This blog is part of a series where our Deputy Director for Research and Evaluation, Dr Sophie Laws, highlights research done by other people (not the CSA Centre) that improves understanding of child sexual abuse.
Based on an online survey of the experiences of support services of adult survivors of child sexual abuse, Hear Me. Believe Me. Respect Me. Focus on Survivors (2015) provides unique insight. Nearly 400 survivors responded to the survey, making this one of the largest studies of its kind – a great achievement when these experiences are so often hidden.
Too often CSA can be discussed as if we are talking about a single incident. The picture built up from this research should correct some common misconceptions; far from being a one-off assault, for most the abuse started when they were young and went on for an average of seven years. Nearly 70% of respondents were abused by someone within their family environment. Half were abused by more than one person. For 70%, the abuse was not reported to police and nearly 90% had not seen their abuser brought to justice.
Findings on disclosure
Key findings are that almost half never verbally disclosed in childhood, with a very long gap for many between abuse and disclosure. The average time between the abuse starting and accessing services was 20 years, with wide variation.
Many used services for a considerable time, because of the effects of the abuse, without disclosing. Only 20% disclosed in response to being asked a direct question, and this was as often asked by a family member or friend as by a professional. The study highlights the importance of professionals asking appropriate questions.
A particularly disturbing finding is that for about 20% of respondents, the abuse did not stop when they disclosed – continuing for an average of six more years. In over 30% of these cases the disclosure had been made to statutory services.
The importance of feeling believed and respected
I wasn’t believed when I was 12. A psychiatrist just said “These things happen”. I am sure if I had been believed then it wouldn’t continue to have haunted me throughout my life. – Adult CSA survivor
Asked whether respondents felt listened to, believed and respected by services, all or nearly all of those who used Sexual Assault Referral Centres, Independent Sexual Violence Advisors, voluntary psychotherapy and counselling services and rape support services responded positively. By contrast, fewer than half of those who used Social Services or A&E/hospital services had felt this. There was mixed experience of counselling and psychotherapy services, with sexual abuse and rape support voluntary sector providers receiving the most positive ratings.
Survivors in Transition
The Survivors in Transition research team have followed this study with a second one published this year, I’ll be a survivor for the rest of my life. This looks in more detail at help-seeking experiences through in-depth interviews with 28 adult survivors. For this group, there is a typical trajectory involving late disclosure, distress, and involvement with psychiatric services over considerable time.
They finally found helpful support from voluntary sector services, or sometimes privately funded psychotherapy. Different approaches found valuable by participants included phone lines, coffee mornings, walking groups, and single sex groups. Meeting other survivors was important to many.
…Changed my life, and [they] are changing my life… I did the group programme. You’re absolutely terrified, but by the end you’re bouncing in. My therapist? There’s never any judgement. She resets my mind in lots of ways and the slow realisation it’s not you. In a group you look around and think what you just described, that’s me. I hadn’t vocalised that, that we weren’t the cause of it. – Male adult survivor
There are unfortunately many accounts of support services failing to respond appropriately, or in some cases ending abruptly close to disclosure. One woman specifically described how she had attempted to disclose to a mental health professional with whom she had engaged over a number of months and had established trust:
She said, “I need to lower my caseload, so you’re being discharged”, I said, “Could I tell you something?”, and she said, “Don’t tell me anything, I don’t want to know, we’re discharging.” So I just left it.
These studies reflect a highly participative process, with active shaping of the study by survivors combined with careful reporting of findings. Survey respondents were recruited through the Survivor Trust’s national network, and self-identified as having been sexually abused. The authors reflect that those who have accessed specialist support are over-represented, but argue that otherwise this sample reflects well a number of known patterns for this population. Respondents were aged between 15 and 73, 87% were women; however, other aspects such as ethnic identity and sexual orientation are not reported.
How we’re building on this
Improving service responses to children and young people is at the heart of the activities of all our Practice Improvement Advisors, who each focus specifically on health, social work, policing, education and the multi-agency team in England and Wales. Our work on the effectiveness of services for children and young people will shed more light on these issues, building on this and other work such as Sneddon et al’s evidence review for Victim Support on sensitive responses to CSA survivors.
The survey’s findings about the balance between different forms of child sexual abuse is one we are very aware of at the CSA Centre. Our scoping study on the Scale and Nature of CSA (now updated with recent data) investigated this, and we are proposing a new kind of prevalence survey that would provide better evidence. Our study on those who abuse children will also take care not to make unwarranted assumptions in developing a new typology of child sexual abuse offending.
Please get in touch to let me know about the research studies that you find most important, and I will consider them for a future blog.