The road to recovery from childhood sexual abuse: After an allegation, what next?
Childhood sexual abuse, including allegations of such incidents, leaves a permanent mark on its victims – and how they recover can make all the difference. But where does one even begin to seek help? CNA outlines a roadmap for healing.
- The Ministry of Social and Family Development's Child Protective Service (CPS) works with families to navigate the psychological challenges of dealing with a disclosure of abuse.
- CPS also instils protective behaviours in child victims in case they need to interact with the perpetrator again.
- The police and court prosecutors try to minimise trauma for victims, such as by allowing them to give evidence via video-link from another location.
- Mental health experts note that the long-term effects of child sexual abuse can include dysfunctional interpersonal relationships and issues related to mental health, such as depression and anxiety.
SINGAPORE: The moon represented a safe haven, a constant amid grave uncertainty, when Sofia Abdullah (not her real name) was being sexually abused by her grandfather as a child.
She would seek solace in the moon to mentally distance herself from the abuse, finding comfort in the fact that the moon was always there even when it waxed and waned.
Later in life, when she got divorced from her husband, she turned to the moon once more to soothe her feelings of abandonment.
Now 40, she has written a book titled The Years of Forgetting under her pen name, Sofia Abdullah, about her abuse, which includes the long-term effects that her experience had on her body and her relationships.
There was, for instance, a period when she became anorexic because it meant she could obsessively control her food intake, making up for the loss of control over her life that she suffered as a child.
“When I first went to university, I had a boyfriend. And when he kissed me or touched me, I was shaking like a leaf, like literally shaking. I was puzzled because if it’s a boyfriend, it’s someone you actually like. It shouldn’t be that way,” she told CNA over Zoom.
“For me, there was a disjoint between what I should be feeling and how my body was rejecting (him). That was my first inkling (that I needed help).”
But growing up, it wasn’t always evident to her that she needed help. She didn’t confide in anyone about the abuse except her mother, and now, her brothers.
Her grandfather has since died – but the after-effects linger.
Families have no roadmap for what to do in such a situation. For a child in Sofia’s position, where can they or their parents turn to for help? What happens after they report the abuse? And how can they begin to move on?
CNA spoke to people who help children and their families heal from childhood sexual abuse, and the complexities involved at every step.
SOCIAL SERVICES: HELP FAMILIES, EQUIP CHILD WITH SAFETY SKILLS
When professionals, such as from the health, social service and education sectors, encounter situations where there is suspicion of child abuse, they can inform the Ministry of Social and Family Development’s (MSF) Child Protective Service, said a ministry spokesperson.
The concerns that professionals look out for depend on a child’s age and what is “developmentally appropriate” for the child.
Depending on the severity of the abuse, and guidance from the Singapore Police Force (SPF) on the nature of contact that the child might have with the alleged perpetrator, the child might be allowed to continue residing in the same household “if safety measures can be put in place”, noted MSF.
Such measures include not leaving the child alone with the alleged perpetrator at all times.
Speaking to CNA over Zoom, manager of the intervention team at CPS Harsharan Kaur shared that CPS works with families to overcome what has happened. This includes preparing them emotionally for what is to come and helping the child return to their family eventually.
“A lot of times, the family reacts with a lot of ambivalence. Some of them are shocked, which is natural. It takes some time for the family to process,” she said.
A spokesperson for AWARE told CNA separately that even if a child understands that they have been abused, many fear that they won’t be believed.
“When the victim is young and the perpetrator known to the rest of the family, listeners often react by blaming the child and dismissing their experiences. It can be very hard for even loving parents to accept that their spouses or relatives could be abusers.”
Non-profit organisation PPIS also told CNA that the trauma may not necessarily be felt by the victim alone; it may also be experienced by the non-offending caregivers.
After disclosure of the abuse, CPS also works with families to ensure they receive practical support. The alleged abuser, who might need to leave home, might have been the sole breadwinner.
