Healing After Childhood Sexual Assault: Meaning Making and Post-Traumatic Growth

Vilenica, S., Shakespeare-Finch, J., & Obst, P. | School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia | Published in Counselling Psychology Quarterly

Abstract

Childhood sexual assault (CSA) is one of the most devastating of all traumatic experiences, with population studies documenting survivors experiencing higher levels of pathology than survivors of other traumatic events. Yet recent research has demonstrated that far from being permanently crippled by their experiences, many adult survivors of CSA manage to heal and move forward in their lives to experience a rich and fulfilling existence.

In this article, two case studies are presented to provide a detailed account of how people who have experienced CSA may find a pathway to healing. Our data demonstrate that meaning making — spiritual or otherwise — is a pivotal part of acceptance of CSA and ensuing growth. The case studies amplify the unique journeys of two women along with underlying similarities in their pathways to healing. Clinical implications of the research are discussed and specific strategies for encouraging healing and growth are outlined.

Keywords: child sexual abuse, child sexual assault, post-traumatic growth, meaning making, healing

Introduction

Sexual assault in childhood is one of the most personally impactful traumas an individual can experience (Frans et al., 2005; Hapke et al., 2006). After exposure to a traumatic event, many people experience initial, short-term post-traumatic symptoms that in most cases abate with time, with only a minority of people going on to develop post-traumatic stress disorder (PTSD; Bonanno, 2004).

For those who experience childhood sexual assault (CSA), however, the trajectory for post-traumatic symptoms is significantly different. Those who experience CSA are not only more likely to develop PTSD at some stage — compared to survivors of other sorts of trauma — but also more likely to endure lifelong PTSD symptoms (Rodrigues, Vande Kemp, & Foy, 1998), a testament to how powerfully impactful sexual trauma can be.

The Wide-Ranging Impact of CSA

The negative effects following CSA are wide-ranging and highly individual. Commonly reported concerns include:

Major depression (Nelson et al., 2002)
Sexual dysfunction (Gold et al., 1999)
Anxiety (Calam et al., 1998)
Suicidal ideation and attempts (Belik et al., 2009)

Perhaps the most devastating outcome associated with CSA is the negative impact on one’s sense of self. People with a history of CSA often report long-standing, negative core beliefs about themselves — perceptions of the self as “wrong,” “damaged,” or somehow separate from others (Isely et al., 2008; Zinzow et al., 2010). These negative core beliefs have been reported by both those who endured repeated abuse over many years and those who experienced a single intrusive contact abuse act (Isely et al., 2008; Molnar, Buka, & Kessler, 2001).

Contributing to these negative core beliefs is an inherent dynamic of CSA, which often involves feelings of complicity and responsibility for the abuse, as well as deep feelings of shame and guilt on behalf of the child (Coffey et al., 1996). All of these factors, compounded by the occurrence of this particular trauma during the formative years, have the potential to be profoundly devastating to a child’s developing sense of self.

The Role of Belief Systems

Current theories of coping after trauma emphasise how traumatic events can be powerful enough to shake the foundations of belief systems — the fundamental assumptions people hold that provide a sense of predictability and meaning in life (Calhoun & Tedeschi, 2006; Janoff-Bulman, 2006).

Janoff-Bulman (1989) conceptualised these fundamental assumptions in three primary areas:

Beliefs that people are basically good, helpful, and kind
World view assumptions such as “people get what they deserve”
Beliefs about the self as a good or worthy individual

These core beliefs are threatened by traumatic events due to the dissonance between previous experience and current reality. Healing then becomes a process of learning to integrate new knowledge about the unpredictability of life, malevolence, and senselessness into a transformed understanding of oneself (Calhoun & Tedeschi, 2006; Janoff-Bulman, 2006).

When trauma occurs during childhood and adolescence — the life stages where assumptive worlds begin forming — the impact appears less about shaking established foundations and more about shaping emerging ones. Many healed and healing survivors of CSA report that only later in life, at the point where they acknowledged how deeply the abuse had negatively affected the way they saw themselves and their world, did the real pain and real healing begin (Bogar & Hulse-Killacky, 2006; O’Dougherty Wright et al., 2007; Woodward & Joseph, 2003).

Meaning Making and Post-Traumatic Growth

The active process of transformation — or reconstruction of inner global views — has been termed “meaning making” (Joseph & Lindley, 2005; Park & Ali, 2006) and appears to be an important component of wellness and growth after trauma (Park, 2010). Meaning making refers to active cognitive engagement to restore or resolve ruptures within one’s global sense of meaning after a life-shattering event.

In action, meaning making may manifest as:

A new way of understanding a particular situation
Reforming beliefs one holds of self, the world, and others
Gaining internal consistency between beliefs and goals (Park & Ali, 2006)

Research has confirmed that post-traumatic growth (PTG) can be an outcome of the shattering of assumptions that accompanies highly stressful life events, with greater PTG found in those with higher levels of deliberate rumination (Cann, Calhoun, & Tedeschi, 2010). PTG can include positive changes in self, a strengthening in relationships with others, and a change in spirituality or philosophy of life (Calhoun & Tedeschi, 2006).

