.17Chapter 6 outlines areas that the Committee believe need to be examined in order to maximise the opportunities of the second anniversary review to deliver improved survivor experiences and outcomes from the NRS.1.18Throughout the interim report the Committee has included quotes that refer to the NRS as the scheme or redress scheme. The Committee has not amended these references.1.19Two appendices accompany this report and provide details on submissions received and a list of witnesses who appeared before the Committee. 1.20A copy of this report, transcripts of hearings and submissions received are available on the Committee’s website at www.aph.gov.au/redress.