“We also help families understand what the child is going through. If the child returns to the family after the whole process, we don't want the child to be blamed,” added Ms Kaur.
“It’s about creating some understanding and awareness within the family of how to deal with this, even after all the partners have exited.”
Most cases that CPS handles involve intra-family abuse, which can be “a very conflicting experience” for the child.
“This person might be their parent, main caregiver, or sibling. At the end of the day, these relationships cannot be denied, regardless of whatever happened. Whether they want to, they may end up having to interact with their abuser,” said Ms Kaur.
She added that the child might not necessarily even want to distance themselves from their abuser, as they could be family members.
As a result, what CPS does is “have conversations about safety”, she explained.
“To the child, to the abuser, to the family, it’s about safety. It’s not about keeping secrets, allowing the abuse to go on, or coaching the child not to share this with anyone. These are conversations we have with the child to (teach them) how to be discerning in these situations.”
Statistics of child sexual abuse cases
The Child Protective Service has been investigating a rising number of cases since 2015, the MSF tells CNA.
|Number of child sexual abuse cases||82||107||181||248||210||261|
Ultimately, CPS wants to equip the child with “protective behaviours”, said Ms Kaur.
“So the child is always looking out for their own safety. Their level of protection is always enhanced after they’ve been through our system, and that’s what we really want.”
This is important as a victim of child sexual abuse might not recognise that they have been abused through a process of sexual grooming, especially if the victim has known the perpetrator for some time, added AWARE’s spokesperson.
“The perpetrator might establish trust via gifts and attention before gradually escalating their actions to abuse. The process is designed to confuse the victim into not recognising abuse for what it is, or feeling complicit in the acts and responsible for them.”
Nonetheless, once concerns have been addressed and the risk level of the case lowered, cases will then be referred to a social service agency, said MSF.
One such agency is Big Love, a child protection specialist centre that provides support and intervention to families in the community. The organisation also sees disclosures of child sexual abuse from existing cases not referred by CPS.
To protect the well-being of the child, Big Love puts in safety plans, which include detailed action steps made in response to specific worries, shared a spokesperson for Big Love.
“For example, if we are worried about a child being sexually abused by the family member, the plan could start from having the perpetrator move out and have no contact with the child victim at all,” she added.
“We could also have family members, friends, neighbours, professionals check in with the family physically or via phone or video calls, to ensure the child’s safety and family’s compliance to the safety plan.”
POLICE: RAPPORT BUILDING, REDUCING TRAUMA
At the same time that CPS is working with the family, the SPF’s Criminal Investigation Department’s Serious Sexual Crime Branch (SSCB) will conduct an investigation into the allegation of abuse.
As part of investigations, the police embark on “One Stop Centre for Multi-Disciplinary Interview” – a collaboration between the police, CPS, and KK Women and Children’s Hospital. Interviews and forensic medical examinations are done together at the hospital by officers who are specially trained to handle sexual crime victims.
“This reduces the trauma faced by child victims, from having to travel to different locations and recount incidents of abuse to different professionals through repeated interviews,” explained SPF.
Building rapport is crucial for the investigating officers to gather information from the child victims to build a case.
“We have a playroom with a dollhouse and toys to allow young victims to feel at ease. We also have anatomical dolls which we use in interviews of young victims to demonstrate and re-enact the incidents,” added SPF.
As child victims of sexual abuse are “often traumatised, and at times, embarrassed and ashamed by their ordeal”, SPF noted, the police also work with Victim Care Officers, who provide the victims with emotional and practical support. These officers have relevant qualifications in areas such as psychology, social work and counselling, and are trained by police psychologists in victim care.
Investigation officers need to be patient with child victims as they might not be able to “particularise the episodes or give a clear account of the incident” due to feeling scared, angry, anxious, upset or even guilty over what happened, said SPF.
In cases involving family members, SPF noted that the independence of a witness account may be questioned or challenged in court, such as when victims or witnesses may be influenced by family members in a way that might impede investigations.
