Sibling Sexual Abuse; A Family Intervention for Treatment

By Lisa Thomas, LCSW, LMFT, DAACS

 

Treating the victim and family following sexual abuse is a challenge for the family, the therapist and the victim alike. Unfortunately, sibling sexual abuse is not an uncommon occurrence in our society. Recent research has illustrated that in almost 90% of child sexual assault cases, the child knows and trusts the perpetrator (Baker, 2002). If you combine this with the fact that availability is the number one factor that most consistently determines who will become a casualty of sexual abuse, the potential for sexual abuse among siblings becomes obvious (Baker, 2002).

Sibling Sexual Abuse; How Does it Happen?

Sibling abuse is perhaps the most underreported form of child sexual abuse. National Statistics research estimates that only 2% of sibling abuse is ever reported to the authorities (Baker, 2002). Children are less likely to report sexual abuse if it happens within the family because the victim often feels ashamed, fearful and conflicted about telling others that a sibling has been sexually abusive (Baker, 2002). The child may feel intimated by threats made, and in some cases the rewards a child may be receiving, such as attention or gifts, may keep them in a circular pattern of silence. Also, attachment to the family member may overshadow their own pain around the abuse (Baker, 2002).

Sexual abuse by a sibling often will cause more damage than sexual abuse by a non-family member because children are dependent for years upon their families. Sibling

abuse traps also the victim in a cycle of shame and betrayal that can span a long time. Further, the amount of damage done in identified sibling abuse families is often times greater than in non-family sexual abuse cases due to the frequency and availability of the victim to the perpetrator (Baker, 2002).

Often, blended families are at a higher risk for identified sibling sexual abuse since the natural bonding process at birth between siblings is not present with these families. Lack of supervision can also be a problem as newly married parents spend quality alone time bonding over a new marriage, excited about possible built-in babysitting options for the younger children within the home. Overall, it is documented that combining families in a hurried fashion is often a recipe for disaster (Baker, 2002).

To avoid siblings with more power taking advantage of their less powerful siblings it is suggested that the children receive a great deal of structure, guidance and support in order to ensure healthy patterns of communication. However, the real tragedy in sibling sexual abuse is not the number of victims that have been targeted, rather it is the fact that the incident as a whole could have been prevented (Baker, 2002).

The Treatment Models; Using Family Centered Approaches

The Multimodal Approach

As family therapists increasingly treat children who have been sexually abused by family members, a multimodal approach that combines individual, group and family therapy has gained wide acceptance as being the best model for treatment (Sheinberg, True & Fraenkel, 1994). The model is structured so the child participates in individual therapy with the therapist and group therapy with other child victims. The parents' participate in parent support groups as well as individual therapy to sort through feelings of shame, loss and guilt, and the entire family participates in family therapy to help restructure the family unit. The research has concluded that the circulation of issues, conflicts and dilemmas between modalities generates a more comprehensive understanding of each family member's unique experience regarding the abuse. With this increased understanding, the therapist can help the abused child reconnect to trustworthy family members in a new way (Sheinberg, True & Fraenkel, 1994).

Further, it is believed that a multimodal approach, with its variety of contexts, offers different perspectives on the abuse experience. These multiple perspectives encourage children as well as adult family members to accept the complex and contradictory feelings often associated with sexual abuse. The multimodal approach allows the use of special therapeutic opportunities, three of which are highlighted in this research (Sheinberg, True & Fraenkel, 1994).

First, the different modalities are used to offer the abused child and other family members the opportunity to generate multiple "Self accounts", or different ways of conceiving themselves as persons in different relationships. Second, by maintaining the focus on material that emerges across therapeutic modalities rather then solely within each modality, research finds there is no need to enter a therapeutic encounter with a predetermined agenda. Rather, the child's participation in individual, group and family

therapy leads naturally to the emergence of feelings and concerns relevant to the victims own incest experience. In other words, this format allows the content of the therapy to be client generated (Sheinberg, True & Fraenkel, 1994).

