SURVIVORS COPING WITH A HISTORY OF CHILD SEXUAL ABUSE IN SOUTH AFRICA
Name: Andriana Karagianni
This is a digitised version of a dissertation submitted to the University of Bedfordshire. It is available to view only. This item is subject to copyright.
SURVIVORS COPING WITH A HISTORY OF CHILD SEXUAL ABUSE IN SOUTH AFRICA
A thesis submitted to the University of Bedfordshire, in fulfilment of the requirements for the degree of Master of Philosophy.
Author: Andriana Karagianni
Date: March 2021
It is available to view only.
This item is subject to copyright.
SURVIVORS COPING WITH A HISTORY OF CHILD SEXUAL ABUSE IN SOUTH AFRICA
Andriana Karagianni
MPhil
2021
UNIVERSITY OF BEDFORDSHIRE
SURVIVORS COPING WITH A HISTORY OF CHILD SEXUAL ABUSE IN SOUTH AFRICA
by
Andriana Karagianni
A thesis submitted to the University of Bedfordshire in partial
fulfilment of the requirements for the degree of
Master of Philosophy
MARCH 2021 iv
SURVIVORS COPING WITH A HISTORY OF CHILD SEXUAL ABUSE IN SOUTH
AFRICA
Andriana Karagianni
Declaration
I, Andriana Karagianni declare that this thesis and the work presented in it are my own and has been generated by me as the result of my own original research.
I confirm that:
• This work was done wholly or mainly while in candidature for a research
degree at this University;
• Where any part of this thesis has previously been submitted for a degree or any
other qualification at this University or any other institution, this has been
clearly stated;
• Where I have drawn on or cited the published work of others, this is always
clearly attributed;
• Where I have quoted from the work of others, the source is always given. With
the exception of such quotations, this thesis is entirely my own work;
• I have acknowledged all main sources of help;
• Where the thesis or any part of it is based on work done by myself jointly with
others, I have made clear exactly what was done by others and what I have
contributed myself;
• Either none of this work has been published before submission, or parts of this
work have been published as indicated on [insert page number or heading.
v
Abstract
Child Sexual Abuse (CSA) is global problem that is found in all societies and cultures.
Although there is research exploring CSA in western countries, the literature shows that there is limited CSA research on developing countries, like South Africa which is the focus of this thesis. Incidence and prevalence rates are substantially higher in South Africa when compared to other countries and for that reason, further research is needed for the context of that region.
The literature shows that ‘coping’ from CSA plays a significant role in survivors’ lives but it is an area that has not been explored sufficiently in South Africa. To this end, the subject of this thesis is to explore ‘coping’ from CSA in South Africa and to explore ways in which
CSA survivors cope with their experiences of abuse. This has been achieved through outlining the existing research on CSA coping in the region with the aim to identify studies that are related with topic; to understand the main learnings for that specific population; and to compare these findings to the strategies of other western countries.
The study identifies a number of coping strategies that have been adopted by CSA survivors in South Africa to cope with the abuse. It is also shown that similar strategies have been used by CSA survivors in western countries. The link between coping strategies in the area and the specific cultural characteristics is discussed as well.
This thesis makes knowledge around coping strategies in South Africa available, and identifies areas for further research. vi
Table of Contents
Declaration ...... iv
Abstract ...... v
Table of Contents ...... vi
List of Tables...... ix
Chapter 1. Overview of Child Sexual Abuse ...... 1
1.1 Introduction ...... 1
1.2 Background Literature...... 3
1.2.1 Definitions of CSA ...... 3
1.2.2 Key historical facts about CSA ...... 5
1.2.3 CSA in South Africa ...... 7
1.2.4 Prevalence and Incidence of CSA ...... 8
1.2.5 Effects of CSA ...... 11
1.2.6 Risk factors of CSA...... 16
1.2.7 Disclosure ...... 18
1.2.8 Recovery and resilience ...... 26
1.3 Conclusions and Research gap ...... 28
Chapter 2. Coping with Child Sexual Abuse ...... 30
2.1 Coping theory and strategies ...... 30
2.1.1 Adaptive coping strategies ...... 31
2.1.2 Maladaptive coping strategies ...... 32
2.2 Models to help survivors cope with the abuse ...... 33 vii
Chapter 3. Methodology ...... 35
3.1 Step 1 - Question formulation ...... 35
3.2 Step 2 - Locating studies ...... 35
3.3 Step 3 – Study selection and evaluation ...... 36
3.4 Step 4 - Analysis and synthesis ...... 41
3.5 Step 5 - Reporting and using the results ...... 42
Chapter 4. Data Analysis ...... 43
4.1 Maladaptive coping strategies ...... 50
4.1.1 Substance misuse...... 50
4.1.2 Sexual risky behaviours ...... 51
4.1.3 Anti-social behaviour ...... 52
4.1.4 Suicidal behaviours ...... 53
4.1.5 Denial ...... 53
4.2 Adaptive coping strategies ...... 53
4.2.1 Utilising support from family, friends and important others ...... 54
4.2.2 Utilising support available at schools ...... 55
4.2.3 Seeking psychological therapy ...... 55
4.2.4 Optimism ...... 57
4.2.5 Religion ...... 58
4.2.6 Regulation of emotions ...... 58
4.2.7 Conscious choices ...... 59 viii
4.2.8 Knowledge – awareness ...... 59
4.2.9 Forgiveness...... 60
4.2.10 Gratitude ...... 60
4.2.11 Connectedness ...... 60
4.2.12 Getting back the control ...... 61
4.2.13 Making meaning of abuse ...... 61
4.2.14 Acceptance of abuse ...... 62
4.2.15 Secrecy ...... 62
4.2.16 Helping others ...... 62
4.2.17 Keeping busy ...... 62
Chapter 5. Discussion ...... 63
Chapter 6. Conclusions ...... 80
6.1 Limitations and further research ...... 84
6.2 Reflections and related ethical concerns ...... 85
Chapter 7. References ...... 86
ix
List of Tables
Table 1: Literature review steps and findings ...... 37
Table 2: Articles selected from each step after abstract review ...... 41
Table 3: Articles selected after full text review ...... 41
Table 4: An overview of the final 22 papers that are relevant to this study ...... 43
Table 5: Coping strategies that have been identified in the 22 articles ...... 49
1
Chapter 1. Overview of Child Sexual Abuse
1.1 Introduction
Child Sexual Abuse (CSA) is a global problem that is found in all societies, cultures and socio-economic levels. For many years, the phenomenon of sexual abuse was neglected by the public but recently, there has been an increase in awareness of CSA. A plethora of prevention measures has been made to identify, reduce CSA and provide therapy interventions to survivors mainly in western countries (WHO, 2006). A number of reviews estimate that the current prevalence rate for children who experience sexual abuse worldwide is between 7.9% to 8.0% for boys and 15% to 19.7% for girls (Barth et al., 2013; Pereda et al., 2009;
Stoltenborgh et al., 2011). CSA is considered to be a major problem in the world and this problem is even worse in many developing countries. More specifically, CSA is a significant issue in South Africa as the prevalence rates are substantially higher when compared to other countries (see next paragraph). For that reason, South Africa has been named as the “rape capital of the world” (Jewkes & Abrahams, 2002, p. 1231).
There are more than 500,000 reported rape cases for children and women per year in
South Africa (Machisa et al., 2017) and a third of all South African children are sexually abused by the age of 18 years according to Artz et al. (2016). The lifetime prevalence rate of CSA in
South Africa is 36.8% for boys and 33.9% for girls (Artz et al., 2016). Such rates are higher than those measured in high-income countries such as the United States with a prevalence rate of 26.6% for girls (Finkelhor et al., 2014), the United Kingdom at 18.6% (Radford et., 2013) and Australia at 20% (Fleming, 1997).
The problem of CSA in South Africa has increased over the last few years and existing legislation is inadequate to support children and families (Jewkes et al., 2005; Mathews et al.,
2013). This combined with the fact that most of the research studies around CSA have been mostly focused on western countries, mean that further research is required to address the issue 2 of CSA in South Africa specifically. Indeed, the number of CSA studies in South Africa accounts for a very low percentage of all CSA studies worldwide, based on the findings of the literature search which is shown in the chapter of Methodology.
It is also generally known that South Africa involves different cultural characteristics when compared to other western countries. This means that, African-based research should consider the unique cultural factors in the area that may have an impact on the prevalence and incidence rates, the effects of CSA, the risk factors to CSA, the factors influencing disclosure, the recovery methods and the coping strategies, thus avoiding biased interventions which were designed for western countries.
To this end, the main research question of this dissertation is “What does the literature tell us about the ways in which CSA survivors in South Africa cope with their experiences of abuse?”. This is achieved through outlining the existing research on CSA coping strategies in
South Africa with the aim to identify the studies that are related to CSA coping strategies in the area, to understand the main findings for that specific population and to compare these findings to the findings relating to coping strategies of other higher-income countries.
It is worth noting that through investigating the literature, it was found that some studies explore the link between coping, resilience and recovery from CSA. All three terms are defined in the next sections. It was shown that some coping strategies help to increase recovery and bounce resilience and for that reason, resilience and recovery are also discussed in this thesis where appropriate. The focus of the thesis remains on coping strategies.
The findings of this research can make a significant contribution to the literature, as they provide insight about the coping strategies that are used by CSA survivors in South Africa.
This is the first study so far which documents the existing literature regarding the coping strategies of CSA in South Africa. There are a relatively small number of studies that are focused on CSA in South Africa when compared to the number of studies focusing on CSA in 3 other western countries. The investigation of CSA coping in South Africa is an area for further research and it is hoped that this study will encourage the research community to further advance their research in this area. Such studies could produce a more comprehensive understanding of survivor’s coping strategies in South Africa which will ultimately help current and future survivors to cope from their abuse more effectively, recover and build resilience.
1.2 Background Literature
In this section, main studies discussing coping with child sexual abuse are discussed.
The section covers definitions of CSA, key historical facts, prevalence and incidence rates of
CSA, the effects of CSA and risk factors associated with CSA. A number of studies which are focused on South Africa are also reviewed in this section to set the context around CSA in
South Africa. A detailed analysis on South Africa is conducted in the following chapters.
1.2.1 Definitions of CSA
According to the World Health Organisation (WHO), CSA is defined in the following way: “Child sexual abuse is 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 and cannot give consent, or that violates the laws or social taboos of society. Child sexual abuse is evidenced by this activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person. This may include but is not limited to: the inducement or coercion of a child to engage in any unlawful sexual activity; the exploitative use of a child in prostitution or other unlawful sexual practices; the exploitative use of children in pornographic performance and materials” (WHO, 2003, p.75).
CSA has been defined differently by researchers over the years and based on different criteria, making comparisons between studies difficult. Some researchers have defined CSA 4 based on the age of the child, some others based on the nature of the abuse, the relationship to the perpetrator, etc. For example, in relation to a child’s age, Russell (1984) defined sexual abuse as an unwanted sexual experience that appears “before the age of 14 years old or rape by the age of 17” (p.180). Dubowitz et al. (1993) defined CSA based on the nature of the abuse, instead of the child’s age, and the definition includes any sexual behaviour that ranges from touching to intercourse. It does not include any non-contact offenses; something which is usually considered in other definitions. With regard to perpetrators, incestuous abuse and unwanted sexual assault which is committed by similarly aged peers or siblings, is often not included in many definitions or research samples. By contrast, Rind et al. (1998) defined CSA as “a sexual interaction involving either physical contact or no contact (e.g. exhibitionism) between either a child or adolescent and someone significantly older, or between two peers who are children or adolescents when coercion is used” (p.23).
Furthermore, CSA definitions and contexts can vary based on the geographical location that they refer to, from country to country and even within a country itself. Even researchers within the same country may use different definitions from the official government one.
Overall, national governments, intergovernmental organisations and different researchers have presented many definitions of CSA. The fact that there are multiple ways of defining CSA could suggest that CSA is perceived differently in different locations at different times. This makes comparison of the studies and research findings more difficult. Such methodological limitations are exemplified in studies such as those by Gorey and Leslie (2001) and Putnam (2003). These authors emphasise that by using “contact and non-contact” abuse in the definition, the studies provide higher rates of prevalence in contrast with the studies that use definitions with “only contact”. For this reason, researchers require more commonly acknowledged definitions in order to avoid such methodological problems (Haugaard, 2000). 5
A reasonable approach to tackle this issue in this study could be the use of the official
South Africa government definition, which is defined as follows: “The Sexual Offences Act
(SOA) defines a ‘child’ as a person under the age of 18 years, or in relation to the offences of statutory rape or statutory sexual assault, a person 12 years or older but under the age of 16 years. The statutory definition of rape in the 2007 Sexual Offences Act includes all forms of sexual penetration and is gender-neutral, meaning ‘any person’ can commit an act of rape or be raped. Children under the age of 12 are viewed by the Act as incapable of consenting to sex.
The Act separates sexual offences into acts of penetrative (rape) and non-penetrative (sexual assault) offences.” (Artz et al., 2016, p. 19).
1.2.2 Key historical facts about CSA
In this section, some key facts about the history of CSA are presented with the intention to show that CSA has not always been recognised as a crime or a social issue. Note that the aim of this section is not to present a comprehensive history of CSA around the world. It was only 40-50 years ago (mid 70s/80s) when CSA started to get more recognition and only a couple of decades ago in the more developing countries, like South Africa which is explored in this thesis. Since then, CSA has always been a complex and a highly sensitive issue. As shown earlier, a universal definition of CSA across countries, organisation and researchers, has not been defined yet.
In 1962, Henry Kempe, a paediatrician in the United States, was the first one to use the term “battered child syndrome” in order to describe children who have been abused by their family members (Kempe et al., 1962). Initially, the publications of Henry Kempe faced criticism and denial, particularly from physicians whose scientific orientation rejected the notion that children could be abused by their parents. Nevertheless, Kempe was able to convey his aims and therefore, promote the importance of the need to protect children suffering from different types of abuse (including exposure to domestic violence), which has been recognised 6 by most national and international organisations. In 1963 in Britain, child abuse was first mentioned as “battered baby syndrome” by Griffiths and Moynihan (orthopaedic surgeons)
(Parton, 1979). For many years, the phenomenon of CSA was ignored and even denied within society (Crane, 2015). This societal refusal was gradually challenged in the 1960s and 1970s in western countries by feminists and system theorists, who recognised CSA as a crime whereby the survivors should be given the right to talk about it (Breckenridge, 1999) and claimed that CSA is a social problem that concerned everyone in society (Carmody, 1997).
Child sexual abuse gradually gained coverage all over the world as more people began to disclose their experiences of being victims and/or witnesses of sexual abuse at some point during their life.
The shocking story of Mary Ellen marked the beginning of the American Society for the Prevention of Cruelty to Children (Watkins, 1990). The case of Mary Ellen who was mistreated by her parents was filed to court. However, due to limited legislation with regard to child protection at that time, the court was unable to immediately impose the necessary action to protect the child from her parents. In 1874, the court granted an order for the protection of
Mary Ellen from her family based on the only relevant law that existed at that time; it was a law pertaining to the protection of animals. This court case marked the first conviction regarding child maltreatment (Watkins, 1990). Subsequently, researchers, such as Tardieu, began to explore the effects of child abuse and specifically childhood sexual abuse (Tardieu,
1878). According to Tardieu’s study, 9,125 people were accused of attempted or completed sexual abuse against children between 1858 and 1869 in France (Masson, 1992).
A few years later, the National Society for the Prevention of Cruelty to Children
(NSPCC) was established in London in 1884. The basic aim of the organisation was to support children and their families. Since its establishment, the NSPCC has helped more than
10 million children over the years. Moreover, the NSPCC contributed and influenced the 7 creation of the first law for the protection of children, which was passed in the UK in 1989.
The Prevention of Cruelty to Children Act (1989), it was also the first statute that imposed the option of prosecution (Gray & Watt, 2013). Over the years a number of organisations were also established in Britain for the protection of children such as Dr Barnardo’s, The Children’s
Society and the Waifs and Strays Society (Brown & Barrett, 2002).
1.2.3 CSA in South Africa
The first research study about CSA in South Africa was performed by Westcott, et al. in the 80s (Westcott, 1982) and the first child rape case – 14-year old Valencia Farmer - was reported in the news in 1999; many years later than in western countries. The report of the child rape, in particular, was a breakthrough and a key milestone for talking about CSA at that time.
Valencia was also stabbed 50 times and found naked in the Western Cape Province. She passed away a day later. As a result of the Valencia case, the government in South Africa was pushed to develop a new Sexual Offences Act. There was a need for a more comprehensive Act to protect and support further CSA survivors. However, this Act was established almost a decade later in 2007 (Artz et al., 2016).
A similar incident took place in South Africa a few years later in 2013, where 17-year old Anene Booysens was found mutilated and raped in the Western Cape Province. Inevitably, the public expressed their disappointment regarding the insufficiency of law on sexual violence in South Africa (Artz et al., 2016). Based on that, the government of South Africa took actions to promote the protection of children. Several interventions have been investigated with support from the non-governmental sector with the intention to recommend policies and frameworks to deal with sexual offences (Artz et al., 2016). The outcome was a number of concomitant laws, regulations and protocols to manage child protection and support. These are the following: i) the Domestic Violence Act (116 of 1998), ii) the Service Charter for Victims of
Crime in SA (2004), iii) the Children’s Act (38 of 2005), iv) the Criminal Law (Sexual 8
Offences and Related Matters) Amendment Act (32 Of 2007) and v) the Children’s
Amendment Act No 41 of 2007.
However, the problem of CSA in South Africa has been increasing and existing legislation is inadequate to support children and families (Jewkes et al., 2005; Mathews et al.,
2013). This combined with the fact that the criminal justice system and police service in South
Africa are not efficient mean that further research and policy interventions are required to address the issues of CSA in South Africa (Richter, 2003).
1.2.4 Prevalence and Incidence of CSA
It is worth noting that the difference between incidence and prevalence in CSA is that the former refers to the single occurrence of abuse for an individual, whereas prevalence refers to the overall condition of the occurrence, i.e. how many CSA victims are known. This differentiation has caused confusion amongst practitioners, specifically in regard to which one they should use to most adequately describe the risk of CSA that children face as they grow up
(Townsend & Rheingold, 2013). The same study reported that, when focusing on how many subjects have experienced CSA one or more times over a period of time, the full-childhood prevalence rate is most commonly used by CSA practitioners instead of a one-year incidence metric. This approach overcomes the inherent limitations of the incidence rate, with the full- childhood prevalence rate often being utilized for estimating the probability of children suffering any sexual abuse as they get older (Townsend & Rheingold, 2013).
1.2.4.1 Prevalence
The worldwide prevalence of CSA was reported at approximately one in eight children according to a study conducted by Stoltenborgh et al. (2011). Global rates of CSA between
7.6–7.9% for boys and 18.0–19.7% for girls were reported in other studies as well (Pereda et al., 2009; Stoltenborgh et al., 2015). 9
Africa was found to have the highest prevalence rates in the world. This is exemplified in a meta-analysis study, which investigated the prevalence rates of CSA reported in 217 publications and 331 independent samples with a total number of 9,911,748 participants; the findings showed that girls in Africa have the highest CSA prevalence rates across the world
(Stoltenborg et al., 2011). Similar findings were reported by another meta-analysis study which shows that that the highest prevalence rates are found in Africa whereas the lowest are in
Europe (Pereda et al., 2009). Within the region of Africa, Morocco, Tanzania and South Africa were found to experience the highest CSA prevalence rates (Pereda et al., 2009).
For the context of South Africa specifically, a study conducted by Seedat et al. (2009) showed that over a third of South African women report a history of CSA. A study by
Andersson et al. (2012) showed that around 18% of both men and women in South Africa have experienced forced or coerced sex by the age of 16 whereas a study by Jewkes et al. (2010) showed that among participants aged 18–26 years in the Eastern Cape Province of South Africa
38% of women and 17% of men reported experiences of sexual abuse before the age of 18.
Prevalence rates of CSA ranging between 0-53% for female and between 0-60% for males were reported based on an overview of thirty-nine prevalence studies in twenty-one countries
(Pereda et al, 2009); and the highest rates for both genders were reported in South Africa
(Pereda et al., 2009). Along the same lines, a study conducted by Madu and Peltzer (2000) in the Northern Province of South Africa including secondary school students, found a prevalence rate of 54.3% for CSA (Madu & Peltzer, 2000). Relatively high lifetime prevalence rates in
South Africa were also reported by Artz et. al (2016), with 36.8% for boys and 33.9% for girls
(Artz et al., 2016).
A relatively low prevalence rate of 1.6% was reported in one of the first national studies in South Africa in 1998 for rape before the age of 15 (Jewkes et al., 2002). However, it was believed that the results underestimated the real prevalence rates due to the fact the study 10 assumed a relatively low upper age limit for the participants involved in the study. A much higher prevalence rate of 39.1% for women and 16.7% for men in South African were reported by the same authors a few years later and after assuming a broader definition of sexual abuse
(Jewkes et al., 2010). This is an example to show how different definitions and research methodologies could result in different findings; even by the same authors.
Overall, prevalence rates of CSA in South Africa are higher than those measured for females in high-income countries such as the United States with a prevalence rate of 26.6%
(Finkelhor et al., 2014), the United Kingdom at 18.6% (Radford et al., 2013) and Australia at
20% (Fleming, 1997). Possible reasons underpinning different prevalence rates between developed and developing countries could be due to gender differences (Quadara et al., 2015), the patriarchal nature of most developing countries (Martin & Silverstone, 2013) and the specific cultural and contextual characteristics (Russell et al., 2020).
It is also worth mentioning that western literature on CSA explains that many survivors of CSA are “emotionally manipulated into a conspiracy of silence” (Mash & Wolfe, 2010, p.
437) and as a consequence, many incidents of sexual abuse are not being reported. This is supported by Badoe (2017), who has published studies on CSA in Africa, believes that most of the cases are not known by official agencies. This means that the real rates could be even higher but more importantly, survivors may experience an ongoing long-term abuse (Singh, 2009) which results in harmful negative effects.
1.2.4.2 Incidence
As explained earlier, incidence is the single occurrence of abuse for an individual.
According to the Overseas Security Advisory Council (OSAC), South Africa has the highest rape rate in the world with more than 53,293 sexual offenses being reported between 2019 and
2020 (OSAC, 2020). This corresponds approximately to 146 sexual abuse offenses per day. 11
In another study conducted at the Red Cross War Memorial Children's Hospital in Cape
Town, it was found that most CSA incidents are reported for children between the age of
10 months old and 13 years old, with the average age being 5.8 years old (Cox et al., 2007).
The authors also found that sexual assaults on children accounted for 44% of all reported incidences of sexual offence (Cox et al., 2007). A similar figure is also provided by the Crime
Information Analysis Centre (2009) which states that 44.4% of all police reports on sexual abuse involve children. Furthermore, it was revealed that incidences of sexual abuse had an increasing trend over the years, with 59 cases of abuse reported to Cape Town’s Red Cross
War Memorial Children’s Hospital in 2003, 91 in 2004, and 144 in 2005 (Cox et al., 2007).
According to statistics revealed by the South African Police Service (2014), 22,781 sexual incidents were reported in South Africa, of which 44% were sexual offences involving children (South African Police Service, 2014). Although incident numbers for CSA are relatively high, it is believed that it is hard to determine the true number of sexual offences involving children. This is because several cases are not being reported (Battiss, 2005; Jewkes
& Abrahams, 2002; Jewkes et al., 2005; Maniglio, 2009).
1.2.5 Effects of CSA
CSA is a public health problem which causes numerous adverse psychological, physical, emotional and social outcomes (Letourneau et al., 2019; Mathews, 2017). This section provides an insight into the consequences of CSA, which is an important component for survivor’s wellbeing and recovery.
Children who have been sexually abused have been subjected to experiences that are inappropriate for their age and their developmental level (Browne & Finkelhor, 1984). When a child becomes a victim of sexual abuse by a perpetrator, he/she is abused both sexually and emotionally and as a result, may display a wide range of short and long-term consequences
(Fisher et al., 2017; Kendall-Tackett et al., 1993). For instance, they may experience mental 12 health problems, such as anxiety (Chen et al., 2010; Kamiya et al., 2016; Lindert et al., 2014;
McCrory et al., 2017; Mills et al., 2016; NSPCC, 2016; Sprober et al., 2014; Trickett et al.,
2011), depression (Beitchman et al., 1992; Chen et al., 2010; Coles et al., 2015; Cooper et al.,
2016; Easton & Kong, 2016; Health Working Group on Child Sexual Exploitation, 2014;
Kamiya et al., 2016; Lindert et al., 2014; Mills et al., 2016; NSPCC 2016; Perez-Gonzalez &
Pereda, 2015; Polusny & Follette, 1995), post-traumatic stress disorder (PTSD) (Breckenridge
& Flax, 2016; Canton-Cortes & Canton, 2010; Canton-Cortes et al., 2011; Chen et al., 2010;
Easton, et al., 2013; Harding et al., 2012; Hebert et al., 2014; Knott, 2014; Maniglio, 2013;
Mills et al., 2016; Paolucci et al., 2001; Wosu et al., 2015), eating disorders (Chen et al., 2010;
Perez-Gonzalez & Pereda, 2015), regression, conduct disorders (Cicchetti & Toth, 2005;
Maniglio, 2013; Maniglio, 2015; Murray & Farrington, 2010), sleeping problems (Chen et al.,
2010; Noll et al., 2006;), suicide attempts (Chen et al., 2010; Curtis, 2006; Devries et al., 2014;
NSPCC, 2016; Perez-Gonzalez & Pereda, 2015) and Dissociative Identity Disorder (DID)
(Bick et al., 2014; Breckenridge & Flax, 2016; Irish et al., 2010). Social problems also emerge through the literature such as unemployment, homelessness (Fisher et al., 2017; Heerde et al.,
2015; Rosario et al., 2012; Rotheram- Borus et al., 1996) and being a psychiatric inpatient
(Spataro et al., 2004).
Furthermore, sexual abuse may cause a variety of physical problems such as poor general health, gastro-intestinal, gynaecologic problems, heart problems, headaches, muscle aches, backaches and joint pain (Allnock et al., 2015; Coles et al., 2015; Havig, 2008; Hulme,
2000; Irish et al., 2010; Kamiya et al., 2016; Mamun et al., 2007; McCarthy-Jones &
McCarthy-Jones, 2014; Newman et al., 2000; Quadara et al., 2016; Richardson et al., 2014;
Trickett et al., 2011; Zeglin et al., 2015); non-epileptic seizures (Nelson et al., 2012; Sharpe &
Faye, 2006) and sexual problems (Crisma et al., 2004; Draucker & Mazurczyk, 2013; Wilson,
2010). 13
A variety of behavioural and relationship problems were also mentioned in the literature, as well as poor academic ability (NSPCC, 2016; Paolucci et al., 2001; Pereira et al.,
2017; Zeglin et al., 2015); intimacy (Jehu, 1988; Liang et al., 2006); parenting (Allbaugh et al.,
2014; Chouliara et al., 2014; Cole & Putnam, 1992; Roberts et al., 2004; Sneddon et al., 2016;
Testa et al., 2011); adjustment problems, teenage pregnancy (Roberts et al., 2004; Trickett et al., 2011); hostility (Young et al., 2007); experience of re-victimisation (Arata, 2002; Classen et al., 2005; Coles et al., 2015; Maniglio, 2009; Neumann et al., 1996; NSPCC, 2016; Ogloff et al., 2012; Olafson & Boat, 2004; Pittenger et al., 2016; Roodman & Clum, 2001; Sneddon et al., 2016; Trickett et al., 2011; Walsh et al., 2010); alcohol and substance abuse
(Breckenridge & Flax, 2016; Cashmore & Shackel, 2014; Draucker & Mazurczyk, 2013;
Freyd et al., 2005; Maniglio, 2013; Min et al., 2007; Nelson et al., 2002; NSPCC, 2016; One in Four, 2015; Ports et al., 2016); sexual relationships and risky sexual behaviour (Beitchmann et al., 1992; DeLillo et al., 2001; Fergusson et al., 2013; Paolucci et al., 2001; Ports et al., 2016;
Putnam, 2003; Stop It Now, 2008; Warrington et al., 2017) and sex trading (Arriola et al.,
2005).
South African populations experience similar negative side effects including mental health problems, such as anxiety, depression and post•traumatic stress disorder (Artz et al.,
2016; Brown et al., 2009; Carey et al., 2008; Collings, 1995; Jewkes et al., 2010). In the South
African context, researchers have found that children may struggle to do their homework, miss school, have suicidal thoughts/attempts, have anti-social behaviours and increased chances of substance use (Artz et al., 2016; Jewkes et al., 2010; King et al., 2004; Meade et al., 2012).
Furthermore, experiences of sexual abuse have been found to be associated with risky sexual behaviours in South Africa, which may then increase risks for HIV infections (Jewkes et al.,
2006a; Pettifor et al., 2005). 14
Overall, CSA has a range of consequences such as behavioural, physical, social and mental health problems. Some of the above-mentioned consequences have the potential to increase the risk of children developing mental disorders later in their life as well (Browne &
Finkelhor, 1985; Somer & Szwarcberg, 2001) which are typically more prevalent for adult survivors of CSA (Hillberg et al., 2011; Hornor, 2010). Some researchers argue that these consequences may last for the duration of the survivors’ lives (Draper et al., 2008; Fisher et. al., 2017; One In Four, 2015; Talbot et al., 2009).
