Working with Child Survivors of Sexual Abuse- Workshop Child Sexual Abuse - Types of Abuse- contact vs non-cantact o Penetrative (vaginal, anal, oral) vs non-penetrative (some form of contacttouching, fondling, no insertion happening) - Powero Imbalance of power (eg- done to a 5 yo by an older person by someone in a position of authority, trust, family, vulnerability, physical dominance) o Consent Done with consent of child, child was okay, did not scream, etc- not a valid - Tactics- Can be difficult for a child to come to an understanding, may not be able to articulate, and it is important to understand the psychological effects o Grooming manipulation by perpetrator to build trust, more emotional sense and sense of comfort with older children material gifts with younger children Works within family too- creation of trust by the perpetrators 3 S’s- secrecy, silence, shame - Secrecy: Younger children- special game, do not tell anyone, older children- online spaces, meeting in places, asking them not to tell their friends Silence- if you tell someone, I will harm someone close to them, having videos or pictures of them, finding ways to silence them Shame (May be of others finding out) Boundaries and Violationo No longer know who to trust, breach of safety and boundary, difficult to understand if the abuser is wrong, especially if the person is very close and trusted like a parent, etc. o May feel emotionally safe, sometimes not- difficult to grapple with what has happened o Attention- Providing it when they follow what they want and not providing it when they don’t listen to them, creates confusion for the child. Why kids don’t tell: - Shame - Guilt - That person told me not to tell anyone Do’s: - Remain calm, believe the child and allow them to talk Provide support Do not panic and blame them, the child might go into a shell and never reach out How to embody: Day 2 Impact of CSA: - Immediate signs- physical and emotional changes Unexplained injuries No concrete answers- I don’t know Bruising in private body parts Constant bruising Difficulty walking or sitting May cry more than telling what happened or where it hurts Pregnancy Pain and itching in genital areas Fatigue and difficulty sleeping- constantly tired, sleepy all day, not sleeping at night o Behaviour changes- Identify premorbid vs post behaviours o o o o o o o o o o o o o o - Accumulation of gifts or money Regressive behaviours- thumb sucking, wetting pants Too much/too little attention to appearances Sudden dislike of certain places or people Withdrawal Short-term impacts- psychological, behavioural, body o Younger children (2-8 yo) Sexualised games/ self stimulating behaviours Nightmares Being clingy Fearfulness, anxiety Emotional outbursts- crying, anger, irritation, frustration, depression Guilt and shame- stays after the abuse too Hyperfocus, hyperactivity- not able to contain themselves Lack of bodily boundaries and privacy- like being naked in the house, even when someone is in the house o Older children (9+ yo) Self-harm Disgust of sexuality, gender Sense of fear when thinking about sex Confusion of sex with love due to grooming during abuse - Long-term- psychological, behavioural, body o Loss of safety due to constantly being in a space of not being space and being unable to speak up o Inability to differentiate between safe and unsafe o Loss of intimacy- even safe touch by partner feels unsafe o Engaging in sexual acts in order to receive the attention they received as a child o Dissociation due to constant stress on body- immunity is on the edge, overwhelm, the body is unable to manage everything- can happen anytime around abuse o Loss of physical connection with body o Loss of sense of self o Re-enactment- Re-creating the scenarios, getting into abusive relationships and repeating the past - Play behaviours- curious play vs sexualised play o Touching themselves or others inappropriately o Add pic from ppt o Parents may have difficulty differentiating between the 2, important to take note of other markers of abuse o Social media can also play a role Mind body impact of CSA - - Complex traumatic experience affecting mind and body Often verbal narratives taken into consideration- too much attention to it Needs more focus on bodily manifestations Memory of it is also stored in somatic memory- muscles, fascia, nervous system, and brain Entire body remembers- from your head to your toes, not only visual memory It means that the body is going to show signs, become a source or storage of memory Need to rely on the body’s truth too- flashbacks, nightmares, anxiety, denial of bodily needs (food, water, hygiene, moving, singing, anything that makes them happy), certain touches might feel very weird (pushing away, clenching), may pass forward as an adult Body is confused whether what they are experiencing is normal or not, constant juggle of complexity or confusion A touch that may not be of sexual intent, like a mother bathing the child, can feel confusing Psychological impact should include the bodily experience Understanding how Abuse Hides Four aspects - Community (Police, mental health practitioners, teachers, principal) - Parents - The offender - The child Keep piece of paper and sketch pens or colours for tomorrow Difficulty with reporting abuse: - Failure to ask as a community by everyone around (labelled as throwing a tantrum) - Fear of not being believed - May not feel safe enough to talk to someone - Grooming - Fear of the perpetrator - Reliving the trauma, may not even want to talk about as it may become to much for the body to handle - Fear that it might get worse if someone interferes Day 2 - Practices as a mental health practitioner Role of a therapist Techniques to work in this space How to talk to the children Journey of healing Play-based and expressive arts methods Safety - The child needs to know about the safety, trust and boundaries offered in the session with you. - At an environmental levelo Child-friendly space o Sofas, o Pets, o Toys, o Lower sitting, o Keeping the door shut o Having some infographics (in the waiting area) - Ensuring and maintaining privacy- involve and inform them (ask the child before enclosing, who to tell, what to tell) - Use simple, clear language, use direct and appropriate words involved - Needs to be a private, safe space, without parents - If the child asks for a parent, ask parent to be there for 10-15 minutes and then ease them into having the parent not being in the room - Create an environment for the child to ask questions, answer them calmly and reflected on body language as well - Include structure, but include choices too (eg: let’s play a game, which one would you like to play) - Emphasise on safe space and boundaries, explain it