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Childhood sexual abuse has an adverse impact on identity development (Oglivie & Daniluk, 1995). More specifically, the basic issues in identity development of "who am I" and "who am I in relationship to others" becomes confused and disrupted as do the establishment and maintenance of physical, emotional, and psychological boundaries that are part of the normal developmental process. When the crucial and ongoing work of self-construction is done in the context of abuse, the early self is misshapen. Survivors of incest often have negative self-perceptions, diminished confidence about social competence, disturbances concerning sexuality, and a tendency to meet nonsexual emotional needs with sex (Blume, 1990). Enns (1996) said, "Trauma and abuse destroy a person's fundamental assumptions about the world as a safe place, one's sense of agency and autonomy, and one's ability to maintain relationships with others in an unsafe world. Thus, survivors of trauma use highly creative methods for dealing with abuse; they may experience memory disturbances, flashbacks, nightmares, dissociation, posttraumatic stress disorder, and multiple personality disorder." (p. 361)

Normal reactions to violation include depression, guilt, shame, fear, anger, self-hatred, resentment, and feelings of being ruined, worthless, and bitter. The survivor believes that not only was something bad done to them but that they, too, are bad (Ratican, 1992). Some survivors have shut down emotionally because feeling is too painful. Incest requires the adult survivor to stop, look, and listen to the echo of her childhood trauma. If she does not, the incest vows to haunt her in later life. Without appropriate redress of childhood victimization, reality is denied.

A woman might not be conscious of how her victimization has adversely affected her, but it has. It is important to remember that abuse must be healed; it does not go away automatically on its own. Blume (1990) said,

Time does not cure the effects of incest. Although the memories go underground, the consequences of the abuse flourish. Sometimes they are buried under other problems--substance abuse, relentless rage, self-destructive behavior. But they lie waiting for the clarity that sobriety brings; waiting for release from thought-confusion and phobias, the lifting of depression, the opening that comes through therapy or intimacy. (p. 15)

Research has shown that "survivors have higher levels of anxiety, depression, self-destructive and suicidal tendencies, and difficulties with intimate relationships than do nonabused individuals" (Ratican, 1992, p. 33). The most common symptom for sexual abuse survivors is chronic depression, which some survivors have learned to perceive as normal. The debilitating crying spells, sustained and uninterrupted periods of irritability, excessive sleeping (e.g., 11 or more hours a day), debt-producing shopping sprees, reliance on food and alcohol for coping, do not serve as blaring warning signs that something is terribly awry. In our doing-oriented culture, chronic productivity may be an indicator of success and competence. Hyperactivity as well as depressed psychomotor movement characterizes depression for some African Americans (Parham, 1992).

In addition to depression, anger is also a prominent feature of psychological healing. As part of the healing work, women must get angry. The tentative relationship that many women have with anger has been implanted. In U.S. culture, women are discouraged from acknowledging and expressing anger because it is inconsistent with the accommodating image of femininity. In addition, men are generally not socialized to be attracted to angry women who are often perceived as difficult. McBride (1990) said, "to act out of their own self interest and motivation is, for many women, experienced as the psychic equivalent of being a destructive person" (p. 24).

Within the African American community, there is a stigma associated with receiving counseling or therapy. Getting help is likened to being inadequate, deficient, or lacking in faith. Yet, having a communicative relationship with God does not indemnify anyone from the need to receive necessary psychological help or from experiencing a range of human emotion that therapy guarantees to deliver. Asking for help is a sign of courage. However, many African Americans are cautious about therapy, and legitimately so. People of color have been and continue to be mistreated by racist therapists. Fortunately, competent mental health workers can respond effectively and empathically to the many layers of psychological oppression that many African American survivors carry. This weight reduces the quality of one's life and detracts from the strength of community.

Depicted frequently in the popular press and media as strong, independent, matriarchal, angry figures, many African American women are unfamiliar with healthy expressions of anger and are unable to recognize and express their own anger. Greene (1994) said,

Many African American women internalize the stereotype of the ubiquitous strong matriarch: In the tradition of the mammy, she acknowledges no personal pain, can bear all burdens, and will take care of everyone. Consequently, many African American women feel deficient if their burdens are too heavy, and will resist asking for help. (p. 21)

Conversely, some women may have intense hostility toward the entire gender or ethnic and racial group of the perpetrator.

Many survivors often feel pressure to be successful and believe that they must try harder and work harder because they are not as good as others. They might feel driven and obsessed. This pressure is heightened for African American women who, because of cultural and gender scripts, might feel that they have to "run twice as fast as White people" to be successful.

