Serving Adult Survivors of Child Sexual Abuse
Jennifer Stith, Dr Sheri Vanino  -  2014/2/25
http://ovc.ncjrs.gov/ovcproviderforum
 
 
I work in a women's prison in Arizona and I have a female sex offender program. I also have a course I call Survivors of Abuse. I have two questions: is it good practice to treat sexual abuse along with other types, such as psychological and physical? And second, what sort of cirriculum do you recommend? Thanks.
 
1.  Jennifer Stith
 I also agree with Dr. Vanino that the issues that stem from childhood sexual abuse are specific and require specialized services. Certainly, CSA can co-occur with physical, psychological and emotional abuse; however, we find that having support groups that focus exclusively on survivors' CSA history is extremely helpful in supporting them through the very difficult recovery process for that specific trauma. Certainly, if you would like more information about forming a WINGS group, please contact me at execdirector@wingsfound.org.
 
2.  Jennifer Stith
 I echo Dr. Vanino's comments on both points. Those who have sexually offended need and require treatment through specialized services designed for their population. At WINGS, we specifically include a question about causing sexual harm to others in our in-take process, and we refer any individual who discloses this (if they were 16 or over when they offended) to other providers, as we absolutely recognize they need services, yet we do not provide them at WINGS. It is important that our support groups be a safe place for survivors, who could be very triggered by being in group with someone who has offended. (If the person offended at 16 or younger, we handle this on a case by case basis.)
 
3.  Dr Sheri Vanino
 If the situation is one where you are treating victims who are NOT sex offenders, and are able to break the populations out into treatment groups (sexual assault victims vs physical abuse victims) that would be ideal. The issues that arise for victims of sexual abuse are different from that of physical or emotional abuse survivors. As for that curriculum, I would suggest “Group Treatment of Adult Incest Survivors (Interpersonal Violence: The Practice Series)” by Donaldson. Wings also have a treatment manual for "therapist facilitated, survivor driven: groups which would likely be quite helpful. http://www.amazon.com/Survivors-Guide-Healing-WINGS-Foundation/dp/B001BJUKV8
 
4.  Dr Sheri Vanino
 If you are asking about treating sex offenders who are also survivors of abuse themselves, I would really make sure you are using a curriculum intended for offender work. You might contact the sex offender management board in your state to ask for specific curriculum.
 
 
I supervise a SANE program(Sexual Assault Nurse Examiner). Many survivors are drawn to this work and do an excellent job. How do you suggest I address my concern that survivors can sometimes lose perspective and work from their personal experience rather than the victim's wishes? I would like to try to avoid hiring someone who lets their own experiences drive their responses to victims.
 
1.  Jennifer Stith
 We also believe that, because services for adult survivors of CSA do not seem to be as available as they should be nation-wide, it is quite likely that many professionals may not have had the chance to work through their CSA trauma, and may recognize a need to do so, well into their careers (in many different professions). If this awareness arises, we advocate for getting the appropriate individual and group support needed to heal the CSA trauma, as it will only make them stronger in the work they do with others.
 
2.  Jennifer Stith
 It is certainly an excellent point to remember that many of us in this field may be drawn to this work by our own personal experiences and backgrounds, which can be quite instructive and offer helpful perspective to inform our work. However, it is critical to be aware of the possibility of being “triggered” and focusing on our own issues, instead of what is helpful to the victim/survivor. At WINGS, we believe in being mindful of this potential dynamic, “bringing it into the field” by discussing it openly in clinical supervision, and if necessary, making adjustments through self-care and/or one’s own therapeutic work.
 
3.  Jennifer Stith
 We also ensure facilitators have a basic understanding of the issue of CSA trauma and its impact on adults (while we also provide a full day orientation and quarterly clinical trainings), and our facilitators are required to attend monthly clinical supervision with our Program Director, to share issues arising in group and to check in on support they may need.
 
4.  Jennifer Stith
 I agree with Dr. Vanino’s comments here. At WINGS, all of our support groups are therapist-facilitated. Our Program Director, who is a licensed professional counselor, interviews all of our potential new facilitators to ensure they have the self-awareness and appropriate boundaries needed to create a safe and supportive environment for our group members, and particularly screens for any signs of victim-blaming language and/or indications that the counselors have not “done their own healing work.”
 
