Understanding Child Sexual Abuse


Childhood sexual abuse is one of the most harmful experiences an individual can go through in their entire life. Often covered up and denied, by both the offender, and society at large, we’ve made great strides in exposing these wounds to the light and developing better treatments for those who have experienced this suffering.

This article reviews a number of elements in the understanding and treatment of child sexual abuse. Because most of the resources on sexual abuse examine women exclusively or primarily, they will be the focus of this article. I hope to write one on male survivors of sexual abuse soon.

Defining Child Sexual Abuse

The World Health Organization (WHO) defines child sexual abuse as “the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared, or else that violate the laws or social taboos of society” (WHO, 2006)

Prevalence of Child Sexual Abuse

In Canada, the rate of sexual assault of those under 18 is approximately 201 per 100,000 (Statistics Canada, 2008), while an Ontario study identified approximately 13% of females and 5% of males had reported sexual abuse. (MacMillan, et. al., 1997) US studies began in the 1950s and reported between 20 and 30% of men and women reported sexual contact with children. (Draucker & Martsolf, 2006; p. 2)

Impact of Child Sexual Abuse

Child sexual abuse has been associated with life-long emotional health challenges including “the development of a range of psychiatric difficulties, including depression…self-harm…anxiety disorders…and post-traumatic stress disorder” (Barrera, Calderon & Bell, 2013) Other negative impacts can include substance abuse (Sartor, et. al., 2013) and risky sexual behaviour. (Roemmele, & Messman-Moore, 2011)

As well, survivors of childhood sexual abuse are also at greater risk for developing physical health issues, with Moeller et. al. (1993) reporting that women who were abused reported “significantly more hospitalizations for illnesses, a greater number of physical and psychological problems, and lower ratings of their overall health” than non-abused women.

False and Recovered Memories

There is a controversy in the treatment of survivors of sexual abuse about the potential for recovered memories, “the recall of traumatic events not previously remembered” (Draucker & Martsolf, 2006; p. 15) and false memories, allegedly implanted by the therapist using improper or even fraudulent techniques.

The general scientific consensus (e.g. as summed up by Ilsley (1998) is that while false memories can occur, they are the exception rather than the rule. Therefore care must be taken to avoid introducing these memories, but survivors of sexual abuse should be believed in the absence of information suggesting otherwise. This does not mean that criminal prosecution should adopt a different standard (indeed, many individuals who receive treatment for sexual abuse could never secure convictions) but merely that the potential for false memories should not dissuade a therapist from providing treatment.

The research is continuing and therefore counsellors should keep themselves informed on the latest developments in this area.

Phase Model for Treatment of Child Sexual Abuse

A phase-based model is a method of treating childhood sexual abuse that is focused on multiple distinct stages of the treatment, with specific goals for each stage. The following example of phase-treatment comes from Courtois (2004):

Phase 1

The goals of phase 1 are to explore the client’s motivation to get better, ensure informed consent (including the client’s rights and responsibilities), and educating the client on what psychotherapy is. This is also the time to establish an effective therapeutic alliance with the client, so that they can ensure the most success.

As Courtois notes, phase 1 doesn’t look much different from other forms of psychotherapy, though it may take much longer to establish in sexual abuse than other presenting problems. The acronym RICH is used as a short-hand for the four goals of phase 1:

  • Respect
  • Information
  • Connection
  • Hope

Building life skills is also a significant component of phase 1. These skills can include techniques like deep breathing, communicating one’s needs, identifying one’s emotional state, coping skills, and a variety of others that may depend on the specific client deficits.

Phase 2

The goals of phase 2 are to begin the process of developing an integrated understanding of the abuse. The client begins to construct a narrative to objectively describe the abuse in terms of the who, what, where, why, and their own reactions to the experience.

Desensitization through graduated exposure therapy is used to help reduce the impact of dissociation and allow the client to separate themselves from the abuse experience. This has been found to be an effective way of increasing the client’s ability to control their emotional regulation and decrease other symptoms. (Cloitre, 2002)

Phase 3

The final phase involves fine-tuning the skills developed in stage 1 and begins to build a new life post-abuse. At this point the client can begin tackling elements typical or a more normal range of experiences including “the development of trustworthy relationships and intimacy, sexual functioning, parenting, career and other life decisions, ongoing decisions/ discussions with abusive others, and so forth.” (Courtois, 2004)

Implications for Crisis Intervention

Helpline callers or chat and text visitor may disclosure historical sexual abuse to you. If they do, there are some things you should keep in mind to respond most effectively:

  • Check for immediate safety if it is not clear the abuse was in the past – this is especially important in a situation where the person is still young
  • Adopt a supportive tone without gawking or getting shocked. This can further stigmatize the individual and heighten their sense of isolation
  • Consider supportive responses as noted by Draucker & Martsolf (2006; p. 44):
    • Acknowledging the difficult step of disclosing
    • Offering support and indicating one’s availability after the session during which the client disclosed
    • Inviting the client to discuss the abuse at his or her own pace
    • Evaluating the client’s mental status and determining any immediate safety concerns (e.g. suicidal thoughts)
  • On the phone, watch for symptoms of dissociation or Dissociative Identity Disorder (DID)
    • If the individual starts to dissociate, try a grounding exercise: have them identify things they can see, hear (including your voice), or smell in the room. This will help them stay focused
    • If a person appears to switch personalities, remain calm but do not breach confidentiality. Treat the second personality as another person but work to get them medical assistance as soon as possible

Additional Resources

The free e-course “Addressing Past Sexual Assault in Clinical Settings” is provided by Women’s College Hospital in Toronto and funded by the Government of Ontario.

The book Counselling Survivors of Childhood Sexual Abuse provides a comprehensive review of the assessment and treatment of sexual abuse in children.

The office of Juvenile Justice and Deliquency Prevention hosted a webinar titled “Male Survivors of Sexual Abuse” which will hopefully be available on their website for viewing soon.


Barrera, M., Calderón, L., & Bell, V. (2013). The Cognitive Impact of Sexual Abuse and PTSD in Children: A Neuropsychological Study. Journal Of Child Sexual Abuse, 22(6), 625-638. doi:10.1080/10538712.2013.811141

Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal Of Consulting And Clinical Psychology, 70(5), 1067-1074. doi:10.1037/0022-006X.70.5.1067

Courtois, C.A. (2004) Complex Trauma, Complex Reactions: Assessment and Treatment. Psychotherapy. 41(4) 214-425. DOI 10.1037/0033-3204.41.4.412. Retrieved on October 8, 2016 from http://www.dhss.delaware.gov/dsamh/files/si10_1396_article1.pdf

Draucker, C.B. & Martsolf, D.S. (2006) Counselling Survivors of Childhood Sexual Abuse. 3rd Ed. London: SAGE Publications.

Ilsley, J. K. (1998). Recovered memories of childhood abuse : We must tell patients that they were not to blame. BMJ : British Medical Journal, 317(7164), 1012.

MacMillan, H.L., Fleming, J.E., Trocme, N., Boyle, M.H., Wong, M., Racine, Y.A., Bearslee, W.R. & Offord, D.R. (1997) JAMA. Prevalence of Child Physical and Sexual Abuse in the Community. 278(2). 131-135

Moeller, T. P., Bachmann, G. A., & Moeller, J. R. (1993). The combined effects of physical, sexual, and emotional abuse during childhood: long-term health consequences for women. Child Abuse And Neglect, (5), 623.

Roemmele, M., & Messman-Moore, T. L. (2011). Child Abuse, Early Maladaptive Schemas, and Risky Sexual Behavior in College Women.Journal Of Child Sexual Abuse, 20(3), 264-283. doi:10.1080/10538712.2011.575445

Sartor, C. E., Waldron, M., Duncan, A. E., Grant, J. D., McCutcheon, V. V., Nelson, E. C., & Heath, A. C. (2013). Childhood sexual abuse and early substance use in adolescent girls: the role of familial influences. Addiction, 108(5), 993-1000. doi:10.1111/add.12115

Statistics Canada. (2008) Child and Youth Victims of Police-reported Violent Crime, 2008. Retrieved on October 8, 2016 from http://www.statcan.gc.ca/pub/85f0033m/2010023/part-partie1-eng.htm

World Health Organisation (WHO). (2006) Preventing child maltreatment: a guide to taking and generating evidence. Retrieved on October 8, 2016 from http://apps.who.int/iris/bitstream/10665/43499/1/9241594365_eng.pdf. Geneva: World Health Organisation (WHO).

Cite this article as: MacDonald, D.K., (2016), "Understanding Child Sexual Abuse," retrieved on June 26, 2019 from http://dustinkmacdonald.com/understanding-child-sexual-abuse/.
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False Accusations of Sexual Violence

A common question asked by men and women is what percent of sexual assault accusations (almost always assumed to be by women against men) are false?