The lack of a single pattern of symptoms to characterise the consequences of CSA has led some researchers to develop models to understand the psychological process and effects of
CSA. The literature shows that one of the most widely known models, is the model developed by Finkelhor and Browne (1985). According to Finkelhor and Browne (1985), the impact of
CSA could be categorised into four different dynamics: traumatic sexualisation, betrayal, stigmatization, and powerlessness. These four dynamics provide an explanatory model for the victim responses following the assault. The first dynamic, the traumatic sexualisation, includes the inappropriate sexual development of a child caused by a sexual abuse. The second dynamic, betrayal, includes the betrayal and the harm that the child feels when the abuse is perpetrated by trusted figures; as a result, this may result in the child developing general trust issues in the future. The third one includes the stigma that the child faces, followed by shame and guilt as a result of the abuse which also influences the child’s self-perception and self-esteem. In the end, the powerlessness dynamic involves a lost sense of control that a child has experienced as a consequence of the abuse and his/her inability to stop it or prevent it. This may cause the child to become disempowered and may increase the likelihood of further victimisation in the future.
In addition to the four dynamics presented above, Glaser (1991) added two further additional dynamics that may provide some clarity as to why the disclosure and treatment of abuse poses many challenges, namely, secrecy and confusion. According to Glaser, secrecy 15 refers to the denial or the disbelief that a survivor may suffer in an attempt to keep the abuse a secret, perplexing the therapy procedure. Confusion on the other hand refers to the certain inability of children to fully understand the purpose of the sexual activities, potentially confusing it as actions of care rather than a sexual abuse.
The symptoms of CSA have also been classified into different categories by some researchers. Saywitz et al. (2000) classified the symptoms of children depending on their severity, by which four levels were created. The first level included children whose symptoms could not be detected through the use of psychological tools. The second level was related to children whose symptoms were not clinical and less severe. The third level involved children with serious psychiatric problems, for example depression, anxiety, sexual behaviours, drugs, aggression and low self-esteem. The fourth level included children with psychological disorders such as PTSD, major depression and overanxious disorder. An important weakness of this classification, however, is that Saywitz et al. (2000) suggest that the first level fails to consider that some of these children may genuinely be resilient and thus not demonstrate any symptoms, hidden or otherwise.
Additional factors which research suggests may moderate the adverse consequences of
CSA are the frequency, duration and severity of abuse that depends on the force and the sexual acts used (Andrews et al., 2004; Beitchman et., 1992; Clemmons et al., 2007; Jonzon &
Lindblad, 2004; Sneddon et al., 2016); the type of abuse, penetrative or non-penetrative
(Kendall-Tackett et al., 1993); early onset of sexual abuse (Jonzon & Lindblad, 2004; Sneddon et al., 2016) and limited social network (Baboolal et al., 2007; Nelson et al., 2002).
Characteristics of the individual victim and survivor (e.g. emotions, beliefs and attitudes) play also an important role (Canton-Cortes et al., 2011; Domhardt et al., 2015).
Further, child’s gender and age; his/her relationship with the alleged abuser and the number of abuser during the abuse or other abusive incidents; the reaction to the disclosure (Asgeirsdottir 16 et al., 2010; Beitchman et al., 1992; Bick et al., 2014; Hulme, 2004; Jonzon & Lindblad, 2004;
Sneddon et al., 2016); and finally, the level of family functionality and social context have influenced the outcomes of abuse (Beitchman et al., 1991; Domhardt et al., 2015; Havig 2008;
Kendall-Tackett et al., 1993; Koverola et al., 1993; Montgomery, 2013; Montgomery et al.,
2015; Williams & Nelson-Gardell, 2012).
1.2.6 Risk factors of CSA
Knowing the risk factors of CSA supports effective assessment and development of preventive interventions and for that reason, a number of studies have explored the risk factors of CSA. The most common risk factors of CSA are the following: prior victimisation of the child other than child abuse, prior or concurrent forms of child abuse in the child’s home environment, parents history of child abuse, parents mental health problems, intimate partner violence, low quality of parent–child relationship and families with stepfathers or single parents, family social isolation, child problems (having a mental/physical chronic problem), and other child characteristics such as being female) (Assink et al., 2019).
The existing body of research on risk factors of CSA has been mostly conducted in developed western countries. However, some research has been focused in developing African countries, and similar factors emerge from the studies (Bridgewater, 2016; Meinck et al., 2015).
In addition to the general risk factors associated with CSA, patriarchy, stereotyped gender norms and the role of the children were also found to be relevant risk factors to CSA in developing countries (Bridgewater, 2016; Plummer & Njuguna, 2009; Whitehead & Roffee,
2016). The economic state of individuals and societies, the absence of governance processes and lack of appropriate child supervision are also additional factors which result in high prevalence rates in developing countries (Royal Commission into Institutional Responses to
Child Sexual Abuse, 2017). 17
In Africa, special cultural beliefs are considered major risk factors for CSA. For example, in Tanzania, ‘witch doctors’ recommend having sex with virgin girls as a method to increase wealth and prosperity (Lalor, 2004). It is also recommended that having sex with virgin girls could cure men who suffer from HIV. In Mwanza, anal sex between boys is described as “an important rite of passage in identity formation” (Rajani & Kudrati, 1996, p.
308). For girls, having sex can be a way to secure food and accommodation. They learn to obey all commandments of the men and they become sexual beings that have to satisfy the desires of their partners. Actions of violence are considered normal (Lalor, 2004). Additionally, a study carried out by Boakye’s (2009) in Ghana showed that crime and sexual abuse are influenced due to the fact that the family does not stay in the same house and makes children’s supervision difficult. This is also influenced by the fact that the main employment in Ghana is fishing and children stay home alone without parental supervision. The rates of teenage pregnancy in
Ghana are relatively high which is somewhat tolerated because births are celebrated and gifts are provided to women. Another risk factor for CSA is arranged marriage, which is a common trend in Africa (Bobnoff-Hajal, 2006).
South Africa, which is the focus of this thesis, is considered as a developing country in Africa and it is believed that it shares similar risk factors with those presented in the previous paragraph (i.e. risk factors of CSA in Africa due to special cultural beliefs). However, there is no research evidence to support this argument – i.e. if South Africa shares similar special cultural beliefs with Africa that may lead to CSA.
Nevertheless, different risk factors that increase the prevalence rates and incidents of
CSA in South Africa and they are not linked to special cultural beliefs have been explored by some studies. It has been recognised that the political, social and economic structures in the area have an impact on CSA. After the end of apartheid in 1994, South Africa become more attractive to other Africans due to the enhanced democratic values, the opportunities for better 18 and equal employment and education and higher living standards in general. This resulted in a large number of immigrants which drove crime in South Africa as a result of the increasing population (Clark & Worger, 2013). Additional factors that influence the problem of CSA in
South Africa are unemployment, violence, living conditions, poverty, gender differences and single-parent families (Banwari, 2011; Dunkle et al., 2013).
More specifically, family environment plays an important role in South Africa. It was found that children who do not live in a relaxing and safe family environment are more likely to become victims of CSA. This is because they tend to engage with people who have violent behaviours involving alcohol consumption and drug use (Artz et al., 2016). Poverty and low education are also related to CSA (Andersson et al., 2012; Jewkes et al., 2002; Madu & Peltzer,
2000).
Another key factor which can contribute to increased levels of CSA in South Africa is patriarchy and gender differences (Whitehead & Roffee, 2016). The society in South Africa demands from women that they satisfy the sexual desires of men (Nduna & Jewkes, 2012) and from children to respect and obey their elders without objections (Townsend & Dawes, 2004).
Overall, it is commonly believed that CSA occurs within a heterogenic group of people as it fluctuates with age, capacity level, financial status, gender, education and effects of the abuse (Yancey et al., 2011). Taken together, these findings suggest that a variety of factors can contribute to increased levels of CSA in South Africa. These factors are difficult to monitor and, as a result, it is challenging to predict their effects (Dhaliwal et al., 1996).
1.2.7 Disclosure
The phenomenon of sexual abuse is a hidden problem that does not only concern the survivors and their families but also the broader spectrum of society as a whole (Wurtele,
2009). Sexually abused children face numerous mental health, physical and psychological problems and this results in a significant economic cost to society associated with the health 19 systems, social care, education and housing services, as well as the criminal justice system since some CSA survivors might develop anti-social behaviours (Stalker et al., 2010).
To this end, the need for early recognition of abused children is important to develop appropriate intervention programmes that assist CSA survivors and their families to deal with the trauma in their lives. It is therefore important for sexually abused children to disclose the abuse as soon as possible, as disclosure could potentially stop the abuse and initiate their recovery. This does not mean that the onus is on children to disclose their abuse, deflecting responsibility away from adults who should be better at identifying, responding and protecting children.
Disclosure is defined as the process whereby a person opens up about his/her feelings and decides to say something about the abuse to someone formally or informally (Ullman,
2003). Disclosure may be purposeful, accidental or even elicited (Alaggia, 2004; Mian et al.,
1986; Sorensen & Snow, 1991). Purposeful disclosure was described as “an intentional and deliberate revelation of the abuse with clear intent of revealing its existence” and accidental disclosure was defined as “a statement made without forethought or intent to reveal the abusive relationship” (Mian et al., 1986; p. 226). Elicited disclosure was described as a disclosure that is caused/assisted by others (Campis et al., 1993).
Disclosure of abuse is a critical part in the beginning of an intervention. In theory, when a child discloses, the abuse would stop and treatment would begin (Alaggia, 2004; Alaggia &
Kirshenbaum, 2005; Goodman-Brown et al., 2003; Paine & Hansen, 2002); as disclosure could facilitate intervention. However, children might also receive negative responses to disclosure
(such as blame, disbelief) from people and communities that could hinder recovery (Chouliara et al., 2014).
Disclosure is also linked to the recovery and healing process (Chouliara et al., 2014;
Banyard & Williams, 2007). According to survivors’ testimonies, disclosing the abuse to a 20 trusted person in a safe environment, helped them to deal with feelings of shame and self- blame. They also started feeling more hopeful for the future (Chouliara et al., 2014).
Disclosure is a dynamic multidimensional process, rather than a singular and static event, and is influenced by many factors such as children’s reactions to the abuse, caregiver’s reactions, threats by abusers, difficult family environments, culture beliefs (Alaggia, 2005;
Alaggia et al., 2017; Reitsema & Grietens, 2015).
Several previous research studies into disclosure have been focused on delayed or never-disclosed sexual abuse experiences, as many survivors did not reveal or usually delayed the disclosure (Collin-Vézina et al., 2015; Crisma et al., 2004; Easton, 2013; Finkelhor et al.,
1990; Hershkowitz et al., 2007; Jonzon & Lindblad, 2004; Schönbucher et al., 2012). Children are more prone to delay for a long time or never disclose until someone else discovers the abuse
(Kelley et al., 1993; McElvaney, 2015; Sorenson & Snow, 1991).
In addition to the never-disclosed and delayed disclosure, research has found that- disclosure is more likely to be revealed by accident than by purpose. A study showed that 43% of disclosures were accidental and 30% of them were purposeful (Sgroi, 1982). Accidentally- discovered abuse has been found to relate to feelings of shame and self-blame for the survivor.
Survivors may feel ashamed as the public may now know about the abuse that they experienced
(Feiring et al., 1996). Further to this, self-blame may be experienced as the victim may think that their silence contributed to the abuse (Bonanno et al., 2002).
This is the case in South Africa as well, as a South African research study showed that
43% of people had an accidental disclosure and 30% had a purposeful disclosure (Collings et al., 2005). These results support previous findings by Sgroi (1982) for western countries (see previous paragraph). Indirect disclosure and eyewitness disclosure account for 9% and 18% respectively (Collings et al., 2005). 21
In an accidental disclosure, children usually show behavioural changes and adopt avoidance strategies (Collings et al., 2005). By contrast, purposeful disclosure is realised by spontaneous verbal disclosure of abuse by the victim. In general, in developed countries and in
South Africa it is shown that older children are more likely to disclose purposefully (Campis et al., 1993; Collings et al., 2005; Mathews et al., 2016; Sorenson & Snow, 1991) while younger children tend to disclose in a more partial-incomplete way (Mordock, 1996). In addition, children in South Africa do not usually disclose immediately, due to the fear of caregiver’s reactions, but they typically make purposeful disclosures to a trusted person who is responsible to inform their caregiver on behalf (Mathews et al., 2016).
1.2.7.1 Factors influencing disclosure
A large and growing body of literature has investigated the factors that influence disclosure. One of the most common factors that prevent disclosure is that survivors believe that disclosure will not change or improve their lives (Sorsoli et al., 2008), and for that reason they decide not to disclose the abuse. Fear, guilt, shame, anxiety and self-blame are also key factors that hinder disclosure (Alaggia, 2004; Collin-Vézina et al., 2015; Crisma et al., 2004;
Dorahy & Clearwater, 2012; Draucker & Martsolf, 2008; Gómez & Ayala 2014; Goodman-
Brown et al., 2003; Hunter, 2011; Kogan, 2004; McElvaney et al., 2014; McElvaney &
Culhane, 2017).
More specifically, fear is linked to survivors’ thoughts that disclosing the abuse will negatively impact their current life and destroy their relationships with significant others
(Donalek, 2001). They also believe that disclosing the abuse could hurt their parents or caregivers as they may experience feelings of guilt surrounding how they had not being able to protect them adequately during their childhood (Alaggia, 2004; Draucker & Martsolf, 2008;
Hunter, 2011). Survivors may also be fearful of the reactions of others as they may think that they will not be believed and accepted from close family members, friends or community 22 members (Alaggia, 2004; Collin-Vézina et al., 2015; Hunter, 2010), or may be blamed by others for the abuse (Hershkowitz et al., 2007; Somer & Szwarcberg, 2001).
In South Africa, in particular, a study by Mathews et al. (2016) found that children do not disclose their abuse to their caregivers as they are afraid of their reactions. Children may be physical punished, blamed or their parents may not believe them (Mathews et al., 2016).
This is due to the social norms in South Africa, where children need to protect themselves and they should not expect any support from their caregivers (Mathews et al., 2016). Indeed, a
South African study found that a quarter of all children involved in the study experienced non- supportive reactions from friends, family, and community members, 16% ignored the disclosure and 10% of cases were persuaded to deny the abuse (Collings & Wiles, 2005). In
South Africa there is also a lot of criminality and violence and as a result, sexual abuse is not considered to be a priority issue within the family context (Mathews et al., 2016). Other factors that may prevent children from disclosing their abuse include the children’s respect towards their parents, family structure and honour (Fontes & Plummer, 2010; Hunter, 2010).
The role of gender in the disclosure process has also been explored by researchers around the world. Data from a number of sources have identified that males do not disclose the abuse as much when compared to females (Bolton et al., 1989; Easton, 2013; Easton et al.,
2014; Gagnier & Collin-Vézina, 2016; Gries et al., 1996; Lamb & Edgar-Smith, 1994; Watkins
& Bentovim, 1992). Male adolescents have been reported to be more hesitant to disclose their abuse, with numerous studies having attempted to explain this tendency in relation to the age of males (Lamb & Edgar-Smith, 1994; Watkins & Bentovim, 1992). It has been also suggested that “the fact that boys are socialised not to reveal doubts, weaknesses, and fears, and the fact that, since most of the abusers are male, boys have the additional taboo of homosexuality to overcome if they tell” (Faller, 1989; p. 282). In the same vein, more recent studies indicated that boys do not want to reveal weakness and there is also the fear of being judged and 23 perceived as being gay (Alaggia, 2005; Dorahy & Clearwater, 2012; Easton et al., 2014;
O’Leary & Barber, 2008). By contrast, when the abuser is a female, males tend to consider that according to social standards, a sexual relationship with an older woman is normal and an accepted socialisation process; therefore, many do not even define it as abuse (Dhaliwal et al.,
1996; Gagnier & Collin-Vézina, 2016; Hecht & Hansen, 1999).
In South Africa, women are afraid to disclose as they might be blamed as being dressed inappropriately in an effort to seduce men with their bodies (Mathews et al., 2016). This reflects
South African societal views about gender and rape that regard women as responsible for men’s sexual aggression (Mathews et al., 2016). When both the abuser and the victim are male (male- male sex) it is considered as a process for masculinity and not an abuse (Duncan & Williams,
1998). In western countries, others also believe that male victims may be judged that they will be abusers in the future as there is the reputation that male survivors are more likely to become abusers themselves (Alaggia, 2005).
Additional factors that may affect disclosure in South Africa include fear of revenge against the survivor or their family; disbelief, feelings of blaming, shame, guilt, humiliation and embarrassment; empathy and love for the abuser; difficulties to have access to public services such as police or social workers; lack of trust and anxiety for the legal processes; flashbacks and reminders during the court; negative behaviour by the police; fear of caregiver’s reaction and fear of upsetting the stability of the family (Mathews et al., 2016). Some additional factors include the fear of loss of economic support by the abuser; fear of being labelled; and the desire to avoid the stigma of raped (Mathews et al., 2016).
In addition to the factors influencing disclosure that have been discussed above for western countries and South Africa, the literature in western countries gives particular focus on the reasons surrounding why children specifically do not disclose the abuse. These reasons 24 are discussed below but there is not further research evidence to support the assumption that similar reasons may influence disclosure of CSA in South Africa.
The absence of language and terminology to explain and depict what occurred, is another key factor which prevents disclosure from children. It had been shown that children find it difficult to discuss the incident with an adult, mainly due to their limited vocabulary
(especially in the pre-school years) (Brilleslijper-Karter et al., 2004; Hunter, 2010). Further to this, at the same time they face their own developmental problems (Brilleslijper-Karter et al.,
2004). According to the social cognitive model “the course of disclosure will vary according to children’s cognitive capabilities, social experience, and the particular situation in which they find themselves” (Bussey & Grimbeek, 1995, p. 186). Finklehor et al.’s (2001) model of crime supported that children cannot distinguish whether what happened to them was abuse and, therefore, as a result they do not disclose. They cannot even define whether what happened to them was appropriate or not (Paine & Hansen, 2002). In a study by Sas and Cunningham (1995) it was illustrated that 40% of children that go to court are not aware that they had been sexually abused at the start of the abuse. They do not even know where and if they should report it
(Staller & Nelson-Gardell, 2005). Sometimes, even if children recognise they have been abused, children may still deny it (Malloy et al., 2007). Many of these children are isolated by the abuse and they often do not have someone to talk to about it (Craven et al., 2006). Abusers may also present the abuse as a normal situation of parenting or education or as “a game or secret” (Faller, 2004). These all lead to the lack of a supportive initiative to assist them in making a disclosure.
Some testimonies of survivors have indicated factors that facilitate the disclosure, for example, it was found that it would be easier for survivors to disclose during childhood if they felt safe and protected from abuse. Whereas adulthood survivors making a disclosure mentioned that one may suppose that their secret could interfere with how close they feel to 25 the person they are disclosing to, since it was believed that the “secret interfered with intimacy”
(Roesler & Wind, 1994). Acknowledgement of abuse and retrieved memories can facilitate an abuse disclosure (Alaggia, 2004). Also, the disclosure can be facilitated by the distance; the further the perpetrator is from the victim, the easier and more helpful it is for the survivor to disclose (Alaggia, 2004; Hunter, 2011).
It is considered that the individual to whom a child reveals what has happened is a person that he or she perceives will be protective, understanding and will offer them belief and acceptance (Jonzon, 2006). Research has outlined that the most probable listener will be the mother of the child. This is illustrated by Stein and Nofziger (2008) that found teenagers between 11 and 17 would be most likely to reveal the abuse to their mother in instances where the abuser was a relative and to a friend when it was a non-family member. Children are less likely to disclose the abuse by a close family member (Arata, 1998; DiPietro et al., 1997;
Sorensen & Snow, 1991). However, some literature suggests that response by mothers may not be always positive or helpful, especially when the abuser is her current partner (Elliott &
Carnes, 2001). Another study also showed that female adolescents who have been abused by their father are more hesitant to disclose (Priebe & Svedin, 2008).
Overall, studies highlight that children disclose mainly to their parents (Jensen et al.,
2005; Paine & Hansen, 2002). Sullivan and Knutzon (2000) also noted that children at preschool age have fewer chances to disclose the abuse through official investigations. With regard to adults, it has been noted that 95% of adult survivors do not disclose to a family member (Somer & Szwarcberg, 2001). The majority of adult survivors disclose to people that they can trust, such as professionals (Deering & Mellor, 2011) partners and friends (Draucker
& Martsolf, 2008; Hunter, 2011; Jonzon & Lindblad, 2004; Smith et al., 2000; Sorsoli et al.,
2008; Stein & Nofziger, 2008). 26
1.2.8 Recovery and resilience
According to Chouliara et al. (2014), resilience is different to recovery, as they defined resilience in how it is “primarily about the protective factors that may insulate survivors from the harmful effects of abuse” whereas recovery as “a wider concept, relates to symptom remission (i.e. clinical recovery) and the survivors’ personal process and experience over time in order to reach a meaningful sense of life post abuse (personal recovery)” (p.69). Various authors support that recovery is occasionally referred to as healing; therefore, this thesis also includes studies that refer to recovery as healing.
Both resilience and recovery are not static indicators as they may be influenced by a plethora of factors and can change over time (Fisher et al., 2017). Both innate and external factors can have an impact on resilience and recovery.
The key factors that promote resilience include survivors’ genes, (Beach et al., 2013), educational engagement during childhood, such as having good performance and positive feelings toward school, and faith (Domhardt et al., 2015; Gall et al., 2007). Personal characteristics including optimism, self-control, self-confidence and cognitive appraisal are additional key factors that promote resilience (Herrman et al., 2011). Support from family and social support from peers, teachers, or significant others were also found to be positive factors towards resilience (Herrman et al., 2011).
Regarding recovery, key factors include survivors’ emotions, beliefs and attitudes, social life, external relationships and experiences of parenthood (Bick et al., 2014; Marriott et al., 2014; Seltmann & Wright, 2013; Zeglin et al., 2015), as well as education and healthcare;
Havig, 2008; Montgomery et al., 2015; Sneddon et al., 2016). Social environment plays also an important role and a plethora of studies indicate the value of social support to survivors
(Arias & Johnson, 2013; Banyard & Williams, 2007; Glaister & Abel, 2001; Merrill et al.,
2001; Panichrat & Townshend, 2010; Walsh et al., 2010). It was found that connection with 27 others is a factor that enhanced recovery (Banyard & Williams, 2007). Researchers also mentioned that social support helps survivors to improve self-worth and as a result, helps them to build inner strength and enhance the recovery process (Hyman & Williams, 2001; Valentine
& Feinauer, 1993). Spirituality and religion can also promote recovery (Banyard & Williams,
2007; Bryant-Davis, 2005). In a study by Leong et.al (2007), religion was found to be a key factor for lowering the possibility of suicide in survivors within Christian’s hubs (Leong et al.,
2007). Some personal characteristics such as self-respect, self-compassion, self-protection and self-acceptance have been cited as factors that help recovery too (Chouliara et al., 2014;
Draucker et al., 2011; Merrill et al., 2001; Phanichrat & Townshend, 2010).
Some factors have a greater influence over recovery more than others. For example, it is important to understand first and foremost the nature of the abuse, whether it was for the purpose of exploitation, love, or discipline. Secondly, the reasons as to why it transpired, particularly whether they were at fault, and subsequently the impact that the abuse had on survivors’ lives (Draucker & Martsolf, 2008; Roller et al., 2009).
Furthermore, survivors’ feelings around the abuse such as feeling shame and self-blame play an important role on recovery. It was shown that survivors who do not feel shame and do not blame themselves for the abuse, have increased self-esteem which aids the recovery process
(Feiring et al., 2002; Lev-Wiesel, 2000). In general, the literature shows that the recovery of some survivors was facilitated by the use of personal coping strategies.
Coping strategies are cognitive and behavioural efforts of survivors to cope with the stressful situations and facilitate recovery from CSA (Folkman & Lazarus 1986). However, some of these strategies may lead to long-term side effects (Updegraff & Taylor, 2000) and for that reason, the investigation of coping is of particular importance as it plays a crucial role on survivors’ lives. This is the subject of this thesis. Coping strategies are explained in the next chapter. 28
1.3 Conclusions and Research gap
CSA is a global social problem which has received increasing attention globally with growing research and media attention due to the high incidence and prevalence rates. Many researchers have investigated the prevalence rates, risk and protective factors and coping strategies which promote recovery, as seen earlier. The background literature review has shown that most of these studies have been focused on western countries and primarily in the US,
Australia and European countries. In recent years, there has been an increasing concern regarding the significant issue of CSA in developing countries (Abeid et al., 2015; Al-Saif et al., 2018; Veenema et al., 2015).
However, CSA research in developing countries such as Africa is still at early stages whereas the western countries have at least 40 years of experience in researching CSA and developing interventions. The background literature has shown that there is a significantly lower number of studies considering CSA in Africa in comparison to developed countries and these studies vary in terms of the definitions used, type of sexual abused studied, and quality of the data collected (Badoe, 2017).
Within the African context, CSA is a critical social issue in South Africa as the prevalence rates are substantially higher when compared to other countries. For that reason,
South Africa has been named as the “rape capital of the world” (Jewkes & Abrahams, 2002, p.
1231). There are more than 500,000 reported rape cases for children and women per year in
South Africa (Machisa et al., 2017) and a third of all South African children are sexually abused by the age of 18 years according to (Artz et al., 2016). The lifetime prevalence rate for boys is
36.8% and 33.9% for girls (Artz et al., 2016). Such rates are higher than those measured for females in high-income countries such as the United States with a prevalence rate of 26.6%
(Finkelhor et al., 2014), the United Kingdom at 18.6% (Radford et al., 2013) and Australia at
20% (Fleming, 1997). 29
The problem of CSA in South Africa has been increasing and existing legislation is inadequate to support children and families (Jewkes et al., 2005; Mathews, et al., 2013). This combined with the fact that most of the research studies around CSA have been mostly focused on western countries, mean that further research is required to address the issue of CSA in
South Africa specifically. The research community should consider the unique cultural factors in the area that may have an impact on the prevalence and incidence rates, the effects of CSA, the risk factors to CSA, the factors influencing disclosure and the coping strategies that promote recovery, thus avoiding biased interventions which were designed for western countries.
The literature shows that coping strategies may increase recovery and bounce resilience. However, it was also shown that they could delay recovery and lead to long-term side effects. For that reason, the investigation of coping is of particular importance as it plays a crucial role on survivors’ lives. The background literature shows that there is limited research on the topic and to this end, the subject of this dissertation is about coping strategies of CSA in South Africa.
The main research question of this study is: “What does the literature tell us about the ways in which CSA survivors in South Africa cope with their experiences of abuse?”
The research objectives to answer the research question are the following: i) to identify studies that are related to CSA coping strategies in South Africa, ii) to understand the main learnings for that specific population and iii) to compare these findings to the strategies of other higher-income countries. Studies that are focused primarily on recovery and resilience are still included in this analysis as such studies incorporate coping strategies as well
30
Chapter 2. Coping with Child Sexual Abuse
2.1 Coping theory and strategies
Some survivors of CSA were able to manage and lessen the negative consequences of their abuse living relatively ordinary lives. Their recovery was facilitated by the use of personal coping strategies that enabled the survivors to cope with abuse and its impacts (Folkman &
Lazarus 1986). However, some of these strategies may lead to long-term side effects
(Updegraff & Taylor, 2000) and for that reason, the investigation of coping is of particular importance as it plays a crucial role on survivors’ lives.
The coping theory includes cognitive and behavioural efforts of survivors to cope with the stressful situations and facilitate recovery from CSA (Folkman & Lazarus 1986). According to Knapp et al. (1997), coping includes strategies that are divided into four groups: ‘avoidance- denial’, ‘social support’, ‘confrontation-negotiation’ and ‘advocacy-seeking’. The first category of avoidance-denial involves strategies to avoid being physically close to the abuser, as well as to avoid thinking about the abuse. The second category of social support involves strategies which aim to receive support from others whereas ‘confrontation-negotiation’ is about directly confronting the abuser. The final one is related with strategies which empower the survivor to report the abuse (Knapp et al., 1997).
More generally, authors and researchers divide coping strategies into two main categories: adaptive and maladaptive coping strategies (Endler & Parker 1994; Folkman &
Lazarus 1986; Zeidner & Saklofske 1996). The term adaptive coping strategies (also known as active, approach, problem-focused and positive) refers to the situation when someone is aware of the problem and tries to reduce its impact. Maladaptive coping strategies (also known as passive, emotion-focused and avoidance) are used when someone intentionally avoids the problem and tries to reduce or cope with the emotional distress caused by the situation rather 31 than solving the problem itself. This coping theory is considered in this thesis and the results in the following sections are grouped into active and maladaptive coping strategies.
A common view throughout the literature is that people have different personality characteristics and different experiences that change over the course of time (Oaksford &
Frude, 2003). As a result, survivors use different coping strategies to manage the abuse including both adaptive and maladaptive strategies. In general, adaptive strategies are considered to be more beneficial to CSA survivors (Collins et al., 1990; Daigneault et al.,
2007), in comparison to maladaptive strategies which may lead to long-term side effects
(Updegraff & Taylor, 2000). Nevertheless, maladaptive coping strategies could have a positive impact in CSA cases at the time of the abuse as some strategies are helpful ‘survival’ strategies in the short-term in a period of danger (Oaksford & Frude, 2009).
The most common adaptive and maladaptive coping strategies are listed below.