5.  Dr Sheri Vanino
 I believe this issue comes down to self-awareness, boundaries and willingness to get support. Once employees are hired, it is imperative that an atmosphere of support be created. Depending on the environment, that could include case discussions and debriefing, encouraging an atmosphere of self-awareness and encouragement of setting limits, getting one’s own therapy, taking breaks/vacations, training on vicarious trauma, trainings in general and supportive supervision.
 
6.  Dr Sheri Vanino
 Interviewing should include looking for potential boundary issues, problem solving abilities when under emotional stress and self-care measures. I like to ask questions such as “tell me about a case you worked on that was distressing and how you dealt with it.” Other examples could include “we believe that everyone is impacted by this work. In fact it’s not IF you are going to impacted be impacted by this work, it’s WHEN and HOW you are you going to deal with it. What are your thoughts on that?”
 
7.  Dr Sheri Vanino
 However, I have to say that it is also important to remember that this is likely the case in all lines of work and it may be impossible to hire someone (in any job) whose own issues don’t drive their responses on some level. That being said, I think there are 2 preventative issues at hand, one being interviewing well and the other being offering a lot of support for employees.
 
8.  Dr Sheri Vanino
 This is a great question. I believe that there are many therapists, advocates, SANE’s etc.. who are drawn to this work due to their own experiences. Often these individuals provide empathic, knowledgeable responses due to understanding sexual assault from a personal perspective. However, you are correct that if a survivor hasn’t done their own work on the issue and then attempts to help others, he or she will be at risk for projecting their own “stuff” onto the victims or clients.
 
 
In victim services professions many staff have a hx of previous victimization. As a supervisor, how do you suggest I help the staff deal with issues that may come up for them so I can help lessen the effects of ongoing traumatization due to working in this field.
 
1.  Jennifer Stith
 Please refer to previous question.
 
2.  Dr Sheri Vanino
 Thanks for your question. Please refer to the previous question on a similar topic.
 
 
Do you know what the best evidenced based therapy is when working with child/adult victims of sexual abuse for short term, crisis intervention type therapy?
 
1.  Jennifer Stith
 I am going to defer to Dr. Vanino on this question.
 
2.  Therese H
 Trauma Focused Cognitive Behavioral Therapy is also an evidence based therapy for children who have experienced sexual abuse. It is, however, a little more long term (12-16 sessions).
 
3.  Dr Sheri Vanino
 I don’t work with children so I would suggest you contact places such as the Kempe Center for input (http://www.kempe.org). Kempe is nationally recognized and very focused on evidence based therapy for children. As for adults, I would encourage looking at John Briere’s work for more in-depth evidence based treatment. One of my all-time favorite treatment guides is a book by John Briere “Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment.” He also has a shorter but very indepth article avaible at this link: http://johnbriere.com/stm.htm. The article is called “Treating adult survivors of severe childhood abuse and neglect: Further development of an integrative model.” Also, obviously there is DBT and EMDR, both evidence based.
 
 
As Children's Advocacy Center our services focus on children's advocacy and mental health needs (this includes family work). So our expertise does not include work with adult survivors of CSA. However, we recently began a community advisory council, which is comprised of several adult survivors. We want to ensure that we are moving forward in a safe, respectful and thoughtful way since some participants have expressed their desire to do community outreach in the future. Do you have input on: •How we work with survivors who want to share their stories via outreach; •how do we make sure they are ready; •how do we best support them throughout? •when/if does sharing their story (or parts of it) not OK? •a suggested process for assessing readiness? Thank you!
 
1.  Jennifer Stith
 They practice telling their story, and at the end of the 7 week program, we have an event where they each take turns doing so. The event is somewhat of a celebration of voice and empowerment for the survivors. And it also helps our agency in being able to identify survivors who are willing to speak, and who we know can do so in a safe and comfortable way – when we might need to engage them in other public speaking opportunities. When possible, we try to include a survivor in our community training presentations, etc. We do believe the voices of survivors are incredibly powerful. If you would like more detailed information on our Speak Out! group, feel free to email me at execdirector@wingsfound.org.
 
2.  Jennifer Stith
 To address your specific question - for many survivors, coming to voice is a very powerful experience, while there are many considerations for providers to consider, when engaging survivors in this type of volunteer role – as you so well point out. At WINGS, we have recently started two specialty groups: a monthly Creative Writing group and a 7 week “Speak Out!” group to help survivors move through that journey of reclaiming their voice and telling their story. They are able to process this journey with a facilitator, and they openly talk about these issues you mentioned (what is the best way to share their experience – when is sharing it not ok), etc.
 
