What is child sexual abuse? 
Child sexual abuse is a form of child abuse that includes sexual activity with a minor. A child cannot consent to any form of sexual activity, period. When a perpetrator engages with a child this way, they are committing a crime that can have lasting effects on the victim for years. Child sexual abuse does not need to include physical contact between a perpetrator and a child. Some forms of child sexual abuse include:

• Obscene phone calls, text messages, or digital interaction

• Fondling

• Exhibitionism, or exposing oneself to a minor

• Masturbation in the presence of a minor or forcing the minor to masturbate

• Intercourse

• Sex of any kind with a minor, including vaginal, oral, or anal

• Producing, owning, or sharing pornographic images or movies of children

• Sex trafficking

• Any other sexual conduct that is harmful to a child's mental, emotional, or physical welfare

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Childhood sexual abuse is all too common. One in four girls and one in seven boys experience sexual abuse during childhood. Child sexual abuse crosses ethnic, racial, religious, and socioeconomic boundaries. It happens to children in every kind of family, neighborhood, and community. Many children keep sexual abuse a secret, sometimes until they become adults. Some children never tell, or do not tell right away. There are many reasons children do not tell about sexual abuse. Children may be afraid they will be blamed for the abuse, or that they will not be believed. Some children care about or have loving feelings for the abuser and do not want him or her to be punished even though they want the sexual abuse to stop. Other children have been threatened that something terrible will happen if they tell. It takes much courage to disclose sexual abuse. It may be frightening or difficult for many children when they begin to disclose the sexual abuse. Children may disclose only a little bit at a time, their stories may change, or they may take back ("recant") what they previously said happened during the abuse. Some children may even deny that the abuse has occurred at all. This is not unusual and may be confusing and frustrating for parents and caregivers. 

It is normal for parents and caregivers of children who disclose sexual abuse to feel very upset, angry, or guilty or even want not to believe that the abuse has happened. However, one of the best predictors that a sexually abused child will recover is the presence of a supportive parent or caregiver. There is hope for children who have experienced sexual abuse. With the right kind of help, children can recover completely and live normal and happy lives.

What is your typical approach to treating child sexual abuse? 
This is a very specific type of trauma and requires a very knowledgeable and sensitive treatment approach at any age.  We begin with a very thorough assessment of current levels of functioning, symptoms, and family history.  The actual facts of the abuse are not disclosed immediately by the victim, as working towards this is part of the treatment process.  Many coping skills are learned before the abuse story is told in therapy. The ultimate goal is to help the victim turn their story into one of a survivor. Through the assessment, we seek to understand the experiences your child had beginning intrauterine and throughout childhood.  This helps us understand how the brain developed and the level of coping skills present. The assessment includes:

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• Review of current symptoms, concerns, duration and intensity

• A thorough review of child development and past medical history

• Review of family systems

• Additional important family background information including history of mental health issues

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Then the best course of treatment is decided together with the caregivers.  Parents and caregivers play a crucial role in treatment because family plays a crucial role in restoring balance to a child's perceived sense of insecurity.  Coping skills and emotional attunement will be learned together with the parents and child, in order to assist in instilling coping skills with the affected child.  Treatment may include a combination of the following:

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• Theraplay® to restore healthy attachment to a caregiver 

• Play therapy, including sandtray, to assist child in expressing what is troubling them when they do not have the verbal language to express thoughts and feelings.

• Non-directive child centered play therapy to assist with emotional expression (used while abuse is under investigation/legal proceedings)

• Family therapy including play to explore and/or challenge existing family dynamics

• Trauma Focused cognitive behavioral therapy, when appropriate due to high levels of safety and cognitive functioning

• Traditional "talk therapy" to create a therapeutic environment of safety and unconditional acceptance

• Psycho-educaiton with family to help learn normal reactions to trauma

• Bibliotherapy to help normalize reactions to abuse 

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