2.1.1 Adaptive coping strategies
Numerous adaptive coping strategies have been used by CSA survivors to deal with the trauma in their lives and promote recovery. Building positive emotions (such as not feeling guilty), finding a purpose/ meaning in life (keeping busy/ taking back the control) and building personal strengths (Linley, 2003) are some typical strategies which enable survivors to find new personal strengths that are beneficial for their recovery. Studies also indicated that survivors, who blame the abuser for what happened, and not themselves lead into recovery
(Arias & Johnson, 2013; Himelein & McElrath, 1996; Lev-Wiesel, 2000, Willis et al., 2015).
Disclosure and/or talking about the abuse might also be beneficial for the recovery process depending upon the response of others (Banyard & Williams 2007; Chouliara et al.,
2014; Sneddon et al., 2016). Poor responses can have their own long-term effects usually emerge because of increased shame and guilt brought on by being blamed or when people stigmatise. 32
Keeping busy, engaging in social activities/ altruistic actions, having hope, living a normal life also promote recovery as these strategies increase the self-esteem of CSA survivors
(Arias & Jonson, 2013; Banyard & Williams, 2007; Chouliara et al., 2014; Draucker et al.,
2012; Oaksford & Frude, 2000). Accepting social support from, peer and family relationships can help CSA survivors to avoid psychological difficulties and recover (Banyard & Williams,
2007; Cossar et al., 2013; Hallett et al., 2003; Malloy et al., 2013; Schönbucher et al., 2014).
Additional studies noted the importance of religion and spirituality to cope with abuse
(Draucker & al., 2011; Gall et al., 2007; Grossman et al., 2006; Valentine & Feinauer, 1993).
Abuse also leads to loss of control, and when survivors take back the control it is considered as a helpful strategy for their recovery (Frazier et al., 2004; Frazier et al., 2005).
Overall, many adaptive coping strategies can be adopted by individuals to promote recovery and deal with the reality of the abuse.
2.1.2 Maladaptive coping strategies
Survivors also tend to use maladaptive coping strategies (passive, emotion-focused and avoidance), such as self-blame and substance use in order to cope with abusive memories
(Street et al., 2005). More specifically, they use substances in order to cope with anxiety and fears, and to feel more sexually attractive (Covington et al., 2008; Ouimette et al., 2000;
Teusch, 1997). Substance use is characterized as self-medication that decreases the pain
(Khantzian, 1997). They also deny or disengage from memories and feelings related to the stressor (Calvete et al., 2008; Choi et al., 2015; Johnson & Kenkel, 1991; Min et al., 2007;
Walsh et al., 2010), through the techniques of running away and drinking too much alcohol
(Chouliara et al., 2014).
Another qualitative study that included 2,986 cases of self-disclosure from sexually abused children (5–18 years old) found that both adaptive and avoidance coping strategies were used by the children in the study. This study took place through telephone counselling services 33
(ChildLine) in Scotland. Children reported the effectiveness of coping strategies that they used in order to cope with the abuse. Some of the strategies that were used by the children were avoidance and trying not to think about the abuse (Jackson et al., 2015).
Whiffen and MacIntosh (2005) concluded that avoidant coping strategies may temporarily reduce feelings of stress, yet they are still related to an increase in distress.
According to the authors, this is a subject that requires further research including larger sample sizes of participants.
2.2 Models to help survivors cope with the abuse
Several models have tried to explore the process of recovery and to demonstrate different coping strategies from general trauma and trauma of CSA. Some models are presented in this section as they are useful for the analysis conducted in the following chapters.
Herman’s (1992) model of trauma includes three stages. Firstly, the stage of safety where the establishment of safety is necessary through creating routines of self-care. The second stage includes the exploration of the traumatic experiences. The third stage consists of the reconnection with others through creating mutual and non-exploitative relationships.
A second model was developed by Arias and Johnson’s (2013) whose research was focused on external contextual factors of healing. Some of these factors include coping strategies as well such as seeking for social support that can be provided by others and social support that can be offered to others through volunteering. Formal education was also recommended in the study of Arias and Johnson’s (2013) as it was found to improve self- esteem and self-confidence. Informal education, such as writing about the experiences of CSA, was found to decrease loneliness and give hope for a better future. Confrontation of abusers such as writing them a letter or meeting them or even imagining meeting them could also be beneficial coping strategies that promote healing. 34
An important model for the trauma of CSA was created by Draucker et al. (2011), which described some stages of healing and the factors that help in progressing from one stage to the other based on the experiences of survivors. Four non-sequential stages of healing were reported: “Grappling with the meaning of CSA”, “Figuring out the meaning of CSA”,
“Tackling the effects of CSA” and “Laying claim to one’s life”. Survivors defined healing as the ability to talk about the abuse, living a satisfied life, and stopping ‘the cycle of abuse’. From this model the factors that facilitate moving from one stage of healing to another were related to survivor's inner personal traits and general support. It was also suggested that the aforementioned healing stages were enacted with several fields of functioning such as parenting, disclosure, spirituality and altruism. This could be attributed to the notion that survivors are different people with different experiences and that they have each developed their own coping strategies to deal with the abuse and promote recovery.
Harvey et al. (1994) model of recovery consists of eight fields that enable recovery, such as “Gaining authority over memories”, “Integration of memory and affect”, “Affect tolerance and regulation”, “Symptom mastery and positive coping”, “Self-esteem”, “Self- cohesion”, “Safe attachment” and “Meaning-making”. The first stages of Harvey’s and colleague’s model refers to traumatic memories and how to cope with them. It is suggested that if survivors work on their memories this could enable their recovery. Others may use maladaptive strategies in order to cope with the distress of the abuse, for example, the use of alcohol (Ireland & Widom, 1994; Moeller et al., 1993; Schuck & Widom, 2001). In another study survivors reported some domains of healing, namely, communicating with important others, looking for safety and re-evaluation of their-self (Draucker et al., 2009).
35
Chapter 3. Methodology
The method used in this study is a narrative literature review that applies a systematic approach to searching for the literature in order to identify the most relevant articles in the field.
This is achieved through selection of appropriate searching keywords (Rousseau et al., 2008;
Tranfield et al., 2003), following a more transparent, explanatory and heuristic structure to minimise any bias and error issues (Denyer & Tranfield, 2009).
Denyer and Tranfield (2009), propose a five-step procedure for conducting a systematic literature review which have been used in this study as well. The five steps are listed below:
Step 1 – Question formulation
Step 2 – Locating studies
Step 3 – Study selection and evaluation
Step 4 – Analysis and synthesis
Step 5 – Reporting and using the results.
3.1 Step 1 - Question formulation
The first step was to define a clear research question to establish the focus of the study and to frame the inclusion criteria. As indicated above, the research question was: “What does the literature tell us about the ways in which CSA survivors in South Africa cope with their experiences of abuse?”
3.2 Step 2 - Locating studies
In this step, relevant studies were located and selected. The literature was searched via the scientific databases of PubMed, PsyArticles, PsycINFO and Social Services Abstracts, using the first keyword of ‘child sexual abuse’. In addition to the ‘child sexual abuse’ keyword, a number of related search terms were used as well. These are the following: child sexual assault, childhood sexual abuse, child sexual trauma, child sexual victimisation, child sexual 36 exploitation, child sexual trafficking and rape. Hence, the search in Step 2 had the following formulation: Step 2 = (Child sexual abuse or Child sexual assault or Childhood sexual abuse or Child sexual trauma or Child sexual victimisation or Child sexual exploitation or Child sexual trafficking or Rape).
The search found 389 papers in the PsychArticles database, 164 in PsycINFO, 5665 in
PubMed and 4352 in SocialServicesAbstract, as shown in Table 1 (see section Step 2). All these articles include at least one of the above search terms in their title. The search was conducted on 14 December 2019.
3.3 Step 3 – Study selection and evaluation
In this step, a number of appropriate filters were applied on the articles found as part of the previous step to focus on the most relevant papers (Step 3.1). Then, the abstract of the resulting articles was assessed to exclude all irrelevant articles (Step 3.2) and after that, the text of the remaining articles was reviewed for making the final decision to include them in the study or not (Step 3.3). All steps are summarised in Table 1 below and a narrative description of each step is presented after the table.
Appropriate filters were applied on the articles as part of Step 3.1. In addition to ‘South
Africa’, the keywords ‘Coping strategies’, ‘Recovery’, ‘Intervention’ and ‘Resilience’ were used subsequently. Although the focus of the study is on coping strategies, the broader terms of recovery, intervention and resilience were also considered to identify additional relevant studies as such studies usually involve research on coping. Each keyword corresponds to a separate intermediate step – i.e. Step 3.1-A applies the filter ‘South Africa’; Step 3.1-B applies the filter ‘Coping strategies’, Step 3.1-C applies the filter ‘Recovery’; Step 3.1-D the filter
‘Intervention’; and Step 3.1-E the filter ‘Resilience’. Relevant search terms were used for each keyword as explained below.
37
Table 1 Literature review steps and findings
Step Search Formulation PsychArticles PsycINFO PubMed SocialServices
Abstract
2 (Child sexual abuse or Child sexual assault or Childhood sexual abuse or Child sexual trauma 389 164 5665 4352
or Child sexual victimisation or Child sexual exploitation or Child sexual trafficking or Rape)1
3.1-A (Child sexual abuse or Child sexual assault or Childhood sexual abuse or Child sexual trauma 7 45 51 24
or Child sexual victimisation or Child sexual exploitation or Child sexual trafficking or Rape)1
AND (South Africa)1
3.1-B (Child sexual abuse or Child sexual assault or Childhood sexual abuse or Child sexual trauma 5 3 2 2
or Child sexual victimisation or Child sexual exploitation or Child sexual trafficking or Rape)1
AND (South Africa)1 AND (Coping strategies or Coping skills or Cope or Coping)2
3.1-C (Child sexual abuse or Child sexual assault or Childhood sexual abuse or Child sexual trauma 5 4 3 4
or Child sexual victimisation or Child sexual exploitation or Child sexual trafficking or Rape)1
AND (South Africa)1 AND (Recovery or Rehabilitation or Healing)
3.1-D (Child sexual abuse or Child sexual assault or Childhood sexual abuse or Child sexual trauma 7 22 24 8
or Child sexual victimisation or Child sexual exploitation or Child sexual trafficking or Rape)1
1 Applied to the title 2 Applied to the text 38
AND (South Africa)1 AND (Interventions or Strategies or Best practices or Therapy or
Treatment)2
3.1-E (Child sexual abuse or Child sexual assault or Childhood sexual abuse or Child sexual trauma 4 6 3 5
or Child sexual victimisation or Child sexual exploitation or Child sexual trafficking or Rape)1
AND (South Africa)1 AND (Resilience or Resiliency or Resilient or Strengths or Hardiness or
Adaptation)
Table 1: The table explains the steps of the literature review including the findings from each database
39
The search formulation for Step 3.1-A is the following: Step 3.1-A = (Step 2) AND
(South Africa) = (Child sexual abuse or Child sexual assault or Childhood sexual abuse or
Child sexual trauma or Child sexual victimisation or Child sexual exploitation or Child sexual trafficking or Rape) AND (South Africa). The results for each database are shown in Table 1
(section Step 3.1-A). Of the total 389 articles found in the PsychArticles database during Step
2, only 7 articles include the term ‘South Africa’ in their title (Step 3.1-A). This shows that there are only a few studies of CSA recovery which are focused on South Africa in comparison to world-wide studies. In a similar way, of the total 164 articles found in the PsychINFO database during Step 2, only 45 articles include the term ‘South Africa’ in their title and so on.
Overall, CSA recovery studies in South Africa, account for a very low percentage of all CSA recovery studies worldwide, based on the findings of the literature search.
Step 3.1-B applies an additional filter on the results using they keyword ‘coping strategies’, as shown in Table 1 above. Search terms related to ‘Coping Strategies’, such as
Coping Skills, Cope and Coping, were used as well. The filter was applied on the text of the papers (not on the title only). The search formulation was the following: Step 3.1-B = (Step 2)
AND (Step 3.1-A) AND (Coping strategies or Coping skills or Cope or Coping). The results are shown in Table 4 (section Step 3.1-B) for each database. Of the total 389 articles found in the PsychArticles database during Step 2, only 7 articles include the term ‘South Africa’ in their title (Step 3.1-A); of which 5 articles include the term/s Coping strategies or Coping skills or Cope or Coping in the text. Similarly, of the total 164 articles found in the PsychINFO database during Step 2, only 45 articles include the term ‘South Africa’ in their title; of which,
3 articles include the term/s Coping strategies or Coping skills or Cope or Coping in the text.
Step 3.1-C uses the filter around the keyword ‘Recovery” to replace the filter of ‘Coping
Strategies’, which was used in the previous step (i.e. Step 3.1.B). Search terms related to recovery were including Rehabilitation and Healing. The search formulation for Step 3.1-C 40 was the following: Step 3.1-C = (Step 2) AND (Step 3.1-A) AND (Recovery or Rehabilitation or Healing). The results are shown in Table 1 (section Step 3.1-D) for each database. Of the total 389 articles found in the PsychArticles database during Step 2, only 7 articles include the term ‘South Africa’ in their title (Step 3.1-A); of which 5 articles include the term/s Recovery or Rehabilitation or Healing in the text. It is worth noting that some of these 5 articles were the same with the 5 articles identified as part of the Step 3.1-B since they include terms related to both Coping strategies and Recovery.
Step 3.1-D includes a filter around the keyword ‘Interventions’ and the related search terms of Best practices, Therapy and Treatment. The search formulation for this step is the following: Step 3.1-D = (Step 2) AND (Step 3.1-A) AND (Strategies or Best practices or
Therapy or Treatment). Again, the results are shown in relevant section of Table 1.
The keyword ‘Resilience’ and the related search terms Resiliency, Resilient, Strengths,
Hardiness and Adaptation were applied as a filter on the text. The search formulation for Step
3.1-E is the following: Step 3.1-E = (Step 2) AND (Step 3.1-A) AND (Resilience or Resiliency or Resilient or Strengths or Hardiness or Adaptation). The results are shown in Table 1.
After the completion of Step 3.1 the abstract of the articles was reviewed to exclude any irrelevant entries. A number of papers were found not be useful for answering the research question; even though the term South Africa was included in the title and some of the keywords were included in the text of the paper. For example, some articles were focused on the prevalence rates of CSA in South Africa and some others on the consequences of CSA in South
Africa. Those topics are not the focus of this thesis. The number of entries that passed the first review is shown in Table 2 for each database. 41
Table 2 Articles selected from each step after abstract review (Step 3.2)
Database Step 3.1-A Step 3.1-B Step 3.1-C Step 3.1-D Step 3.1-E
PsychArticles 2 2 2 2 1
PsycINFO 12 3 1 7 4
PubMed 18 2 1 5 2
SocialServicesAbstract 8 2 4 5 3
Table 2: This table shows the number of articles that passed the first review (Step 3.2 – abstract review) for each database
Then, the remaining publications were fully reviewed to ensure that the context was relevant for addressing the research question of this study. The number of entries that were chosen for further investigation are summarised in Table 3. In the end, 22 papers in total were found to be relevant for this study.
Table 3 Articles selected after full text review (Step 3.3)
Database Final Articles
PsychArticles 2
PsycINFO 12
PubMed 8
SocialServicesAbstract 5
Total 22
Table 3: The number of articles that were chosen for further investigation based on full text review for each database
3.4 Step 4 - Analysis and synthesis
The relevant information was extracted from the collection of the 22 most relevant papers to answer the research question which is stated in Step 1. The outcome of this step was 42 the description of the methods, participants and the main interventions adopted by the survivors in each case – chapter of Data Analysis. Some of the selected articles are not entirely focused on coping strategies, which is the subject of this thesis, but they have been selected for further consideration as they were useful for answering the research question. For example, some of the articles are focused on possible interventions, recovery and resilience; yet these studies incorporate information on coping strategies as well. The results are summarised in Table 4 below.
3.5 Step 5 - Reporting and using the results
In the end, the main findings of the literature review were summarised and discussed in the chapter of Discussion and Conclusions.
43 Chapter 4. Data Analysis
The main findings of the 22 articles that have been chosen following the methodology of the previous chapter are summarised in Table 4.
Table 4 An overview of the final 22 papers that are relevant to this study
No. Author(s) & Article title Aim of the study Study Method of data Participants Origin Main Findings Year Design collection
1 Berg, Hobkirk, The role of substance use The study explored if Mixed Face to-face clinical 161 men of Western Cape CSA was linked with substance use Joska & Meade, coping in the relation substance use coping, methods interview CSA of South coping by CSA survivors in an effort 2017 between childhood sexual mediates the relationship African to manage their stress. CSA and abuse and depression between CSA and The Alcohol, Smoking and 108 women depression were mediated by among methamphetamine depression. Substance Involvement of CSA substance use coping. users in South Africa. Screening Test
Childhood Trauma Questionnaire
Patient Health Questionnaire
COPE Inventory
2 Choi, Sikkema, Maladaptive coping This study explored the Quantitative Demographic questionnaire 84 women Cape Town, Childhood trauma was linked with Velloza, Marais, mediates the influence of association between South African depression and PTSD symptoms. Jose, Stein, Watt & childhood trauma on childhood trauma and Childhood Trauma Childhood Maladaptive coping was a mediator Joska, 2015 depression and PTSD mental health problems Questionnaire Short Form trauma between childhood trauma and among pregnant women in such as depressive/PTSD survivors, depression and PTSD symptoms. South Africa. symptoms. Edinburgh Postnatal including Depression Scale CSA
Davidson Trauma Scale
Brief COPE
3 Hobkirk, Watt Mediators of interpersonal This study explored the Quantitative Interpersonal violence 159 Women South African Interpersonal violence was related Green, Beckham violence and drug relationship between questionnaire with drug use. PTSD and substance Skinner & Meade, addiction severity among interpersonal violence and 201 Men use coping were mediating this 2015 methamphetamine use. relationship. The authors also 44 methamphetamine users in investigated PTSD Breslau Short Screening Interpersonal Cape Town, South Africa symptoms and substance Scale Violence, use coping as mediators of including this association. Addiction Severity Index- CSA Lite
The COPE
4 Jewkes, Dunkle, Associations between This study explored the Quantitative Stepping stones 1415 South African Sexual abuse was linked with alcohol Nduna, Jama & childhood adversity and prevalence of childhood intervention Women, youth use in men and depression and alcohol Puren, 2010 depression, substance use experiences of adversity use in women. and HIV and HSV2 and their relationships Childhood Trauma 1367 Men incident infections in rural with health problems. Questionnaire South African youth. Adverse 12-item AUDIT scale childhood experiences, Blood tests including CSA
5 King, Flisher, Substance abuse and This study explored the Quantitative Socio-demographic 519 female South African Tobacco and drug use were not linked Noubary, Reece, behavioural correlates of prevalence of rape in a questions and items about students adolescents with sexual violence; however, Marais, Lombard, sexual assault among South high school in Cape town substance abuse, sexual alcohol use was associated with sexual 2004 African adolescents and the association activity, and other 400 male violence. between sexual assault and adolescent health risk students use of alcohol, tobacco behaviours. and other drug use. The behavioural problems, and suicidality thoughts were also investigated.
6 Meade, Watt, Methamphetamine use is This study examined the Mixed WHO Alcohol Use 1454 female Cape Town, Methamphetamine users with a Sikkema, Deng, associated with childhood prevalence of methods Disorders Identification participants South Africa history of child sexual abuse were Ranby, Skinner, sexual abuse and HIV methamphetamine use and Test using marijuana, inhalants, and Pieterse & sexual risk behaviours its association to HIV 1874 male injection drugs. Meth use was also Kalichmann,2012 among patrons of alcohol- sexual risk behaviours. Traumatic Events participants linked with sexual risky behaviours. serving venues in Cape Questionnaire Meth use mediated the association Town, South Africa between childhood sexual abuse and Conflict Tactics Scale all sexual risky behaviours.
Questions about sexual risk and demographics 45 7 Vermeulen & Family Resilience The study aimed to Qualitative Semi-structured interviews 9 parents of Western Cape Family resilience was influenced by Greeff, 2015 Resources in Coping with investigate factors that children with Province, parents’ relationship with their Child Sexual Abuse in help families to cope with CSA history South Africa children, parents’ emotional South Africa child sexual abuse and functioning, children’s ability to cope promote family resilience. with the abuse, boundaries in the family, children’s needs, sibling relationships, as well as support from family members, friends, community- based non-profit organizations and schools.
8 Mathews, Exploring Mental Health This study aimed to Qualitative Semi-structured and 30 Western Cape Factors such as emotional support Abrahams & Adjustment of Children explore the psychological structured interviews Caretakers town, South from parents and social services, Jewkes, 2013 Post Sexual Assault in adjustment of children of Africa increased survivor’s recovery. South Africa sexual assault. 30 Children of CSA
9 Phasha, 2010 Educational Resilience This study aimed to Qualitative In-depth interviews 21 women of South Africa Educational resilience was influenced Among African Survivors develop a theory CSA by participants’ interpretations of their of Child Sexual Abuse in describing how their racial experience, behaviour exhibited at South Africa socialisation and identity 1 man of school, determination to succeed, and mitigates the negative CSA educational and career aspirations effects of their experience and how they come to experience educational resilience.
10 Walker-Williams, Coping Behaviour, This study explored Qualitative Semi-structured interviews 10 women of South Africa Positive coping behaviours was Van Eeden, & Van posttraumatic growth and coping behaviours and CSA related with inner strength and well- der Merwe, 2013 psychological well-being in posttraumatic growth of being. women with childhood women who have been sexual abuse. sexually abused, and their influence on women’s well-being.
11 Walker-Williams, A Strengths-Based Group This study aimed to Qualitative Drawings, narratives, and 10 women of South Africa Emotional awareness, decisive action, & Fouche, 2017 Intervention for Women explore the benefits of a transcriptions CSA post trauma identity, and a healing Who Experienced Child “survivor to thriver” group context had an impact on Sexual Abuse strengths-based group survivor’s wellbeing. intervention program with survivors’ of CSA. 46 12 Booley, 2008 Subjective accounts of This study aimed to Qualitative Semi-structured interview 10 women's South African Making peace, meaning-making, post-rape adjustment explore the post-rape experiences reconnecting with the self, making among South African rape adjustment of CSA of rape, 2 of time for themselves, writing, gaining survivors survivors. them were personal insight, keeping busy, being survivors of positive, having goals and helping CSA others helped their post-rape adjustment.
13 Walker-Williams, Resilience enabling This study aimed to Qualitative Drawings, narratives, and 8 women of South African Group intervention, coping strengths, & Fouche, 2018 processes and evaluate the benefits of a transcriptions CSA meaning-making and spirituality had a posttraumatic growth programme from positive impact on participants’ outcomes in a group of “Survivor to Thriver”, recovery. women survivors of survivors of CSA childhood sexual abuse
14 Walker-Williams, The Prevalence of Coping This study aimed to Quantitative Biographical questionnaire 60 women of South African Therapy and religion were found to be Van Eeden & Van Behaviour, Posttraumatic explore coping strategies, CSA positive components of their recovery der Merwe, 2012 Growth and Psychological posttraumatic growth and COPE Inventory (COPE) process. Positive contribution had also Well-Being in Women who psychological well-being personal strengths, appreciation of life Experienced Childhood of CSA survivors. Coping Self-efficacy Scale and spirituality. Sexual Abuse (CSE)
Posttraumatic Growth Inventory (PGI)
Mental Health Continuum – Short Form (MHC-SF)
Rosenberg Self-esteem Scale (RSES)
General Health Questionnaire (GHQ)
15 Marivate & Levels of Social Support This study examined the Mixed Child Maltreatment 115 men of South Africa Social support from their family Ntomchukwu and Coping Strategies in influence of social support methods Interview Schedule members, praying, getting busy, Madu, 2007 Adult Survivors of Child coping strategies on the 383 women support from health professionals had Sexual Abuse psychological adjustment General Health a positive impact on psychological of CSA survivors. Questionnaire Of which adjustment of survivors. 148 Ways of Coping Scale participants, 47 Open-ended questions- reported interview contact CSA
16 Phasha, 2008 The role of the teacher in This study aimed to Qualitative Individual and focus group 21 sexually South Africa Providing support, building trusting helping learners overcome investigate school interviews abused relationships, safety, offering the negative impact of functioning of sexually female preventive/ treatment programs and child sexual abuse abused learners and the students making referrals were all positive role of teachers in factors. supporting them. 1 male student
Two groups of teachers.
17 Hogarth, Martin & Relationship between The study aimed to Quantitative Childhood trauma (CTQ) 689 girls Cape Town, Emotional, physical and sexual abuse Seedat, 2019 childhood abuse and explore the association South Africa were related to alcohol/drug use. substance misuse problems between childhood abuse Alcohol (AUDIT) 460 boys is mediated by substance and substance use. use coping motives, in Drug problems (DUDIT) school attending South African adolescents Coping orientation (A- COPE)
18 Watt, Ranby, Posttraumatic Stress This study explored the Mixed- Adult emotional intimate 560 women, Cape Town, Alcohol use and PTSD symptoms Meade, Sikkema, Disorder Symptoms association between methods partner violence (IPV) including South Africa were linked with traumatic MacFarlane,Skinn Mediate the Relationship traumatic experiences and CSA experiences. There was a strong er, Pieterse, Between Traumatic alcohol use and examined Childhood Trauma relationship between traumatic Kalichman, 2012 Experiences and Drinking PTSD as a mediator of this Questionnaire exposure and drinking levels, which Behavior Among Women relation. was largely mediated by PTSD Attending Alcohol-Serving World Health Organization symptoms. Venues in a South African Composite International Township Diagnostic Interview
Alcohol Use Disorders Identification Test (AUDIT)
PTSD Checklist–Civilian Version (PCL-C) 48 19 Abraham, Jewkes, Impact of telephonic This study explored the Mixed Telephonic support 279 rape Western and No evidence was found that the Lombard, psycho-social support on impact of a telephonic methods survivors Eastern Cape telephonic psycho-social support Mathews, adherence to post-exposure psycho-social support for Face to face follow-up intervention increased medication Campbell & Meel, prophylaxis (PEP) after rape survivors in South interviews adherence or improved psychological 2010 rape Africa to continue outcomes of rape survivors in South medication and provide 20-item CES-Depression Africa. psychological support. Scale
20 Leibowitz, Child Rape: Extending the This study aimed to Qualitative A description of the Survivors of South Africa Child's social and family context Mendelsohn, & Therapeutic Intervention to describe therapeutic interventions with CSA child rape needed to be taken into account in the Michelson, 1999 Include the Mother-Child interventions with CSA survivors at Alexandra and sexual interventions, using the mother as co- Dyad survivors. Clinic in Gauteng. abuse therapist.
21 Van der Linde & “It’s Like Uprooting This study aimed to Qualitative This systematic case study Case study South Africa It was shown that therapy Edwards, 2013 Trees”: Responsive examine the treatment documents 27 sessions of of Bongi (23 interventions were valuable Treatment for a Case of process of Bongi who was assessment and treatment years old) experience for Bongi’s recovery. Complex Post-Traumatic raised in a punitive with cognitive therapy Stress Disorder Following environment, was raped Multiple Rapes three times, the first time at age 9, and was in a series of abusive relationships.
22 Edwards, Sakasa Trauma, resilience and This study aimed to Qualitative Two case studies of CSA Two case South Africa Gender, developmental factors, social & Van Wyk, 2005 vulnerability to PTSD: A explore the factors that are survivors studies support and personality factors review and clinical case linked with resilience and increased resilience from CSA. analysis the PTSD symptoms following abuse.
Table 4: This table summarises the main findings of the 22 articles that have been chosen for review following the methodology of the previous chapter 49
The 22 articles of Table 4 were fully reviewed and the main coping strategies that have been used by survivors of CSA in South Africa based on previous research are analysed below.
It is worth noting that the coping strategies presented in this thesis are based on the studies conducted by the researchers of Table 4. Evidence generated by research is used in this thesis to understand CSA coping in South Africa and this may not provide the full picture. The coping strategies are grouped into the two main categories of maladaptive (also known as passive, avoidant and emotion-focused) and adaptive (active, approach, problem-focused and positive).
Key themes have been identified within the maladaptive and adaptive categories as shown in
Table 5. The relevant papers of Table 4 are cited in each theme.
Table 5 Coping strategies that have been identified in the 22 articles
Maladaptive coping strategies Adaptive coping strategies
Substance misuse Utilising support from family, friends and important others
Sexual risky behaviours Utilising support at school
Anti-social behaviours Seeking psychological therapy
Suicidal behaviours Optimism
Denial Religion
Regulation of emotions
Conscious choices
Knowledge – awareness
Forgiveness
Gratitude
Connectedness
Getting back the control
Making meaning of abuse
Acceptance of abuse
Secrecy
Helping others 50
Keeping busy
Table 5: This table shows the coping strategies that have been adopted by CSA survivors in South Africa and can be grouped into the two main categories of maladaptive and adaptive coping strategies.
4.1 Maladaptive coping strategies
Through investigating the literature, maladaptive coping strategies were found to play an important role in South African survivors of CSA. These include substance misuse, sexual risky behaviours, anti-social behaviours, suicidal behaviours and denial coping strategies.
4.1.1 Substance misuse
Substance use coping was linked with CSA among the South Africa studies as it was found to be a strategy for managing their stress. For example, Berg et al. (2017) examined 269 survivors and showed that CSA was significantly linked with higher methamphetamine use.
However, it was shown in the study that substance use was only a temporary effective solution as it was further related to long-term depressive symptoms.
These findings align with the outputs of the study which was conducted by Meade et al. (2012) who showed that sexual abuse experiences during childhood were related with methamphetamine use. About 25% of all methamphetamine users in the study had history of
CSA and 50% of them had experienced intimate partner violence.
