Clinician's Digest - Page 5

How Traumatizing Is Child Abuse?

In the 1980s, a recovery movement spearheaded by feminists as well as books such as Laura Davis and Ellen Bass's The Courage to Heal brought the once-taboo subject of child sexual abuse to wide public awareness. The therapeutic community began to recognize that childhood sexual abuse was far more widespread than previously believed, and the belief took hold that such abuse was invariably connected with severe psychological trauma, influencing many treatment approaches that continue in use to this day. But in her controversial new book The Trauma Myth, psychologist Susan Clancy argues that, in many cases, the trauma associated with the sexual abuse sometimes isn't caused by the perpetrator, but by well-meaning relatives, friends—and therapists.

When Clancy was a graduate student at Harvard in the 1990s, she and her associates interviewed about 200 adults who'd been sexually abused as children, hoping to learn more about the nature of their trauma. To her surprise, she found that most people recalled the abuse not as clearly traumatizing, but as a much more puzzling and ambiguous experience. With a large number of the subjects, along with a sense that something was done that wasn't right, their memory of abuse was also influenced by positive feelings. Some recalled feeling wanted, accepted, loved, and special or being rewarded with gifts. Some felt stirrings of physical pleasure that were difficult to express or understand. Aside from the complicated negative and positive feelings and emotions that her subjects described, what stood out for Clancy was that many of the people interviewed had never been asked what their experience had really been like for them. In fact, their trauma, Clancy concluded, often came from the narrative others, including mental health professionals, subsequently insisted upon: that the abuse was so horrific that the children had repressed their memories or lied to themselves about how it had felt. Often for people abused as children, this disjunction between their own and others' narratives created guilt, shame, and distrust of their own perceptions and feelings.

Although Clancy is clear that any sexual advance to children, no matter how gentle or mixed with positive emotion, is still abuse, she believes that these experiences need not necessarily create deeply disturbing psychological effects. That viewpoint, a decidedly minority position in the abuse treatment community, discouraged her from writing her book for years. But she finally decided that the victims' accurate reports of their abuse, not the inaccurate reports of their well-meaning advocates, needed to be aired.

Some within the field have begun to moderate the view that sexual abuse is always traumatic. "It's not just the specific act of abuse that's so damaging in itself," says Chicago trauma specialist Mary Jo Barrett. "It's a series of interactions with others that can either reinforce the sense of vulnerability or counteract it. The community can heal, traumatize, or retraumatize."

Clancy is highly critical of trauma experts who refuse to understand the variety of individual responses to abuse and who, she says, insist on seeing every case through the same lens. But many trauma experts fear that the effect of Clancy's work will be to cause people to take abuse less seriously and to blur the protective boundaries for children. Christine Courtois, author of Healing the Incest Wound, insists that all sexual abuse is traumatic and that although other issues can exacerbate the trauma, the traumatizing action itself provides the foundation that the later issues build on.

Clancy's advice to therapists who treat clients who've been sexually abused comes from an early research subject's reply to her queries about the "traumatic" abuse: "If you're trying to figure out why the abuse screwed me up so badly," the young woman told Clancy, "why are you asking so many questions about what it was like when it happened? What you need to be focusing on is what it was like later on."

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