Treating childhood sexual abuse

Women with a history of childhood sexual abuse take many years to report what happened – but derive benefit from one-on-one therapy as adults.

That’s according to Dr Kim McGregor, a researcher at the School of Population Health in The University of Auckland Faculty of Medical and Health Sciences, whose PhD study examined New Zealand women’s experience of childhood sexual abuse, and the effectiveness of one-on-one therapy.

Dr McGregor sent over 250 questionnaires to women who wanted to participate in the study. A sample of 191 women returned the questionnaire. The majority (91.1%) reported childhood sexual abuse to be at the level of genital contact, attempted penetration or actual penetration. The average age for the abuse to begin was 6.3 years old and the average age of the last episode was 12.9 years.

“The average time to disclosure was 16.3 years. Less than 4% had told anyone about the childhood sexual abuse immediately, and 31.3% took between 21-56 years to tell. The first disclosure was usually to family, friends and partners (76.3%). Only 14.9% of first disclosures were made to therapists and 3.9% to doctors and other health professionals,” said Dr McGregor.

“The 191 women had seen a total of 663 therapists (average 3.4). The majority of the women (85.7%) reported that, overall, they found therapy either ‘Very helpful’ or ‘Somewhat helpful’. Just over six percent reported that, overall, therapy was ‘Somewhat unhelpful’ or ‘Very unhelpful’.

“The women in the study generally gave therapists in this country a big vote of approval with many reporting that therapy was ‘life-saving’.

“Therapy was reported as helpful when the women could find therapists they felt compatible with and when they felt therapists were warm, understanding, supportive, interactive and knowledgeable about childhood sexual abuse and its effects. In particular, women valued therapists who were able to help them work through all of the effects on their lives (not just depression and posttraumatic stress but also related issues such as anger, relationships and parenting difficulties).

“However, many women had difficulty accessing the help they needed. Obstacles included cost, restricted therapy hours funded by ACC, and encountering health professionals with a lack of training to competently ask about a history of childhood sexual abuse, deal with disclosures, and the ability to assist with the working through of ‘all’ the effects of abuse. To address these difficulties we need to improve access to sufficient and competent support,” said Dr McGregor.

“The incidence of childhood sexual abuse may never be known precisely,” said Dr McGregor. “One New Zealand study found that 20% of women in a community sample experienced childhood sexual abuse (defined as genital contact) before the age of 16 years, 13% before the age of 12 years. The NZ Youth 2000 study (9570 students under 18 years) found that 22.2% of girls and 11.3% of boys reported an experience of unwanted sexual behaviour.

“Such high prevalence rates make childhood sexual abuse a significant public health issue. When health, mental health and legal costs are combined with losses in earnings and the loss of potential in a person’s life, the overall cost to this country has been estimated at $2.6 billion per year.”

Although not all people with a history of child sexual abuse will experience serious long-term negative effects on their lives, many become high users of health and mental health services, said Dr McGregor.

“We need to promote more public awareness of ways of accessing support. The group of women in my study experienced severe childhood sexual abuse and they were left alone to deal with the impact of these experiences for most of their developmental years.

“Given that the first people told about childhood sexual abuse are generally family, friends and partners we need to resource and educate the community. People need to know how to deal with disclosures of childhood sexual abuse and where to seek support should they want it,” said Dr McGregor.