Similarly, Hobkirk et al. (2015) examined the link between interpersonal violence
(including CSA) and drug addiction in South Africa. It was found that substance misuse
(primarily methamphetamine use) was used by the participants of the study to mitigate the symptoms of PTSD caused due to their violent experiences.
In the same vein, the practice case study which explored the case of Bongi in South
Africa (Bongi is the name of a CSA survivor in South Africa) shows that Bongi was smoking marijuana in order to manage her stress (Van der Linde & Edwards, 2013).
Alcohol misuse was also evident among South African survivors. The study that was carried out by Jewkes et al. (2010) examined the relationship between adverse childhood 51 experiences (including CSA) and their association with healthy outcomes. It was found that alcohol misuse was more common in women and men who had experienced CSA than other forms of abuse.
Similarly, the relationship between traumatic experiences and drinking behaviour was explored by Watt et al. (2012) based on a sample with women in South Africa. It was found that women who had been previously sexually abused had a high rate of drinking when compared to women with no history of CSA (Watt et al., 2012). The study of King et al. (2004) showed that alcohol misuse was related with sexual assault of adolescents in South Africa.
Similar findings were reported by Hogarth et al. (2019) who showed that CSA was positively associated with alcohol misuse in adolescents. Mathews et al. (2013) investigated the psychological adjustment of older children of post sexual assault and showed that the use of drugs and alcohol was evident among the survivors. Finally, the study of Phasha (2010) that examined 16-23 years old young adult survivors of CSA showed that survivors found relief in drugs and alcohol within the school.
4.1.2 Sexual risky behaviours
Meade et al. (2012) identified that CSA was related with sexual risky behaviours, which may include selling and buying unprotected sex with multiple partners. It was found that survivors of CSA had more sexually transmitted infections compared to those who did not have a history of CSA. According to Meade et al. (2012), the adoption of sexual risky behaviours is an action from the survivor and for that reason it can be considered as a coping strategy and not only as a consequence of the abuse.
In addition to exploring the relationship between CSA and alcohol misuse (mentioned in the previous theme), Jewkes et al. (2010) also explored the link between CSA and sexually transmitted infections in South Africa. The study showed that women who have been sexually 52 abused were at a higher risk of obtaining sexually transmitted infections, such as HIV, due to a more intense sexual life.
According to Phasha (2010), CSA survivors at schools may develop a sex-oriented mindset. Such behaviours were interpreted as offensive by the teachers but in reality, these children were strongly sexualised, and their thoughts and actions involved sex content (Phasha,
2010). The study of Mathews et al. (2013) showed that survivors engaged in risky sexual behaviour, such as partied with an older group of peers.
4.1.3 Anti-social behaviour
King et al. (2004) investigated the substance use and sexual abuse experiences in adolescence (as explained in the section of substance use), but they also investigated the link between the anti-social behaviours and CSA. They found that anti-social behaviour, such as stealing and causing damage to properties, bulling others and getting involved in physical fights was more likely to be adopted by sexually abused adolescents than those who did not experience CSA. Again, anti-social behaviour is considered as a coping mechanism due to the experience of abuse.
Similar findings were reported by Mathews et al. (2013), who showed that their CSA adolescent participants had several behavioural problems. It was shown that the participants were more prone to develop friendships with wrong people, they did not use to return home after a night out, they used to skip school and being aggressive. Young survivors in Phasha’s study (2010) used to have bad behaviour against teachers, be involved in fights, getting involved in burglaries, having aggressive behaviour, being bullied to others and skipping school on a regular basis (Phasha, 2010). Social isolation and skipping school were also some of the coping strategies that were used by the survivors explored in the study of Edwards et al.
(2005). 53
4.1.4 Suicidal behaviours
It was also found that CSA survivors in South Africa had suicidal behaviours (King et al., 2004; Van der Linde & Edwards, 2013). In the first study, King et al. (2004) show that approximately 30% of the participants had suicidal impulses of which 8% of the sample reported suicidal thoughts, around 10% reported suicidal dialogue and about 10% had attempted suicide (King et. al., 2004). Making a reference to the latter study which is the case study of Bongi (a CSA survivor in South Africa as explained above), the girl reported suicidal thoughts (Van der Linde & Edwards, 2013). Although suicidal behaviour can be an impact of the abuse, it is also considered as a coping strategy.
4.1.5 Denial
It has been shown in several studies that childhood trauma, especially CSA, is significantly associated with depression and PTSD. The study which was carried out by Choi et al. (2015) showed that denial (denying the abuse) is a maladaptive coping strategy that could mitigate depression/ PTSD caused due to childhood trauma.
Avoid dealing with the rape and pretending to be fine it was also a common technique among South African women, who participated in the study of Booley (2008), with the intention to prevent and/or to treat depression and PTSD. However, it was shown that denial coping was not sufficient by itself to address depression and PTSD effectively (Booley, 2008).
4.2 Adaptive coping strategies
The term adaptive or active/ positive coping strategies refers to the situation when someone is aware of the problem and tries to reduce its impact. Several adaptive coping strategies have been adopted by the South African participants in the studies of Table 4 including accepting support from family, friends and important others, getting professional 54 therapy, religion, being optimistic, regulation of their emotions and expressions, acceptance of the abuse, etc. as summarised in Table 5.
4.2.1 Utilising support from family, friends and important others
The study that was carried out by Vermeulen and Greeff (2015) examined the resources that help families to cope with CSA and lead to resilient outcomes. The relationship between parents and children was found to be an important factor for building up family resilience.
Accepting support from family friends, employers and social services were found to be valuable external family resources that helped families and survivors to cope with CSA and enhance resilience (Vermeulen & Greeff, 2015). These findings were also confirmed by
Mathews et al. (2013) who conducted interviews with caretakers and CSA survivors and showed that accepting emotional support from important others and caregivers is beneficial for children’s psychological adjustment.
The significance of accepting social support was also investigated by Marivate and
Ntomchukw Madu (2007). The authors showed that utilising social support from the family members was the most significant factor which assisted the CSA survivors of the study to cope with the abuse. In the same vein, seeking social support from friends, family and professionals were also some of the strategies which had positive impacts on survivor’s lives (Walker-
Williams et al., 2013). Edwards et al. (2005) and Walker-Williams and Fouche (2018) also agreed that accepting social support from family and peers increase resilience from CSA.
Along the same lines, talking to a friend or a relative about the abuse was also found to be a positive strategy (Booley, 2008; Marivate & Ntomchukw Madu, 2007). Finally, disclosing the abuse to a friend and receiving empathy, helped Bongi (a CSA survivor) to cope with the abuse
(Van der Linde & Edwards, 2013). 55
4.2.2 Utilising support available at schools
Learners who had been previously abused expressed the importance of accepting both academic and emotional support from teachers (Phasha, 2008). This, involves being around teachers who gave courage and guidance, as well as the opportunity to the children to discuss about their sexual abuse experience and express their feelings.
Moreover, Phasha (2010) highlighted how important is for CSA survivors to know that they can talk to a school staff if they have the desire to talk to somebody about family problems.
Accepting social support from teachers and other school members (such as the secretaries) complements family support and helps children build resilience. These findings were also confirmed by Vermeulen and Greeff (2015).
4.2.3 Seeking psychological therapy
In several South African studies, survivors reported that choosing to have therapy sessions was a positive experience (Edwards et al., 2005; Marivate & Ntomchukw Madu, 2007;
Van der Linde & Edwards, 2013; Walker-Williams et al., 2012). More specifically, the study by Mathews et al. (2013) showed that utilising support from social services and having therapies, such as counselling and play therapy, were found to be highly beneficial for children’s wellbeing. Similar findings are also applied in adult’s recovery as it was revealed in the study conducted by Van der Linde and Edwards (2013) about the case study of Bongi. The study showed that cognitive therapy contributed to positive changes and Bongi herself mentioned that therapy had been a valuable experience, as she was feeling more alive, confident and was able to take care of herself. Marivate and Ntomchukw Madu (2007) also agree that getting help from a health professional was a helpful coping strategy among the participants of their study; and Edwards et al. (2005) also found that their CSA participants were responding positively to the offered psychotherapy sessions. 56
The benefits of having therapy were also investigated by Walker-Williams and Fouche
(2017). The authors used a quasi-experimental, group of women with a history of CSA to evaluate the benefits of an intervention programme. The program was aiming to enable survivors to adopt a more positive mindset, let behind the victim-based thoughts and become a survivor-thriver. This was achieved through activities that aimed to support survivors to better understand their personal strengths and values, enable them to share their stories with others and informing them about a range of possible coping strategies that can be used in their case.
Similar findings were reported in the more recent study of the same authors, Walker-
Williams and Fouche (2018), who investigated the resilience enabling processes and posttraumatic growth outcomes in a group of women survivors of CSA. The authors found that accepting the intervention program had a positive impact on participants by improving their resilience by using both internal and external strengths.
According to Walker-Williams and Fouche (2017) and Walker-Williams and Fouche
(2018), having therapy sessions were found to have a positive impact on survivors’ lives.
Survivors had the chance to meet other survivors during the therapy sessions and hear their stories. This made them to feel stronger as they realised that other people have had similar challenges in their lives (Walker-Williams & Fouche, 2018).
Another intervention program for South African survivors of CSA was investigated by
Leibowitz et al. (1999). The authors of that study used a therapy model for survivors, following the steps of talking about their traumatic experience, recognising the impact on their lives, removing any feelings of guilty, getting informed about a wide range of possible coping strategies and making ambitions for the future. The authors also included a therapeutic intervention with the ‘mother-child dyad’ whereby the mother was used as a co-therapist for providing emotional support to the child, showing her empathy and facilitating discussions.
Overall, the program showed that the CSA survivors who had professional therapy sessions 57 felt relieved which had a positive impact on their feelings and CSA recovery (Leibowitz et al.,
1999).
Although therapy sessions were found to be key coping strategy among several studies in South Africa, it is worth mentioning one study which showed that telephonic therapies were not useful for the participants involved in the study. In this study, the authors explored the benefit for having live consultations over the phone to support CSA survivors. The counsellor used counselling skills such as listening and validating the traumatic events, persuading survivors to continue their medication, to look for support from family and friends and to use counselling services further. However, no evidence was found that the telephonic support had a positive impact on survivors after 28 days of trial.
4.2.4 Optimism
Optimistic attitudes such as no self-blaming attitudes, realising that the negative feelings will be temporary or receiving CSA as a learning experience were also found particularly beneficial for CSA survivors (Phasha, 2010). Through realising that they are not responsible for the abuse, survivors were able to adopt a more optimistic and positive approach and minimise their negative feelings. As a result, survivors were able to forgive and not feeling anger. This enhanced their sense of self-efficacy and confidence (Walker-Williams et al.,
2013).
Further, having a purpose in their life, positive emotional function and attitudes enabled
CSA survivors (and their families) to cope better with the abuse (Vermeulen & Greeff, 2015).
In a case study about the PTSD of a survivor in South Africa who was raped multiple times, it was shown that survivor’s optimistic views such as being positive, making plans to travel and continue her professional career were helpful coping strategies (Van der Linde & Edwards,
2013). 58
Other optimistic coping strategies from CSA survivors include having hope about rebuilding their lives, continuing their studies and having some sense of control over their future (Edwards et al., 2005). Walker-Williams and Fouche (2017) showed that the participants of their study had signs of improvement when they had transition from the survivor to the more thriver position. This was achieved through restructuring themselves using hardiness, internal locus of control, sense of purpose and positive outlook (Walker-Williams & Fouche, 2017).
Additional positive coping strategies around optimism include living day to day, having goals and thoughts about the future, and engaging in positive activities (e.g. having regular exercise and following daily routines) (Booley, 2008; Walker-Williams & Fouche 2018).
4.2.5 Religion
Psycho-spiritual resources and religious coping helped South African survivors to cope with the abuse (Walker-Williams et al., 2013). Creating a relationship with the God through praying was found particularly beneficial for the participants in that study, regardless the fact that they felt abandoned by the God soon after the abuse.
Religion in particular, was also reported by the participants in additional studies, as a helpful factor to their recovery process by receiving guidance and strength from God through pray (Marivate & Ntomchukwu Madu, 2007; Walker-Williams et al., 2012). Religion was also reported by the participants of Phasha, (2010) and Vermeulen and Greeff, (2015). Similarly, the participants in the study of Walker-Williams and Fouche, (2018) reported that the relationship with God provided them comfort and strength overcoming their challenges.
4.2.6 Regulation of emotions
The impact on survivors’ recovery through regulation of emotions was explored by
Walker-Williams et al. (2013). Understanding their feelings and recognising the link with their thoughts and actions, as well as confronting their emotions and preventing themselves to have 59 negative thoughts were beneficial coping mechanisms for their recovery (Walker-Williams et al., 2013). It was shown that South African participants become stronger through their pain and despair and were able to reconstruct their lives by regulating their negative emotions (Booley,
2008; Walker-Williams et al., 2013; Walker-Williams & Fouche, 2018).
An intervention programme for CSA survivors was also explored by Walker-Williams and Fouche (2015) with the aim to encourage participants to develop coping strategies useful for their recovery. This includes coping skills to identify, face and constraint the impact of negative feelings related to the abuse. The outcome was an indication of a changed perception of themselves which had positive impact on participants.
4.2.7 Conscious choices
The strategy conscious choices is about survivors making the decision to face the trauma in their lives and move on. This was found to be an effective adaptive coping strategy according to Walker-Williams et al. (2013). This is also linked with the strategy that participants make a conscious decision to see themselves as a new person through a different perspective in order to become stronger and address their struggle with CSA (Walker-Williams
& Fouche, 2018).
4.2.8 Knowledge – awareness
This coping strategy is about survivors recognising the trauma in their lives and accepting the fact that the abuse had a significant impact on their lives. The awareness of the facts improves self-awareness and initiates the process restructuring and reframing for adopting a more thriver mind-set (Walker-Williams & Fouche, 2018). Emotional awareness is also important according to the same authors and this can be achieved through the experience of talking to somebody about the abuse and expressing their emotions (Walker-Williams & 60
Fouche, 2015). Additional factors which improve self-knowledge and awareness can be gained through talking, reading, studying and attending therapies (Walker-Williams et al., 2013).
In another study by the same authors, the participants were urged to acknowledge aspects of their selves that should feel proud of (Walker-Williams & Fouche, 2018). The adoption of a more positive mindset due to deeper self-knowledge was also evident in Walker-
Williams et al. (2013) study as survivors were able to acknowledge their worthiness and uniqueness. Being ‘no-one’s shadow’, being ‘valuable’, having the same ‘rights’ as other people who have not been raped and having ‘dignity’ are some of the expressions used by the participants of the study (Walker-Williams et al., 2013) to explain how deeper self-knowledge is affecting coping in a positive way.
4.2.9 Forgiveness
Forgiveness of the abuser and self-forgiveness about what happened were also found among the coping strategies used by CSA survivors in South Africa (Booley, 2008; Walker-
Williams et al., 2013; Walker-Williams & Fouche, 2017). Their ability to forgive enabled them to build personal resilience and strength which had a positive impact on their recovery (Walker-
Williams et al., 2013).
4.2.10 Gratitude
Having an appreciation of their lives was found to be a beneficial strategy for CSA survivors in South Africa (Walker-Williams et al., 2012; Walker-Williams et al., 2013). This mainly refers to fact about having a greater appreciation about the life and being pleased with life in general (Walker-Williams & Fouche, 2018).
4.2.11 Connectedness
Connectedness is an additional active coping strategy which refers to an improved connection to others. Such approach improves the psychological wellbeing of CSA survivors 61 and allows them to adopt a more positive attitude which is beneficial for their recovery
(Walker-Williams et al., 2013).
In addition to reconnecting with others, reconnecting with themselves was also important for CSA survivors. This was demonstrated through making time for themselves, talking to themselves, writing, and gaining personal insight (Booley, 2008).
4.2.12 Getting back the control
It was shown in the literature that by having control of their own processes and decisions, participants feel empowered which helps them deal with the trauma in their lives
(Walker-Williams et al., 2013; Walker-Williams & Fouche, 2017). Firstly, CSA survivors have the best understanding about their emotions and needs and for that reason they have a key role in their recovery process. Secondly, it was stated that numerous people can give advice about facing the negative feelings related to CSA but the real change is dependent on survivors’ willing to change (Walker-Williams et al., 2013; Walker-Williams & Fouche, 2017). It was also mentioned that writing their thoughts and feelings helped them to gain control of their emotions and expressions (Booley, 2008) which has a positive contribution on survivors’ recovery as shown in the section Regulation of Emotions above.
4.2.13 Making meaning of abuse
Trying to make a meaning about why the abuse happened to them was found to be a helpful coping strategy for South African survivors (Walker-Williams et al., 2013). Thinking that the abuse makes them a better person, or the abuse is a reason to learn how to deal with difficulties in life were some of the examples stated by the participants of the study (Walker-
Williams et al., 2013). In addition to that, making assumptions about the abuser and setting some context around the abuse helped them to justify the reasons of the abuse which had a 62 positive impact on their healing. This was also confirmed by Booley (2008) who showed that survivors who were able to contextualise the abuse reported positive experiences.
4.2.14 Acceptance of abuse
Survivors reported that accepting that the abuse happened to them, (Marivate &
Ntomchukw Madu, 2007), as well as realising that they need to cope with the consequences of the abuse helped to move on with their lives (Walker-Williams, et al., 2013; Walker-Williams
& Fouche, 2018).
4.2.15 Secrecy
The review of Booley’s case study shows that the participant took control of the disclosure process and kept the abuse secret for a while until she felt strong enough to share her experiences (Booley, 2008). This allowed them to draw controlled support from friends, partners, counsellors and other rape survivors on her own pace as needed, which made the recovery process more effective (Booley, 2008).
4.2.16 Helping others
Helping others and giving unconditionally were useful strategies for CSA survivors because through their support to others were able to support themselves as well. It was also shown that assisting others could foster hope and meaning (Booley, 2008; Walker- Williams-
Fouche, 2018), as well as it could enhance personal strength (Walker-Williams et al., 2012).
4.2.17 Keeping busy
Getting busy in order to stop thinking about the abuse, as the mind is occupied with other things was another coping strategy adopted by the participants of Marivate and
Ntomchukw Madu (2007) and Booley (2008). For example, by keeping herself busy with academic responsibilities, the participant in the study conducted by Van der Linde and
Edwards, (2013) was able to stop thinking about the abuse. 63
Chapter 5. Discussion
A variety of coping strategies that indicate and influence the path of coping from CSA in South Africa has been identified in the previous chapter. These strategies were grouped into specific themes within the two main categories of maladaptive and adaptive coping according to the coping theory presented in Chapter 2. The work so far, addresses the first research objective which is about identifying studies that are related to CSA coping in South Africa (the research question and research objectives are reproduced below for reference3). This chapter discusses the main findings of CSA coping in South Africa and describes the main differences and similarities with the relevant literature on western countries where possible. This, addresses the other research objectives.
It was illustrated through the investigation of the studies that the use of maladaptive coping strategies (e.g. substance misuse, sexual risky behaviours, anti-social behaviour, etc.) was frequently reported among CSA survivors in South Africa. The South African studies show the link between CSA and maladaptive coping but only a few studies support the fact that maladaptive coping is a beneficial approach for dealing with the trauma. Most of the studies do not highlight the long-term impact of maladaptive strategies on survivors’ recovery path.
Maladaptive strategies were found to be more effective in the short-term. They are coping strategies which help survivors to stay away from the reality of the abuse. Survivors are not overwhelmed by the abuse and for that reason such strategies may be beneficial for survivors to function better at school, work, socially, etc. In the long-term, the use of maladaptive strategies is associated with a variety of psychological problems such as distress, depression, PTSD symptoms. This was recognised both in western and South African studies
3 Research question: “What does the literature tell us about the ways in which CSA survivors in South Africa cope with their experiences of abuse?” Research objectives: i) to identify studies that are related to CSA coping strategies in South Africa, ii) to understand the main learnings for that specific population and iii) to compare these findings to the strategies of other higher-income countries. 64
(Min et al., 2007; Morris et al., 2014; Whiffen & MacIntosh, 2005; Woodhead, et al., 2014).
Maladaptive use makes CSA survivors to separate from the abuse in the short-term by having distractions; however, some survivors do not actually deal with the consequences of the abuse.
It also worth noting that continuous use of maladaptive strategies, such as substance misuse, is likely to put survivors’ physical and mental health at risk irrespectively of the abuse.
Substance misuse was found to be a common maladaptive coping strategy both in South
Africa and western countries. Drugs and alcohol are used by CSA survivors to minimise or block the pain caused by the abuse because is a method to escape from their feelings and memories. The short-term alcohol-induced and/or drug-induced euphoria after substance use is also considered as a coping strategy for survivors to start feeling good again. However, this coping strategy becomes often an addition which can severely compromise the quality of survivors’ lives.
Without generalising the results, as the studies considered in this thesis have different subject and focus, methamphetamine, tobacco and alcohol use were evident in 9 out of the 22
South African studies of Table 4 (not all of the 22 studies focused on/ measured substance misuse). Substance misuse was also evident in research studies conducted in western countries as well (Butt et al., 2011; Chouliara et al., 2014; Delima & Vimpani, 2011; Dube et al., 2005;
Freyd et al., 2005; Goldstein et al., 2010; Konkolÿ Thege et al., 2017; Min et al., 2007; Moeller et al., 1993; Molnar et al., 2001; Morojele et al., 2016; Nelson et al., 2002; Saban et al., 2014;
Schuck & Widom, 2001; Sommer et al., 2017; Vilhena-Churchill & Goldstein, 2014). The participants of these studies in general, used substances to cope with anxiety and fears and reduce their stress caused by the abuse, as well as to feel more sexually attractive (Covington et al., 2008; Leeies et al., 2010; Ouimette et al., 2000; Robinson et al., 2011; Ullman et al.,
2013). 65
For the context of South Africa in particular, substance misuse could be influenced due to the established drug-trafficking groups in the area which have made substances widely available to South African people (Mbwambo et al., 2012; United Nations Office on Drugs and
Crime, 2014). Poor police functioning, poverty and unemployment have a significant impact on increasing substance misuse as well (Andersson et al., 2012; Hobkirk et al., 2016; Watt et al., 2014).
In addition to substance misuse, sexual risky behaviours were common among South
African and western populations (Brennan et al., 2007; Maniglio, 2009; Mimiaga et al., 2009,
Wilson & Widom 2010). It was shown that methamphetamine use was a mediator between
CSA and risky sexual behaviours such as having unprotected sex with multiple partners and buying and selling sex. For that reason, CSA survivors in South Africa were found to have increased risk of acquiring sexually transmitted infections such as HIV and HSV2. This is consistent with research conducted by Volkow et al. (2007), who showed that CSA survivors who use substances tend to have increased sexual desire which makes them adopt more sexual risky behaviours. The adoption of sexual risky behaviours can be considered as a long-term negative impact of maladaptive strategies but investigation of the studies in Table 4 suggests that sexual risky behaviours can also be considered as coping strategies. Having an intense sexual life can be a coping mechanism for CSA survivors to distract from emotions and the pain of the abuse. It is also a method to start feeling good again and they also believe that they are in control of their body instead of the abuser (Bagley & LaChance, 2000).
In South Africa, sexual risky behaviours are influenced by poverty, unemployment and special cultural beliefs. For example, it was shown that the adoption of sexual risky behaviours and having sex with multiple partners could be a way to secure food and accommodation
(Lalor, 2004). Being sexually abused and having an intense sexual life becomes the norm for 66
CSA survivors and as shown in the study of Phasha (2010), the young CSA survivors developed a sex-oriented mindset which could lead to numerous sexually risky behaviours.
South African studies explored the anti-social behaviours of CSA survivors. As seen in the section of Data Analysis, adopting anti-social behaviour can be considered as a conscious effort to tolerate the negative impacts caused by the abuse and for that reason, is referred as a coping strategy. Distracting from emotions, seeking attention and relief of tension and anger can help CSA survivors to block the pain from the abuse. It is also possible that survivors adopt anti-social behaviour and cause harm to somebody as they cannot confront the abuser.
There was a plethora of anti-social behaviour examples in the studies considered in this thesis, such as stealing property, causing physical damage to property, skipping school, bulling others and getting involved in physical fights. Similar anti-social behaviour is observed in western countries as well with survivors showing aggression and running away from home and school (Arata et al., 2005; Bentovim et al., 2009; Choquet et al., 1997; Dinwiddie et al., 2000).
In addition to the anti-social behaviours, the review of the articles showed that suicidal behaviours are associated with CSA. In the study of King et al. (2004) specifically, about 30% of the participants reported suicidal behaviour including suicidal thoughts, suicidal dialogue and suicide attempts. Suicidal behaviours were reported by CSA survivors in western countries as well (Dinwiddie et al., 2000; Dube et al., 2005; Molnar et al., 2001; Nelson et al., 2002).
The study of Dube et al. (2005), in particular, involved approximately 17,500 survivors to investigate abuse and household dysfunction during childhood in California. The results showed that CSA survivors experienced more than twice possibility to have suicide attempts in comparison to other forms of abuse (Dube et al., 2005). Having suicidal thoughts could be a strategy to escape and a mechanism to avoid dealing with the challenges in their lives. Some
CSA survivors fall into suicidal thoughts to cope with the abuse. 67
Another maladaptive coping strategy that is used by South Africa survivors in order to face their depression, is denial. Denial as a coping strategy is a method to remove memories of the abuse. CSA survivors do not admit that the abuse has happened to them and for that reason, they do not necessarily have to deal with it. This enables them to move on with their lives.
Denial is also observed in western survivors of CSA and research has found that denial mediate the relation between CSA and psychological distress (Calvete et al., 2008; Johnson & Kenkel,
1991; Min et al., 2007). Again, denial is an effective method in the short-term as denying the abuse has been shown to hinder recovery and to be associated with eating disorders and PTSD
(Andrews et al., 2003; Borja et al., 2006; Waller & Ruddock, 1993).
The maladaptive coping strategies explained above, could also be considered as examples of disconnection from others. This is common with CSA survivors in western countries and it is described by Herman’s Stage-based model (Herman, 1992) (mentioned in
Chapter 2). According to Herman (1992), the recovery process from CSA starts by the establishment of safety through the adoption of routines of self-care and the use of maladaptive coping strategies; then it includes the exploration of the traumatic experiences; and finally, it involves re-connection with others. This means that the maladaptive strategies adopted by the
CSA survivors of the South African studies explored in this thesis can be linked with the first stage of Herman’s model which is about disconnection and keeping distance with situations and thoughts that remind the abuse. They are coping mechanisms which help survivors to deal with the abuse and do not feel overwhelmed in the short-term.
In addition to the maladaptive coping strategies, South African populations have also adopted positive coping strategies to face the trauma in their lives.
At the beginning, accepting support from family members, friends, peers and employers was a common way of coping with the abuse among the South African studies explored in this thesis. The importance of emotional support has also been investigated substantially in western 68 countries (Arias & Johnson, 2013; Allnock & Miller, 2013; Banyard & Williams, 2007; Cossar et al., 2013; Malloy et al., 2013; Merrill et al., 2001; McElvaney et al., 2014; Glaister & Abel,
2001; Hallett et al., 2003; Hymann et al., 2003; Panichrat & Townshend, 2010; Schönbucher et al., 2014; Spaccarelli, 1994; Walsh et al., 2010). Family and peer relationships can help CSA survivors to avoid psychological difficulties, lessen their stress and recover (Banyard &
Williams, 2007; Harper et al., 2005; Lynskey & Fergusson, 1997). Being emotionally supported has been described as being loved and accepted, to have the reassurance that there is someone there for them, and not being abandoned or blamed by others for the abuse (Gries et al., 2000). Furthermore, Merrill et al. (2001) noted that parental support promotes future adjustment of CSA survivors and Draucker et al. (2009), also found that support from friends and family were key healing factors. Overall, it was shown that support from family, friends and peers, through believing, non-disputing and accepting the abuse (Gries et al., 2000), is one of the most important factors in survivors’ lives.
Although accepting support from family members and peers was found to be an effective coping strategy both in South Africa and western countries, the analysis showed that some of the South African children in the studies did not receive sufficient support from their families (Mathews et al., 2013). As shown earlier, unemployment, violence, bad living conditions, poverty, gender differences and single-parent families in South Africa are factors which create dysfunctional families. Unsupervised care, lack of understanding about children’s emotions and physical abuse can be typically found within families in South Africa, Hence, it may be more difficult for some South African survivors to receive adequate support from their family environment.
It was also shown among the studies that a few CSA survivors in South Africa have parents who were sexually abused as children as well. This can be explained due to the high prevalence rates of CSA in the region. It is less likely for CSA children in South Africa to 69 receive support from a parent who was sexually abused, as the local cultural expects that children to overcome their own challenges without showing weakness.
Building the family bond enables family members to reconnect with each other which is linked to CSA recovery (Walsh, 2012). It was found that family warmth, togetherness, communication, supportiveness and stable income promotes family resilience (Benzies &
Mychasiuk, 2009; Bhana & Bachoo, 2011). When there is a lack of parent's support, then other family members, such as grandparents, can offer emotional support to children and influence their resilience (Bhana & Bachoo, 2011; Lietz, 2011).
However, it was shown that several families may live together in South Africa due to poverty and the abuser may be within the family environment. This combined with other cultural characteristics, such as patriarchy, stereotyped gender norms and the role of children within the family, mean that building the family bond may not be suitable for South African survivors of CSA.