Thirdly, the therapist encourages the child and family members to participate actively in deciding when and how to transfer material between modalities, and with whom the information is shared. This is the "decision dialogue" and is viewed as a central therapeutic contribution to the child's developing sense of personal agency. Further, because the child engages in deciding with whom to share material about themselves, the decision dialogue brings forth decisions and feelings that keep them from sharing with family members. With these concerns articulated by the victim, the therapist is then able to understand and respond to the relational difficulties that constrain the child from turning towards those family members (Sheinberg, True & Fraenkel, 1994).

In therapy, the meanings surrounding the abuse should be discussed at length, paying close attention to staying open to the idea that there are multiple ways to describe the experience and multiple ways to reframe the event. The emphasis also remains on helping the victim to express and consider often multiple contradictory feelings without feeling obligated to select one over another. A combination of role-play, open ended stories, games and drawings can also allow children to express feelings surrounding the abuse more specifically to the adults and the therapist. The criteria for completion of therapy is when; The victim has someone in the family they can go to when they are upset. The victim can talk of a range of feelings when upset in therapy and on the outside. The victim is doing as well in school as they were prior to the incident(s) occurring. The victim is not symptomatic (bed-wetting, not-sleeping, nightmares) (Steinberg, True & Fraenkel, 1994).

Focal Approach

A second approach that can be used in therapy is known as the Focal Approach. This purely family systems approach considers almost exclusively the systemic complications and contributions to the abuse. The basic outline for the approach is as follows; The approach is developmentally oriented and considers the health of the family in the context of the lifestyle within and across generations. Therapy is explicitly offered, and the approach is oriented to any possible pathology in the family while not ignoring the family strengths. The family is viewed as a system which has human beings as its components embedded in a social context. Thus, societies attitudes towards men, women and children are represented within the family and manifested through the personal histories of the parents Bentovim & Ratner, 1991).

Traumatic events are regarded as the prime originator of disturbances that bring families to professional help. Such events are associated with intense anxiety and helplessness. They frequently cannot be talked about and are represented by repetitive patterns of action that are dysfunctional, reflecting the feelings of helplessness. Such patterns can include sexually abusive patterns towards children. We therefore hold that therapeutic work has to change such patterns of actions, as well as deal with the original traumatic experience(s). In other words the family has to both change its way of being and gain a clearer understanding of how the dysfunction arose (Bentovim & Ratner, 1991).

The course of therapy includes assessment of the family, creating a focal hypothesis which includes diagnosing the symptomology connected to the general interaction of the family along with the question of "Can the family be restated in a family interactional form or as an expression of family meaning?" Next asked is "What is the function of the current interaction and what would happen if the current interaction was not present?" Still in pursuit of the focal hypothesis, asked is "What is the disaster feared by the family that maintains the current interaction?" Finally, asked is "Is their a plausible link from the current events to the original traumatic events and stressful experiences?" (Bentovim & Ratner, 1991).

Finally, the focal hypothesis is summarized and the changes to be achieved in therapeutic work can take shape. Specific techniques at this stage can include family sculpting, creation of a therapeutic metaphor, the therapist meeting with the parents without the children, exploration of the parental style, apology session and finally the exploration of the abuse. As a final note, the parents are asked by the therapist to make contact with the police to report the abuse. If the parents remain unwilling or unable to do so, it remains the responsibility of the therapist to make sure the authorities are contacted and a report of child sexual abuse is made (Bentovim & Ratner, 1991).

Conclusion

Finally as a footnote, it is both important and well documented in the literature for the parents who are involved in sibling sexual abuse and all child sexual abuse cases not to overreact as a first response to their child(ren). Parents rather need to react calmly and decisively. When parents talk to their child surrounding what has occurred it is important to remain as neutral as possible. Children often will shut down if they are exposed to a flood of traumatic reaction surrounding the abuse especially if it received from their own parent (Baker, 2002). Parents should be calm and cool as they try and gather information to then pass on to a trained therapist and the authorities in order to develop an understanding of how they can keep the child safe and process the experience of what has occurred to the family.

References

 

Baker, L. Protecting Your Child From Sexual Predators. 2002.

 

Bentovim, A., & Ratner, H. Sibling Abuse in a Reconstituted Family: A Focal Family Therapy Approach. Casebook of Sexual Abuse Treatment, 1991.

 

Sheinberg, M., True, F., & Fraenkel, P. Treating the Sexually Abused Child: A Recursive Multimodal Approach. Family Process, 1994.