After the investigation is completed, including the collection of forensic evidence and interviewing all involved parties, the police consult the Attorney-General’s Chambers (AGC) to ascertain whether the accused person would be prosecuted in court.
COURT: EMPATHY AND UNDERSTANDING CRUCIAL
Prosecutors also try to minimise the trauma associated with court hearings for child victims, a spokesperson from the AGC told CNA.
“This includes applying for a gag order to ensure victims’ identities are protected, or for the victims to give evidence ‘in camera’, which means the courtroom is closed to members of the public. In suitable cases, permission is sought from the court for victims to testify via video from another location.”
In some cases, AGC added that the prosecution also applies for case officers, counsellors and care workers to be present when victims give evidence, or for victims to give evidence in court “behind a shielding measure” so they don’t need to see the accused.
Similar to the police, prosecutors are trained to handle child victims with empathy and understanding, and to assess the evidence “as impartially and objectively as possible”, said AGC.
“Our prosecutors allow victims to bring items which would help them calm down, such as soft toys. They also ensure victims are in an environment where they feel comfortable, so they can narrate what happened more easily.”
LAWYERS: VICTIM’S COURAGE, MENTAL STAMINA MATTERS
Even when a case is won in court, there is no success, family lawyer Dharma Jayaram said.
“The damage is irreversible on the person. There is a whole part of them that they cannot reconnect anymore with because of what has happened.
“I’ve never seen a successful case where the person is relieved, only validated. There is no victory in sexual abuse. I want to be very clear about that.”
Ms Jayaram explained that the investigative process “sets something in motion”, so even if the outcome might not support the allegation of abuse, there are still consequences to bear.
“It can still ruin relationships, heighten acrimony between ex-spouses. There is a finality in a divorce, but such an allegation can rekindle acrimony. Then the kid is caught again in the middle of it,” she said.
What, then, compels lawyers like Ms Jayaram to take on a case?
For Ms Jayaram, the starting point would be the courage of her client, which usually means at least one parent and their child.
“I am only as strong as them. I'm not a vigilante, I can't (just) fight for them. They are going to live that life. What happens if I do something and I win whatever they need to do? And (what if) they can’t (accept the outcome), and they don’t want to?” she said.
For this reason, she needs to know what her clients want when they approach her.
“If the general reason is that you want to protect yourself and your daughter, for example, then I can do that. But if you want some (public) justice, some display of something, you’re not going to get it. Family courts are quite private, so we know there’s a gag order because it’s a kid,” she said.
“But most of the time, if they’ve come this far, they just don’t want (the abuse) to happen again. They don’t care if (the abuser) is punished; they don’t care if he disappears.”
Ms Jayaram also illustrated the lack of “finality” if, for instance, the child’s alleged abuser was the father.
“As a wife, I can create finality in my life by having a divorce. But a child can’t create finality if the court never sees him as a perpetrator. (The man) can always be an ex-husband, but he can never be an ex-father. There’s no such thing,” she said.
Some of her clients eventually retract their allegations as the case proceeds due to fatigue.
“Court cases have certain timelines. It’s not like I can make the application and go to court today, and it’s all heard today. There’ll be a chance for the other person to reply,” she added.
“If the perpetrator isn’t staying in the same house, maybe there’s some mental strength people can use to go through. But if the perpetrator is staying within the same vicinity or house, or has (applied to) continue seeing the child, then there is a certain fatigue that will hit people. There’s a certain, like, ‘I can’t do this.’”
It takes time to get any justice, she admitted.
“Time dilutes the seriousness of an action. (Some clients) backtrack because the urgency isn’t set in motion. It’s not purposely done; it’s just the way things are.”
Challenges in handling child sexual abuse cases
- Perpetrator is a family or household member and would likely want to have contact with the child even when the child is not ready. No place for the perpetrator to move to temporarily if the perpetrator is to stop contact with the child.
- Disbelief from other family members, which may affect the healing of the child.
- Child victim retracting statements.
- Child’s continued loyalty to the perpetrator.