Method

Participants

The two women discussed in this article are participants in a larger ongoing research project examining pathways to healing and growth after sexual assault in childhood. Participation was based on self-selection on three primary conditions:

The sexual assault must have involved physical contact
Participants must have deemed their experiences to be traumatic
Participants had to consider themselves healed from the sexual trauma or well into their healing journey

The women were 52 (Participant 1) and 44 years of age (Participant 2) at the time of interview. The case studies were chosen for their representativeness of broader themes in the study, the clarity with which the women reported their healing journeys, and their disparity in terms of the onset and duration of offences.

Procedure

Participants were recruited via a general public invitation through a state-wide radio station. Participation involved a 90-minute semi-structured phone interview covering a brief history of the assault, the initial and later effects of the abuse, what contributed to their healing, and any potential benefits participants felt to have come out of their healing journeys. Each interview was transcribed verbatim.

Data exploration was conducted using interpretive phenomenological analysis (IPA), an idiographic approach where each participant’s narrative is individually analysed before any generalisations are made to other cases (Langdridge, 2004).

Results

Global Beliefs: The Impact of Trauma

Participant 1 describes the seismic change that occurred at the core of her being as a result of the first rape:

“I died, meaning the person I was or was developing into was no more. That person still isn’t here today. That person was shattered the moment of that first abuse. I didn’t know who or what I was. I became segregated within myself. It was like being, my whole soul had been splintered into thousands of pieces and I didn’t know how to put it together again.” — Participant 1

Beliefs About Self

Both women reflected on the self-beliefs they held before their healing journey began:

“I didn’t have any real values or beliefs, because it didn’t matter what you believed in or what values you had, because they could be taken away from you. There was always in the back of my mind the idea that I wasn’t good enough, that I was guilty for what had happened to me or what I let happen, so nothing good should happen to me unless I pay for it.” — Participant 1

“I couldn’t handle being less than perfect, I just had to be. If I was less than perfect then I was that hideous slimy creature that I thought I was because I had been raped. What I couldn’t articulate at the time was really profound shame.” — Participant 2

The sexual assault had a profound impact on the way the women came to view themselves. Beliefs of being unworthy, guilty, or hideous stem from deep feelings of shame and perceived guilt over the assaults — incorrectly internalising the assaults as something they contributed to and were responsible for.

Beliefs About the World and Others

Both women spoke of holding global negative beliefs about others, the world, and their place in it:

“I trusted no one, the moment it happened the first time. I didn’t believe in role models because of my belief that everyone had something bad happen to them. I believed all the men were going to abuse me.” — Participant 1

“After those two events I had a really weird idea of what my value was in the world. I assumed that my value to boys and men was sex, and so I had way, way too many sexual relationships with people because I thought that is what boys want and they are going to take it so I might as well give it to them.” — Participant 2

Avoidance and Dissociation

As a way of coping as children, both women used avoidance and dissociation from their experience:

“In my 20s it didn’t have an effect on me. Of course it did, but I believed that it was just something I could tell people. It was like in the third person. It was this little girl, but it wasn’t me.” — Participant 1

“I hadn’t given much thought to being sexually assaulted, it was just something that I thought of as… I went to school and I was sexually assaulted. It was all the same.” — Participant 2

Without the defence mechanism of dissociation, life could become overwhelming to the point of unbearable. Staying disconnected from the emotional intensity of the trauma provided the women a measure of functionality in their daily lives before they were ready to honestly accept their experiences.

The Healing Journey

Turning Points

For both women there came a time when avoidance of the depth of their experiences could no longer be maintained. Both were confronted with the necessity to accept the truth of what they had been through:

“I suppose the biggest influence — I planned a trip around Australia, the first time I was ever going to be alone in my life. It was pretty terrifying to think of that but I knew I had to do that. I knew I had to get out of my life as it was and get away from it all to be able to focus on being able to heal.” — Participant 1

“It was exactly 10 years after the first rape that I acknowledged what had happened and called it what it was. That was actually when it became really overwhelming. To call it rape. It was like a pit of horror to take the lid off the box and actually look inside.” — Participant 2

Awareness of the Inner World

During this stage, each woman confronted significant insights about their inner worlds:

“I learnt that I can be by myself and not be scared of being by myself. Accepting all my faults and believing that I was a good person and it wasn’t my fault and I wasn’t guilty of that happening to me. Mostly I did it by myself, reading books and sitting with myself, and learning how to meditate.” — Participant 1

The Role of Counselling

There naturally came a time for both women when each sought counselling to work on deeper issues stemming from the abuse. Both emphasised the crucial importance of trust in the therapeutic relationship:

“Finding someone I trusted was a huge thing, because if you don’t trust the person you are talking to then you won’t bring it out, you just won’t, you will hide stuff.” — Participant 1