Incest can alter a woman's conceptions of herself and others. Once women determine how their lives have been transformed by incest, they can feel cleansing rage. Although confronting anger as well as the fear of one's anger can leave a woman feeling out of control, vulnerable, and overwhelmed, these feelings are important to healing. The group facilitator needs to be sure that women are psychologically ready to confront their deep emotions. Otherwise, harm can occur.

Realizing that a survivor can and must change her thoughts and the messages that she sends herself is a powerful tool in psychological recovery. A support group is a dynamic way of bearing witness to this process in oneself and in others. One technique that can aid a woman's psychological healing is to reframe the abusive situation from the perspective of a child. Many women have tremendous guilt about how, as children, they handled their abuse. They might ask themselves "Why didn't I tell anyone, run away, or fight?" Although their questions are appropriate and deserve to be responded to, a counselor might ask a survivor to imagine a child who is currently the same age of the survivor when she was abused. I have said:

that little black girl

how tall is she?

how many pounds does she weigh?

how much money does she have saved?

can she talk?

can she walk?

where under the sun can she run?

Who will help her?

anybody please.

Children have no fiscal power and lack the cognitive and emotional maturity to sanction sexual acts let alone understand them. As mature and responsible women with bank accounts, cars, status, titles, educations, and jobs, it is much too easy to assert, while reflecting in safety, what they should have done differently.

The cognitive-behavioral tradition of refuting and replacing negative thoughts with positive ones has an appropriate place in the treatment of incest (Ratican, 1992). Replacing self-defeating thoughts (e.g., "I am responsible for my incest and deserved to be mistreated") with life affirming statements (e.g., "I am not responsible for my incest; I am responsible for healing from incest; I deserve to be loved and respected") allows the mind to process different yet positive messages that, in time, alter thinking and behavior. This new mind begins to understand and know that as a child, the survivor was not responsible for the irresponsible actions of adults or persons to whom her care was entrusted.

With the loving support of community, unearthing vile memories allows a woman to integrate her past with her present and move forward to a new future that she has constructed. Connecting with others and having faith that things do change characterize optimal strategies of psychological resistance (Robinson & Ward, 1991). Hewn from herself, her life is hers to live on her own terms. In choosing not to be asphyxiated by her past, addictions, and denial, which are suboptimal strategies of psychological resistance, she is able to heal (Robinson & Ward, 1991).

Many women are engaged in an ongoing battle to feel comfortable with their sexuality. Bass and Davis (1988) said, "our culture leaves little room for any woman to develop a healthy, integrated sexuality" (p. 239). Among survivors, some difficulty with sexuality is related to the indecent exposure, fondling, penetration, oral sex, or other forms of inappropriate sexual activity introduced by someone who they probably trusted.

Struggle with sexuality, sex, or both, is amplified when the woman is sexually active or is at least expected to be, as is the case in marriage, yet has not resolved issues surrounding her violation. Prior to beginning healing work, marriage is not recommended, even between loving partners. The intimacy of marriage intensifies any existing problems a single person has. The survivor who has not begun her healing work is often confused about sex and what feels good, what is good, and what is not sexually safe. Consequently, as an adult, she is unable to discern those sexual positions, touches, or acts that might be a source of pleasure but which she experienced in childhood with neither her understanding nor consent. Certain sexual acts that may be a source of secret pleasure can be perceived to be vulgar (e.g., giving or receiving oral sex) especially when they have been committed against her will. If verbal abuse was involved during violation, (e.g., being told that she was a tramp or that she was worthless) damaging scripts are activated during sexual activity. In an effort to survive, some women permit themselves not to submit to sexual acts that arouse fear, feelings of being out of control, or both. Good sex requires trust, mutuality, respect, and vulnerability.

In the process of healing and establishing boundaries, many women understand that emotional or sexual dysfunction in relationships should not be attributed solely to them. In other words, their husbands, partners, friends, family members have baggage as well. Some women might realize that some of the discomfort with sex cannot be attributable to incest. A woman might not enjoy sex with her husband. The familiar media depiction of Black women on welfare as single mothers with many children and as prostitutes portrays them as being sexually easy and indiscriminate, lazy, and morally loose (Greene, 1994). These images can add to the reproach that many survivors feel concerning their sexual identities.