Accepting social support from family, friends and important others, gave also the opportunity to CSA survivors in South Africa to talk about their traumatic memories. Survivors willing to talk about the abuse without feeling overwhelmed is similar to Harvey's (1996) definition of recovery which refers to the ability about remembering the past experiences without losing control. After the stage of secrecy and suppression of their desire to disclose, survivors described how helpful it was for them to find the courage to talk about their abuse.
These findings are in agreement with those obtained in other western studies by
Chouliara et al. (2014) and by Banyard and Williams (2007) who both found that talking about the abuse was a beneficial coping strategy which helped recovery. In Banyard and Williams
(2007) study, women survivors indicated some ideas about the recovery process, such as talking about the abuse and their feelings. More specifically, it was mentioned that they realised they had reached recovery when they began to talk about the abuse and not experience any 70 adverse feelings. Further, talking about their past experiences, as presented in Little and
Hamby’s (1999) study, women demonstrated that this helped them to cope with CSA, characterising it as a useful and helpful coping strategy.
For the context of South Africa in particular, there is an ancient African word known as ‘Ubuntu’ which means humanity to others (Tutu, 1999). South African people share values of interdependence with each other and for that reason, it is more likely to seek support from friends and important others.
South African people have also grown up in a society where race was an important part of their culture. They faced discrimination for being ‘Black’ and for that reason they learned from a young age to pride themselves and being supportive to each other (Biko, 1978). Seeking support at difficult times, like coping with CSA, is part of their values and culture.
Accepting support from social services and school members, as well as engaging in social activities were also evident among the South Africa populations of the studies investigated in this thesis. Accepting social support and undertaking social activities can work as healthy coping strategies for survivors’ negative feelings and emotions. This is aligned with the findings of Chouliara et al. (2014) who found that engaging in social activities increases recovery, as social support services help survivors to engage in social activities and community groups. Through these activities survivors’ self-esteem and self-perceptions can be enhanced.
It was shown in the chapter of Data Analysis that studies have also explored the efficacy of education on survivors’ lives with focus on the role of the teacher in helping learners/students/children overcome the effects of CSA, through academic and emotional support. The literature shows that it is possible for sexually abused children to seek for a trusting relationship with their teachers and learners to cope with the trauma in their lives. The importance of education and seeking support from teachers have also been investigated in western countries (Arias & Johnson, 2013; Dass-Brailsford, 2005; Floyd, 1996). The research 71 of Arias and Johnson (2013) in particular, focuses on educational factors of healing and shows that sexually abused children who engaged in formal education helped them to improve self- esteem and self-confidence. Informal education, such as writing about the experiences of CSA, has been found to decrease the loneliness and give hope for a better future. Confrontation of abusers, such as writing them a letter, meeting them or even imagining a meeting with them, could also promote healing.
However, research has revealed that, in the field of CSA, teachers are not fully educated or aware and they have not attained a satisfying amount of knowledge (Renk et al., 2002).
“Studies consistently show that teachers lack the knowledge and the confidence to be effective reporters of child abuse and neglect, particularly of child and youth sexual abuse” (Goldman
& Grimbeek, 2014, p. 3).
For the case of South Africa, in particular, existing legislation about CSA is inadequate and the police service is not efficient, as mentioned earlier. There are not clear policies which support teachers in order to identify, report and help victims of CSA. Seeking support and protection from school and teachers may be more challenging for CSA survivors in South
Africa.
South African survivors also reported that having therapeutic sessions as a method to cope with the abuse seemed to have a positive impact on their recovery. Through therapy sessions survivors in South Africa heard stories from other survivors (including more challenging stories) and got inspired by other survivors who managed to overcome their trauma. The importance of therapy was explored in western countries as well and Arias and
Johnson (2013) found that making the decision to have therapy promotes recovery.
Furthermore, in the context of South Africa, Edwards et al. (2005) mention that the participants in their study were responding positively to psychotherapy. These testimonies match those obtained in other studies that support the importance of CBT, counselling and psychotherapy 72 for the recovery process (Allnock et al., 2015; Benuto & O’Donohue, 2015; Cohen et al., 2000;
Domhardt et al., 2015; Feeny et al., 2004; Hetzel-Riggin et al., 2007; One in Four, 2015;
Radford at al., 2017; King et al., 2003; Koss & Figueredo, 2004; Sneddon et al., 2016; van
Toledo et al., 2013). A study that examined professionals’ and survivors’ perspectives, noted the importance and the benefits of talking therapies for CSA survivors (Chouliara et al., 2011).
Survivors who participated in talking therapies were able to decrease their isolation, feel safe when they disclose the abuse, have a trust therapeutic alliance, increase their self-esteem and decrease the stigma (Chouliara et al., 2011). Taken together, all these coping mechanisms may open the path for their recovery.
CSA survivors who decided to have therapeutic interventions were also likely to build a trusting therapeutic alliance as shown in one of the studies of Table 4. Therapeutic alliance is defined as the relationship between professionals and survivors and it is an area that has been explored by other researchers in western countries. It was shown that regardless of the intervention, the therapeutic alliance between therapist and survivors is important during the therapy (Allnock et al., 2012; Gabbard, 2005).
However, the availability of centres to provide therapeutic sessions to CSA survivors is a major concern in South Africa. There are some centres in the large cities but researchers stated that professional service centres in the rest of the country are scarce (Higson et al., 2004).
It was shown that a small percentage of abused children have access to therapeutic institutions
(Abrahams & Mathews, 2008). To this end, group treatments were found to be well-suited in
South Africa as it supports the lack of resources in the country (Walker-Williams & Fouche,
2017).
Optimism, such as having positive thinking, having hope, having high career and educational aspirations, being determined to succeed and complete school and having a sense of purpose in life, were beneficial coping strategies which had a positive impact on survivors’ 73 recovery in South Africa. Thinking positively in particular was suggested as the most common behavioural coping strategy by Frazier and Burnett (1994). Along the same lines, a study that was carried out by Oaksford and Frude (2009) concluded that one of the main strategy for dealing with the sexual abuse was “wishful thinking”, which is about survivors having hope that they will have a normal and better life in the future (Harvey et al., 2000; Oaksford & Frude,
2009). Having hope amends looking for support, acceptance and cognitive reappraisal
(Phanichrat & Townsend, 2010).
The use of more optimistic explanations for the event of abuse, such as blaming the abuser and not their selves for what happened was also helpful for the South African participants. This was explained by Peterson and Park (1998) in a western-based study that by having an optimistic approach towards the negative events in their lives, survivors were able to link the abuse as an external situation of life which is only a temporary event; this improved the process of recovery.
The investigation of the studies in this thesis, revealed that living a normal life, such as staying busy and doing normal things, promotes a satisfying life which alleviates the side effects of the abuse. This statement matched those observed in several western studies where keeping themselves busy was found to be a common coping strategy among CSA survivors
(Banyard & Williams, 2007; Grossman et al., 2006; Herman, 1998; Hymann et al., 2003;
Panichrat & Townshend, 2010). Harvey et al. (2004) argue that keeping busy and living a normal life involves a fundamental change in mindset to realise that life does not stand still and what has happened in the past could not be reversed. In particular, trying to offer a normal life to children was found to be an important and a helpful form of support. This may involve day- to-day activities, such as going to school and participating in social activities. It was recommended that children should not be treated as victims. If children are to have a normal 74 life and participate in activities, the struggle to overcome the experience of sexual abuse in the survivor’s life will decrease, as they focus on other activities.
Faith was a popular coping strategy among the studies reviewed in this thesis. Religious coping helped the survivors of the South African studies to cope with the abuse, regardless the fact that they felt abandoned by the God initially. This could be explained by the fact that
African populations in general have strong links with religion as they are raised in religious environments. Hence, it is more likely for them to ask support and guidance from God during challenging times (Sanchez & Carter, 2005). It is also believed that life is determined by God and for that reason, they see abuse as God’s will (Kasambala, 2005). Such thoughts have a positive impact on their recovery (Boyd-Franklin & Walker, 2003; Dass-Brailsford, 2005).
Religion coping has been investigated in western countries as well with several studies highlighting the importance of religion and spirituality to cope with abuse (Beveridge &
Cheung, 2004; Bogar & Hulse-Killacky, 2006; Domhardt et al., 2015; Draucker & al., 2011;
Gall, 2006; Gall et al., 2007; Glaister & Abel, 2001; Grossman et al., 2006). For example, survivors who had developed some spiritual beliefs or who were members of a religious community, reported that their healing was helped (Grossman et al., 2006). Those who believed that they had a relationship with a God they felt supported (Glaister & Abel, 2001). Religion, faith and spirituality have been characterised as protective factors for mental health problems, substance abuse and trauma for CSA (Williams et al., 2001). Furthermore, spirituality can help to lower the possibility of suicide in survivors within Christian’s hubs (Leong et al., 2007) and according to Pellauer et al. (1987), survivors may experience healing at some point during the liturgical ritual. Finally, spirituality was found to enhance the support and inner strength of survivors (Valentine & Feinauer, 1993) and help participants to give meaning of the abuse, promoting their psychological growth (Baumgardner & Crothers 2009). 75
The importance of religion as a coping strategy for CSA survivors is also included in
Herman’s Stage-Based model (1992) about the recovery process from trauma. The second stage of the model refers to the exploration of traumatic experiences with the aid of spirituality, social support from friends and family, highlighting the importance of sharing and talking about the abuse with others. Through all these positive strategies, it is clear that survivors could change their life philosophy, grow in wisdom, act more altruistically, showing that trauma may have some positive outcomes (Tedeschi et al., 1998).
Regulation of their emotions and emotional awareness (through approaching, learning how to deal with their negative feelings, recognising that their painful feelings are just temporary) were depicted as positive coping strategies in South African populations. Survivors who were aware and acceptive about their situation managed to cope with the abuse more effectively. The adoption of self-regulatory emotional, cognitive and behavioural strategies was explored in western countries as well and it was shown that such strategies are beneficial
(Eisenberg & Ota Wang, 2003). Researchers have highlighted the effectiveness and importance of identifying and confronting their emotions which leads to resilience (Ho et al., 2011; Wright et al., 2007).
The pain and despair experienced by survivors in South Africa gradually helped them to getting stronger. The studies showed that their inner strength and personal determination were able to facilitate the healing and recovery process. In the same line, several western studies showed that personal strength can be experienced by survivors through the recovery process (McElheran et al., 2012; Tarakeshwar et al., 2006). These personal strengths were enhanced by mutual cohesion; family warmth, togetherness, supportiveness; family resilience
(Bhana & Bachoo, 2011; Bowes et al., 2010; Chouliara et al., 2014).
Making conscious choices to face the trauma in their lives were also found among the
South African studies. Conscious choices enabled survivors to cope with the side effects of the 76 abuse and regained confidence to find healing at a physical and emotional level. These results are consistent with research conducted in western countries such as (Wong, 2003). Burgess and
Holmstrom (1979) talked about the importance of conscious coping strategies in aiding recovery and suggested that unconscious defences may not always be adequate. Other studies have also promoted the use of conscious coping through cognitive behavioural training, such as the cognitive restructuring (Foa & Rothbaum, 1998; Jaycox et al., 2002).
Knowledge and awareness of the trauma were characterised as another coping strategy by South African survivors. Knowledge and awareness could be gained through talking, reading, studying and attending therapies. According to Cruz and Essen (1994), knowledge and awareness of the trauma and its consequences could be translated into the gradual decrease of denial and other psychological defences. This, provides the basis for understanding and accepting what is necessary to achieve healing. These findings are confirmed with a number of qualitative studies focused on western countries which show that acknowledging the abuse was a necessary step for both starting and completing recovery (Easton et al., 2015; Kia-Keating et al., 2005). In addition to having knowledge of the abuse, knowing some aspects of themselves, having positive self-evaluation of their worthiness and their uniqueness also enhanced recovery of South African survivors. Indeed, self-acceptance is considered to be as one of the most fundamental dimensions of psychological well-being (Ryff, 1989).
Forgiveness of the abuser and self-forgiveness was also depicted through the South
African studies. Survivors had a sense of personal resilience and strength due to their ability to forgive themselves. Self-forgiveness reduces anger and negative feelings and could restore relationships with others. Several western studies investigated self-forgiveness and indicated that the survivors who did not blame themselves about the abuse, presented more positive outcomes which facilitated their recovery (Arias & Johnson, 2013; Himelein & McElrath,
1996; Lev-Wiesel, 2000). For example, in Lev-Wiesel’s (2000) study, survivors who blamed 77 the perpetrator for the abuse, and not themselves, retained their self-esteem and positive adjustment and had a better quality of life. In another study of 120 survivors in the US, it was reported that, survivors during their recovery realised that it was not their fault and as a consequence they felt better, less guilty and less ashamed (Easton et al., 2015). Similar findings were shown in another research study which showed that, by blaming the abuser and not themselves, the survivors’ healing process was enhanced (Arias & Johnson, 2013; Willis et al.,
2015). Finally, self-forgiveness could also be achieved through a supportive environment of people around survivors who they should remind them that the abuse was not their fault (Arias
& Johnson, 2013).
Having an appreciation of their lives and being pleased with life in general was found to be a beneficial coping strategy for CSA survivors in South Africa. This is consistent with research in western countries which showed that having appreciation on everyday life things could motivate CSA survivors to experience positive feelings (Baumgarder & Crothers, 2009;
Calhoun & Tedeschi, 1999; Emmons & Mishra, 2011).
Connectedness with themselves and others through giving unconditionally love without fear of rejection was related to healing in two South African studies. This positive approach and the reinvestment in relationships is a well-studied element of posttraumatic growth in western countries (Carver, 1998; Fromm et al., 1996). Ensuring connectedness between parents and children was also important for survivors’ well-being (Spies, 2006; Walker-Williams et al., 2013). In addition to this, the importance of connectedness in recovery is seen in the final stage of the Herman’s model which is about re-connecting with others and themselves.
Having the control back into their lives was an important coping strategy for South
African survivors. A number of western studies confirmed that abuse leads to loss of control, and when survivors take back the control, helps their recovery (Frazier et al., 2004; Frazier et al., 2005). It is also recommended that professionals should give control and power to survivors 78 during their therapy process as this is considered to be beneficial for their development
(Drauker, 2000; Koehn, 2007; Pope & Brown, 1996). By having internal control seems to be linked with a more effective approach for dealing with challenges in life (Compton & Hoffman,
2013; Hefferon & Boniwell, 2011; Tedeschi & Calhoun, 1995). Additionally, Morrow and
Smith (1995) examined 160 forms of coping strategies for CSA and concluded that there were two crucial strategies that survivors should use. These were strategies that help survivors avoid being submerged by threatening feelings; and strategies to cope with powerlessness and lack of control.
Making meaning of their traumatic experiences was a helpful healing strategy for CSA survivors in South Africa which enabled them to rebuild their lives. Typical examples are thinking that the abuse makes them a better person and it is a reason to learn how to deal with difficulties in life. Such findings were found in western studies as well which shows the value of finding a meaningful purpose in life after the abuse (Domhardt et al., 2015; Kaye-Tzadok &
Davidson-Arad, 2016; Marriott et al., 2014; Orbke & Smith, 2013).
Survivors in South Africa reported that accepting the abuse and making the decision to cope with the consequences of the abuse, contributed in recovery. Accepting the abuse as a strategy to cope with the abuse was also investigated by researchers in western countries including (Chouliara et al., 2014; Draucker et al., 2011; Merrill et al., 2001; Phanichrat &
Townshend, 2010).
Secrecy after the abuse was found to be a helpful coping strategy among South
Africans, as it was a way of denying the abuse until they feel strong enough to talk about it.
However, a study conducted by Chouliara et al. (2014) for western countries showed that secrecy hinders recovery and Glaser (1991) mentioned that secrecy may be a factor that prevents treatment in the long-term. 79
Helping others and getting involved in volunteering tasks were another coping strategy among South African survivors. According to Banyard and Williams (2007), taking part in altruistic actions influences and develops survivors’ self-worth and sense of fulfilment. This combined with volunteering can help survivors to gain social skills, develop a social network, improve their self-efficiency and thus, help their recovery process (Quinn, 1995). This view is also supported in other previous studies (Arias & Jonson, 2013; Draucker et al., 2011) where the authors claim that volunteering is a way to give something valuable back to the community which enhances the self-esteem of survivors. Having a mission in their lives by helping other and offering their experience as gift to help other survivors, alleviates the negative side effects of their own abuse (Herman, 1992).
80
Chapter 6. Conclusions
The main research question of this study was “What does the literature tell us about the ways in which CSA survivors in South Africa cope with their experiences of abuse?” This has been addressed through outlining the existing research on CSA coping strategies in South
Africa with the aim i) to identify studies that are related to CSA coping in South Africa, ii) to understand the main learnings for that specific population and iii) to compare these findings to the strategies of other higher-income countries. The overall outcome of this dissertation is to make the knowledge around the coping strategies used by CSA survivors in South Africa available, to identify areas for further research. It is expected that this study would encourage the research community to further advance research in this area with the overarching goal to help current and future survivors to deal with the trauma in their lives more effectively and enhance recovery.
The main research question has been answered through a review of 22 studies which are related to CSA coping strategies in South Africa. The coping strategies that were used by the South African survivors were identified and discussed in the previous chapters. It was shown that the majority of the 22 articles were focused on adult survivors of CSA instead on children survivors. The main principles that have been identified in this study are shown below.
Accepting emotional support from family, friends and important others including teachers were found to be among the most significant coping strategies that could have a positive impact on survivor’s wellbeing. This, combined with the development of a positive future-oriented perspective and being optimistic, enable survivors to move forward with their lives and promote recovery.
Having a normal life and keeping themselves busy, such as doing normal things and engaging with several day-to-day distractions, were also found to be effective positive coping strategies among the CSA survivors of South Africa. If survivors are to have a normal life and 81 participate in activities, the struggle to overcome the experience of sexual abuse will decrease as their focus on other spheres will increase.
Additional key coping strategies were religion, getting back the control, connection to others, forgiveness, conscious choices, making meaning of the abuse, regulation of their emotions, having gratitude and acceptance of abuse. Accepting professional help, such as having therapy, could also serve as an additional coping mechanism which has a positive contribution on recovery.
A number of maladaptive strategies are also evident in the South African studies including substance misuse (alcohol, drugs, tobacco), sexual risky behaviours, anti-social behaviours, suicidal behaviours and denial. Substance misuse was found to be an effective strategy in the short-term whereas in the long-term, substance misuse was associated with a variety of elevated psychological problems such as distress, depression and PTSD symptoms.
No research evidence exists on the effectiveness of the other maladaptive coping strategies.
This means that a more comprehensive study about coping strategies for CSA in South Africa is needed.
It was shown that generally, there are not significant differences between the coping strategies used in South African and those used by western populations. The coping strategies that were used by the South African survivors in the studies explored in this thesis, have been identified in western countries as well.
Nevertheless, the results suggest that there is a link between a number of coping strategies and the region of South Africa. These are the coping strategy of i) substance misuse, ii) risky sexual behaviours, iii) support from family, iv) social support, v) support from school, vi) therapy and vii) religion. The main differences when compared to the western studies are discussed below: 82
Substance misuse was reported frequently as a coping strategy among the South African studies. This could be explained due to the established drug-trafficking groups in the area which have made substances widely available to South African people. Poor police functioning, poverty and unemployment have a significant impact on increasing substance misuse.
Substance misuse was found to be related with sexual desire which makes CSA survivors to adopt more sexual risky behaviours. Having unprotected sex with multiple partners and buying and selling sex were reported by CSA survivors in South Africa. They were also found to have increased risk of acquiring sexually transmitted infections such as HIV and
HSV2 which is also influenced by the fact that South African populations are less educated and aware about sexually transmitted infections. By contrast, western populations tend to be more informed and precautious about sexual diseases. In South Africa, sexual risky behaviours are also influenced by poverty, unemployment and special cultural beliefs in the area. For example, it was shown that the adoption of sexual risky behaviours and having sex with multiple partners could be a way to secure food and accommodation.
Patriarchy and gender differences in South Africa could also influence sexual risky behaviours. The society in South Africa demands from women to satisfy the sexual desires of men and from children to respect and obey their elders without objections. Being sexually abused and having an intense sexual life becomes the norm for women and children in South
Africa for that reason may developed a sex-oriented mindset which could lead to numerous sexually risky behaviours in the future.
Although accepting support from family members and peers was found to be an effective coping strategy both in South Africa and western countries, it was shown that it may be more difficult for some South African survivors to receive adequate support from their family environment. This is because factors like unemployment, violence, bad living conditions, poverty, gender differences and single-parent families create dysfunctional 83 families. Further to this, several families live together in South Africa due to poverty and there are several cases where the abuser was within the family environment.
It was also shown that CSA survivors in South Africa may have parents who were sexually abused as children as well. This can be explained due to the high prevalence rates of
CSA in the region when compared to the lower prevalence rates found in other western countries. To this end, it is less likely for CSA children in South Africa to receive support from a parent who was sexually abused, as the local cultural expects that children to overcome their own challenges without showing weakness.
Accepting support from friends and important others was found to be an important coping strategy among the CSA survivors in South Africa. South Africans share values of supporting each other as it can be depicted by cultural characteristics and traditions (e.g. the
African ancient word Ubuntu which means humanity to others). Additionally, South African people have grown up in a society where race was an important part of their culture. They faced discrimination for being ‘Black’ and for that reason they learned from a young age to pride themselves and being supportive to each other. Seeking support at difficult times, like coping with CSA, is part of their values and culture.
Utilising support and protection from school and teachers may be more challenging for
CSA survivors in South Africa when compared to western countries. This is because existing legislation about CSA in South Africa is inadequate and the police service is not efficient.
There are not clear policies which support teachers in order to identify, report and help victims of CSA.
Group treatments were found to be well-suited in South Africa because it supports the lack of resources in the country. There are not sufficient centres and professionals in the country, specifically outside the large cities, and as a result the coping strategy of seeking 84 support from therapeutic institutions is not available for the greatest percentage of abused children.
Finally, religion was a reported a few times among the studies reviewed in this thesis.
This could be explained by the fact that African populations in general have strong links with religion as they are raised in religious environments. Hence, it is more likely for them to ask support and guidance from God during challenging times in comparison to western people. It is also believed that life is determined by God and for that reason, they see abuse as God’s will.
Such thoughts have a positive impact on their recovery.
6.1 Limitations and further research
The generalisability of these results is subject to certain limitations. Firstly, this study was limited by the absence of homogenous studies. The reviewed studies are focused on different aspects of CSA, target groups, aims and objectives. Coping strategies for CSA were not always the main subject of the studies and some findings on CSA in these studies were simply research observations rather than research outcomes deriving from answering the research question. Similar authors were also involved in the identified studies which sets a limitation on the investigated topics and adopted methods. The literature review conducted in this study did not find any qualitative studies which investigated coping strategies of CSA survivors in South Africa in general – i.e. asking survivors directly about how they cope instead of focusing on specific strategies. This demonstrates that all the data used in this study is data peripheral to the central study which means that a partial picture has been achieved.
Moreover, limited evidence was available to compare the coping strategies used in
South Africa and western countries with particular focus on identifying the specific cultural characteristics in the area. This is something which has not been investigated so far and therefore, it was not possible to draw any further conclusions. This is an area of further research. 85
In spite of these limitations, this study is a comprehensive investigation of CSA coping in South Africa and certainly enhances our understanding about the coping strategies that are used by local CSA survivors. It also identifies that there is a relatively small number of studies that are focused on CSA in South Africa when compared to the number of CSA studies in western countries. The investigation of CSA coping in South Africa is an area for further research. Such study could produce a more comprehensive understanding of survivor’s coping strategies in South Africa which will help current and future survivors to deal with the abuse more effectively.
6.2 Reflections and related ethical concerns
The method used in this study was a narrative literature review that applied a systematic approach to search for the literature and for that reason it did not consider any specific ethical issues.
Conducting research on sensitive topics can be distressing and for that reason, the following measures were taken during the research to ensure my wellbeing. Firstly, I read several articles related to CSA to get familiar with the topic and feel more comfortable doing the research. Secondly, I was undertaking relatively short sessions of work giving me time to relax and switch off from the research on such a sensitive topic. This was important to avoid experiencing trauma as well. Finally, I was having regular meetings with my supervisory team where I was able to reflect on my work and avoid any sense of isolation during the study. 86
Chapter 7. References
Abeid, M., Muganyizi, P., Massawe, S., Mpembeni, R., Darj, E., & Axemo, P. (2015). Knowledge and attitude towards rape and child sexual abuse - a community-based cross- sectional study in Rural Tanzania. BMC Public Health, 15. https://doi.org/10.1186/s12889- 015-1757-7.
Abrahams, N., & Mathews, S. (2008). Services for child sexual abuse are lacking. South African Medical Journal, 98(7), 494.
Abrahams, N., Jewkes, R., Lombard, C., Mathews, S., Campbell, J., & Meel, B. (2010). Impact of telephonic psycho-social support on adherence to postexposure prophylaxis (PEP) after rape. AIDS Care, 22(10),1173–81.
Alaggia, R. (2004). Many ways of telling: expanding conceptualizations of child sexual abuse disclosure. Child Abuse and Neglect, 28(11), 1213-1227.
Alaggia, R. (2005). Disclosing the trauma of child sexual abuse: A gender analysis. Journal of Loss and Trauma, 10(5), 453-470.
Alaggia, R., & Kirshenbaum, S. (2005). Speaking the unspeakable: Exploring the impact of family dynamics on child sexual abuse disclosures. Families in Society, 86, 227–234.
Alaggia, R., Collin-Vézina, D., & Lateef, R. (2017). Facilitators and Barriers to Child Sexual Abuse (CSA) Disclosures: A Research Update (2000-2016). Trauma, Violence & Abuse, 20(2), 260-283. doi: 10.1177/1524838017697312
Aldwin, C. M. (1994). Stress, coping and development. New York, NY: Guilford.
Allbaugh, L. J., Wright, M. O. D., & Seltmann, L. A. (2014). An Exploratory Study of Domains of Parenting Concern among Mothers Who Are Childhood Sexual Abuse Survivors. Journal of Child Sexual Abuse, 23(8), 885-899.
Allnock, D., & Miller, P. (2013). No one noticed, no one heard: A study of disclosures of childhood abuse. London. Retrieved from https://www.nspcc.org.uk/globalassets/documents/research-reports/noone-noticed-no-one- heard-report.pdf 87
Allnock, D., Hynes, P., & Archibald, M. (2015) Self-reported experiences of therapy following child sexual abuse: messages from a retrospective survey of adult survivors. Journal of Social Work, 15(2),115-137.
Allnock, D., Radford, L., Bunting, L., Price, A., Morgan-Klein, N., Ellis, J., & Stafford, A. (2012). In demand: Therapeutic services for children and young people who have experienced sexual abuse. Child Abuse Review, 21(5), 318-334.
Al-Saif, D. M., Al-Eissa, M., Saleheen, H., Al-Mutlaq, H., Everson, M. D., & Almuneef, M. A. (2018). Professionals’ attitude toward reporting child sexual abuse in Saudi Arabia. Journal of Child Sexual Abuse, 27(1), 22–37. https://doi.org/10.1080/10538712.2017.1360429.
Andersson, N., Paredes-Solís, S., Milne, D., Omer, K., Marokoane, N., Laetsang, D., & Cockcroft A. (2012). Prevalence and risk factors for forced or coerced sex among school- going youth: National cross-sectional studies in ten southern African countries in 2003 and 2007. Peer-Reviewed Medical Journal Open, 2(2), 754. doi: 10.1136/bmjopen-2011- 00075.
Andrews, B., Brewin, C. R., & Rose, S. (2003). Gender, social support, and PTSD in victims of violent crime. Journal of Traumatic Stress, 16(4), 421–427.
Andrews, G., Corry, J., Slade, T., Issakidis, C., & Swanston, H. (2004). In Ezzati, M., Lopez, A. D., Rodgers, A., Murray, C. J. L. (Eds). Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors, 2, 1851-940. Geneva: World Health Organization.
Arata, C. M. (1998). To tell or not to tell: Current functioning of child sexual abuse survivors who disclosed their victimization. Child Maltreatment, 3(1), 63-71.
Arata, C. M. (2002). Child sexual abuse and sexual revictimization. Clinical Psychology: Science and Practice, 9(2), 135–164.
Arata, C. M., Langhinrichsen-Rohling, J., Bowers, D., & O'Farrill-Swails, L. (2005). Single versus multi-type maltreatment: An examination of the long-term effects of child abuse. Journal of Aggression, Maltreatment and Trauma, 11(4), 29-52. 88
Arias, B. J. & Johnston, C.V. (2013). Treatment of childhood sexual abuse survivors: Voices of healing and recovery from childhood sexual abuse. Journal of Child Sexual Abuse, 22(7), 822-841.
Arriola, K. R. J., Louden, T., Doldren, M. A., & Fortenberry, R. M. (2005). A meta- analysis of the relationship of child sexual abuse to HIV risk behaviour among women. Child Abuse & Neglect, 29(6), 725–746.
Artz, L., Burton, P., Ward, C. L., Leoschut, L., Phyfer, J., Lloyd, S., … Le Mottee, C. (2016). Sexual victimisation of children in South Africa. Final report of the Optimus Foundation Study: South Africa. Cape Town: UBS Optimus Foundation.
Asgeirsdottir, B. B., Gudjonsson, G. H., Sigurdsson, J. F., & Sigfusdottir, I. D. (2010) Protective processes for depressed mood and anger among sexually abused adolescents: The importance of self-esteem. Personality and Individual Differences, 49(5), 402-407.
Baboolal, N. S., Lalla, S., Chai, M., Curtis, R., Nandwani, C, Oliveri, L., & Smith, C. (2007). ‘Childhood sexual abuse among outpatients attending adult psychiatric outpatient clinics: A case-control study’. West Indian Medical Journal, 56(2), 152–158.