“There were no particular strategies or revelations; it was just the slow work of healing.” — Participant 2

Meaning Making: Reconstructing the Self

Both women reported that it was in working with their counsellors where they began to look at their core beliefs and learn how to create new, self-congruent ones:

“Learning how to focus on me and not turn away from myself and what had happened to me. And learning how to gradually change the way I was thinking, and change my ideas and values and beliefs, because everything was negative. I started looking at me, and trying to find the real me, because I had lost that person all those years ago.” — Participant 1

“I suppose the healing was going through and looking at my world view and my view of myself and unpicking it all and putting it back together again was the real nuts and bolts thing. It was the process of becoming a whole person and not a rape survivor.” — Participant 2

Understanding the way their global views were shaped by their traumatic experiences was deeply healing for both women. Negative beliefs of the self and world began to change through the process of first understanding what beliefs were held, knowing how they came to be, and then uncovering why they were untrue.

Transformation of Self

Both women reflected on the transformation that came through integration and acceptance of the trauma:

“Now I just see me. I am not defined by the abuse anymore. The abuse, although traumatic, was just a part of my life, there is so much more to me. My life is my own, I want to give, not take, and feel being a part of this world.” — Participant 1

“It is like a scar that has healed, you can see the scar is still there but there is not a wound there anymore. It is not a horrible disfiguring scar anymore — it is a part of lots of other things that have happened in my life that have all made me who I am now.” — Participant 2

Post-Traumatic Growth

Both women spoke of how their lives were enriched by working through their suffering:

“There is so much that has come good out of, dare I say, being abused. Everything that happened to me has eventually helped me be the person I am today. It has helped prepare me for other parts of my life.” — Participant 1

“It has made me an optimistic person, knowing that you do get better and that you can survive really traumatic events. And being able to listen to other people who have trauma in their lives and being able to bring compassion into their lives.” — Participant 2

Discussion

The preceding exploration of the impact of CSA revealed how the experience of sexual trauma shaped the fundamental, global beliefs of the women reviewed in this article. Far from holding positive views of benevolence, meaningfulness of the world, and worthiness of self (Janoff-Bulman, 1989), both women reported that sexual trauma had a fundamentally negative impact on their emerging global views.

Despite the offences occurring at widely disparate times and differing in duration, the beliefs the women held were remarkably similar — highlighting the critical effect that sexual trauma exerts on emerging beliefs, regardless of whether the assaults occurred during childhood or early adolescence.

The Process of Belief Change

This study shows that for women who suffered CSA, the modification of beliefs occurred when they understood:

What beliefs they held
How those beliefs historically developed
Why those beliefs were ultimately untrue

Through counselling, both women began to understand the fundamental beliefs they held — beliefs that formerly were out of their conscious awareness because they were so entrenched in patterns of thought. The conditions under which beliefs changed appeared to be when the thought of facing their fears became less frightening than continuing to live under them.

An important finding (echoed in the larger study) is that the conditions under which beliefs came to be changed almost exclusively arose via the assistance of another, most often within a therapeutic relationship. Working within a trusted therapeutic relationship that provides acceptance and non-judgement can provide individuals with the safety required to look deeply at their often conflicted belief structures so that change can occur.

From Defined by Abuse to Whole Person

What occurred as a result of re-working their beliefs of self, world, and others was a total change in their inner relationship — moving from hostile and negative to connected and optimistic. Both women reported a fundamental change in their view of self: from once feeling defined by the abuse to now knowing that it is but one part of the larger whole that makes up who they are.

They accepted the abuse as part of the whole individual, rather than as the dominant or defining feature. This was the process of becoming “a whole person.”

Clinical Implications

The clinical implications of this study point specifically to the crucial role that beliefs play in one’s perception of reality, and as a consequence, how people come to see themselves, others, and their world.

Far from being static, negative beliefs can be highly malleable and can be fundamentally changed through awareness — and awareness itself can be curative (Chodron, 1997). When working with those who have suffered CSA, clinicians should:

Raise awareness of existing beliefs — Becoming aware of what beliefs are held is the first step to being able to change them.
Link beliefs to their historical root — Being able to connect beliefs to a historical context creates space for clients to see that their existing beliefs are not chosen but were shaped during a highly influential and formative stage of life.
Explore what the true beliefs actually are — Re-working beliefs needs to incorporate an understanding of why negative core beliefs are false, as well as an exploration to uncover what the person’s authentic beliefs actually are.
Allow time for the process — Re-working fundamental beliefs that have existed for years — and in many cases decades — is not a process that happens quickly or easily. Both therapist and client need to be mindful that this process takes time, effort, patience, and above all, compassion.

As is clearly evidenced here, change, healing, and growth after CSA is not only possible but perhaps an inevitable outcome of re-working belief structures — and one that is vital to establishing a healthier, more authentic way of being.

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Exploring the process of meaning making in healing and growth after childhood sexual assault: A case study approach