to them, what it is, how it works, give a lot of description of what safe looks like, ask the child what it looks like, ask their preferences on what they would like in the room - Avoid being alarmed, overprotective, advise (don’t do this, do this, avoid this person, being scared when they talk about things) How to talk at different stages Add from PPT Leading vs non-leading questions From ppt The Window Approach - Create openings for each window one by one Children- talk about body, then people safety (this mom, grandma, etc and boundaries), protection and general safety, slowly transitioning Adolescents- talk about attraction and love, needs and pleasures, consent and boundaries, slowly transitioning to consent vs sexual abuse Journey of Healing - Helping the child understand what happened and making sense of it - Teach themo Assertivenesso teach the child how to say no, o voice their concerns, o building self-esteem, o making them aware that it was not their fault o Emotion Regulation, guided imagery, maintaining a mood diary, normalization and reintegration with society Play and Expressive Arts Methods - Creating an outline of the body, the child can mark body parts where they feel various emotions or feelings, like where they feel safe/ unsafe, provide prompts - Teaching good vs bad touch to children - Conversation about body safety and body mapping - Moving stories- talk about the elements of the story, what does it tell you how you can take back home, etc Day 3 - Legal obligations POCSO Duty of practitioners- confidentiality, gray areas, reporting Safety Plan Case study (video) Rights of Children - No child-specific laws for children - Child needs to have strong safety measures, privacy - Right to have a trusted adult or parent during recording statement - Right to counselling, legal assistance, educational services, psychological recovery, and provided with compensation. POCSO- in 2012 - No laws before that outlined protection of children from CSA - POCSO- Protection of Children from Sexual Offences - Men and women can both be tried under this act - Minor offender under the Child Juvenile Justice Act, major offender under the POCSO - Looking at how we can provide them proper psychological guidance to minor offenders and reintegration with society with respect - Dilemma of confidentiality vs how much to report by the counsellor o Nothing can be exposed to the media, including their identity o Make sure that the identity is protected, and charges if not done o Special courts for POCSO cases, outside public not allowed, only the child, family member or assistance and the offender Offences under POCSO Add from ppt- table with offenders, punishments, features - Charges can be clubbed (like sexual assault + penetrative SA, the imprisonment time and fine gets added up) Confidentiality vs duty to report - If client discloses incident of SA - Wait for consent from parent and child before you report - Sometimes they may not be ready to report, what to do in that case? o Maybe because Legality Society's judgment concerns Offender in position of power o Steps to take Talking to the child, record what is being said through documentation Discuss with family, take consent from the child first (If the child says no, ask them about a safe or trusted adult they can discuss it with) Educate the child and the parent about POCSO and the law- what it is, how the process looks, infographics, three points- protection, justice and safety Reassure- you are not going to report unless they agree, no pressure Reporting may be necessary when: High chance of re-abuse No way of modifying the child’s environment Exception and grey areas come in here Need to assess severity, any modification possible Exploring the hesitations of the parent and child- why they are feeling scared, ask about their reasons for not wanting to report + making them understand the situation- empathy + reassurance, practical measures to protect the child till you report- safety of the child is paramount I am not going to disclose any information to any media for the safety and protection of the child Explain what will happen through the next steps If still not willing to report, look at practical measures Document all the 7 steps followed, in case the child goes on to report in the future, to protect your practice, while showing the steps followed. All documentation should be included. How was the child's safety ensured? Whom to report to? Police, special juvenile police unit, child welfare committee, district child protective unit, 1908 helpline, POCSO ebox o Process of reporting Recorded by a woman police officer, not in uniform At the child’s home, in the presence of a safe adult In the language the child understands and speaks Frequent breaks Medical examination within 24 hours in the presence of parents or trusted adults, results can sometimes be excluded if done a long time after the incident Gentle conversation, not questioned too much In a child-friendly manner Audio recording of the statement, which is read out to the child and parent Court hearing- the child is not expected to show up in court, may be asked to meet the judge separately with a trusted adult, court visit is selective and pre-informed, role of counsellor to prepare the child Case dilemma - If a child is ready to report but parents or guardians are not - - o Look at age of child 7 or under, may not understand what it looks like Explain to them in the presence of an adult they are close or comfortable with. Make sure they understand what the legal case would be like Is the safety of the child jeopardised in any way? Is the parent still going to support the child even if they choose to report? Can bring in a social worker to work with the child and the parent o If done by a school teacher, report to the principal, and talk to the parent o Responsibility of parent and school authorities to report further o If the school does not take enough measures, the school may be involved in legal proceedings for not taking steps Constant risk, no way to change the surroundings, you as a therapist can go ahead and report, the best thing to do- calling the child helpline 1098, which provides a social worker for the case, talk to the parent that you will have to report Steps for an offender who is a minor o Getting more information on what is happening in the offender’s surroundings, needs to be equally empathetic to both o Understanding about their developing sexual curiosity vs abuse o Take time to understand both their experiences o Inform the parent that they will also be provided with support to get through it Child safety steps No consent, ensuring the safety of the child Add from PPT
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