3.  Jennifer Stith
 However, as you suggest, some CAC's may not be funded for or feel equipped to provide the specialized care for adult survivors. Theoretically, it would be very interesting to consider an "adult survivor advocacy center" (arranged very similarly to CAC's - but for adult clients) - as adult survivors have specific issues from their CSA trauma that perhaps no other formal provider is really addressing. (Rape crisis centers may address CSA trauma if it comes up, however many adult survivors may not consider turning to an RCC, if they did not also experience rape as an adult.) WINGS wishes to be a voice for adult survivors nationally – that this population needs better specialized services for individual therapy/healing.
 
4.  Jennifer Stith
 This is a great question. And I would just point out that you bring up an opportunity for further discussion. Some adult survivors do find it very helpful to receive services at CAC's, as the CAC's provide a very specialized service that the adult survivors could have and should have had access to in childhood, but did not. And some survivors find it helpful to address that childhood trauma in a place that understands the complicated issues surrounding CSA trauma - particularly intra-familial abuse.
 
 
Is it possible for a child to be traumatized vicariously through an adult survivor of childhood sexual abuse? If so, how prevalent is this, and what should be done (i.e. individual counseling, group counseling, both)?
 
1.  Jenny Stith
 Creating a space where all people, particularly children, can be seen, heard, valued and respected – no matter what they need to talk about – is the best way to avoid vicarious trauma for others (particularly children) in an adult survivor’s life. Also note – at WINGS, we recognize that the lives of loved ones are impacted by the childhood sexual abuse that the survivor in their life experienced. So we have a Loved Ones group for adults wishing to explore their own needs and feelings. http://www.wingsfound.org/get-information/loved-ones-of-survivors/ We do not currently have any offerings for children.
 
2.  Jenny Stith
 So WINGS believes it is critical that adult survivors do their own recovery work, which is best done with individual counseling and group support – to resolve their own history of trauma. However, if they are caregivers for other children, exploring family counseling may very well be useful – particularly for the children. In general, we find that as survivors become more aware of their own needs, emotions and feelings, they become much more aware of and in-tune with the emotions of others. Of course, being in-tune with children’s needs, thoughts and feelings are essential to creating a healthy environment for children to develop healthy life and coping skills.
 
3.  Jenny Stith
 Yes, it is possible for a child to be traumatized vicariously through an adult survivor who has resolved trauma. We know that CSA trauma can contribute to significant health challenges like substance abuse, addictions, and other serious issues. So these symptoms of CSA can make an adult less aware of and responsive to the needs of children in their care. Moreover, unresolved CSA trauma also contributes to other forms of domestic/family violence. Finally, if an adult survivor has not dealt with her or his own history of childhood sexual abuse, he or she may not be able to recognize the signs of abuse in their own children, if that may be occurring.
 
 
how do adult victims of childhood abuse parent differently? how are they likely to react to their own children being sexually abused? I am seeing many moms who have been abused as children, not believe their own children and really pick their predator boyfriend over their child. Is this common and why?
 
1.  Jenny Stith
 For adult survivors who do come to terms with their history of childhood sexual abuse and take the necessary measures to move through it, we find that they can be very in-tune with their children’s needs – often, because they did not receive this response in childhood. In general, creating healthy spaces for conversations where all people, especially children, are free to express their needs, concerns, thoughts and feelings – is essential to identifying and responding to childhood sexual abuse – if it should occur.
 
2.  Jenny Stith
 Sometimes, parents with unresolved CSA trauma become extremely overprotective and raise children in an environment where everything appears to be a danger or threat. This can have unintended negative consequences, as well, in making children feel like the world is not a safe place to be in.
 
3.  Jenny Stith
 This is, unfortunately, fairly common. It is very important to still place the responsibility for the abuse on the actual perpetrator. However, it seems that adult survivors typically experience the lack of response by their non-offending caregiver as being more of a betrayal than the actual abuse. As to the “why” of the dynamic for an adult survivor to partner with a perpetrator – that is a very complicated dynamic to explain, but it ties directly into the adult survivor’s unresolved original trauma, which is why WINGS always advocates for adult survivors to engage in their very important healing work – to begin to break the cycles of abuse in their own family systems and be able to create healthy interpersonal relationships.
 