False accusations of sexual assault result in significant upheaval in an individual’s life. An individual who is accused of sexual assault may be terminated from their employment, removed from their school, and face impairment in their relationships. This is true whether they are found guilty or not. An additional complication is that newspapers often publish the names of accused individuals, regardless of their conviction. Rape shield laws usually prevent the publication of the accuser.

In the United States, enforcement of the provisions of Title IX have resulted in individuals removed from their universities without trial, which may be a violation of their due process and civil rights.

There is significant debate on the prevalence rates of false accusations which depend on the methodology of the studies consulted and the source.

Police Beliefs Regarding Sexual Assault

Jordan (2004) notes a 1980 study that found that police believed an average of 3 out of 5 rape accusations were false, and a 1997 study where at least half of the surveyed police believed 25% of rape accusations to be false. This reflected police belief that rapes are primarily conducted by strangers off the street, not by people who went out for the night with their rapist. Additional studies noted by Jordan have false rapes pegged police at 50-80%. It is clear that many police officers believe false rape accusations are common. These studies all seem to refer exclusively to male perpetrators and female victims.

Characteristics noted by Jordan as influencing police decisions to classify a case as false include:

  • Impaired (drugs or alcohol)
  • A delay in reporting the crime to police
  • Having previously had consensual sex with the accused
  • Having a previous rape or abuse
  • Mental health issues
  • Perceiving the accuser as immoral
  • An intellectual impairment
  • A previous false rape complaint
  • Concealing information important to the investigation

One factor noted that strongly influenced the rate of genuineness was the presence of physical injuries, which may not be present in many instances of sexual violence. Johnson, Griffith & Barnaby (2013) discuss the frequent error in suspect identification when the perpetrator is black and the victim is white and how this may influence false accusations.

Prevalence of False Accusations

Spohn, White & Tellis (2014), who examined police files of the LAPD and found a rate of 4.5%, while Lonsway, Archambault & Lisak (2009) found a rate of “between 2 and 8%” when studies with strong methodology have been taken into account. This last study notes the issues with police classifications that may result in the under-reporting of the rate of sexual violence.

Spohn, White & Tellis cite other studies in their literature review, which are reproduced here for reference:

  • Kelly (2010) found a rate of 3% – This study is discussed in the Opposing Narrative section.
  • Lisak (2010) found a rate of 6%

Spohn et. al. note methodological issues with both of these studies.

Opposing Narrative

Kelly (2010) states that rape is a gendered crime, “which creates conditions of virtual impunity for predatory men.” It also states there is a lack of services for women who are victim-survivors of sexual violence.

Kelly, Lovett & Regan (2005) notes that of the 8% of rape cases declared false in their first study, only 18% had a named suspect, and less than 3% involved an arrest. This contradicts the belief that many men are being arrested for false accusations.

In their second study, “rates of false allegations ranged between 1% and 9%, with the majority at 6% or less.” Kelly’s rate of 3% was determined by excluding cases where the suspect’s credibility was based on the issues identified by Jordan above.

O’Neal et. al. (2014) identify five categories that may result in false accusations:

  1. Avoiding trouble
  2. Providing an alibi
  3. Anger or revenge
  4. Attention seeking
  5. Mental illness
  6. Guilt or remorse.

They state that a more complex view of false accusations is necessary, to take into account the personal factors that may lead to a false accusation.

Potential Solutions

There are few solutions to the problem of false accusation as one cannot control an individual’s statements to police. Improving the coding standards of police to ensure that accusations dropped for lack of evidence or retracted because of a disinterest in the legal process are not automatically classified as false.

Additionally, cases where falsehoods have been proven, prosecution of that individual is necessary in order to deter future instances of false accusation. Edit Oct-20/2015: I’d like to clarify this statement. In cases where beyond a reasonable doubt (e.g. a confession or video taped exculpatory evidence) an accusation of sexual assault was made in bad faith, it is important that, as with all false police reports involving major crimes, the accuser is prosecuted. This should hold true regardless of gender of the perpetrator or victim.

Rewriting rape shields laws so as to protect the names of both the accused and the accuser would prevent false accusations from pre-emptively causing damage to the life of someone who has not been convicted yet.

Finally, removing the ability of campuses in the United States to remove individuals who have not been convicted (indeed, or even charged) of a crime may improve their adherence to due process and protection of individuals civil rights.

Limitations in the Literature

One area that has not, as far as I know, received any exploration in the literature is the prevalence of false accusations by men against women. Interestingly, while sexual assault is assumed to be primarily by male perpetrators against women victims/survivors, the assumption is reversed in false accusations (with nobody believing men would make false accusations of sexual violence against a woman.)


