Childhood sexual abuse is a topic that has received more attention in recent years. 28 to 33% of women and 12 to 18% of adult men have been victims of sexual abuse during childhood or youth (Roland, 2002, cited in Long, Burnett and Thomas, 2006). Sexual abuse, excluding inappropriate touching, and other types of sexual abuse are not reported as often, meaning the number of people who were sexually abused as children may actually be higher (Maltz , 2002). With such a high percentage of people having experienced childhood sexual abuse, it is likely that many people seeking therapy will have stories that include sexual abuse. It is essential that counselors are aware and familiar with the symptoms and long-term effects associated with childhood sexual abuse in order to better understand the elements necessary for counseling. This report will define childhood sexual abuse and examine the impact it can have, explore the long-term effects and symptoms associated with childhood sexual abuse, and discuss the implications for counseling. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get the original essay Childhood Sexual Abuse: Long-Term Effects and Solutions There are multiple forms of childhood sexual abuse. The abuse may involve the child and/or minor being seduced by a loved one or it may involve a violent assault committed by a complete stranger. Sexual abuse can be difficult to determine because it can take many different forms, different levels of frequency, as well as the various circumstances that can accompany it, as well as the different relationships that can be linked to it. Maltz (2002) presents the following definition: “Sexual abuse occurs whenever one person dominates and exploits another through sexual action or suggestion” (Maltz, 2001a, cited in Maltz, 2002, p. 321): Any sexual act, open or covert, between a child and an adult (or an older child, when the participation of the younger child is obtained by seduction or coercion). However childhood sexual abuse is defined, it generally has a negative and pervasive psychological impact on its victims. (p. 33) The majority of sexual abuse occurs in childhood, with incest being the most common form (Courtois, 1996, cited in Maltz, 2002). The impact of childhood sexual abuse varies from person to person and from case to case. One study compared the experiences of women who had experienced sexual violence from a family member with those of women who had experienced non-family violence. They found that women who experienced violence from a family member reported higher levels of depression and anxiety when thinking about the violence. Other variables that they found increased reported levels of distress were experiences involving more extensive sexual abuse, a higher number of sexual abuse experiences, and younger age at first sexual abuse experience. (Hartman, Finn and Leon, 1987). Although the nature and severity of the sexual act may have more serious consequences, many other factors can influence the degree of harm suffered by the victim. Other factors may include the individual's perspective, the internal resources the individual has access to, and the individual's level of support (Courtois, 1988, cited in Ratican, 1992). Although not all forms of childhood sexual abuse include direct contact, it is important thatTherapists understand that childhood sexual abuse can take many different forms that continue to sexually exploit and cause harm to the victim. The perpetrator(s) may exploit the child by introducing them to pornography, molesting them via the Internet, or manipulating them into taking pornographic photos. Childhood sexual abuse infringes on fundamental human rights. Children should be able to have sexual experiences at the appropriate time in their development and under their control and selection. The nature and dynamics of sexual abuse and sexually abusive relationships are often traumatic. When sexual abuse occurs during childhood, it can interfere with normal social growth and be the cause of many psychosocial problems (Maltz, 2002). Childhood sexual abuse has been associated with higher levels of depression, guilt, pity, self-blame, eating disorders, somatic concerns, anxiety, dissociative patterns, repression, denial, sexual problems and relationship problems. Depression is one of the most common long-term symptoms among survivors. Survivors may have difficulty externalizing the violence and thus have a negative view of themselves (Hartman et al., 1987). After years of negative thoughts about themselves, survivors experience feelings of worthlessness and avoid others because they believe they have nothing to offer (Long et al., 2006). Ratican (1992) describes symptoms of depression in survivors of child sexual abuse as feeling depressed most of the time, suicidal ideation, disrupted sleeping patterns, and disrupted eating habits. Survivors often experience guilt, shame, and self-blame. In many cases, it was noted that survivors often take personal responsibility for the abuse. When sexual abuse is committed by a trusted and valued adult, it can be difficult for children to see the abuser in a negative light, leaving them unable to view what happened as wrong. their fault. Survivors often blame themselves and internalize negative messages about themselves. Survivors tend to engage in more self-destructive behaviors and experience more suicidal ideation than those who were not abused (Browne & Finkelhor, 1986). Body issues and eating disorders have also been cited as a long-term effect of childhood sexual abuse. Ratican (1992) describes the symptoms of body image problems in sexually abused children as being related to feelings of dirtiness or ugliness, dissatisfaction with their body or appearance, disorders of diet and obesity. Survivor distress can also lead to somatic problems. One study found that female survivors reported significantly more medical problems than those who did not experience sexual abuse. The most common medial complaint was pelvic pain (Cunningham, Pearce, & Pearce, 1988). Some symptoms in survivors are often related to pelvic pain, gastrointestinal problems, headaches, and difficulty swallowing (Ratican, 1992). Stress and anxiety are often long-term effects of childhood sexual abuse. Childhood sexual abuse can be frightening and cause stress long after the experience(s) has ended. Survivors often suffer from chronic anxiety, stress, panic attacks, and phobias (Briere & Runtz, 1988, cited in Ratican, 1992). One area compared post-traumatic stress symptoms in veteransof Vietnam and adult survivors of childhood sexual abuse. The study