4.  Jenny Stith
 Typically, there are three primary trends we find in parents who were victims of childhood sexual abuse, regarding the way they parent. If the adult survivor has not dealt with their history of CSA trauma, they may be more likely to re-constellate a family structure in which abuse is more likely to occur/continue. In this case, they may partner/marry someone who is a perpetrator and be in denial of, or unable or unwilling to see, the signs and symptoms of abuse or other neglect that may be happening to their child, which creates a very unsafe environment for their children.
 
 
As child abuse/neglect investigators we frequently interview parents who are accused of abuse/neglect either directly or by omission of protective action. We know that there is a significant number of parents who were victims of trauma as youth and children. Is there any research or comments on avoiding or, more importantly, dealing with asking non-triggering questions? I know we are there to assure safety and get the facts of the case, but can we avoid doing damage and interview in a manner that assists us in better engaging out parents?
 
1.  Jennifer Stith
 So – again, I defer to experts who work with intra-familial CSA trauma on this issue. I'd like to learn more about it and share more discussion, to help improve services. But overall, I advocate for trauma-informed services for the entire family, including family re-unification when possible.
 
2.  Jennifer Stith
 Regarding being “triggered” by asking about a history of CSA in adult survivors, generally speaking – I think this concern is secondary to the possibility that adult survivors have actually never been asked about this. So many are relieved to be able to share their history and surprised to know that 1) it was a crime and 2) they should have been provided with resources to address it. So I believe in asking this question on most in-takes for social service and healthcare providers, to identify and help treat a history of CSA trauma. My concern in asking during a current CSA investigation is that the way the questions are asked could affect the outcome of the child’s treatment.
 
3.  Jennifer Stith
 So in general (and I’m sorry for the very long answer, but I think this is an important and delicate topic) - I believe in providing trauma-informed communication and counseling services to all family members, as CSA is so often a family-system problem. And I believe those questions to parents about their own CSA history need to be handled carefully, within that overall investigation protocol – for their benefit and primarily for the benefit of the child. (We do get referrals to WINGS in these instances – a child has been sexually abused, and then the parent realizes they were, too. So this can be a prime opportunity for parents to receive services.)
 
4.  Jennifer Stith
 I also believe we need to talk about the fact that those who sexually offend children need treatment, as well – for their own health and well-being, as well as for justice for the harm they have caused to a child. If this person is a sibling, parent, uncle/aunt or grant parent, the family that has to come to terms with this reality needs services to help them do so.
 
5.  Jennifer Stith
 So as providers, we need to be aware of this dynamic – do everything we can to ensure the child’s well-being is paramount, and communicate to parents and other family members in way that is trauma-informed, non-judgemental, and compassionately competent in helping families face and move through this very difficult family-system trauma. Educating parents about of the nature of childhood trauma (and how it can lead to future abuse), as well as informing them that services do exist for adults who experienced CSA as children (should they have that history) are important pieces of the conversation, I believe.
 
6.  Jennifer Stith
 Here’s my related concern: because CSA is a crime, and if it is disclosed, there is a possibility of the perpetrator facing criminal charges, a family in which CSA has occurred faces serious and significant stressors. Children can often pick up on these stressors and try to “make them go away” by recanting and not telling the full story of what happened to them, which is a missed opportunity for healing for the child – and the entire family system. This can have long lasting and negative implications for all involved.
 
7.  Jennifer Stith
 The reason I hesitate to offer a micro-level answer about specific questions to ask parents during the investigation interview is that my first concern would be for the safety and well-being of the child. There are often high occurrences of denial and manipulation by family members when a child discloses current sexual abuse. So I would assume that trauma-informed protocols are in place about how to effectively have that conversation with parents (though your question makes me suspect we have room to improve them?)
 
8.  Jennifer Stith
 And I believe we do need better resources to help families deal with this reality once the abuse has occurred, as well. That is my “macro-level” answer.
 
9.  Jennifer Stith
 Certainly, I support holding those who have offended accountable – 100%. And I believe we – as a culture and as service providers – have to get better about talking about the realities of CSA – how and why it happens, that it happens in “good homes” and in “good families” – across all races, socioeconomic levels, and religions. It’s my personal belief that most families in which CSA has been silently occurring for generations lack the language to be able to talk openly about what’s happening. CSA thrives in that silence. So you are wise to ask the question – how can we get better about talking with parents about this? And I would say – we need to start sooner – before they are in the situation where a child has disclosed that abuse has occurred.
 