- Child victim is re-traumatised. Being removed from their homes could lead to their routines being disrupted (if perpetrator is not able to move out temporarily).
Source: Big Love
MENTAL HEALTH EXPERTS: COMPLICATED LONG-TERM EFFECTS OF ABUSE
The long-term effects of child sexual abuse vary, with some reporting “very few effects” and others suffering from “overwhelming abuse-related difficulties”, observed experts who spoke to CNA.
“The way victims react to trauma is likely the result of resilience. This is possibly biological and related to how the person reacts to stress,” said Associate Professor Daniel Fung, chief executive officer of the Institute of Mental Health.
The manner of sexual abuse is also key when assessing long-term impact, such as whether the child was groomed or had the abuse done to them in a traumatic way, like forcible rape, he added.
One of the main long-term effects includes struggling with interpersonal relationships.
“Sexual abuse is linked to sexuality and sexuality is about relationships. In relationships where trust is misplaced and responsible adults (or even older teenagers) use the young child as an object of their physical sexual gratification, it creates a warped idea of what it means to be loved,” explained Assoc Prof Fung, who is also a child psychiatrist.
“They may view relationships as bad and struggle in forming relationships in the future and may also become sexually inhibited, suffering from an ability to deal with physical intimacy. Alternatively, they may become excessively sexualised in all relationships.”
There is also the issue of “transgenerational transmission”.
“The idea is about how victims of sexual abuse can become sexual abusers later in life, not necessarily on their own children but other children,” he said.
The most likely mechanism for "transmission" to occur is psychodynamic, which is where victims try to re-enact the abusive relationship in order to deal with the anger towards the perpetrator and achieve possible arousal and satisfaction in the original abuse.
“Put simply, a child sexual abuse victim who doesn’t work through the abuse may resort to abusing other children when they grow, as a means to deal with their pain and betrayal.”
But it is hard to work through the abuse when many victims don’t recognise the impact of the abuse on them, said Ms Abigail Lee, a counsellor at Healing Hearts Centre who specialises in working with children and families, as well as trauma survivors.
While most of her cases have been through child protective services, some might also lack awareness about how to seek help via the public system, she said.
For many, it has also been “too long”, and they might not see the impact of the abuse.
One of the main complexities involved in cases of child sexual abuse is that healing “isn’t necessarily a linear process,” added Ms Lee, who’s been in practice for 15 years. “There could be possible repercussions many years down the road.”
“Many times, I see (these cases) for presenting issues years later, not specifically for abuse. Such issues include depression or anxiety. It’s only through the process of counselling that many recognise these issues are the impact of abuse that they experienced many years ago,” she explained.
Assoc Prof Fung pointed out that depression is the most commonly reported symptom “with a fourfold greater lifetime risk” in sexual abuse victims than in individuals with no abuse history.
“Victims of child sexual abuse may also experience generalised anxiety disorder, obsessive-compulsive disorder and somatisation disorders, including developing headaches, stomachaches and muscle tension. Victims of sexual abuse have been reported to have chronic irritability and unexpected rage towards self or others,” he added.
Other issues that some victims may face in later life include post-traumatic stress disorder (PTSD) symptoms, which can persist into adulthood with the victim “re-experiencing the abuse”, said Assoc Prof Fung.
Some might also experience “psychological numbness” where they lose their memory around traumatic events. They may experience an “out-of-body” feeling or re-experience the trauma in a “dream-like state”, usually as a “psychological defence against the pain of trauma”, he added.
As for Sofia, she lived with this sense of dissociation from her body after being sexually abused by her grandfather in childhood. When she initially started to seek help, she tried all avenues, including therapy.
Nothing worked, until she started rock climbing.
“It was rock climbing that forced me to unite my mind and body. In rock climbing, the term is commitment. If you’re not committed to a move, your body will tense and you’ll fall off. It forced me to be present in whatever I was doing,” she said.
On the wall, with every hold and every step, she found her way back to her body.