Professionals Often Feel Pulled In Several Directions In Their Work On Child Sexual Abuse Cases
Although most professionals want to help the victim, potentially competing concerns include the feeling that sex offenders should be punished, a concern that the offender may be dangerous to others, a belief that sexual abuse is a mental health problem, a concern about the impact of disclosure upon the mother, a belief that the mother is partly responsible for the abuse, an awareness of the effect of sexual abuse and intervention on non-victim siblings, and a feeling that everyone in the family needs help.
Taking a victim-centered approach is a way of dealing with conflicting goals in sexual abuse intervention. A victim-centered approach is one in which considerations of what is in the victim’s best interest override competing concerns.
What is in the victim’s best interest? That may vary depending on the case, and it may not always be easily discernible. Ascertaining the victim’s best interest usually begins by finding out what the victim wants to happen, the older the child the more weight given to the victim’s wishes. Does she want to be removed from the home or have the offender removed? Does she want the offender to be prosecuted or to get some help? Of course, there are times when what the victim wants is not in her best interest, because it risks her safety or psychological well-being. In such cases, the child’s best interest should be pursued, but with a developmentally appropriate explanation to the child about why her wishes cannot be granted.
The Potential Iatrogenic Effects of Intervention
For some time professionals have been concerned with iatrogenic or system-induced trauma. One of the reasons that pursuit of the victim’s best interest is so important is that a fundamental trauma resulting from sexual abuse is a sense of powerlessness. The victim’s body is used by the offender for his gratification; the child is psychologically intimidated by the offender into cooperation with the sexual activity; and the child may be compelled by the offender to keep the sexual abuse a secret. Additionally, out of concern for the impact of disclosure on the family, the victim may feel forced not to disclose or that the consequences of disclosure may be worse than the abuse itself.
The complaint of many victims is that when the sexual abuse is discovered, things get worse rather than better because their lives continue to be controlled by others, and they experience all sorts of additional traumas. These may be repeated, insensitive, and humiliating interviews; a frightening medical exam; a confrontation involving the perpetrator or the victim’s family; an unpleasant placement experience; treatment that the child finds unhelpful or traumatic; and court testimony. Often the most problematic aspects of intervention are not knowing what is going to happen and having no say in decisions. It is important that the intervention not exacerbate the child’s sense of powerlessness.