10.  Jennifer Stith
 Those of us in the field who are trauma-informed professionals are more likely to understand this reality. I believe the general public does not understand it as well, and the media does not help accurately portray it, either. (If you consider recent CSA cases in the media, one might think CSA happens only by priests and coaches – which should certainly be discussed and properly dealt with, yet the less recognized reality is - a significant portion of CSA happens within the family.) The tendency for those who have sexually abused children to be vilified (and I don’t mean that to sound like I’m at all condoning that behavior) – makes it very difficult for families to deal with a situation in which one family member has sexually abused a child in the family.
 
11.  Jennifer Stith
 You bring up an important issue - that a significant portion of childhood sexual abuse is intra-familial abuse. And understanding the neurobiology of trauma can help explain why that abuse gets replicated (note van der Kolk’s work): http://www.thefpr.org/traumaprivate/pdf/DEV_van_der_Kolk.pdf (Many individuals who sexually abuse children have been physically or sexually abused themselves).
 
12.  Jennifer Stith
 I appreciate your question very much, in recognizing the high prevalence of CSA trauma in adults’ lives, and the high frequency of inter-generational patterns of that abuse. Because I’m not experienced in working with forensic interviews, I’m hesitant to offer insight on this topic, although I’d welcome the opportunity to research this further and talk with you and other investigators in more depth about it. I do have thoughts, which I will share, but please check with other professionals.
 
 
What are the most effective techniques have you come across that assist in healing Adult Survivors of Sexual Assault? I understand that there is a new method of therapy call REMS (?). What are your thoughts on this method? Thanks!
 
1.  Jennifer Stith
 Finally, we also suggest various types of art and expressive therapies (journaling, writing, painting, collage-making), and we absolutely suggest getting the body involved in healing strategies like trauma-sensitive yoga, equine therapy, dance, and other forms of movement.
 
2.  Jennifer Stith
 WINGS believes in empowering survivors and those upon whom they rely for healing services to understand the various types of techniques and strategies to healing, and to try different ones to see what is most helpful to each survivor. Across the board, we advocate for group support, as sharing experiences with other survivors seems to be universally helpful to survivors and, in fact, research has shown that survivors who have access to group support have greater success in healing than those who do not.
 
3.  Jennifer Stith
 Others are comfortable in settings that are more focused on the previous types of therapies mentioned. It is important to remember that every survivor’s abuse experience is different, and how that abuse affects each survivor is different (as influenced by a number of factors, including age of the abuse, relationship to perpetrator, frequency, duration and type of abuse, response by other care-givers, etc). So a therapeutic technique that may work for one survivor may not resonate with another.
 
4.  Jennifer Stith
 There are so many different types of therapeutic strategies for adult survivors of sexual abuse. Some of the more recent ones showing great success include, EMDR, DBT (Dialectical Behavior Therapy), and Somatic Experiencing. Some survivors have found it helpful to access services at children’s advocacy centers, with counselors trained in understanding and responding to the early trauma of childhood sexual abuse, particularly if it happened within a family system.
 
5.  Therese H
 We have had a lot of success at our center utilizing EMDR with survivors of sexual assault or incest. It has been particularly beneficial to those clients who find it difficult to "talk through" the assault using Cognitive Processing Therapy or other interventions. Some clients who have done EMDR refer to it as "magic" as it seems to relax them faster when doing resourcing/relaxation exercises, move them through some of their traumatic experiences faster, and they are able to see things in a different perspective.
 
6.  Melissa
 Yes. I am not certain on the wording. For some reason I thought it was Rapid Eye Movement...
 
7.  Dr Sheri Vanino
 I am not familiar with REMS. Are you by any chance referring to Eye Movement Desensitization and Reprocessing? (EMDR)?
 
 
I am a victim advocate/forensic interviewer employed by a DA's office but work at a child advocacy center. There have been some cases of adult survivors of child sexual abuse that have received services at our CAC due to the sensitivity/trauma of the survivor. Are there others that consider location of services due to the individualized needs of the survivors?
 