Baddeley, J. L., & Singer, J. A. (2009). A social interactional model of bereavement narrative disclosure. Review of General Psychology, 13, 202–218. doi:10.1037/a0015655
Badoe, E. (2017). A critical review of child abuse and its management in Africa. African Journal of Emergency Medicine, 7, 32-35.
Bagley, C. & LaChance, M. (2000). Evaluation of a family-based programme for the treatment of child sexual abuse. Child and Family Social Work, 5, 205 – 213.
Banwari, M. (2011). Poverty, child sexual abuse and HIV in the Transkei region, South Africa. African Health Sciences, 11(1), S117–S121.
Banyard, V. L., & Williams, L. M. (2007). Women’s voices on recovery: A multi-method study of the complexity of recovery from child sexual abuse. Child Abuse & Neglect, 31, 275-290. 89
Banyard, V. L., Williams, L. M., & Siegel, J. A. (2004). Childhood sexual abuse: A gender perspective on context and consequences. Child Maltreatment, 9(3), 223–38.
Barth, J., Bermetz, L., Heim, E., Trelle, S., & Tonia, T. (2013) The current prevalence of child sexual abuse worldwide: a systematic review and meta-analysis. International Journal of Public Health, 58, 469-4
Battiss, B. (2005). Hypnotherapy and childhood sexual abuse: The experiences of adult survivors (Thesis D Litt Et Phil), p. 21. Rand Afrikaans University, Johannesburg, South Africa. Retrieved from etd.rau.ac.za/theses/available/etd-091205-095638.
Baumgardner, S. & Crothers, M., 2009. Positive Psychology. Upper Saddle River, N.J.: Prentice Hall.
Beach, S. R. H., Brody, G. H., Lei, M. K., Gibbons, F. X., Gerrard, M., Simons, R. L., Cutrona, C. E., & Philibert, R. A. (2013) ‘Impact of child sex abuse on adult psychopathology: A genetically and epigenetically informed investigation’: Correction to Beach et al. (2013). Journal of Family Psychology, 27(2), pp.329-329
Beitchman, J. H., Zucker, K. J., Hood, J. E., daCosta, G. A., & Akman, D. (1991). A review of the short-term effects of child sexual abuse. Child Abuse & Neglect, 15(4), 537- 556.
Beitchman, J., Zucker, K., Hood, J., DaCosta, G., Akman, D., & Cassavia, E. (1992). A review of the long-term effects of child sexual abuse. Child Abuse & Neglect, 16, 101-118.
Bentovim, A., Cox, A., Bingley Miller, L. & Pizzey, S. (2009) Safeguarding Children Living with Trauma and Violence: Evidence-based Assessment, Analysis and Planning Interventions. London: JKP.
Benuto, L. T., & O’Donohue, W. (2015), Treatment of the Sexually Abused Child: Review and Synthesis of Recent Meta-Analyses. Children and Youth Services Review, 56, 52-60.
Benzies, K. & Mychasiuk, R. (2009). Fostering family resiliency: A review of the key protective factors. Child & Family Social Work, 14(1), 103–114. doi: 10.1111/j.1365- 2206.2008.00586.x 90
Berg, M. K., Hobkirk, A., Joska, J. A., & Meade, C. S. (2017). The role of substance use coping in the relation between childhood sexual abuse and depression among methamphetamine users in South Africa. Psychological Trauma: Theory, Research, Practice, and Policy, 9, 493–499.doi.org/10.1037/tra0000207.
Beveridge, K., & Cheung, M. (2004). A spiritual framework in incest survivors’ treatment. Journal of Child Sexual Abuse, 13, 105–120.
Bhana. A., & Bachoo, S. (2011). The determinants of family resilience among families in low-and middle-income contexts: A systematic literature review. South African Journal of Psychology, 41(2), 131–139. doi: 10.1177/008124631104100202.
Bick, J., Zajac, K., Ralston, M. E., & Smith, D. (2014) Convergence and divergence in reports of maternal support following childhood sexual abuse: Prevalence and associations with youth psychosocial adjustment. Child Abuse & Neglect, 38(3), 479-487.
Biko, S. (1978). I write what I like. Cape Town, South Africa: Hennemann.
Boakye, K. E. (2009). Attitudes towards rape and victims of rape: A test of the feminist theory in Ghana. Journal of Interpersonal Violence, 24(10), 1633-1651
Bobroff-Hajal, A. (2006). “Why Cousin Marriage Matters in Iraq.” Christian Science Monitor. December 26.
Bogar, C. B., & Hulse-Killacky, D. (2006). Resiliency determinates and resiliency processes among female adult survivors of childhood sexual abuse. Journal of Counseling and Development, 84, 318–327.
Bolton, F. G., Morris, L. A., & MacEachron, A. E. (1989). Males at risk. Newbury Park, CA: Sage.
Bonanno, G. A., Keltner, D., Noll, J. G., Putnam, F. W., Trickett, P. K., LeJeune, J., & Anderson, C. (2002). When the face reveals what words do not: Facial expressions of emotion, smiling, and the willingness to disclose childhood sexual abuse. Journal of Personality & Social Psychology, 83(1), 94-110. 91
Booley, A. 2008. ‘Subjective accounts of post-rape adjustment amongst South African rape survivors.’ Paper presented at the 14th South African Psychology Congress, Johannesburg, August.
Borja, S. E., Callahan, J. L., & Long, P. J. (2006). Positive and negative adjustment and social support of sexual assault survivors. Journal of Traumatic Stress, 19(6), 905-914. doi: 10.1002/jts.20169
Bowes, L., Maughan, B., Caspi, A., Moffitt, T., & Arseneault, L. (2010). Families promote emotional and behavioural resilience to bullying: Evidence of an environmental effect. Journal of Child Psychology and Psychiatry, 51(7), 809–817. doi:10.1111/j.1469- 7610.2010.02216.x
Boyd-Franklin, N., & Walker, L. (2003). Spirituality and religion: Implications for psychotherapy with African American clients and families. In F. Walsh (Ed.), Spiritual resources in family therapy (pp. 90-103). New York: Guilford.
Brazelton, J. F. (2015). The secret storm: Exploring the disclosure process of African American women survivors of child sexual abuse across the life course. Traumatology: An International Journal, 21, 181–187.
Breckenridge, J. (1999). Subjugation and Silences: the role of the professions in silencing victims of sexual and domestic violence. In: Breckenridge J and Laing L (eds) Challenging Silence: Innovative responses to sexual and domestic violence. St. Leonards, N.S.W: Allen and Unwin, pp. 6–31.
Breckenridge, J., & Flax, G. (2016) Service and support needs of specific population groups that have experienced child sexual abuse. University of New South Wales/Royal Commission into Institutional Responses to Child Sexual Abuse, Australia
Brennan, D. J., Hellerstedt, W. L., Ross, M. W., & Welles, S. L. (2007). History of childhood sexual abuse and HIV risk behaviors in homosexual and bisexual men. American Journal of Public Health, 97(6), 1107–1112. doi:10.2105/AJPH.2005.071423. 92
Bridgewater, G. (2016). Physical and sexual violence against children in Kenya within a cultural context. Community Practitioner: The Journal of the Community Practitioners’ & Health Visitors’ Association, 89(2), 30–34.
Brilleslijper-Kater, S., Friedrich, W., & Corwin, D. (2004). Sexual knowledge and emotional reaction as indicators of sexual abuse in young children: Theory and research challenges. Child Abuse & Neglect, 28, 1007-1017.
Brown, A., & Barrett, D. (2002). Knowledge of evil. Child prostitution and child sexual abuse in twentieth century England. William Publishing: Devon.
Brown, D. W., Riley, L., Butchart, A., Meddings, D. R., Kann, L., & Phinney-Harvey, A. (2009). Exposure to physical and sexual violence and adverse health behaviours in African children: Results from the Global School-based Student Health Survey. Bulletin of the World Health Organization, 87, 447–455. doi: 10.2471/BLT.07.047423.
Brown, J., & Saied-Tessier, A. (2015). Preventing child sexual abuse: towards a national strategy for England. London: NSPCC.
Browne A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99, 66–77.
Browne, A., & Finkelhor, D. (1984). The impact of child sexual abuse: A review of the literature. Paper presented at the 2nd National Conference for Family Violence Researchers, Durham, NH.
Bryant-Davis, T. (2005). Coping strategies of African American adult survivors of childhood violence. Professional Psychology, 36, 409-414.
Burgess, A. W., & Holmstrom, L. L. (1979). Adaptive strategies and recovery from rape. American Journal of Psychiatry, 136, 1278–1282.
Bussey, K., & Grimbeek, E. J. (1995). Disclosure processes: issues for child sexual abuse victims. In: K. J.Rotenberg (Ed.), Disclosure processes in children and adolescents (pp. 166–203). Cambridge: Cambridge Univ. Press. 93
Butt S., Chou S., & Browne, K. (2011). A rapid systematic review on the association between childhood physical and sexual abuse and illicit drug use among males. Child Abuse Review, 20, 6–38.
Calhoun, L. G., & Tedeschi, R. G. (1999). Facilitating posttraumatic growth: A clinician’s guide. New York, NY: Routledge.
Calvete, E., Corral, S., & Estévez, A. (2008). Coping as a mediator and moderator between intimate partner violence and symptoms of anxiety and depression. Violence Against Women, 14, 886–904. http://dx.doi.org/10.1177/1077801208320907
Campis, L. B., Hebden-Curtis, J., & Demaso, D. R. (1993). Developmental differences in detection and disclosure of sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 920–924.
Canton-Cortes, D., & Canton, J. (2010) Coping with child sexual abuse among college students and post-traumatic stress disorder: the role of continuity of abuse and relationship with the perpetrator. Child Abuse and Neglect, 34(7), 496-506.
Canton-Cortes, D., Cortes, M. R., Canton, J., & Justicia, F. (2011) The effects of perpetrator age and abuse disclosure on the relationship between feelings provoked by child sexual abuse and posttraumatic stress. Anxiety Stress and Coping, 24(4), 451-461.
Carey, P. D., Walker, J. L., Rossouw, W., Seedat, S., & Stein, D. J. (2008). Risk indicators and psychopathology in traumatised children and adolescents with a history of sexual abuse. European Child & Adolescent Psychiatry, 17(2),93–98. doi: 10.1007/s00787-007- 0641-0.
Carmody, M. (1997). Submerged voices - social work co-ordinators of sexual assault services speak of their experiences. Journal of Women and Social Work, 12(4), 452 -470.
Carver, C. S. (1998). Resilience and thriving: Issues, models, and linkages. Journal of Social Issues, 54, 245–266.
Cashmore, J., & Shackel, R. (2014) Gender Differences in the Context and Consequences of Child Sexual Abuse. Current Issues in Criminal Justice, 26(1), 75-104. 94
Chen, L. P., Murad, M. H., Paras, M. L., Colbenson, K. M., Sattler, A. L., Goranson, E. N., ... & Zirakzadeh, A. (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo clinic proceedings, 85(7), 618-629.
Choi, K. W., Sikkema, K. J., Velloza, J., Marais, A., Jose, C., Stein, D. J., ... & Joska, J. A. (2015). Maladaptive coping mediates the influence of childhood trauma on depression and PTSD among pregnant women in South Africa. Archives of women's mental health, 18(5), 731-738.
Choquet, M., Darves-Bornoz, J.-M., Ledoux, S., Manfredi, R., & Hassler, C. (1997). Self- reported health and behavioural problems among adolescent victims of rape in France: Results of a cross-sectional survey. Child Abuse & Neglect, 21(9), 823–832.
Chouliara Z., Karatzias T., Scott-Brien G., et al. (2011). Talking therapy services for adult survivors of childhood sexual abuse (CSA): in Scotland: perspectives of service users and professionals. Journal of Child Sexual Abuse, 20(2), 128–156.
Chouliara, Z., Karatzias, T., & Gullone, A. (2014). Recovering from childhood sexual abuse: A theoretical framework for practice and research. Journal of Psychiatric and Mental Health Nursing, 21, 69-78.
Cicchetti, D., & Toth, S. L. (2005). Child maltreatment. Annual Review of Clinical Psychology, 1, 409−438.
Clark, N. L & Worger, W. H. (2013), South Africa: The Rise and Fall of Apartheid.
Classen, C. C., Palesh, O. G., & Aggarwal, R. (2005). Sexual revictimization: A review of the empirical literature. Trauma, Violence & Abuse, 6(2), 103–29.
Clemmons, J.C. Walsh, K. DiLillo, D., & Messman-Moore, T. L. (2007). Unique and combined contributions of multiple child abuse types and abuse severity to adult trauma symptomatology. Child Maltreatment, 12(2), 172–181.
Cockcroft, A. (2012). Prevalence and risk factors for forced or coerced sex among school- going youth: National cross-sectional studies in 10 southern African countries in 2003 and 2007. BMJ Open, 2(2). doi:10.1136/bmjopen-2011-000754 95
Cohen, J. A., Mannarino, A. P., Berliner, L., & Deblinger, E. (2000). Trauma-focused cognitive-behavioral therapy: An empirical update. Journal of Interpersonal Violence, 15, 1203–1223.
Cole, P. M., & Putnam, F. W. (1992). Effect of incest on self and social functioning: A developmental psychopathology perspective. Journal of Consulting and Clinical Psychology, 60, 174-184.
Coles, J., Lee, A., Taft, A., Mazza, D., & Loxton, D. (2015). Childhood sexual abuse and its association with adult physical and mental health: results from a National cohort of young Australian women. Journal of Interpersonal Violence, 30(11), 1929-1944.
Collings, S. (1995). The long-term effects of contact and noncontact forms of child sexual abuse in a sample of university men. Child Abuse & Neglect, 19, 1-6.
Collings, S. J., & Wiles, W. A. (2005). Secondary victimization of child rape victims. Paper presented at the 6th National Conference of the South African Professional Society on the Abuse of Children, Pretoria, South Africa.
Collings, S., Griffiths, S. & Kumalo, M. (2005). Patterns of disclosure in child sexual abuse. South African Journal of Psychology, 35(2), 270-285.
Collins, R. L., Taylor, S. E., & Skokan, L. A. (1990). A better world or shattered vision? Changes in life perspectives following victimization. Social Cognition, 8(3), 263–285.
Collin-Vezina, D., Sablonni, D. L., Palmer, A. M., & Milne, L. (2015). A preliminary mapping of individual, relational, and social factors that impede disclosure of childhood sexual abuse. Child Abuse & Neglect, 43, 123–134. doi:10.1016/j.chiabu.2015.03.010
Compton, W. C., & Hoffman, E. (2013). Positive psychology: The science of happiness and flourishing (2nd ed.). Belmont, CA: Wadsworth Cengage Learnin
Cooper, K., Quayle, E., Jonsson, L., & Svedin, C. G. (2016). Adolescents and self-taken sexual images: A review of the literature. Computers in Human Behavior, 55(Part B), 706- 716. 96
Cossar, J., Brandon, M., Bailey, S., Belderson, P., Biggart, L., & Sharpe, D. (2013). ’It takes a lot to build trust’. In recognition and telling: developing earlier routes to help for children and young people. Office of the Children’s Commissioner: London.
Covington, S., Burke, C., & Keaton, S. (2008). Evaluation of a Trauma-Informed and Gender-Responsive Intervention for Women in Drug Treatment. Journal of Psychoactive Drugs, 5, 377 – 385.
Cox, S., Andrade, G., Lungelow, D., Schloetelburg, W., & Rode, H. (2007). The child rape epidemic: Assessing the incidence at Red Cross Hospital, Cape Town, and establishing the need for a new national protocol. South African Medical Journal, 97, 950-955.
Crane, J. (2015). 'The bones tell a story the child is too young or too frightened to tell': The Battered Child Syndrome in Post-war Britain and America. Social History of Medicine, 28,767-788.
Craven, S., Brown, S., & Gilchrist, E. (2006). Sexual grooming of children: Review of literature and theoretical considerations. Journal of Sexual Aggression, 12, 287–299.
Crisma, M., Bascelli, E., Paci, D. & Romito, P. (2004) Adolescents who experienced sexual abuse: fears, needs and impediments to disclosure. Child Abuse and Neglect (28), 1035-1048.
Cruz, F. G., & Essen, L. (1994). Adult survivors of childhood emotional, physical, and sexual abuse: Dynamics and treatment. Mahwah, NJ: Jason Aronson.
Curtis, C. (2006). Sexual abuse and subsequent suicidal behavior: Exacerbating factors and implications for recovery. Journal of Child Sexual Abuse, 15(2), 1-21.
Daigneault, I., Cyr, M., & Tourigny, M. (2007) Exploration of recovery trajectories in sexually abused adolescents. Journal of Aggression Maltreatment and Trauma, 14(1), 165- 184.
Dass-Brailsford, P. (2005). Exploring resiliency: Academic achievement among disadvantaged Black youth in South Africa. South African Journal of Psychology, 35(3), 574-591. 97
Daugherty, L. (2006). Why Me? Help for victims of child sexual abuse (4th ed.). Roswell, NM: Cleanan Press.
Deering, R., & Mellor, D. (2011). An exploratory qualitative study of the self-reported impact of female-perpetrated childhood sexual abuse. Journal of Child Sexual Abuse, 20(1), 58-76.
DeLillo, D., Giuffre, D., Tremblay, G. & Peterson, L. (2001). A closer look at the nature of intimate partner violence reported by women with history of child sexual abuse. Journal of Interpersonal Violence, 16,116-132.
Delima, J. & Vimpani, G. (2011). The neurobiological effects of childhood maltreatment: An often overlooked narrative related to the long-term effects of early childhood trauma? Family Matters, 89, 42–57.
Denyer, D. & Tranfield, D. (2009). Producing a systematic review. In Buchanan, D. (ed.), The Sage Handbook of Organization Research Methods. London: Sage, pp. 671– 689.
Devries, K. M., Mak, J. Y. T., Child, J. C., Falder, G., Bacchus, L. J., Astbury, J., & Watts, C. H. (2014) Childhood Sexual Abuse and Suicidal Behavior: A Meta-analysis. Pediatrics, 133(5), 1331-1344.
Dhaliwal, G. K., Gauzas, L., Antonowicz, D. H., & Ross, R. R. (1996). Adult male survivors of childhood sexual abuse: Prevalence, sexual abuse characteristics, and long- term effects. Clinical Psychology Review, 16, 619–639.
Dinwiddie, S., Heath, A. C., Dunne, M. P., Bucholz, K. K., Madden, P. A., Slutske, W. S. et al. (2000). Early sexual abuse and lifetime psychopathology: a co-twin—control study. Psychological Medicine, 30, 41-52.
DiPietro, E. K., Runyan, D. K., & Fredrickson, D. D. (1997). Predictors of disclosure during medical evaluation for suspected sexual abuse. Journal of Child Sexual Abuse, 6, 133-142. 98
Domhardt, M., Münzer, A., Fegert, J.M. & Goldbeck, L., 2015, ‘Resilience in survivors of child sexual abuse’, Trauma, Violence, & Abuse 16(4), 476–493. https://doi. org/10.1177/1524838014557288
Donalek, J. G. (2001). First incest disclosure. Issues in Mental Health Nursing, 22, 573– 591.
Dorahy, M.J. & Clearwater, K. (2012). Shame and guilt in men exposed to childhood sexual abuse: A qualitative investigation. Journal of Child Sexual Abuse, 21(2), 155-175.
Draper, B, Pfaff, J. J., Pirkis, J., Snowdon, J., Lautenschlager, N. T., Wilson, I., & Almeida, O. P. (2008). Long-term effects of childhood abuse on the quality of life and health of older people. Journal of American Geriatrics Society, 56(2), 262–271.
Draucker, C. B., & Martsolf, D. (2008). Storying childhood sexual abuse. Qualitative Health Research, 18(8),1034–1048.
Draucker, C. B., & Mazurczyk, J. (2013) Relationships between childhood sexual abuse and substance use and sexual risk behaviors during adolescence: An integrative review. Nursing Outlook, 61(5), 291-310.
Draucker, C. B., Martsolf, D. S., Roller, C., Knapik, G., Ross, R., & Stidham, A. W. (2011). Healing from childhood sexual abuse: A theoretical model. Journal of Child Sexual Abuse, 20, 435–466.
Draucker, C. B., Martsolf, D.S., & Poole, C. (2009). Developing distress protocols for research on sensitive topics. Archives of Psychiatric Nursing, 23(5), 343-350.
Drauker, C. B. (2000). Counselling survivors of childhood sexual abuse (2nd ed.). London: Sage.
Dube, S. R., Anda, R. F., Whitfield, C. L., Brown, D. W., Felitti, V, J., Dong, M., & Giles, W. H. (2005). Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine, 28, 430–438 99
Dubowitz, H., Black, M., Harrington, D., & Verschoore, A. (1993). A follow-up study of behaviour problems associated with child sexual abuse. Child Abuse & Neglect, 17, 743- 754.
Duncan, L. E., & Williams, L. M. (1998). Gender role socialization and male-on-male vs, female-on-male child sexual abuse. Sex Roles, 39, 765-785.
Dunkle, K. L., Jewkes, R. K., Murdock, D. W., Sikweyiya, Y., & Morrell, R. (2013). Prevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional study. PLoS Med, 10(6), e1001472. doi: https://doi.org/10.1371/journal.pmed.1001472
Easton, S. D. (2013). Disclosure of child sexual abuse among adult male survivors. Clinical Social Work Journal, 41, 344–355. doi:10. 1007/s10615-012-0420-3
Easton, S. D., & Kong, J. (2016) Mental health indicators fifty years later: A population- based study of men with histories of child sexual abuse. Child Abuse and Neglect, 63, 273– 283.
Easton, S. D., Renner, L. M., & O’Leary, P. (2013) Posttraumatic growth among men with histories of child sexual abuse. Child Maltreatment, 18(4), 211-220.
Easton, S. D., Saltzman, L. Y., & Willis, D. G. (2014). “Would you tell under circumstances like that?”: Barriers to disclosure of child sexual abuse for men. Psychology of Men & Masculinity, 15, 460–469.
Easton, S., Leone-Sheehan, D., Sophis, E., & Willis, G. (2015). Turning points in the healing process for men recovering from child sexual abuse, Journal of Child Sexual Abuse, 24, 152-173. doi:10.1080/10538712.2015.997413.
Edwards, D. J. A., Sakasa, P., & van Wyk, G. (2005). Trauma, resilience and vulnerability to PTSD: A review and clinical case discussion. Journal of Psychology in Africa, 15, 143- 153.
Eisenberg, N., & Ota Wang, V. (2003). Toward a positive psychology: Social development and cultural contributions. In L. G. Aspinwall & U. M. Staudinger (Eds.), A psychology of 100 human strengths. Fundamental questions and future directions for a positive psychology. Washington, DC: American Psychological Association.
Elliott, A. N. & Carnes, C. N. (2001). Reactions of non-offending parents to the sexual abuse of their child: A review of the literature. Child Maltreatment, 6(4), 314-331.
Emmons, R. A., & Mishra, A. (2011). Why gratitude enhances well-being: What we know, what we need to know. In K. M. Sheldon, T. B. Kashdan, & M. F. Steger (Eds.), Designing positive psychology: Taking stock and moving forward (pp. 248–264). New York, NY: Oxford University Press.
Endler, N. S., & Parker, J. D. (1994). Assessment of multidimensional coping: task, emotion, and avoidance strategies. Psychological Assessment, 6(1), 50-68.
Faller, K. C. (1989). Characteristics of a clinical sample of sexually abused children: how boy and girl victims differ. Child Abuse and Neglect, 13, 281–291.
Faller, K. C. (2004). Disclosure of sexual abuse: Research findings and practice implications. Paper presented at the Fifteenth Congress of the International Society for the Prevention of Child Abuse and Neglect, Brisbane, Australia.
Feeny, N. C., Foa, E. B., Treadwell, R. H., & March, J. (2004). Posttraumatic stress disorder in youth: A critical review of the cognitive and behavioral treatment outcome literature. Professional Psychology: Research and Practice, 35(5), 466–476.
Feiring, C., Taska, L., & Lewis, M. (1996). A process model for understanding adaptation to sexual abuse: The role of shame in defining stigmatization. Child Abuse and Neglect, 20, 767–782.
Fergusson, D. M., McLeod, G. F. H., & Horwood, L. J. (2013). Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child Abuse and Neglect, 37(9), 664-674.
Finkelhor, D. (1986). A Sourcebook on Child Sexual Abuse. Beverly Hills, CA: Sage Pub.
Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry, 55(4), 530-541. 101
Finkelhor, D., Hotaling, G., Lewis, I. A., & Smith, C. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse & Neglect, 14, 19-28.
Finkelhor, D., Shattuck, A., Turner, H., & Hamby, S. (2014). The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence. Journal of Adolescent Health, 55, 329-333.
Finkelhor, D., Wolak, J., & Berliner, L. (2001). Police reporting and professional help seeking for child crime victims: A review. Child Maltreatment, 6, 17–30.
Fisher, C., Goldsmith, A., Hurcombe, R., & Soares, C. (2017). The impacts of child sexual abuse: A rapid evidence assessment. London: Independent Inquiry into Child Sexual Abuse.
Fleming, J. M. (1997). Prevalence of childhood sexual abuse in a community sample of Australian women. The Medical Journal of Australia, 166(7), 65-68.
Floyd, C. (1996). Achieving despite the odds: A study of resilience among a group ofAfrican American high schools seniors. Journal of Negro Education, 65(2), 181-189.
Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: cognitive-behavioral therapy for PTSD. New York: Guilford Press.
Folkman, S. & Lazarus, R. S. (1986). Stress-processes and depressive symptomatology. Journal of Abnormal Psychology, 95(2), 107–113.
Fontes, L. A., & Plummer, C. A. (2010). Cultural issues in disclosures of child sexual abuse. Journal of Child Sexual Abuse, 19, 491–518.
Fouché, A. & Walker-Williams, H. J. (2016). A group intervention programme for adults survivors of childhood sexual abuse. Social work, 52(4), 525-543. doi: 10.15270/52-2-529
Frazier P. A. (2003). Perceived control and distress following sexual assault: A longitudinal test of a new model. Journal of Personality and Social Psychology, 84, 1257– 1269. 102
Frazier, P., & Burnett, J. (1994). Immediate coping strategies among rape victims. Journal of Counseling and Development, 72, 633–639.
Frazier, P., Tashiro, T., Berman, M., Steger, M., & Long, J. (2004). Correlates of levels and patterns of positive life change following sexual assault. Journal of Consulting and Clinical Psychology, 72(1), 19–30.
Frazier, P.A., Mortensen, H., & Steward, J. (2005). Coping strategies as mediators of the relationships among perceived control and distress in sexual assault survivors. Journal of Counseling Psychology, 52(3), 267–278.
Freyd, J. J., Putnam, F. W., Lyon, T. D., Becker-Blease, K. A., Cheit, R. E., Siegel, N. B., & Pezdek, K. (2005). The science of child sexual abuse. Science, 308(5271), 501. doi:10.1126/science.1108066
Fromm, K., Andrykowski, M. A., & Hunt, J. (1996). Positive and negative psychological sequelae of bone marrow transplantation: Implications for quality of life assessment. Journal of Behavioural Medicine, 19, 221–240.
Gabbard, G. (2005). Major modalities: Psychoanalytic/psychodynamic. In: Gabbard G, Beck J, Holmes J, editor(s). Oxford Textbook of Psychotherapy. Oxford: Oxford University Press.
Gagnier, C., & Collin-Vezina, D. (2016). The disclosure experiences of male child sexual abuse survivors. Journal of Child Sexual Abuse, 25, 221–241.
Gall, T. L. (2006). Spirituality and coping with life stress among adult survivors of childhood sexual abuse. Child Abuse & Neglect, 30(7), 829–844.
Gall, T. L., Basque, V., Damasceno-Scott, M., & Vardy, G. (2007). Spirituality and the current adjustment of adult survivors of childhood sexual abuse. Journal for the Scientific Study of Religion, 46(1), 101-117.
Glaister, J. A. & Abel, E. (2001). Experiences of women healing from childhood sexual abuse, Archives of Psychiatric Nursing, 15(4), 188–194. 103
Glaser, D. (1991). Treatment issues in child sexual abuse. British Journal of Psychiatry,159, 255-265.
Goldman. J. D. G., & Grimbeek, P. (2014). Reporting intervention preservice content preferred by student teachers. Journal of Child Sexual Abuse, 23, 1-16.
Goldstein A.L., Flett G.L., Wekerle C. (2010). Child maltreatment, alcohol use and drinking consequences among male and female college students: An examination of drinking motives as mediators. Addictive Behaviors, 35, 636–639.
Gómez, L. C., & Ayala, E. S. (2014). Psychological Aspects, Attitudes and Behaviour Related to the Practice of Sexting: A Systematic Review of the Existent Literature. Procedia - Social and Behavioral Sciences, 132, 114-120.
Goodman-Brown, T. B., Edelstein, R. S., Goodman, G. S., Jones, D. P. H., & Gordon, D. S. (2003). Why children tell: A model of children’s disclosure of sexual abuse. Child Abuse & Neglect, 27, 525–540.
Gorey, I., & Leslie, D. (1997). The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement bias. Child Abuse and Neglect, 23, 391–398.
Gray, D., & Watt, P. (2013). Giving Victims a Voice: Joint Report into Allegations made Against Jimmy Savile (MPS / NSPCC).
Gries, L. T., Goh, D. S., & Cavanaugh, J. (1996). Factors associated with disclosure during child sexual abuse assessment. Journal of Child Sexual Abuse, 5(3), 1 –19.