Johnson, M.B., Griffith, S., Barnaby, C.Y. (2013) African Americans Wrongly Convicted of Sexual Assault Against Whites: Eyewitness Error and Other Case Features. Journal of Ethnicity in Criminal Justice, 11:277–294. doi: 10.1080/15377938.2013.813285.

Jordan, J. (2004) Beyond belief? Police, rape and women’s credibility. Criminal Justice. 1466–8025; Vol: 4(1): 29–59. doi: 10.1177/1466802504042222

Kelly, L. (2010) “The (In)Credible Words of Women: False Allegations in European Rape Research,” 16 Violence Against Women 1345–55.

Lisak, D, Gardinier, L., S.C. Nicksa, & Cote, A.M. (2010) False Allegations of Sexual Assault: An Analysis of Ten Years of Reported Case. Violence Against Women 1318–34.

Lonsway, K.A., Archambault, J., & Lisak D. (2009) False Reports: Moving Beyond the Issue to Successfully Investigate and Prosecute Non-Stranger Sexual Assault. The Voice. 1–11.

O’Neal, E. N., Spohn, C., Tellis, K. & White, C. (2014) The Truth Behind the Lies: The Complex Motivations for False Allegations of Sexual Assault. Women & Criminal Justice, 24:324–340.

Spohn, C., White, C., Tellis, K. (2014) Unfounding Sexual Assault: Examining the Decision to Unfound and Identifying False Reports. Law & Society Review. (48)1.

Cite this article as: MacDonald, D.K., (2015), "False Accusations of Sexual Violence," retrieved on June 26, 2019 from http://dustinkmacdonald.com/false-accusations-of-sexual-violence/.

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Efficacy of Sex Offender Counselling

July 20, 2016 Note: This article’s title has changed; the URL remains unchanged

Social Worker and Sex Offender

A social worker based in North York is coming before the disciplinary committee of the Ontario College of Social Workers and Social Service Workers, because of his conviction for sexual interference and sexual assault. This would not be unusual in it’s own right, except that he has been cited in court records as a counsellor/therapist for sex offenders released into the community.

This got me interested in the evidence for rehabilitation and counselling/psychotherapy for sex offenders.

Sex Offender Rehabilitation

Levenson & Prescott’s 2014 review summarized the existing body of research:

  • A 1989 review of sex offender recidivism found that because of methodological errors, no statistically significant differences in recidivism were reported
  • A 2013 re-review found more weaknesses, including the lack of randomized controlled trials and highlighting the ethical issues inherent with control groups receiving no treatment
  • The age of the studies used for both reviews was of concern; most of them collected before CBT became the standard

Their review continues, noting conflicting research but also that the same elements of methodological rigour associated with well-designed studies may also mask treatment effects.

For instance, if a study ends after one year and a client is still scoring “high” on an assessment tool, does that mean the treatment has failed? What about if their tool declines in a non-statistically significant way? What if they haven’t reoffended in that time? What if decline continues beyond the end of the study but that information isn’t recorded?

Additionally, treatment manuals (often required in studies to ensure that treatment is consistent) can limit the ability of the therapist to be flexible to client needs, and may make their therapy less effective as they are constrained by limits on number and length of sessions and precluded from using techniques outside of, for instance, the cognitive behavioural repertoire even if those techniques may show promise with the client.

The Sex Offender Treatment and Evaluation Project (SOTEP) program was a “compared the reoffense rates of offenders treated in an inpatient relapse prevention (RP) program with the rates of offenders in two (untreated) prison control groups” (Marques, et. al., 2005) It had negative results – that is, the program was not any more effective than the control group in controlling relapse rates as a whole.

One interesting finding though, was that individuals who met their treatment goals had lower rates of re-offending than those who merely completed the program (or were in the control group) who did not reoffend.

Psychotherapy for sex offenders is something that is new to me — I knew it was practiced but knew very little about it before this blog post (and after reading a few articles have still only scratched the surface), but it appears to a field in it’s infancy as far as research converted into practice goes.