1.  Jenny Stith
 Finally, wherever they choose to access services, WINGS does believe it is essential for adult survivors to work with a trauma-informed individual therapist to resolve their CSA trauma, along with joining a support group (which we hope to make available nation-wide) for optimum healing results. However, we know that not all therapists understand the impact of CSA trauma on adult survivors’ lives, unfortunately. So WINGS offers this list of questions for survivors to consider, when exploring the counseling option that may work best for them. http://www.wingsfound.org/get-information/how-to-find-a-therapist/ And WINGS will be offering additional training to providers on how to best meet the needs of adult survivors. Please stay tuned and check back with us at wingsfound.org.
 
2.  Jenny Stith
 The multiple barriers to services highlighted here are problematic for survivors and really do constitute a victim’s rights issue – as well as opportunity- for improved care. WINGS advocates for strong collaboration among and between providers, to ensure we are meeting survivors of CSA where their needs are. We must be mindful that adult survivors of CSA are victims of a crime. They have a right to know how their life and health may be impacted by CSA trauma, and they have a right to make informed choices about their recovery process – according to their individualized needs.
 
3.  Jenny Stith
 Providers trying to address this history of multiple traumas may be challenged with offering services that can effectively address each component of their trauma history – specifically the victim’s history of CSA. Most importantly for survivors, however, is that they may not identify with the term “rape” if they did not also experience that specific type of abuse. So many adult survivors of childhood sexual abuse may not consider turning to a rape crisis center for counseling services, which WINGS believes could also create a barrier for survivors in accessing care.
 
4.  Jenny Stith
 Other places for adult survivors to receive services include rape crisis centers, or sexual assault centers, located across all regions in every state. However, the trauma of rape/adult sexual assault is very different than the trauma of experiencing childhood sexual abuse. So the treatment approaches are very different. There is typically a high correlation between experiencing CSA and being later revictimized by adult sexual assault and domestic violence, unfortunately. So many victims who turn to rape crisis centers or domestic violence shelters for current crisis needs, may find that they have underlying CSA trauma, as well.
 
5.  Jenny Stith
 However, funding restrictions may prevent many CACs from offering services to adult survivors, and many adult survivors may not have the insight to reach out to a CAC, since they are no longer a child. WINGS believes this dynamic creates a significant barrier to specialized services that could greatly benefit adult survivors.
 
6.  Jenny Stith
 This is an excellent question and reveals opportunities for improvement in offering services that meet the individualized needs of adult survivors, which WINGS believes need to be better addressed, nationwide. It makes great sense to us that adult survivors be given the opportunity to receive services at children's advocacy centers, if they desire to do so. Because the trauma occurred in childhood, it is that part of the survivor's history that needs to be directly addressed. Also, if the abuse happened in their family system, staff at CAC's are very skilled in understanding intra-familial abuse and taking a family systems approach to helping the adult survivor work through that original trauma.
 
 
I work in a domestic violence educational group setting. We don't necessarily have the time to explore everyone's trauma history individually but it is definitely present and affects our discussions. Do you have any ideas/resources as to how to integrate the topic of their childhood abuse in a helpful way?
 
1.  Jennifer Stith
 Please stay tuned to www.wingsfound.org, as we hope to make this option available to you in the future. In the meantime, if you would like more information about our program to begin exploring opportunities, please contact me at execdirector@wingsfound.org.
 
2.  Jennifer Stith
 At WINGS, we often get referrals from peer providers in our area because we provide a service that they do not; likewise, we refer our group members who need support from other agencies (like individual therapy or substance abuse resources) to other providers. We believe that victim/survivor centered care is best offered when providers work closely together, to meet the victim/survivor where their needs are. As such, we are recognizing the incredible value of co-locating services, where-by we provide educational/training opportunities with providers about CSA trauma and its impact on adults, and providers host a WINGS group for survivors needing that service, at their agency, where the survivors are receiving other, complementary services.
 
3.  Jennifer Stith
 In the meantime, I advocate for including a question about CSA in your in-take process. Sometimes, providers fear asking this question because it could be triggering to a survivor. We often find that survivors are relieved to be able to share this history, and that, in fact – no one has ever asked them this question before. If your staff does not have the resources on site to provide further individual or group support for CSA services, please refer these clients to a local provider who does. And/or, consider having that provider offer training to your agency.
 
4.  Jennifer Stith
 WINGS believes it is essential to address and help heal that early/root trauma of CSA, in order for adults to be able to break the cycles of violence that have entrapped them, and to be able to form healthy, happy violence- free lives. Thus, we believe domestic violence programs may offer a key point of access for adult survivors to begin to look at their CSA trauma and take steps forward on their healing journey. We are working on training curriculum for DV providers on this very topic.
 