Gries, L. T., Goh, D. S., Andrews, M. B., Gilbert, J., Praver, F., & Stelzer, D. N. (2000). Positive reaction to disclosure and recovery from child sexual abuse. Child Sexual Abuse, 9, 29-51.
Grossman, F. K., Sorsoli, L., & Kia-Keating, M. (2006). A gale force wind: Meaning making by male survivors of childhood sexual abuse. American Journal of Orthopsychiatry, 76(4), 434–443. 104
Hallett, C., Murray, C., & Punch, S. (2003). Young People and Welfare: negotiating pathways. In: C. Hallett and A. Prout (eds) Hearing the Voices of Children: social policy for a new century. London: Routledge Falmer.
Harding, H. G., Burns, E. E., & Jackson, J. L. (2012). Identification of Child Sexual Abuse Survivor Subgroups Based on Early Maladaptive Schemas: Implications for Understanding Differences in Posttraumatic Stress Disorder Symptom Severity. Cognitive Therapy and Research, 36(5), 560-575.
Harker, L., Jutte, S., Murphy, T., Bentley, H., Miller, P., & Fitch, K. (2013). How safe are our children? London: NSPCC.
Harper, K., Stalker, C. A., Palmer, S., & Gadbois, S. (2005). Experiences of adults abused as children after discharge from inpatient treatment: Informal social support and self-care practices related to trauma recovery. Families in Society, 86(2), 217-225.
Harvey, J. H., Barnett, K., & Overstreet, A. (2004). Trauma and growth and other outcomes attendant on loss. Psychological Inquiry, 15, 26–29.
Harvey, M. (1996). An ecological view of psychological trauma and trauma recovery. Journal of Traumatic Stress, 9, 3-23. doi:10.1002/jts.2490090103
Harvey, M. R., Mishler, E. G., Koenen, K., & Harney, P. A. (2000). In the aftermath of sexual abuse: Making and remaking meaning in narratives of trauma and recovery. Narrative Inquiry, 10(2), 291–311. doi:http://dx.doi.org/10.1075/ni.10.2.02har
Harvey, M.R., Western, D., Lebowitz, L., Saunders, E., Avi-Yonah, O. & Harney, P. (1994). Multidimensional Trauma Recovery and Resiliency Interview (MTRR-I), Cambridge, MA: Victims of Violence Program, Department of Psychiatry, Cambridge Health Alliance.
Haugaard, J. J. (2000). The challenge of defining child sexual abuse. American Psychologist, 55(9), 1036–39. 105
Havig, K. (2008) The health care experiences of adult survivors of child sexual abuse: A systematic review of evidence on sensitive practice. Trauma, Violence, & Abuse, 9(1),19- 33.
Health Working Group. (2014). Health Working Group Report on Child Sexual Exploitation. London: Department of Health.
Hebert, M., Lavoie, F., & Blais, M. (2014). Post Traumatic Stress Disorder/PTSD in adolescent victims of sexual abuse: resilience and social support as protection factors. Ciencia & Saude Coletiva, 19(3),685-694.
Hébert, M., Tourigny, M., Cyr, M., McDuff, P., & Joly, J. (2009). Prevalence of childhood sexual abuse and timing of disclosure in a representative sample of adults from Quebec. The Canadian Journal of Psychiatry, 54(9), 631-636.
Hecht, D. B., & Hansen, D. J. (1999). Adolescent victims and intergenerational issues in sexual abuse. In V. B. Van Hasselt & M. Hersen (Eds.), Handbook of psychological treatment with violent offenders: Contemporary strategies and issues (pp. 303-328). New York: Kluwer Academic/Plenum.
Heerde, J. A., Scholes-Balog, K. E., & Hemphill, S. A. (2015) Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: A systematic literature review. Archives of Sexual Behavior, 44(1), 181-212.
Hefferon, K., & Boniwell, I. (2011). Positive psychology: Theory, research and applications. London, England: McGraw-Hill and Open University Press.
Herman, J. L. (1992). Trauma and recovery: The aftermath of violence-from domestic to political terror. New York: Basic Books
Herman, J. L. (1998). Trauma and recovery. London: Pandora.
Herrman, H., Stewart, D. E., Diaz-Granados, N., Berger, E. L., Jackson, B., & Yuen, T. (2011). What is resilience? Canadian Journal of Psychiatry, 56, 258–265.
Hershkowitz, I., Lanes, O., & Lamb, M. E. (2007). Exploring the disclosure of child sexual abuse with alleged victims and their parents. Child Abuse & Neglect, 31, 111–123. 106
Hetzel-Riggin, M., Brausch, A., & Montgomery, G. (2007). A meta analytic investigation of therapy modality outcomes for sexually abused children and adolescents: an exploratory study. Child Abuse & Neglect, 31, 125–141.
Higson, C., Lamprecht, L., & Jacklin, L. (2004). Access to specialist services and the criminal justice system: Data from the teddy bear clinic. In L. Richter, A. Dawes, & C. Higson-Smith (Eds.), Sexual abuse of young children in Southern Africa (pp. 335–355). Cape Town, South Africa: HSRC Press.
Hilberg. T., Hamilton- Giachritsis, C., & Dixon, L. (2011). Review of meta-analyses on the association between child sexual abuse and adult mental health difficulties: A systemic approach. Trauma, Violence, and Abuse, 12, 38-49.
Himelein, M.J., & McElrath, J. A. V. (1996). Resilient child sexual abuse survivors. Child Abuse & Neglect, 20(8), 747-758.
Ho, S. M. Y., Chan, M. W. Y., Yau, T. K., & Yeung, R. M. W. (2011). Relationships between explanatory style, posttraumatic growth and posttraumatic stress disorder symptoms among Chinese breast cancer patients. Psychology & Health, 26(3), 269–285.
Hobkirk, A. L., Watt, M. H., Green, K. T., Beckham, J. C., Skinner, D., & Meade, C. S. (2015). Mediators of interpersonal violence and drug addiction severity among methamphetamine users in Cape Town, South Africa. Addictive Behaviors, 42, 167–171. http://dx.doi.org/10.1016/j.addbeh.2014.11.030
Hobkirk, A. L., Watt, M. H., Myers, B., Skinner, D., & Meade, C. S. (2016). A qualitative study of methamphetamine initiation in Cape Town, South Africa. International Journal on Drug Policy, 30, 99–106. http://dx.doi.org/10.1016/j.drugpo.2015.10.006
Hobkirk, A.L., Watt, M.H., Myers, B., Skinner, D. & Meade, C.S. (2016). A qualitative study of methamphetamine initiation in Cape Town, South Africa. International Journal of Drug Policy, 30, 99-106. doi:10.1016/j.drugpo.2015.10.006
Hogarth, L., Martin, L., & Seedat, S. (2019). Relationship between childhood abuse and substance misuse problems is mediated by substance use coping motives, in school 107 attending South African adolescents. Drug and Alcohol Dependence, 194, 69–74. https://doi.org/10.1016/j.drugalcdep.2018.10.009
Hornor, G. (2010). Child sexual abuse: Consequences and implications. Journal of Pediatric Health Care, 24, 358-364.
Horwitz, A. V., Widom, C. S., McLaughlin, J., & White, H. R. (2001). The Impact of Childhood Abuse and Neglect on Adult Mental Health: A Prospective Study. Journal of Health and Social Behavior, 42(2), 184-201.
Hulme, P. A. (2000). Symptomatology and health care utilization of women primary care patients who experienced childhood sexual abuse. Child Abuse & Neglect, 24, 1471–1484.
Hulme, P. A. (2004). Theoretical perspectives on the health problems of adults who experienced childhood sexual abuse. Issues in Mental Health Nursing, 25, 339–361.
Hunter, S. V. (2010). Evolving narratives about childhood sexual abuse: Challenging the dominance of the victims and survivor paradigm. The Australian and New Zealand Journal of Family Therapy, 31, 175-190.
Hunter, S. V. (2011) Disclosure of child sexual abuse as a life-long process: Implications for health professionals. Australian and New Zealand Journal of Family Therapy, 32(2), 159-172.
Hyman, B., & Williams, L. (2001). Resilience among women survivors of child sexual abuse. Affilia, 16, 198–219.
Hymann, S. M., Gold, S. N., & Cott, M. A., (2003). Forms of social support that moderate PTSD in childhood sexual abuse survivors. Journal of Family Violence, 18, 295–300.
Ireland, T., & Widom, C. S. (1994). Childhood victimization and risk for alcohol and drug arrests. International Journal of the Addictions, 29, 253-274.
Irish, L., Kobayashi, I., & Delahanty, D. L. (2010) Long-term Physical Health Consequences of Childhood Sexual Abuse: A Meta-Analytic Review. Journal of Pediatric Psychology, 35(5), 450-461. 108
Irish, L., Kobayashi, M. S., & Delhanty, D. L. (2010). Long-term Physical Health Consequences of Childhood Sexual Abuse: A Meta-Analysis. Journal of Pediatric Psychology, 35(5), 450-461.
Jackson, S., Newall, E., & Backett-Milburn, K. (2015). Children's narratives of sexual abuse. Child & Family Social Work, 20(3), 322-332. doi:10.1111/cfs.12080
Janoff-Bulman, R. (2006). Schema-change perspectives on posttraumatic growth. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth (pp. 81–99). Mahwah, NJ: Lawrence Erlbaum.
Jaycox, L. H., Zoellner, L. A., & Foa, E. B. (2002). Cognitive-behavior therapy for PTSD in rape survivors. Journal of Clinical Psychology, 58, 891–906. doi:10.1002/jclp.10065 Jehu, D. (1988). Sexual abuse and beyond. Chichester: Wiley.
Jensen, K. J., Gulbrandsen, W., Mossige, S., Reichelt, S., & Tjersland, O. A. (2005). Reporting possible sexual abuse: A qualitative study on children’s perspectives and the text for disclosure. Child Abuse & Neglect, 29, 1395–1413.
Jewkes, R. K., Dunkle, K., Nduna, M., Jama, P. N., & Puren, A. (2010). Associations between childhood adversity and depression, substance abuse and HIV and HSV2 incident infections in rural South African youth. Child Abuse & Neglect, 34, 833–841.
Jewkes, R., & Abrahams, N. (2002). The epidemiology of rape and sexual coercion in South Africa: An overview. Social Science & Medicine, 55, 1231–1244. doi:10.1016/S0277-9536(01)00242
Jewkes, R., Dunkle, K., Nduna, M., Levin, J., Jama, N., Khuzwayo, N., Koss, M., Puren, A., & Duvvury, N. (2006). Factors associated with HIV sero-status in young rural South African women: Connections between intimate partner violence and HIV. International Journal of Epidemiology, 35(6), 1461–1468.
Jewkes, R., Levin, J., Bradshaw, D., & Mbananga, N. (2002). Rape of girls in South Africa. The Lancet, 359, 319–320. 109
Jewkes, R., Penn-Kekana, L., & Rose-Junius, H. (2005). “If they rape me, I can’t blame them”: reflections on gender in the social context of child rape in South Africa and Namibia. Social Science & Medicine, 61(8), 1809-1 820.
Johnson, B. K., & Kenkel, M. B. (1991). Stress, coping, and adjustment in female adolescent incest victims. Child Abuse & Neglect, 15, 293–305.
Jonzon, E. M. C. (2006). Child sexual abuse: Disclosure, social support and subjective health in adulthood. Doctoral thesis, Karolinska Institutet, Stockholm, Sweden.
Jonzon, E., & Lindblad, F. (2004). Disclosure, reactions and social support: findings from a sample of adult victims of child sexual abuse. Child Maltreatment, 9(2), 190-200.
Kamiya, Y., Timonen, V., & Kenny, R. A. (2016) The impact of childhood sexual abuse on the mental and physical health, and healthcare utilization of older adults. International Psychogeriatrics, 28(3), 415-422.
Kasambala, A. E. (2005). The impact of an African spirituality and cosmology on God images in Africa: A challenge to practical theology and pastoral ministry, an International Report. International Journal of Practical Theology, 9, 300-323.
Kaye-Tzadok, A., & Davidson-Arad, B. (2016). ‘Posttraumatic growth among women survivors of childhood sexual abuse: Its relation to cognitive strategies, posttraumatic symptoms and resilience’, Psychological Trauma: Theory, Research, Practice and Policy 8(5), 550–558. https://doi.org/10.1037/ tra0000103
Kelley, S. J., Brant, R., & Waterman, J. (1993). Sexual abuse of children in day care centers. Child Abuse and Neglect, 17, 71–89.
Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemueller, W., & Silver, H. K. (1962). The battered-child syndrome. Journal of the American Medical Association, 181, 17–24.
Kendall-Tackett, K.A., Meyer Williams, L., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review synthesis of recent empirical studies. Psychological Bulletin, 113, 164-180. 110
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harvard Review of Psychiatry 4, 231–244
Kia-Keating, M., Grossman, F. K., Sorsoli, L., & Epstein, M. (2005). Containing and resisting masculinity: Narratives of renegotiation among resilient male survivors of childhood sexual abuse. Psychology of Men &Masculinity, 6, 169–185.
Kia-Keating, M., Sorsoli, L., & Grossman, F. K. (2010). Relational Challenges and Recovery Processes in Male Survivors of Childhood Sexual Abuse. Journal of Interpersonal Violence, 25(4), 666-683.
King, G., Flisher, A. J., Noubary, F., Reece, R., Marais, A., & Lombard, C. (2004). Substance abuse and behavioral correlates of sexual assault among South African adolescents. Child Abuse & Neglect, 28, 683–696. http://dx.doi.org/10.1016/j.chiabu.2003.12.003
King, N. J., Heyne, D., Tonge, B. J., Mullen, P., Myerson, N., Rollings, S., & Ollendick, T. H. (2003). Sexually abused children suffering from post-traumatic stress disorder: Assessment and treatment strategies. Cognitive Behaviour Therapy, 32, 2-12.
Knapp, D. E., Faley, R. H., Ekeberg, S. E., & Dubois, C. L. (1997). Determinants of target responses to sexual harassment: A conceptual framework. Academy of Management Review, 22(3), 687-729.
Knott, T. (2014). Maternal Response to the Disclosure of Child Sexual Abuse: Systematic Review and Critical Analysis of the Literature. Issues in Child Abuse Accusations, 20(1), 1-6.
Koehn, C. V. (2007). Women’s perceptions of power and control in sexual abuse counselling. Journal of Child Sexual Abuse, 16(1), 37–60.
Kogan, S. M. (2004). Disclosing unwanted sexual experiences: Results from a national sample of adolescent women. Child Abuse & Neglect, 28, 147–165. doi:10.1016/j.chiabu.2003.09.014 111
Koss, M. P., & Figueredo, A. J. (2004). Change in cognitive mediators of rape’s impact on psychosocial health across 2 years of recovery. Journal of Consulting and Clinical Psychology, 72(6), 1063–1072.
Koverola, K., Pound, J., Heger, A., & Lytle, C. (1993). Relationship of child sexual abuse to depression. Child Abuse & Neglect, 17, 393-400.
Lalor, K., & McElvaney, R. (2010). Child sexual abuse, links to later sexual exploitation/high-risk sexual behavior, and prevention/treatment programs. Trauma, Violence and Abuse, 11(4), 159-177.
Lamb, S., & Edgar-Smith, S. (1994). Aspects of disclosure mediators of outcome of childhood sexual abuse. Journal of Interpersonal Violence, 9, 307–326.
Leeies, M., Pagura, J., Sareen, J., & Bolton, J.M. (2010). The use of alcohol and drugs to selfmedicate symptoms of posttraumatic stress disorder. Depression and Anxiety, 27(8), 731-736. doi:10.1002/da.20677
Leibowitz, S., Mendelsohn, M. & Michelson, C. (1999). Child rape: Extending the therapeutic intervention to include the mother–child dyad. South African Journal of Psychology, 29(3), 103–139.
Leong, F. T. L., Leach, M. M., Yeh, C., & Chou, E. (2007). Suicide among Asian Americans: What do we know? What do we need to know? Death Studies, 31, 417–434. doi:10.1080/07481180701244561
Letourneau, N., Dewey, D., Kaplan, B. J., Ntanda, H., Novick, J., Thomas, J. C., ... & APrON Study Team. (2019). Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex. Journal of Developmental Origins of Health and Disease, 10(1), 88-99.
Levitan, R. D., Rector, N. A., Sheldon, T., & Goering, P. (2003). Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: Issues of co-morbidity and specificity. Depression and Anxiety, 17, 34-43. 112
Lev-Wiesel, R. (2000). Quality of life in adult survivors of childhood sexual abuse who have undergone therapy. Journal of Child Sexual Abuse, 91, 1-13.
Liang, B., Williams, L. M., & Siegel, J. A. (2006). Relational outcomes of childhood sexual trauma in female survivors: a longitudinal study. Journal of Interpersonal Violence, 21, 42–57. doi:10.1177/0886260505281603
Lietz, C. A. (2011). Empathic action and family resilience: A narrative examination of the benefits of helping others. Journal of Social Service Research, 37(3), 254–265. doi:10.1080/01488376.2011.564035
Lindert, J., von Ehrenstein, O. S., Grashow, R., Gal, G., Braehler, E., & Weisskopf, M. G. (2014) Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis. International Journal of Public Health, 59, 359-372.
Linley, P. A. (2003). Positive adaptation to trauma: Wisdom as both process and outcome. Journal of Traumatic Stress, 16, 601–610.
Little, L., & Hamby, S. L. (1999). Gender differences in sexual abuse outcomes and recovery experiences: a survey of therapist-survivors. Professional Psychology: Research and Practice, 30, 378–385.
Lynskey, M. T., & Fergusson, D. M. (1997). Factors protecting against the development of adjustment difficulties in young adults exposed to childhood sexual abuse. Child Abuse & Neglect, 21, 1177-1190.
Machisa, M., Jina R., Labuschagne, G., Vetten, L., Loots L., Swemmer, S., Meyersfeld, B., & Jewkes, R. (2017). Rape justice in South Africa: A retrospective study of the investigation, prosecution and adjudication of reported rape cases from 2012. Pretoria, South Africa. Gender and Health Research Unit, South African Medical Research Council. Retrieved from https://rapecrisis.org.za/wp-content/uploads/Resources/RAPSSA-Report- 18-July-2017.pdf 113
Madu, S. N. & Peltzer, K. (2000). Risk factors and child sexual abuse among secondary school students in the Northern Province (South Africa). Child Abuse & Neglect, 24, 259- 268.
Malloy, L. C., Lyon, T. D., & Quas, J. A. (2007). Filial dependency and recantation of child sexual abuse allegations. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 162-170.
Malloy, L., Brubacher, S. P., & Lamb, M. E. (2013). “Because she’s the one who listens”: children discuss disclosure recipients in forensic interviews. Child Maltreatment 18(4), 245–251. doi:10.1177/1077559513497250.
Mamun, A. A., Lawlor, D. A., O’Callaghan, M. J., Bor, W., Williams, G. M., & Najman, J. M. (2007). Does childhood sexual abuse predict young adult’s BMI? A birth cohort study. Obesity, 15(8), 2103-2110.
Maniglio, R. (2009). The impact of child sexual abuse on health: A systematic review of reviews. Clinical Psychology Review, 29(7), 647–657. doi:10.1016/j.cpr.2009.08.003
Maniglio, R. (2013) The impact of child sexual abuse on the course of bipolar disorder: a systematic review. Bipolar Disorders, 15(4), pp.341-358
Maniglio, R. (2013b) Child Sexual Abuse in the Etiology of Anxiety Disorders: A Systematic Review of Reviews. Trauma, Violence & Abuse, 14(2), pp.96-112
Maniglio, R. (2015) Significance, nature, and direction of the association between child sexual abuse and conduct disorder: A systematic review. Trauma, Violence, & Abuse, 16(3), 241-257.
Marivate, P., & Madu, S. N. (2007). Levels of social support and coping strategies in adult survivors of child sexual abuse. Journal of Psychology in Africa, 17, 133-136.
Marriott, C., Hamilton – Giachristis, C., & Harrop, C. (2014). Factors Promoting Resilience Following Childhood Sexual Abuse: A Structured, Narrative Review of the Literature. Child Abuse Review, 23, 17–34. 114
Martin, E. K., & Silverstone, P. H. (2013). How much child sexual abuse is “below the surface,” and can we help adults identify it early?. Frontiers in Psychiatry, 4, 58.
Mash, E. J., & Wolfe, D. A. (2010). Abnormal child psychology. Belmont, NC: Wadsworth.
Masson, J., (1992). The assault on truth: Freud and child sexual abuse, London: Fontana.
Mathews, B. (2017). Optimising implementation of reforms to better prevent and respond to child sexual abuse in institutions: Insights from public health, regulatory theory, and Australia’s Royal Commission. Child Abuse & Neglect, 74, 86 –98.
Mathews, S., Abrahams. N., & Jewkes, R. (2013). Exploring Mental Health Adjustment of Children Post Sexual Assault in South Africa. Journal of Child Sexual Abuse, 22, 639–657.
Mathews, S., Hendricks, N., & Abrahams, N. (2016). A psychosocial understanding of child sexual abuse disclosure among female children in South Africa. Journal of Child Sexual Abuse, 25, 636–654
Mathews, S., Loots, L., Sikweyiya, Y. & Jewkes, R. (2013). Sexual abuse: crime, violence and injury prevention in South Africa: developments and challenges. Pretoria: Medical Research Council & University of South Africa.
Mbwambo, J., McCurdy, S.A., Myers, B., Lambdin, B., Kilonzo, G.P., & Kaduri, P. (2012). Drug trafficking, use, and HIV risk: The need for comprehensive interventions. SAHARAJ: Journal of Social Aspects of HIV/AIDS, 9(3), 154-159. doi:10.1080/17290376.2012.743832
McCarthy-Jones, S., & McCarthy-Jones, R. (2014) Body mass index and anxiety/depression as mediators of the effects of child sexual and physical abuse on physical health disorders in women. Child Abuse & Neglect, 38(12), pp.2007-2020
McCrann, D., Lalor, K., & Katabaro, J. (2006). Childhood sexual abuse among university students in Tanzania. Child Abuse & Neglect, 30(12), 1343–1351. 115
McCrory, E. J., Gerin, M. I., & Viding, E. (2017) Annual Research Review: Childhood maltreatment, latent vulnerability and the shift to preventative psychiatry – the contribution of functional brain imaging. Journal of Child Psychology and Psychiatry, 58,338-357.
McElheran, M., Briscoe-Smith, A., Khaylis, A., Westrup, D., Haywarde, C., & Gore- Feltone, C. (2012). A conceptual model of post-traumatic growth among children and adolescents in the aftermath of sexual abuse. Counseling Psychology Quartely, 25, 73-82. doi:10.1080/09515070.2012.665225
McElvaney, R. (2015). Disclosure of child sexual abuse: Delays, non-disclosure and partial Disclosure. What the research tells us and implications for practice. Child Abuse Review, 24, 159–169.
McElvaney, R., & Culhane, M. (2017). A retrospective analysis of children's assessment reports: what helps children tell?. Child abuse review, 26(2), 103-115.
McElvaney, R., Greene, S., & Hogan, D. (2014). To tell or not to tell? Factors influencing young people’s informal disclosures of child sexual abuse. Journal of Interpersonal Violence, 29, 928–947.
McNair, L., & Neville, H. (1996). African American women survivors of sexual assault: The intersection of race and class. Women & Therapy, 18, 107-115.
Meade, C. S., Watt, M. H., Sikkema, K. J., Deng, L. X., Ranby, K. W., Skinner, D., Kalichmann, S. C. (2012). Methamphetamine use is associated with childhood sexual abuse and HIV sexual risk behaviors among patrons of alcohol-serving venues in Cape Town, South Africa. Drug and Alcohol Dependence, 126(1–2), 232–239. http://dx.doi.org/10.1016/j.drugalcdep.2012.05.024
Meinck, F., Cluver, L. D., Boyes, M.E., & Mhlongo, E. L. (2015). Risk and protective factors for physical and sexual abuse of children and adolescents in Africa: A review and implications for practice. Trauma, Violence & Abuse, 16(1), 81–107. https://doi.org/10.1177/1524838014523336.
Merrill, L. L., Thomsen, C. J., Sinclair, B. B., Gold, S. R., & Milner, J. S. (2001). Predicting the impact of child sexual abuse on women: The role of abuse severity, parental 116 support, and coping strategies. Journal of Consulting and Clinical Psychology, 69(6), 992– 1006.
Meursing, K., Vos, T., Coutinho, O., Moyo, M., Mfupo, S., Oneko, O., Mundy, V., Dube, S., Mahlangu, T., … & Sibindi F. (1995). Child sexual abuse in Matabeleland, Zimbabwe. Social Sciences and Medicine, 41(12), 1693-1704.
Mian, M., Wehrspan, W., Klajner-Diamond, H., LeBaron, D., & Winder, C. (1986). Review of 125 children 6 years of age and under who were sexually abused. Child Abuse & Neglect, 10, 223–229.
Mills, R., Kisely, S., Alati, R., Strathearn, L., & Najman, J. (2016) Self-reported and agency-notified child sexual abuse in a population-based birth cohort. Journal of Psychiatric Research, 74, 87-93.
Mimiaga, M.J., Noonan, E., Donnell, D., Safren, S. A., Koenen, K. C., Gortmaker, S., & Mayer, K. H. (2009). Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE Study. Journal of Acquired Immune Deficiency Syndromes, 51(3), 340–348. doi:10.1097/QAI.0b013e3181a24b38
Min, M., Farkas, K., Minnes, S., & Singer, L. T. (2007). Impact of childhood abuse and neglect on substance abuse and psychological distress in adulthood. Journal of Traumatic Stress, 20(5), 833–844.
Moeller, T., Bachmamn, G., & Moeller, J. (1993). The combined effects of physical, sexual, and emotional abuse during childhood: Long-term health consequences for women. Child Abuse and Neglect, 17, 623-640.
Molnar, B. E., Berkman, L. F., & Buka, S. L. (2001). Psychopathology, childhood sexual abuse and other childhood adversities: Relative links to subsequent suicidal behaviour in the US. Psychological Medicine, 31, 965-977.
Molnar, B. E., Buka S. L., & Kessler, R. C. (2001). Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health, 91(5),753–760. 117
Montgomery, E. (2013). Feeling Safe: A Metasynthesis of the Maternity Care Needs of Women Who Were Sexually Abused in Childhood. Birth, 40(2), 88-95.
Montgomery, E., Pope, C., & Rogers, J. (2015). A feminist narrative study of the maternity care experiences of women who were sexually abused in childhood. Midwifery, 31(1), 54- 60.
Mordock, J. B. (1996). Treatment of sexually abused children: interview technique, disclosure, and progress in therapy. Journal of Child Sexual Abuse, 5(4), 105–121.
Morojele N. K., Brook, J. S., & Brook, D. W. (2016). Tobacco and alcohol use among adolescents in South Africa: shared and unshared risks. Journal Child Adolescent Mental Health, 28, 139–152.
Morris, M. C., Kouros, C. D., Fox, K. R., Rao, U., & Garber, J. (2014). Interactive models of depression vulnerability: The role of childhood trauma, dysfunctional attitudes, and coping. British Journal of Clinical Psychology, 53, 245–263. http://dx.doi.org/10.1111/bjc.12038
Morrow, S. L., & Smith, M. L. (1995). Constructions of survival and coping by women who have survived childhood sexual abuse. Journal of Counseling Psychology, 42(1), 24– 33.
Murray, J., & Farrington, D. P. (2010). Risk factors for conduct disorder and delinquency: key findings from longitudinal studies. Canadian Journal of Psychiatry, 55(10), 633-642.
Nduna, M., & Jewkes, R. (2012). ‘Disempowerment and Psychological Distress in the Lives of Young People in Eastern Cape, South Africa’. Journal of Child and Family Studies, 21, 1018-1027.
Nelson, E. C., Heath, A. C., Madden, P. A., Cooper, M. L., Dinwiddie, S. H., Bucholz, K. K. et al. (2002). Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: Results from a twin study. Archives of General Psychiatry, 59(2), 139–45. 118
Nelson, S., Baldwin, N., & Taylor, J. (2012) Mental Health Problems and Medically Unexplained Physical Symptoms in Adult Survivors of Childhood Sexual Abuse: An integrative literature review. Journal of Psychiatric and Mental Health Nursing, 19(3), 211-220.
Neumann, D., Houskamp, B., Pollock, V., & Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: a meta-analytic review. Child Maltreatment, 1, 6-16.
Neville, H., & Pugh, A. (1997). General and cultural-specific factors influencing African- American women’s reporting patterns and perceived social support following sexual assault. Violence Against Women, 3, 361-381.
Newman, M. G., Clayton, L., Zuellig, A., Cashman, L., Arnow, B., Dea, R., et al. (2000). The relationship of childhood sexual abuse and depression with somatic symptoms and medical utilization. Psychological Medicine, 30, 1063–1077.
Noll, J., Trickett, P. K., Susman, E. J., & Putnam F.W. (2006). Sleep disturbances and childhood sexual abuse. Journal of Pediatric Psychology, 31, 469–480.
NSPCC (2016). It’s time campaign report. London: NSPCC.
Oaksford, K., & Frude, N. (2009). The process of coping following child sexual abuse: A Qualitative study. Journal of Child Sexual Abuse, 12(2), 41–72.