found that childhood sexual abuse is traumatic and can result in symptoms compared to war-related trauma (McNew & Abell, 1995). Some survivors may have dissociated during the sexual abuse incident in order to protect themselves when it was too much for them to deal with mentally. As adults, they may still use this coping mechanism when they feel unsafe or threatened (King, 2009). Dissociation for survivors of childhood sexual abuse can include feelings of confusion, feelings of disorientation, nightmares, flashbacks, and difficulty experiencing feelings. Denial and depression over sexual abuse are considered by some to be long-term effects of childhood sexual abuse. Symptoms may include amnesia regarding parts of their childhood, denial of the effects and impact of the sexual abuse, and feeling that they should forget the abuse (Ratican, 1992). Whether or not survivors can forget their past experiences of childhood sexual abuse and later regain these memories is a controversial issue. Some therapists believe that sexual abuse can cause enough trauma that the victim forgets or represses what they felt about the experience as a coping mechanism. Others believe that the recovered memories are false or that the client is being guided to create them (King, 2009). Survivors of sexual abuse may have difficulty establishing interpersonal relationships. Symptoms related to childhood sexual abuse can hinder the maturation and development of relationships. Common relationship difficulties that survivors may experience are difficulty with trust, fear of intimacy, fear of being different or weird, difficulty establishing interpersonal boundaries, passive behaviors, and getting involved in abusive relationships (Ratican, 1992). Feinauer, Callahan, and Hilton (1996) examined the relationship between a person's ability to adjust to an intimate relationship, depression, and the severity of childhood maltreatment. Their study found that as the severity of abuse increased, scores measuring the ability to adjust to intimate relationships decreased. Sexual abuse is often initiated by someone the child loves and trusts, which breaks trust and can lead the child to believe that the people they love will harm them (Strean , 1988 cited in Pearson, 1994). Kessler and Bieschke (1999) establish a significant relationship between adult women who were sexually abused as children and victimization as adults. Many survivors experience sexual difficulties. Long-term effects of abuse suffered by the survivor, such as: depression and dissociative patterns. Affects survivors' ability to function sexually. Maltz (2001a, cited in Maltz, 2002) gives a list of ten main sexual symptoms that often result from experiences of sexual abuse: “avoidance of, fear of, or lack of interest in sex; consider sex as an obligation; experiencing negative feelings such as anger, disgust or guilt upon contact; have difficulty getting aroused or feeling sensations; feeling emotionally distant or absent during sex; having intrusive or disturbing sexual thoughts and images; engaging in compulsive or inappropriate sexual behavior; experience difficulty establishing or maintaining an intimate relationship; experiencing vaginal pain or orgasmic difficulties (women); and experience erectile, ejaculatory ororgasmic (men; p. 323). A United States survey on the prevalence and predictors of sexual dysfunction found that victims of sexual abuse experience more sexual problems than the general population. They found that men who were sexually abused during childhood were more likely to suffer from erectile dysfunction, premature ejaculation and low sexual desire, and that adult women were more likely to suffer from sexual dysfunction. excitement (Laumann, Piel and Rosen, 1999). It is important to note that although research has proven significant relationships between long-term outcome variables and childhood sexual abuse, each victim's reactions and experiences will not be the same. Although it is often considered a traumatic experience, there is no single symptom among all survivors and it is important for clinicians to focus on the client's individual needs. There are many important things a counselor should consider when helping a survivor overcome long-term effects or symptoms of sexual abuse. The literature regarding the therapeutic process after disclosure is limited and no specific treatment model is suggested (Kessler, Nelson, Jurich, & White, 2004). Although no specific treatment model is used to counsel survivors, researchers and clinicians have offered important suggestions and implications for counselors to think about. This part of the paper will explore these counseling implications. Kessler et al. (2004) identified common treatment decision-making practices of therapists treating adult survivors of childhood sexual abuse. Their study found that regardless of treatment mode, therapists found it important to assess the client with problems, the effects of the abuse on their current functioning, and how the client is currently coping. Because clients often have difficulty externalizing violence, therapists may need to work with them to increase their ability to accurately assign responsibility. To help reduce levels of depression and anxiety, helpful goals for the survivor may be to increase their sense of dominance and increase their ability to accurately assign responsibility (Hartman et al., 1987). The therapeutic alliance is imperative to helping survivors feel safe. Survivors of childhood sexual abuse often present with symptomatic problems, feelings, and behaviors that result from the abuse, rather than the sexual abuse itself (Courtois 1988, cited in Ratican, 1992). Feelings of fear or vulnerability may prevent the client from disclosing childhood sexual abuse. Relationship building techniques such as the use of encouragement, validation, self-disclosure, and boundary setting are encouraged to help establish the therapeutic connection. Embracing the survivor's version of their experience of sexual abuse is often therapeutic and helps strengthen the alliance (Pearson, 1994). It is important that the counselor allows the client time to develop feelings of trust, safety and receptivity, as sexual abuse is inherently an abuse of power, equality is emphasized as an important factor. It is important to allow the patient to dominate both the pace and direction of the healing process (Ratican, 1992). Client empowerment is a technique used by survivors. Van Velsor and Cox (2001) suggest that it is essential to help survivors process, discover, and express their anger, because anger can be used..