5.  Jennifer Stith
 I am so glad you asked this question! There is an incredibly high correlation between experiencing childhood sexual abuse and being later re-victimized through interpersonal and domestic violence. I have seen statistics as high as 80% - in terms of DV clients who also have a history of CSA. When boundaries are broken so early in childhood through sexual abuse, and when services aren’t properly received (as is the case 90% of the time) – then child victims of CSA grow up, often repeating patterns of that early abuse (either as a perpetrator of violence, or as a repeat victim). Recent research in the area of the neurobiology of trauma is important to look to understand this dynamic.
 
 
Any tips on how to best help now adult survivor that is at public comment sessions opposing the release of an offender serving time for sexual abusing the person as a child? Sometimes it has been 20-25 years later & you can visibly still see that now adult living in childhood fear.
 
1.  Jennifer Stith
 On a related note, WINGS has recently started two 7 week specialty groups: a Creative Writing group and a “Speak Out” group to help survivors move through that journey of reclaiming their voice and telling their story. They are able to process this journey with a facilitator and express themselves in ways that feel comfortable to them. This helps survivors reclaim a sense of control over their abuse experience and can be very empowering for them. So you might also consider ways to help survivors understand that these types of healing strategies are available.
 
2.  Jennifer Stith
 WINGS believes it is never too late to address the CSA trauma from childhood, and that all adult survivors have a right to know how the trauma may be impacting their live – and be given the opportunity to heal from it. To find out resources in your area, check with your local sexual assault coalition (every state has one), check with RAINN: https://ohl.rainn.org/online/ Or here is a list of other resources, as well: http://www.wingsfound.org/get-help/resources/national-resources/ In the future, WINGS hopes to be able to serve as a local resource in your area. So please stay tuned with us at www.wingsfound.org, as well.
 
3.  Jennifer Stith
 Without that support structure, however, I can imagine that the event could be very re-wounding (which sounds like what you are describing). You may be identifying a key opportunity for providers to appropriately inform adult survivors of their rights (as a victim of the crime of CSA) to receive specialized services to heal from their CSA trauma. If the survivor has never been made aware of that information, this may be a key opportunity to provide them with a brochure of local or national resources and encourage them to seek support they have always deserved and had rights to.
 
4.  Jennifer Stith
 Has the survivor received any services to help address and heal their CSA trauma, prior to the public comment session – or at that time? I can imagine it would be very difficult to face an abuser without having had any individual or group support. At the same time, with the right prior processing and support, it could be very empowering for a survivor to speak publicly about their abuse experience and to face their abuser (and, ideally, to be able to process that experience with a therapist, support group members or other friends/allies).
 
 
Do you find that Adult survivors are ever able to regain a healthy relationship with their sexuality, outside of intensive personal counseling? Many of my clients do not want to go to counseling, yet continue to be in unhealthy relationship after another... is it possible for them to do "independent study" without the guided expertise of a clinician?
 
1.  Jennifer Stith
 Group members who have had the most successful results have worked hard in individual therapy and in their WINGS group. Many have gone on to have very healthy lives and relationships.
 
2.  Jennifer Stith
 However, we also believe it is essential to work through the trauma with an individual trained therapist, and we find that group support is one of the most helpful tools for survivors. Being able to share their experiences with other adults who understand what they have been going through, and can help validate one another’s thoughts, feelings, concerns, etc. is incredibly helpful for survivors to regain their sense of self-identity and re-build a healthy sense of interpersonal trust (often damaged by the CSA they experienced in childhood). We have been told over and over again that our group members feel their WINGS group has been a life changing experience, for the better.
 
3.  Jennifer Stith
 I agree with Dr. Vanino on this question. It can be very helpful to study the issue of CSA, and our “Survivors Guide to Healing” handbook is a very comprehensive resource for survivors to learn about the ways their lives may have been impacted by the abuse they experienced. It is available online at: http://www.amazon.com/Survivors-Guide-Healing-WINGS-Foundation/dp/B001BJUKV8 There are other resources to suggest, like: http://www.wingsfound.org/get-help/resources/recommended-reading-list-2/
 
4.  Dr Sheri Vanino
 Because child sexual abuse occurs in the context of a relationship that typically includes position of trust, healing most typically occurs within a therapeutic relationship. It is very difficult for a survivor to look at and re-work sense of self and sense of others by themselves without a trusting safe therapeutic environment. Perhaps helping your clients identify and discuss the blocks to getting treatment including imagining what it would be like to get support. I do not believe that healing only happens in intensive personal counseling. In fact, some of the most amazing CSA therapy I have ever witnessed has gone on in therapy groups.
 
