While the perpetrators of human trafficking treat their victims as commodities to be bought and sold at the best price, the survivors of this abhorrent trade are left to deal with the emotional and psychological impact of their ordeal.
This article explains the complex interplay between the short and long-term impact of child sexual abuse on the mental health of that child. It then moves on to exploring how psychotherapy has been shown to help alleviate mental health problems and how the evidence obtained can be used to further improve outcomes for the abused survivor as well as to inform preventative programs.
What mental health issues do sexually abused children experience?
The first thing to understand is that human psychology is a complex mechanism and the experience of sexual abuse affects children in many ways, both immediately and in the months and years that follow.
Although mental health is often talked about in a vague way, there are specific disorders that victims of sexual abuse are at risk of developing, each with their own unique symptoms (albeit with a great deal of overlap).
To begin with, the sexual abuse itself has an immediate impact which comes under the label ‘trauma.’
Trauma is manifested through a wide range of symptoms and related behaviors and syndromes. Some of the most common include feelings of guilt, low self-esteem and sleep disturbances. This can lead to ongoing problems with forming relationships and damaging behaviors such as substance abuse and self-harm.
These symptoms can be seen as seeds which often – but not always – develop into ongoing mental health problems. This explains, to a degree, why some young people seem to recover surprisingly quickly from their experiences while others are affected well into adulthood and, in fact, never recover.
The most common mental health issues that germinate from these seeds seem to be anxiety (both general and separation anxiety), depression, eating disorders and post-traumatic stress disorder (PTSD). It is also common for sex trafficking survivors to develop a range of dissociation and personality disorders.
Of course, these mental health conditions can be complicated by behaviors such as alcohol and substance abuse. If victims of sexual abuse attempt to deal with their trauma by drinking excessively or taking psychoactive substances, the short-term and long-term effects will muddy the waters. This makes it difficult for psychiatrists, psychotherapists and other health professionals to disentangle the separate effects of these different contributing factors.
Even legal prescription drugs given to help manage mental health conditions will have psychological effects – not all of them positive in nature!
Does individual or group therapy provide better outcomes?
Although it is recognized that access to therapy can improve outcomes for the survivors of sexual abuse, much of this evidence has come from individual case studies and anecdotes from clinical work. There is also limited evidence for which types of therapy provide the best outcomes, especially research where the necessary scientific controls have been put in place.
An exception was a Department of Health and Mental Health Foundation study carried out at multiple centers in England. Led by Dr Judith Trowell and Professor Issy Kolving of the Tavistock Clinic in London, the study involved 71 female survivors of sexual abuse. All of the girls were between the ages of 6 and 14.
To create the control conditions, the girls were divided into two random groups with one group allocated 30 weeks’ individual psychoanalytic based therapy and the other given 12 to 18 sessions of group therapy sessions combining psychotherapy and educational work.
On a positive note, most of the girls involved in the study showed considerable improvement in their mental health across a number of standard measures. A year after the study, a follow up survey found that most girls had experienced a reduction in the severity of attention disorder, anxiety (both general and separation), depression, PTSD and social phobia. In addition, they had shown an improvement in educational measures, although they still lagged behind their peers in terms of academic achievement.
However, a third of the girls had residual problems following the therapy and 5% actually got worse with some of these developing new PTSD symptoms.
With regards to the type of therapy, no significant difference in efficacy was found between individual and group therapy.
Understanding the role of familial risk factors
Exploring the impact of family background on vulnerability to abuse has to be carried out with sensitivity. Parents of sexually abused children already have to work through psychological issues of their own and can feel judged and blamed by external agencies.
Recognizing the influence of family risk factors on vulnerability to human trafficking, the Tavistock Clinic study gave carers the option of psychotherapeutic support. Not all parents consented but those that did helped the researchers to understand some of the familial issues that may have contributed to the victims’ vulnerability.
They found that many of the birth parents had themselves suffered physical and sexual abuse. In addition, the family home was often dysfunctional and characterized by communication problems, confused roles and a lack of appropriate involvement and discipline. The study explained that it was not possible to clarify whether these factors contributed to the abuse or whether they resulted from the dynamics of having an abused child within the family.
Lessons to be learned
Helping a sexually abused child to overcome their mental health issues and function successfully in life is challenging but the results of the Tavistock Clinic study are cautiously promising. They suggest that with appropriate access to mental health services, it is likely that the majority of sex trafficking survivors will gradually improve and that this improvement will extend beyond the duration of their sessions.
However, a minority of victims may continue to suffer and even develop new symptoms, such as PTSD, as their lives progress. It is important that work continues to identify these young people so that further support can be given to them.
Teachers should also understand that while therapy can improve concentration, confidence and self-esteem, survivors of sexual abuse are likely to need ongoing support to catch up with their peers.
While psychological support is crucial to help abused young people to move on from their traumatic experiences it does seem that individual and group psychotherapy are equally beneficial. This is good news for children’s mental health services as they can be more flexible with service provision. The fact that most of the girls in the Tavistock study continued to improve after their sessions had ended is also promising news. It is clearly much easier for mental health services to arrange and fund a limited number of therapy sessions rather than ongoing therapy.
It should be borne in mind that while the Tavistock study (and therefore this article) has focused mainly on sexually abused girls, the Journal of Trauma and Dissociation estimates that one in six boys have also experienced sexual abuse. Boys are even less likely than girls to report abuse and are less likely to be believed when they do.
Finally, the findings relating to the contributory effect of the family background can be used to help design early intervention packages. Building healthy, resilient families is the best way to keep young children out of the clutches of sexual abusers and human traffickers.
Author Bio –
Peter Janci, a Partner at Crew Janci LLP, is advocating for victims of sexual abuse and other crimes. He has represented more than one hundred victims of sexual abuse over nearly a decade. As an expert sexual harassment attorney, Peter strives to obtain exceptional results for his clients through zealous advocacy and creativity. He has helped obtain dozens of other significant settlements for other survivors of sexual abuse. He has been selected five times as a “Rising Star” by Super Lawyers Magazine.
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