Additional Reading:


Levenson, J., Prescott, D.S. (2014): Déjà vu: from Furby to Långström and the evaluation of sex offender treatment effectiveness, Journal of Sexual Aggression: An international, interdisciplinary forum for research, theory and practice, DOI: 10.1080/13552600.2013.867078

Marques, J.K., Wiederanders, M., Day, D.M., Nelson, C., van Ommerman, A. “Effects of a relapse prevention program on sexual recidivism: final results from California’s sex offender treatment and evaluation project (SOTEP).” Journal of Sex Abuse. 2005. 17(1); 79-107

Cite this article as: MacDonald, D.K., (2015), "Efficacy of Sex Offender Counselling," retrieved on June 26, 2019 from http://dustinkmacdonald.com/does-sex-offender-counselling-work/.

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How to Help People Experiencing Sexual Violence

Sexual violence is a term that applies to a number of crimes including sexual assault, sexual harassment, rape, and any other scenario where a person has experienced unwanted sexual contact or the threat of unwanted sexual contact.

At Durham College and UOIT, I sat on a Working Group that drafted a new “Sexual Violence Response Protocol.” The impetus for the formation of this working group was because of a posting on a Facebook page, Spotted at DC/UOIT. This page allows people to submit posts about the college and students which are posted anonymously.

In the days after CampusFest, the orientation event, a student posted that she had met a man at the beginning of the night and explained she wasn’t interested in having sex. Later in the night, after many drinks, they had sex; clearly she felt taken advantage of (and stated as much.) This was an obvious case of sexual violence, as she was too drunk to consent.

Unfortunately, the response from the campus community was not one of warmth and acceptance, but one of victim-blaming. While the post was deleted, the comments (from both men and women) were focused on the amount of alcohol she had drank. Obviously that was not a helpful response.

A group of concerned students (including a student who later became a member of the working group with me) spoke to the Durham College Leadership Team. This led to the formation of a “Building Respect” team and a smaller working group that drafted a new policy.

The old policy was focused on a Campus Safety model. If you reported sexual violence, you would be sent to Campus Security; if the event involved a student, an assessment would be made to determine whether the student posed a threat. Information could be passed to the police and you could referred to other resources like the Durham Region Domestic Violence and Sexual Assault Care Centre (DVSACC), as well as counselling, but for most people it was not a good experience.

The new model involves:

  • Single access point phone number
  • Focus on emotional support – what does the person in front of us want?
  • Respect and non-judgemental support
  • Training for Outreach Services, Campus Athletics and other front-line workers
  • Counselling referrals

The new protocol provides options for every situation, from someone who is reporting sexual violence anonymously to someone who wishes for direct police intervention – and any situation in between.

Elements for Helping Sexual Violence Survivors

  • Believe the person. Nobody asks to be sexually assaulted, and it doesn’t matter what elements precipitated the assault (clothing, intoxication, choice of transportation, etc.)
  • Tell the person that the violence was not their fault or responsibility. Part of the reason that reports of sexual violence are so low is the tendency to self-rationalize that it was not an assault or it was the fault of the survivor.
  • Validate the survivor’s feelings. After sexual violence, a survivor can be feeling a range of experiences including guilt, regret, anger, sadness, or simply numbness. All these experiences are okay.
  • The survivor may not want referrals. They may not want a solution. A survivor may not be able to talk about much. Stay with them. Simply listen. Be okay with silence.
  • Refer if necessary. Help the survivor identify or access the resources that they are interested in, while respecting their decision not to do so. Remember that you should respect confidentiality as much as your position requires you to. Know before you get someone in front of you what your confidentiality requirements are.

Men in particular have a difficult time reporting sexual violence because of long-standing beliefs that men cannot be assaulted; the above elements are even more important with them because of the stigma of sexual assault.

Knowing resources for male survivors will become more important; many women who are victims of sexual violence experience a difficulty working with male care providers (therapists, doctors, advocates) and men may find themselves similarly limited. Respect their choices for gendered helpers as they work through the healing process.

Additional Training for Sexual Violence

The US Office for Victims of Crime (OVC) produces a program for training Sexual Assault Advocates. This includes a comprehensive instructor’s manual and complete training, including slides. While the information is American-based it is still a fantastic resource.

Local Rape Crisis Centres. For women who have experienced sexual violence from men, rape crisis centres often provide advocacy, crisis intervention, suicide prevention, and emotional support on 24-hour helplines and with trained rape counsellors. One limitation of the Rape Crisis Centres (at least in Ontario) is that many of them do not provide support to men or to trans women who have not had sexual reassignment surgery.

Cite this article as: MacDonald, D.K., (2015), "How to Help People Experiencing Sexual Violence," retrieved on June 26, 2019 from http://dustinkmacdonald.com/how-to-help-people-experiencing-sexual-violence/.

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