It is not uncommon for some heterosexually oriented survivors to participate in same-sex sexual relationships. Yet it is important to recognize that sexual abuse does not cause homosexual activities or homosexuality (Woititz, 1989). In addition to feeling enormous guilt and shame about lesbian behavior, confusion can exist about sexual identity. Wilson (1994) addressed this issue and said,

Whether some Black women choose to love other women sexually is not the issue. What is important is that Black communities examine their own homophobic attitudes, without creating scapegoats and inflicting further pain on those already having to withstand abusive attitudes within those communities. (p. 84)

Some survivors tend to sexualize relationships; thus, women need to be careful about definitive statements regarding their sexual orientation while still in the early phases of healing. Part of the healing process is to unravel the woman's true sexual self from the self that was broken and dismantled. Lesbian activity is not synonymous with a lesbian identity. A survivor's same-sex sexual activity might feel empowering because she chooses her sexual partner. Often, a survivor's first sexual encounters were with a man who took indecent liberties with her spirit and her body. Some female survivors of incest do not feel sexually safe with men. Survivors, along with others in the population, are situated along the continuum of sexuality, which includes homosexuality, bisexuality, and heterosexuality (Dworkin & Gutierrez, 1992).

Both men and women can and do behave sexually inappropriately with children. New research suggests that women are sexually victimizing children at much higher rates than suspected earlier (Priest & Smith, 1992). The estimates put the percentage of boys sexually abused by women at roughly 20% and the percentage of girls sexually abused by women at 5% (Oglivie & Daniluk, 1995). In their roles as caretakers, women have a large degree of latitude with children. The research suggests that the aftereffects for these children are similar to those from other forms of incest. Additional shame might be associated with the rarity of the abuse and the desecration of the maternal bond, which is perceived culturally as nurturing (Oglivie & Daniluk, 1995)

To respond effectively to the children in our midst, school guidance counselors need to watch for sudden and unexplained changes in a child's demeanor. This could include increased aggressiveness, being injury prone or clingy, and having extreme sadness. F. Cress Welsing (personal communication, July 9, 1998) stated that inappropriate sexual play, gestures, or language might be indications of sexual violation that the child is unable to verbally communicate. Of course, some behaviors could be attributed to various circumstances in the child's life; however, counselors need to be aware of warning signs. Any statements from children about being abused sexually by other children or adults need to be investigated swiftly. The appropriate school and local authorities (e.g., social services) need to be notified.

It is clear that incest affects men and women across race, ethnic, and class groups. Yet, African American women, when compared with European American women, are less likely to disclose sexual assault (Wyatt, 1992). Most African American women understand the dynamics of discrimination and realize that their stories of childhood sexual assault might be minimized or might not be believed. I believe it was for this reason that I, as an African American woman, was sought out by African American women to facilitate a support group. A European American can be an appropriate counselor for an African American woman; however, race is a fugitive topic in this culture (McIntosh, 1989). Training programs tend not to address how or when to name this issue within a cross-cultural counseling relationship. Before speaking to a client, counselors must be clear about the role of race and racism in the lives of African American women, must not be afraid to offend a client by raising this issue if they deem it appropriate, and should assure clients that they (the counselor) do not need to be protected from a discussion of race or related topics (Greene, 1994). In broaching the topic, counselors must be ready to deal with race issues in depth.

Counselors also need to help clients weigh their decisions about confronting an abuser. This should be done only if the survivor has seriously considered her motivations, expectations, and consequences. In other words, the effective counselor asks in a nonjudgmental way "Why do you want to confront the violator?" "What do you want to have happen?" and "What will you do if the violator denies responsibility for his or her actions?" A sense of triumph might be felt when a woman is ready to confront her violator; however, speaking truth does not mean others are able to hear it. Sometimes the violator denies the act of incest or the survivor's biological family rallies around the abuser. This last act of betrayal is usually devastating to the survivor. The survivor might even be accused of having false-memory syndrome, which refers to the charge that therapists and their clients create false memories of abuse (Enns, 1996).

Some survivors decide against confronting their abusers. This is an acceptable decision, yet clients need to know why they are choosing to stay silent. Some survivors do not wish to "cause any trouble." This feedback from clients can be informative to counselors because it helps them to assess where their clients are in recovery and if they are still seeking to protect others. What many clients fail to understand is that the trouble has already happened. Some survivors who, for example, might have been abused by a father who was left to raise his children alone might feel a need to identify with or protect the father (Ratican, 1992). Independent of the client's choice, counselors need to remember their role as facilitators of client decision making and maintain responsibility for assisting and supporting their clients with the choices they have made (Daniluk & Haverkamp, 1993).

Families of origin might not be appropriate sources of love and support; thus, many survivors have created a family from nonbiological sources. Bass and Davis (1988) said,

It is painful to make a break with your family, but it is even more painful to keep waiting for a miracle ... if your original family is not a source of enrichment in your life, put your energy into cultivating what you want from sources that can actually yield. Look to your friends, the members of your incest group, your partner, or your children. Although they will not replace what you have lost, they can offer abundant opportunities for nurturing, closeness, and comfort. This is what makes a healthy family. (pp. 305-306).