5.  Dr Sheri Vanino
 I believe that survivors can do a lot of work on their own including reading books on the topic, journaling or getting support from friends. However, that being said, the ideal is really individual therapy combined with group work if possible. All people (survivors or not) tend to seek out relationships whereby childhood issues continue to arise. Therefore it is not a surprise if someone is an abuse survivor and continues to find themselves in unhealthy relationships.
 
6.  Diane Harmon
 In facilitating a peer-support group at a domestic/sexual abuse crisis center, I have noticed that some of the survivors also seek individual counseling, others find their healing taking root in the support group, working through the stages of grief together, supporting and encouraging one another, with many developing an appreciation and knowledge of healthy sexuality and healthy relationships-or at least hopes and goals towards.
 
 
Because so many adult survivors have never told or never gotten help for past sexual abuse, how do you get them to access services--to feel safe enough, to even realize some of the problems they are dealing with might stem from the abuse (mental health, drug/alcohol abuse, poor relationship choices, self-destructive behaviors, etc...and to realize that healing is possible. I see lots of alcohol/drug abuse overlap with dv and sexual abuse up here.
 
1.  Jennifer Stith
 Of course, please remember - If, when and how a survivor decides to address their CSA trauma should be their choice. Two resources that might be helpful to share are: Common trauma symptoms: http://www.wingsfound.org/get-information/common-trauma-symptoms/ Become an ally: http://www.wingsfound.org/get-involved/become-an-ally/
 
2.  Jennifer Stith
 Also - we often find that it’s most helpful for survivors to see and hear from someone like them – who has been through and overcome similar issues. When adult survivors have come out publicly about their abuse, others who have been quietly starting to question their own history feel safer in reaching out for help. At WINGS, we are actively working on increasing elements on our website to help survivors take that first step. And we are enhancing training for providers to better reach clients already in their care – about this specific issue and opportunity for healing. So please stay tuned with us at www.wingsfound.org about these projects, as well. We'd love to be a resource for you and the survivors in your care.
 
3.  Jennifer Stith
 As such, we are recognizing the incredible value of co-locating services, where-by we provide educational/training opportunities with providers about CSA trauma and its impact on adults, and providers host a WINGS group for survivors needing that service, at their agency, where the survivors are receiving other, complementary services. Please stay tuned to www.wingsfound.org, as we hope to make this option available to you in the future.
 
4.  Jennifer Stith
 At WINGS, we often get referrals from peer providers in our area because we provide a service that they do not; likewise, we refer our group members who need support from other agencies (like individual therapy or substance abuse resources) to other providers. We believe that victim/survivor centered care is best offered when providers work closely together, to meet the victim/survivor where their needs are.
 
5.  Jennifer Stith
 Sometimes, providers fear asking this question because it could be triggering to a survivor. We often find that survivors are relieved to be able to share this history, and that, in fact – no one has ever asked them this question before. If your staff does not have the resources on site to provide further individual or group support for CSA services, please refer these clients to a local provider who does. And/or, consider having that provider offer training to your agency.
 
6.  Jennifer Stith
 Being able to say responses like, “I’m sorry that happened to you. Have you ever talked about that with a professional before? Did you know that resources exist for just this type of experience?” are great statements to share.
 
7.  Jennifer Stith
 That said, it is wonderful to recognize that we might be able to serve as a bridge to healing for someone who is an adult survivor with unresolved trauma. AND – we need to be very careful in how we approach this. Creating a space where survivors can share events that might have happened to them in childhood with you in a non-judgemental way is a great offering. If you are a provider, including a question that would reveal CSA in your in-take process, or through other group work or individual case management may help open the topic for further dialogue.
 
8.  Jennifer Stith
 You are absolutely correct. It can be very difficult for adult survivors to connect their present day challenges (including substance abuse, addictions, eating disorders, domestic violence, relationship challenges, etc.) with the sexual abuse they experienced in childhood. Many may not even identify what they experienced as being “abuse”. Additionally, some survivors do not have full memories of the abuse, as our psyches often protect us from that knowledge until a time when we are ready to start acknowledging it.
 
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