Child sexual abuse: A comprehensive family based approach to treatment

Narrow definitions of CSA which focus on repeated penetrative abuse yield prevalence rates of 2%
and 4% for males and females respectively. Most abusers are male. About two thirds of all victims
develop psychological symptoms and for a fifth these problems remain into adulthood. Children who
have been sexually abused show a range of conduct and emotional problems coupled with
oversexualized behaviour. Traumatic sexualization, stigmatization, betrayal and powerlessness are
four distinct yet related dynamics that account for the wide variety of symptoms shown by children
who have been sexually abused. The degree to which children develop the four traumagenic
dynamics and associated behaviour problems following sexual abuse is determined by stresses
associated with the abuse itself and the balance of risk and protective factors within the child's family
and social network. Case management requires the separation of the child and the abuser to prevent
further abuse. A family therapy based multisystemic programme of therapeutic intervention should
help the child process the trauma of the abuse and develop protective relationships with non-abusing
parents and assertiveness skills to prevent further abuse. For the abuser therapy focuses on letting
go of denial and developing and abuse free lifestyle.