Counselors can help clients reframe family as loving people to include relatives and others. Counselors also need to be aware that survivors are vulnerable to revictimization later in their lives (Allers, Benjack, & Allers, 1992). Boundaries for self-protection are not adequately established for women who have been assaulted as children; thus, there is a substantial relationship between childhood victimization rates and later incidents in adulthood. Consequently, many survivors of violence feel anxiety and terror. Those who fear becoming victimized again experience a sense of being out of control. Even among elderly women who were abused as children, the residual effects were evident (Allers et al., 1992). Learned helplessness, difficulty with discerning trustworthy persons from those who are not, the trauma of incest, and developmental derailments that shunted the formation of trust, autonomy, and initiative all play a role in a woman's revictimization. For example, in Russell's study between 33% and 68% of the women who had been sexually abused as children were raped in their adulthood (Allers et al., 1992). Counselors need to be aware of this pattern.

Often, the best that a counselor can do with a client is to be with them and listen. Believing that the client is oriented to healing and wholeness allows the counselor to wait with the client as her healing unfolds. This is one of the most effective tools a counselor can possess.

When providing support to survivors of incest, counselors need to be prepared for possible upheaval in their own lives. Any unfinished emotional business will be excavated in the process of helping others. Knowing how and when to access necessary support is critical, because many counselors have a difficult time getting help for themselves. Given the high percentage of survivors in the population, helpers need to be mindful of caseloads. Daniluk and Haverkamp (1993) stated, "a heavy caseload of sexual abuse counseling may result in considerable emotional and physical exhaustion for the counselor, thereby impairing his or her professional competence, judgment, and efficacy" (p. 18). Because working with survivors of any type of abuse is bound to elicit feelings in the therapist (Ratican, 1992), effective counselors work through their own feelings of anger, sadness, and rage. The counselor might wish to consider personal therapeutic contact or rely on established social and emotional supports. To be effective healers, counselors need to be well, psychologically and emotionally. An examination of their own spiritual beliefs is essential.

This article defined and discussed both psychological and spiritual healing for African American women survivors of childhood incest. Where appropriate, my experiences as a facilitator of support groups for African American women survivors were discussed. Some of the therapeutic practices mentioned were developed from my experiences as a licensed professional counselor In private practice for over 4 years and my experiences as a university professor in a counselor education program for 11 years.

The aftereffects of sexual assault on women's lives are often calamitous; however, because a person has been victimized does not mean that the person remains a victim. Many women become empowered survivors and even become advocates and activists (Bass & Davis, 1988).

Making the hurt go away is possible and necessary but requires safe places for survivors to come together to share their stories, listen, heal, weep, and simply be. May we all remember, whether we are survivors of incest or not, that "love heals. We recover ourselves in the act and art of loving" (hooks, 1993, p. 129).

- Robinson, T. L. (Jul 2000). Journal of Multicultural Counseling & Development, 28(3).

Reviewed 2023

Peer-Reviewed Journal Article References:
Çimşir, E., & Akdoğan, R. (2021). Childhood Emotional Incest Scale (CEIS): Development, validation, cross-validation, and reliability. Journal of Counseling Psychology, 68(1), 98–111.

Guzmán-Díaz, A. V., & Trujano Ruiz, P. (2023). Co-constructing women’s stories about the sexual effects of child sexual abuse: A relational constructionist approach. Qualitative Psychology. Advance online publication. https://doi.org/10.1037/qup0000251

Riabzev, A., & Bensimon, M. (2023). “When I sing—I exist”: A qualitative inquiry on posttraumatic growth in voicework groups with women coping with incest. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0001557

Rudolph, A., Schröder-Abé, M., & Schütz, A. (2020). I like myself, I really do (at least right now): Development and validation of a brief and revised (German-language) version of the State Self-Esteem Scale. European Journal of Psychological Assessment, 36(1), 196-206.

Shevlin, M., Murphy, S., Elklit, A., Murphy, J., & Hyland, P. (2018). Typologies of child sexual abuse: An analysis of multiple abuse acts among a large sample of Danish treatment-seeking survivors of childhood sexual abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 263–269.

So, C. J., LaVoy, E. C. P., Harmouch, S., & Alfano, C. A. (2023). Objective and subjective sleep patterns and biomarkers of stress among women with a history of sexual abuse in childhood. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0001600

QUESTION #26
Prior to beginning healing work, why is marriage not recommended for survivors of sexual abuse, even between loving partners? To select and enter your answer go to Test.

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