Ogloff, J. R. P., Cutajar, M. C., Mann, E., & Mullen, P. (2012) Child sexual abuse and subsequent offending and victimisation: A 45 year follow-up study. Trends & issues in crime and criminal justice No. 440. Australian Institute of Criminology
Olafson, E., & Boat, B.W. (2004). Long-term management of the sexually abused child: Considerations and challenges. In Treatment of Child Abuse: Common Ground for Mental Health, Medical and Legal Practitioners, Reece MR (ed.). The Johns Hopkins University Press: Maryland.
O'Leary, P. J., & Barber, J. (2008). Gender differences in silencing following childhood sexual abuse. Journal of Child Sexual Abuse, 17(2), 133-143. 119
One In Four. (2015). Survivors’ voices: breaking the silence on living with the impact of child sexual abuse in the family environment. Retrieved from https://www.basw.co.uk/system/files/resources/basw_102251-7_0.pdf
Orbke, S., & Smith, H.L., (2013). ‘A developmental framework for enhancing resiliency in adult survivors of childhood abuse’, International Journal for the Advancement of Counselling, 35(1), 46–56. https://doi.org/10.1007/s10447-012-9164-6
OSAC. (2020). South Africa 2020 Crime & Safety Report. Retrieved from https://www.osac.gov/Country/SouthAfrica/Content/Detail/Report/63e37d80-c040-462d- a868-181c51cf7188
Ouimette, P. C., Kimerling, R., Shaw, J., & Moos, R. H. (2000). Physical and sexual abuse among women and men with substance use disorders. Alcoholism Treatment Quarterly, 18, 7–17.
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2008). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 3–36.
Paine, M. L., & Hansen, D. J. (2002). Factors influencing children to self-disclose sexual abuse. Clinical Psychology Review, 22, 271–295
Paolucci, E., Genuis, M., & Violato, C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology, 135(1), 17–36.
Park, C. L., & Helgeson, V. S. (2006). Introduction to the special section: Growth following highly stressful events – Current status and future directions. Journal of Consulting and Clinical Psychology, 74, 791–796.
Parton, N. (1979). The natural history of child abuse: A study in social problem definition. British Journal of Social Work, 9(4), 431–451.
Pellauer, M. D., Chester, B., & Boyajian, J. (1987). Sexual assault and abuse: A handbook for clergy and religious professionals. San Francisco: Harper San Francisco. 120
Pereda, N., Guilera, G., Forns, M. & Gomez-Benito, J. (2009). The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clinical Psychology Review, 29, 328–38.
Pereira, S. M. P., Li, L., & Power, C. (2017). Child maltreatment and adult living standards at 50 years. Pediatrics, 139(1), e20161595.
Perez-Gonzalez, A., & Pereda, N. (2015). Systematic review of the prevalence of suicidal ideation and behavior in minors who have been sexually abused. Actas Espanolas De Psiquiatria, 43(4), 149-158.
Peterson, C., & Park, C. (1998). Learned helplessness and explanatory style. In D. F. Barone, V. B. Van Hasselt, & M. Hersen (Eds.), Advanced personality (pp. 287–310). New York: Plenum
Pettifor, A. E., Rees, H. V., Kleinschmidt, I., Steffenson, A. E., MacPhail, C., Hlongwa- Madikizela, L., Vermaak, K., & Padian, N. S. (2005). Young people’s sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS, 19, 1525–1534.
Phanichrat, T., & Townshend, J. M. (2010). Coping Strategies Used by Survivors of Childhood Sexual Abuse on the Journey to Recovery. Journal of Child Sexual Abuse, 19(1), 62-78.
Phasha, T. N. (2008). The role of the teacher in helping learners overcome the negative impact of child sexual abuse. School Psychology International, 29(3), 303–327.
Phasha, T. N. (2010). Educational resilience among African survivors of child sexual abuse in South Africa. Journal of Black Studies, 40(6), 1234–1253. https://doi.org/10.1177/0021934708327693
Pinheiro, P. S. (2006). World Report on Violence against Children. Geneva: United Nations. 121
Pittenger, S. L., Huit, T. Z., & Hansen, D. J. (2016) Applying ecological systems theory to sexual revictimization of youth: a review with implications for research and practice. Aggression and Violent Behavior, 26, 35-45.
Polusny, M. A, & Follette V. M. (1995). Long-term correlates of child sexual abuse: Theory and review of the empirical literature. Applied and Preventive Psychology, 4(3), 143–166.
Pope, K. S., & Brown, L. S. (1996). Recovered memories of abuse: Assessment, therapy, and forensics. Washington, DC: American Psychological Association
Ports, K. A., Ford, D., & Merrick, M. T. (2016). Adverse childhood experiences and adult sexual victimization. Child Abuse & Neglect, 51, 313–322.
Priebe, G., & Svedin, C. G. (2008). Child sexual abuse is largely hidden from the adult society. An epidemiological study of adolescents' disclosures. Child Abuse & Neglect, 32, 1095-1108.
Putnam, F.W. (2003). Ten-year research update review: Child sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 269–278.
Quadara, A., Nagy, V., Higgins, D. & Siegel, N. (2015). Conceptualising the prevention of child sexual abuse. 1-74. Australia: Australian Institute of Family Studies.
Quadara, A., Stathopoulos, M., & Carson, R. (2016). Family Relationships and the Disclosure of Institutional Child Sexual Abuse. Australian Institute of Family Studies. Royal Commission into Institutional Responses to Child Sexual Abuse, Australia.
Quinn, J. (1995). Positive effects of participation in youth organizations. In M. Rutter (Ed.) Psychosocial disturbances in young people: Challenges for prevention (pp. 274-304). Cambridge: University
Radford, L., Corral, S., Bradley, C., & Fisher, H. L. (2013). The prevalence and impact of child maltreatment and other types of victimization in the UK: Findings from a population survey of caregivers, children and young people and young adults. Child Abuse & Neglect, 37, 801-813. doi:10.1016/j.chiabu.2013.02.004 122
Radford, L., Richardson Foster, H., Barter, C., & Stanley, N. (2017). Rapid Evidence Assessment: What can be learnt from other jurisdictions about preventing and responding to child sexual abuse. University of Central Lancashire: Preston
Rajani, R., & Kudrati, M. (1996). The varieties of sexual experience of the street children of Mwanza, Tanzania. In S. Zeidenstein & K. Moore (Eds.), Learning about sexuality, a practical beginning (pp. 301–323). New York: The Population Council.
Reitsema, A. M., & Grietens, H. (2015). Is anybody listening? The literature on the dialogical process of child sexual abuse disclosure reviewed. Trauma Violence Abuse. doi:10.1177/152483801 5584368
Renk, K., Liljequist, L., Steingberg, A., Bosco, G. & Phares, V. (2002) Prevention of child abuse – are we doing enough? Trauma, Violence & Abuse, 3(1), 68–84.
Richardson, A. S., Dietz, W. H., & Gordon-Larsen, P. (2014). The association between childhood sexual and physical abuse with incident adult severe obesity across 13 years of the National Longitudinal Study of Adolescent Health. Pediatric Obesity, 9(5), 351-361.
Richter, L. M. (2003), Baby rape in South Africa. Child Abuse Review, 12, 392 – 400.
Rind, B., Tromovitch, P., & Bauserman, R. (1998). A meta-analytic examination of assumed properties of child sexual abuse using college samples. Psychological Bulletin, 124(1), 22-53.
Roberts, R., O’Conner, T., Dunn, J., Golding, J., & The ALSPAC Study Team (2004). The effects of child sexual abuse in later family life; mental health, parenting, and adjustment of offspring. Child Abuse & Neglect, 28, 525–545.
Robinson, J., Sareen, J., Cox, B. J., & Bolton, J. M. (2011). Role of self-medication in the development of comorbid anxiety and substance use disorders: A longitudinal investigation. Archives of General Psychiatry, 68(8), 800-807. doi:10.1001/archgenpsychiatry.2011.75
Roesler, T. A., & Wind, T. W. (1994). Telling the secret: Adult women describe their disclosures of incest. Journal of Interpersonal Violence, 9, 327–338. 123
Roller, C., Martsolf, D. S., Draucker, C. B., & Ross, R. (2009). The sexuality of childhood sexual abuse survivors. International Journal of Sexual Health, 21, 49–60.
Roodman, A. A., & Clum, G. A. (2001). Revictimization rates and method variance: Ametaanalysis. Clinical Psychological Review, 21(2), 183−204.
Rosario, M., Schrimshaw, E. W., & Hunter, J. (2012) Risk factors for homelessness among lesbian, gay, and bisexual youths: A developmental milestone approach. Children and Youth Services Review, 34(1), 186-193.
Rotheram‐Borus, M. J., Mahler, K. A., Koopman, C., & Langabeer, K. (1996). Sexual abuse\history and associated multiple risk behavior in adolescent runaways. American Journal of Orthopsychiatry, 66, 390‐400.
Rousseau, D., Manning, J. & Denyer, D. (2008). Chapter 11: evidence in management and organizational science: assembling the field's full weight of scientific knowledge through syntheses. Academy of Management Annals, 2, 475– 515.
Royal Commission into Institutional Responses to Child Sexual Abuse (2017). Final report Volume2 Commonwealth of Australia. Retrieved from https://www.childabuseroyalcommission.gov.au/nature-and-cause.
Russell, D. E. H. (1984). Sexual exploitation: Rape, child sexual abuse and workplace harassment. Beverly Hills, CA: Sage.
Russell, D., Higgins, D. & Posso, A. (2020). Preventing child sexual abuse: A systematic review of interventions. Child Abuse & Neglect, 102, 1-14.
Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069– 1081.
Saban, A., Flisher, A. J., Grimsrud, A., Morojele, N., London, L., Williams, D. R., & Stein, D. J. (2014). The association between substance use and common mental disorders in young adults: results from the South African Stress and Health (SASH) Survey. The Pan African Medical Journal, 17 (Suppl 1). 124
Sanchez, D., & Carter, R. (2005). Exploring the relationship between racial identity and religious orientation among African American college students. Journal of College Student Development, 46(3), 280-295.
Sas, L. D., & Cunningham, A. H. (1995). Tipping the balance to tell the secret: The public discovery of child sexual abuse. London, Ontario, Canada: London Family Court Clinic.
Saywitz, K.J., Mannarino, A.P., Berliner, L., & Cohen, J. A. (2000). Treatment for sexually abused children and adolescents. American Psychologist, 55, 1040–1049.
Schönbucher, V., Maier, T., Mohler-‐Kuo, M., Schnyder, U., & Landolt, M. A. (2014). Adolescent perspectives on social support received in the aftermath of sexual abuse: a qualitative study. Archives of Sexual Behavior, 43(3), 571–586.
Schönbucher, V., Maier, T., Mohler-Kuo, M., Schnyder, U., & Landolt, M. A. (2012). Disclosure of child sexual abuse by adolescents: A qualitative in-depth study. Journal of Interpersonal Violence, 27, 3486–3513.
Schuck, A. M., & Widom, C. S. (2001). Childhood victimization and alcohol symptoms in females: Causal inferences and hypothesized mediators. Child Abuse and Neglect, 25, 1069-1092.
Seedat, M., Van Niekerk, A., Jewkes, R., Suffla, S., & Ratele, K. (2009). Violence and injuries in South Africa: prioritising an agenda for prevention. Lancet, 374, 1011–1022.
Seligman, M. E. P. (1975). Helplessness: On depression, development, and death. San Francisco: W. H. Freeman.
Seltmann, L., & Wright, M. (2013). Perceived Parenting Competencies following Childhood Sexual Abuse: A Moderated Mediation Analysis. Journal of Family Violence, 28(6), 611-621.
Sgroi, S. (1982). Handbook of Clinical Intervention in Child Sexual Abuse. New York, NY: The Free Press.
Sharpe, D., & Faye, C. (2006). Non-epileptic seizures and childhood sexual abuse: A critical review of the literature. Clinical Psychology Review, 26, 1020–1040. 125
Singh, A. (2009). Helping South Asian immigrant women use resilience strategies in healing from sexual abuse: A call for a culturally relevant model. Women & Therapy, 32, 361–376. doi:10.1080/02703140903153229
Smith, D., Letourneau, E., Saunders, B., Kilpatrick, D., Resnick, H. & Best, C. (2000). Delay in disclosure of childhood rape: Results from a national survey. Child Abuse & Neglect, 24(2), 273-287.
Sneddon, H., Wager, N., & Allnock, D. (2016) Responding sensitively to survivors of child sexual abuse: an evidence review. Victim Support
Somer, E., & Szwarcberg, S. (2001). Variables in delayed disclosure of childhood sexual abuse. American Journal of Orthopsychiatry, 71, 332-341.
Sommer J., Hinsberger M., Elbert T., Holtzhausen L., Kaminer D., Seedat S., Madikane S., & Weierstall R. (2017). The interplay between trauma, substance abuse and appetitive aggression and its relation to criminal activity among high-risk males in South Africa. Addictive Behaviors, 64, 29–34.
Sorensen, T., & Snow, B. (1991). How children tell: The process of disclosure in child sexual abuse. Child Welfare, 70, 3–15.
Sorsoli, L., Kia-Keating, M. & Grossman, F.K. (2008), “I keep that hush-hush”: male survivors of sexual abuse and the challenges of disclosure”, Journal of Counselling Psychology, 55(3), 333-45.
South African Police Services. (2014). Police crime statistics. Pretoria, South Africa.
Spaccarelli, S. (1994). Stress, appraisal, and coping in child sexual abuse: A theoretical and empirical review. Psychological Bulletin, 116, 340–362.
Spataro, J., Mullen, P.E. Burgess, P.M., Wells, D.L. & Moss, S.A. (2004). Impact of child sexual abuse on mental health. British Journal of Psychiatry, 184, 416-421.
Sperry, D. M., & Gilbert, B. O. (2005). Child peer sexual abuse: preliminary data on outcomes and disclosure experiences. Child Abuse & Neglect, 29(8), 889-904. 126
Spies, G.M. (2006). The effect of sexual abuse on a child, In G.M. Spies (Ed), Sexual Abuse: Dynamics, Assessment and Healing, Pretoria: Van Shaik
Sprober, N., Schneider, T., Rassenhofer, M., Seitz, A., Liebhardt, H., Konig, L., & Fegert, J. M. (2014). Child sexual abuse in religiously affiliated and secular institutions: a retrospective descriptive analysis of data provided by victims in a government-sponsored reappraisal program in Germany. BMC Public Health, 14
Stalker, K., Green Lister, P., Lerpiniere, J. & McArthur, K. (2010). Child Protection and the Needs and Rights of Disabled Children: A bridged Report. University of Strathclyde Faculty of Education/ Sir Halley Stewart Trust: Glasgow, Scotland.
Staller, K. M. & Nelson-Gardell, D. (2005). 'A burden in your heart': Lessons of disclosure from female preadolescent and adolescent survivors of sexual abuse. Child Abuse & Neglect, 29(12), 1415-1432.
Stein, R. E., & Nofziger, S. D. (2008). Adolescent sexual victimization: Choice of confidant and the failure of authorities. Youth Violence and Juvenile Justice, 6, 158-177.
Stoltenborgh, M., van Ijzendoorn, M. H., Euser, E. M., & Bakermans-Kranenburg, M. J. (2011). A global perspective on child sexual abuse: Meta-analysis of prevalence around the world. Child Maltreatment, 16(2), 79–101. doi:10.1177/ 1077559511403920
Street, A. E., Gibson, L. E., & Holohan, D. R. (2005). Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies on PTSD symptoms in female survivors of domestic violence. Journal of Trauma Stress, 18(3), 245–252.
Sullivan, P. M., & Knutson, J. F. (2000). Maltreatment and disabilities: A population-based epidemiological study. Child Abuse and Neglect, 24, 1257–1273.
Swanston, H. Y., Plunkett, A. M., O’Toole, B. I., Shrimpton, S., Parkinson, P. N., & Oates, R. K. (2003). Nine years after child sexual abuse. Child Abuse & Neglect, 27(8), 967–984. doi:10.1016/S0145-2134(03)00143-1
Talbot, N. L., Chapman, B., Conwell, Y., McCollumn, K., Franus, N., Cotescu, S., & Duberstein, P. R. (2009). Childhood sexual abuse is associated with physical illness burden 127 and functioning in psychiatric patients 50 years of age & older. Psychosomatic Medicine, 71, 417–422. doi:10.1097/PSY.0b013e318199d31b
Tarakeshwar, N., Hansen, N. B., Kochman, A., Fox, A. & Sikkema, K. J. (2006). Resiliency among individuals with childhood sexual abuse and HIV: Perspectives on addressing sexual trauma, Journal of Traumatic Stress, 19(4), 449–460.
Tardieu, A. (1878). Étude médico-légale sur les attentats aux moeurs, 7th edn. Paris : Baillière.
Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing in the aftermath of suffering. Thousand Oaks, CA: Sage.
Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth:Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1–18.
Tedeschi, R. G., Park, C. L., & Calhoun, L. G. (Eds.). (1998). The LEA series in personality and clinical psychology. Posttraumatic growth: Positive changes in the aftermath of crisis. Lawrence Erlbaum Associates Publishers.
Testa, M., Hoffman, J. H., & Livingston, J. A. (2011) Intergenerational transmission of sexual victimization vulnerability as mediated via parenting. Child Abuse and Neglect, 35(5), 363-371.
Teusch, R. (1997). Substance-abusing women and sexual abuse. In: Straussner SLA, Zelvin E, editors. Gender and Addictions: Men and Women in Treatment. Northvale, NJ: Jason Aronson.
Thege, B. K., Horwood, L., Slater, L., Tan, M. C., Hodgins, D. C., & Wild, T. C. (2017). Relationship between interpersonal trauma exposure and addictive behaviors: a systematic review. BMC psychiatry, 17(1), 164.
Townsend, C., & Rheingold, A. A. (2013). Estimating a child sexual abuse prevalence rate for practitioners: A review of child sexual abuse prevalence studies. Charleston, S.C.: Darkness to Light. 128
Townsend, L., & Dawes, A. (2004). Individual and contextual factors associated with the sexual abuse of children under 12: A review of recent literature. In L. Richter, A. Dawes, & C. Higson-Smith (Eds.), Sexual abuse of young children in South Africa (pp. 55-94). Cape Town, Republic of South Africa: Human Sciences Research Council Press.
Tranfield, D., Denyer, D., & Smart, P. (2003). Towards a methodology for developing evidence-informed management knowledge by means of systematic review. British Journal of Management, 14, 207–222
Tremblay, C., Hebert, M., & Piche C. (1999). Coping strategies and social support as mediators of consequences in child sexual abuse victims, Child Abuse & Neglect, 23, 929– 945.
Trickett, P. K., Noll, J. G., & Putnam, F. W. (2011) The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study. Development and Psychopathology, 23(2), 453-476.
Tutu, D. (1999). No future without forgiveness. Broadway, NY: Harper Collins.
Tyler, K., & Cauce, A. M. (2002). Perpetrators of Early Physical and Sexual Abuse Among Homeless and Runaway Adolescents. Child Abuse & Neglect, 26, 1261–1274.
Ullman, S.E., Relyea, M., Peter-Hagene, L., & Vasquez, A.L. (2013). Trauma histories, substance use coping, PTSD, and problem substance use among sexual assault victims Addictive Behaviors, 38(6), 2219-2223. doi:10.1016/j.addbeh.2013.01.027
United Nations Office on Drugs and Crime. (2014). World Drug Report 2014. Vienna, Austria: United Nations.
Updegraff, J. A. & Taylor, S. E. (2000). From vulnerability to growth: Positive and negative effects of stressful life events. In J. H. Harvey and E. D. Miller (Eds.), Loss and trauma: general and close relationship perspectives, pp. 3–28. Philadelphia: Brunner- Routeledge.
Valentine, L., & Feinauer, L. L. (1993). Resilience factors associated with female survivors of childhood sexual abuse. The American Journal of Family Therapy, 21, 216–224. 129
Van der Kolk, B. A. (1996). Trauma and memory. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body and society (pp. 279–302). New York: Guilford Press.
Van der Linde, F., & Edwards, D. (2013). “It's like Uprooting Trees”: Responsive treatment for a case of complex post-traumatic stress disorder following multiple rapes. Journal of Psychology in Africa, 23(1), 21-29
Van Toledo, A., & Seymour, F. (2013). Interventions for caregivers of children who disclose sexual abuse: A review. Clinical Psychology Review, 33(6), 772-781.
Veenema, T. G., Thornton, C. P., & Corley, A. (2015). The public health crisis of child sexual abuse in low and middle income countries: An integrative review of the literature. International Journal of Nursing Studies, 52(4), 864–881. https://doi.org/10.1016/j.ijnurstu.2014.10.017.
Veenhoven, R. (2011). Greater happiness for a greater number: Is that possible? If so, how? In K. M. Sheldon, T. B. Kashdan, & M. F. Steger (Eds.), Designing positive psychology: Taking stock and moving forward (pp. 396–409). Oxford: Oxford University Press.
Vermeulen, T, & Greeff, A. P. (2015). Family resilience resources in coping with child sexual abuse in South Africa. Journal of Child Sexual Abuse, 24(5), 555–571. https://doi.org/10.1080/10538712.2015.1042183.
Vilhena-Churchill N., & Goldstein A.L. (2014). Child maltreatment and marijuana problems in young adults: examining the role of motives and emotion dysregulation. Child Abuse Neglect, 38, 962–972.
Volkow, N.D., Wang, G.J., Fowler, J.S., Telang, F., Jayne, M., Wong, C., 2007. Stimulant induced enhanced sexual desire as a potential contributing factor in HIV transmission. American Journal of Psychiatry, 164, 157–160.
Walker-Williams, H. J., & Fouché, A. (2017). ‘A strengths-based group intervention for women who experienced child sexual abuse’. Research on Social Work Practice, 27(2), 194–205. https://doi.org/10.1177/1049731515581627 130
Walker-Williams, H. J., & Fouché, A. (2018). Resilience enabling processes and posttraumatic growth outcomes in a group of women survivors of childhood sexual abuse. Health SA Gesondheid (Online), 23, 1-9.
Walker-Williams, H. J., Van Eeden, C., & Van der Merwe, E. K. (2012). ‘The prevalence of coping behaviour, posttraumatic growth and psychological well-being in women who experienced childhood sexual abuse’. Journal of Psychology in Africa, 22, 617–626. https://doi.org/10.1080/14330237.2012.10820576
Walker-Williams, H. J., Van Eeden, C., & Van der Merwe, E. K. (2013). ‘Coping behavior, posttraumatic growth and psychological well-being in women with childhood sexual abuse, Journal of Psychology in Africa, 23, 89–98. https://doi.org/10108/14330237.2013.10820622
Waller, G., & Ruddock, A. (1993). Experience of disclosure of childhood sexual abuse and psychopathology, Child Abuse Review, 2, 185–195.
Walsh, K., Fortier, M., & DiLillo, D. (2010). Adult coping with childhood sexual abuse: a theoretical and empirical review. Aggression and Violent Behavior, 15, 1-13.
Walsh, K., Rassafiani, M., Mathews, B., Farrell, A., & Butler, D. (2012). “Exploratory factor analysis and psychometric evaluation of the teacher reporting attitude scale for child sexual abuse.” Journal of Child Sexual Abuse, 21, 489-506.
Warrington, C., Beckett, H., Ackerley, E., Walker, M., & Allnock, D. (2017). Making noise: Children’s voices for positive change after sexual abuse. Children’s Commissioner for England.
Watkins, B., & Bentovim, A. (1992). The sexual abused of male children and adolescents: a review of current research. Journal of Child Psychology and Psychiatry, 33, 197–248.
Watkins, S.A. (1990). The Mary Ellen myth: Correcting child welfare history. Social Work, 35(6), 500-503.
Watt, M. H., Meade, C. S., Kimani, S., MacFarlane, J. C., Choi, K. W., Skinner, D., Pieterse, D., Kalichman, S. C., & Sikkema, K. J. (2014). The impact of methamphetamine ("tik") on 131 a peri-urban community in Cape Town, South Africa. International Journal of Drug Policy, 25(2), 219–225. https://doi.org/10.1016/j.drugpo.2013.10.007
Watt, M. H., Ranby, K.W., Meade, C. S., Sikkema, K. J., MacFarlane, J. C., Skinner, D., Pieterse, D. & Kalichman, S.C., (2012). Posttraumatic stress disorder symptoms mediate the relationship between traumatic experiences and drinking behavior among women attending alcohol-serving venues in a South African township. Journal on Studies of Alcohol and Drugs, 73(4), 549-586.
Westcott, D. L. (1982). Sexual abuse of children. A hospital based study. South African Medical Journal, 65(22), 895–897.
Wethington, H. R., Hahn, R. A., Fuqua-Whitley, D. S., Sipe, T. A., Crosby, A. E., Johnson, R. L., Liberman, A. M., Moscicki, E., Price, L. N., Tuma, F. K., Kalra, G. & Chattopadhyay, S. K. (2008). The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents. American Journal of Preventive Medicine, 35(3), 287–313.
Whiffen, V. E., & MacIntosh, H. B. (2005). Mediators of the Link Between Childhood Sexual Abuse and Emotional Distress: A Critical Review. Trauma, Violence, & Abuse, 6(1), 24–39. doi: http://dx.doi.org/10.1177/1524838004272543
Whitehead, J., & Roffee, J. (2016). Child sexual abuse in Fiji: Authority, risk factors and responses. Current Issues in Criminal Justice, 27(3), 323–334.
Whitfield, C. L., Anda, R. F., Dube, S. R., & Felitti, V. J. (2003). Violent childhood experiences and the risk of intimate partner violence in adults: assessment in a large health maintenance organization. Journal of Interpersonal Violence, 18(2), 166 – 185.
Williams, J., & Nelson-Gardell, D. (2012). Predicting resilience in sexually abused adolescents. Child Abuse & Neglect, 36(1), 53-63.
Williams, N., Lindsey, E., Kurtz, P., & Jarvis, S. (2001). From trauma to resiliency: Lessons from former runaway and homeless youth. Journal of Youth Studies, 4, 233–253. 132
Willis, D. G., DeSanto-Madeya, S., & Fawcett, J. (2015). Moving beyond dwelling in suffering: A situation-specific theory of men’s healing from childhood maltreatment. Nursing Science Quarterly, 20(1), 57-63.
Wilsnack, S. C., Vogeltanz, N. D., Klassen, A. D., & Harris, T. R. (1997). Childhood sexual abuse and women’s substance abuse: National survey findings. Journal of Studies on Alcohol, 58(3), 264-271.
Wilson, H. W., & Widom, C. S. (2010). The role of youth problem behaviors in the path from child abuse and neglect to prostitution: A prospective examination. Journal of Research on Adolescence, 20(1), 210-236.
Wong, P. T. P. (2003). Pathways to posttraumatic growth. International Network on Personal Meaning. Retrieved February 11, 2012 from http://www.meaning.ca/archives/ presidents_columns/pres_col_may_2003_post-trauma
Woodhead, E. L., Cronkite, R. C., Moos, R. H., & Timko, C. (2014). Coping strategies predictive of adverse outcomes among community adults. Journal of Clinical Psychology, 70, 1183–1195. http://dx.doi.org/10.1002/jclp.21924
Woodward, C., & Joseph, S. (2003). Positive change processes and post-traumatic growth in people who have experienced childhood abuse: Understanding vehicles of change. Psychology and Psychotherapy: Theory, Research and Practice, 76, 268-283.
World Health Organisation (2003). Guidelines for medico-legal care for victims of sexual violence. Retrieved from http://www.who.int/violence_injury_prevention/publications/violence/med_leg_guidelines/ en/.
World Health Organization. (1999). Report of the Consultation on Child Abuse Prevention, 29–31 March 1999. Geneva: World Health Organization.
World Health Organization. (2006). Preventing child maltreatment: a guide to taking action and generating evidence. Geneva: World Health Organization 133
Wosu, A. C., Gelaye, B., & Williams, M. A. (2015) Childhood sexual abuse and posttraumatic stress disorder among pregnant and postpartum women: review of the literature. Archives of Women’s Mental Health, 18(1), 61-72.
Wright, M. O., Crawford, E., & Sebastian, K. (2007). Positive resolution of childhood sexual abuse experiences: The role of coping, benefit-finding and meaning-making. Journal of Family Violence, 22, 597–608.
Wright, M. O., Fopma-Loy, J., & Fischer, S. (2005). Multidimensional assessment of resilience in mothers who are child sexual abuse survivors. Child Abuse & Neglect, 29(10), 1173–1193.
Wurtele, S. (2009). Preventing Sexual Abuse of Children in the Twenty-First Century: Preparing for Challenges and Opportunities. Journal of Child Sexual Abuse, 18(1), 1-18.
Wyatt, G. (1992). The sociocultural context of African American and White American women’s rape. Journal of Social Issues, 48, 77-91.
Young, M. S., Harford, K., Kinder, B., & Savell, J. K. (2007). The relationship between childhood sexual abuse and adult mental health among undergraduates: Victim gender doesn’t matter. Journal of Interpersonal Violence, 22, 1315–1331.
Zeglin, R. J., DeRaedt, M. R., & Lanthier, R. P. (2015) Does having children moderate the effect of child sexual abuse on depression? Journal of Child Sexual Abuse: Research, Treatment, & Program Innovations for Victims, Survivors, & Offenders, 24(6), 607-626.
Zeidner, M., & Saklofske, D. (1996). Adaptive and maladaptive coping. In: Zeidner M, Endler N (eds) Handbook of coping: theory, research, applications. Wiley, New York
Zimmerman, M. A., & Brenner, A. B. (2010). Resilience in adolescence: Overcoming neighborhood disadvantage. In: Reich J, Zautra AJ, Hall JS, editors. Handbook of adult resilience. New York, NY: Guilford Press; 283–308.