In recent years, child and adolescent sexual abuse has received increase media attention, due in part to nationally covered kidnapping cases and the difficulties in the Catholic Church. In addition to a greater public awareness and increased litigation, there has been renewed attention to the mental health treatment of both victims and offenders. Sexual abuse involves trauma which drastically impacts the spirit. It eventuates in what has been called soul murder, which is a “dramatic term for circumstances that eventuate in crime — the deliberate attempt to eradicate or compromise the separate identity of another person... Children are the usual victims. For the child’s almost complete physical and emotional dependence on adults easily makes for possible tyranny and therefore child abuse”.1 It is the Christian counselor’s privilege and responsibility to reach into and minister in this place. Some discussions of sexual abuse of children distinguish between pedophilia and ephebophilia. A pedophile refers to an adult who sexually victimizes prepubescent children (generally 13 years old or less), while an ephebophile victimizes pubescent children or adolescents (generally 5 years older than the victim). This article precludes exploring the differences, but it is important to briefly look at both victims and offenders.
*Victims* Child and adolescent victims of sexual abuse have been traumatized and thus need a therapeutic experience that is safe and empowering. They need a place to tell their story, while not being forced to necessarily verbalize their pain. Therapy should touch the senses and provide an opportunity to gain the mastery and control that have been stripped away by the traumatizing experience[s]. The sensory and kinesthetic quality of play therapy and other expressive therapies are beneficial in this regard. This makes both practical and diagnostic sense. The diagnostic criteria for Posttraumatic Stress Disorder, which is frequently diagnosed in cases of sexual trauma, is largely sensory based. This makes sense because trauma itself is sensory based and, therefore, the best treatment should also be sensorybased. “Talk-based” counseling approaches do not meet this need. Though many children and adolescent are verbally sophisticated, the need for a means of expression which provides therapeutic distance (such as art or play) may be crucial. As verbal communication becomes more difficult when nearing the traumatic experience in therapy, the need for an expressive means for abreaction—for discharging and gaining control of the traumatic bind—becomes critical. Since abuse trauma significantly impacts every aspect of a victim’s life, there is growing recognition of the need for a multimodal approach to this treatment. Other important interventions include social support, family therapy, parent training, behavior management, pharmacotherapy, sensory integration therapy, recreational therapy, psychoeducational interventions, group therapy, inpatient care, and other adjuncts. These principles should be respected by everyone working with abuse victims. In light of the highly intrusivenature of sexual abuse for victims, the therapist should be intentionally nonintrusive, allowing the client sufficient freedom to explore, to process, and to grow.
Therapy for child and adolescent victims must include an expressive element such as play or art, so that issues too difficult to verbalize may find means for expression. The trauma of sexual abuse most often occurs within the framework of the family. Thus, systemic conceptualization and family therapy will be crucial elements of the therapeutic milieu. Treatment must attend to a continuum of issues, including physiological, cognitive, psychological, and spiritual concerns. Trauma may involve damage to any and all of these areas.
*Offenders* Historically, sexual offender treatment has been grouped with the poorest success rates in the mental health field. And, because of the abhorrent nature of sexual abuse, pedophiles and ephebophiles are vilified throughout all strata of society. The need for dedicated, empathic and well-trained mental health professionals is paramount. Most sex offenders are male, and they can be heterosexual, homosexual, or bisexual. They are frequently characterized as having significant cognitive distortions, deviant sexual fantasies, depleted self esteem, lack of interpersonal skills, low victim empathy, and pathological sexual arousal patterns. The etiology of perpetrating behavior is not real clear. Deviant sexual behavior may stem from early childhood trauma, unresolved inter- generational family issues, learned deviant behavior, inappropriate sexual arousal, neurological or genetic factors, and various social factors. Cormorbid psychological factors, particularly substance abuse, are also important etiological considerations.
There is no acknowledged cure for pedophilia or ephebophilia, but there are effective treatments focused on management of psychological and behavioral issues. Following a complete psychiatric and psychosexual evaluation, there are numerous treatment options, including: (1) aversive conditioning techniques; (2) arousal reconditioning; (3) covert desensitization; (4) cognitive therapy; (5) psychodynamic therapy; (6) pharmacotherapy; and (7) long-term aftercare and monitoring. Appropriate treatment with offenders will remember these truths. In spite of the highly offensive nature of sexual perpetration, it can not be forgotten that offenders are persons of value and worthy of God’s love. While many offenders have been victimized themselves, this is not true of all offenders, nor does this mitigate the severity of offending behavior in any way. Offender treatment must be multimodal, recognizing the complex etiology of sexually deviant behavior. Treatment must attend to a continuum of issues, including physiological, cognitive, psychological, and spiritual concerns. Offenders have incurred and inflicted damage in any and all of these areas.
*Conclusion* There are many issues to be considered in sexual abuse situations. The following thoughts are offered when working with these challenging issues: It is both a spiritual and professional calling to work with victims or offenders of child and adolescent sexual abuse. The work is hard, but the One who calls provides the old_resources. Appropriate training is required. Clinical work in the area of sexual abuse will involve direct encounters with horrible and horrifying circumstances. The professional and personal impact of this on the therapist should never be underestimated. The focus of treatment should never be the victim’s trauma or the offender’s offense. The focus of treatment should always be the person of the victim and the person of the offender. The wounding of sexual abuse must be addressed, and the Christian community should be at the forefront of this effort. Counselors must work against leaving a generation of hurting children and adults to live out lives of hurt, anxiety, anger and confusion.
*Endnotes* 1. L. Shengold, L. Soul murder: The effects of childhood abuse and deprivation. (New Haven: Yale University Press, 1989).
Daniel S. Sweeney, Ph.D. is an Associate Professor and Clinical Director in the The need for dedicated, empathic and well-trained mental health professionals is paramount.