Kaare Torgny Pettersen An Exploration into the Concept and Phenomenon of Shame within the Context of Child Sexual Abuse An Existential-Dialogical Perspective of Social Work within the Settings of a Norwegian Incest Centre Thesis for the degree of Philosophiae Doctor Trondheim, October 2009 Norwegian University of Science and Technology Faculty of Social Sciences and Technology Management Department of Social Work and Health Science NTNU Norwegian University of Science and Technology Thesis for the degree of Philosophiae Doctor Faculty of Social Sciences and Technology Management Department of Social Work and Health Science © Kaare Torgny Pettersen ISBN 978-82-471-1764-4 (printed ver.) ISBN 978-82-471-1765-1 (electronic ver.) ISSN 1503-8181 Doctoral theses at NTNU, 2009:184 Printed by NTNU-trykk Abstract The present study is an exploration into the concept and phenomenon of shame within the context of sexual abuse and within the settings of a Norwegian Incest Centre. The problem of interest which I have chosen in this study is how shame is used as a concept and how it appears as a phenomenon at the Incest Centre in Vestfold. This is an institution which has struggled for the recognition of sexually abused children since 1988. The Centre is founded and led by a professional social worker who endorses the use of social work practice among victims of child sexual abuse and their relatives. How social work is advocated in this institution is of interest in this exploration. The dissertation is divided into six parts and 29 chapters. Part One consists of one chapter where I explain why I have chosen to write a dissertation on this subject and why I have chosen the Incest Center in Vestfold as the site for the emipircal research in this study. I also describe the critical-hermeneutical position I have chosen in this exploration and why I mean the existential-dialogical perspective of Søren Kierkegaard and Martin Buber are important for this study. Axel Honneth’s theory of recognition is explicated as being a girder for merging the existential-dialogical perspective within the context of social work practice. Part Two consists of two chapters where I describe the settings for my study that has been carried out within the context of child sexual abuse and within the settings of a Norwegian Incest Centre. I first describe the problems involved in defining sexual abuse and how the many definitions influence the variation of studies that have measured the prevalence of sexual abuse in various populations and cultures. I then give a presentation of some of the possible consequences of sexual abuse. Thereafter follows a description of the Incest Centre in Vestfold where this study has been carried out. Their manner of working, therapy which is offered, and qualifications the workers at this Centre have are depicted. Finally in part Two, I illustrate other crucial categories than shame and explain how these categories have come forth in this study. Part Three consists of six chapters where I explore different theoretical aspects which I have chosen as relevant in this study. I start with an exploration into Kierkegaard’s existential philosophy and Buber’s dialogical philosophy before exploring sociological 3 and psychological theories which I have found significant. I close part Three with reflections of shame as both a moral and social emotion. This study emphasizes how shame is manifested in social relations, and shame is described as a social-self- conscious emotion. Shame may also be a major component of our conscience; a moral emotion. It can signal a moral transgression even without thoughts and words. Shame seems to come into being in situations characterized by a threat against inter-relational bonds. It may signal that there are problems in a relationship and/or that the individual has failed to live up to his or her social and moral standards. Part Four consists of five chapters and starts with a consideration of the ethical and methodological issues involved in a study of the sensitive subject of shame in vulnerable individuals who have suffered sexual abuse. This is to insure that the material that is collected is treated in such a way that the demands concerning anonymity and integrity are not violated. I then describe the design used in the qualitative study. Interviews with 19 informants are videotaped, transcribed and analyzed with QSR NVivo7. Active interviewing is described as the method used in the interviews and explained within the context of constructivist grounded theory and a hermeneutical dialectical process. Part Four concludes with two quantitative surveys which I have carried out in order to explore shame-proneness and other self-conscious affects (Test of Self-Conscious Affects, TOSCA-3) in a group of 221 university/college students and in a group of 180 sexually abused men and women. These surveys are carried out because I was curious about: in what degree shame-proneness is a phenomenon which can be measured; if people who have been sexually abused have a greater degree of shame-proneness than university college students; which possible relation shame-proneness might have to other self-conscious emotions such as guilt and pride; and to investigate if TOSCA-3 really measures what it intends to measure (construct validity). The results from this survey seem to show among others; that those who have been sexually abused do not seem to have a greater degree of shame- proneness than university/college students but they seem to show a higher degree of correlation between shame-proneness and guilt-proneness (r=.68). The statistical findings are examined and the need for further statistical examination is discussed at the end of part Four. A number of statistical tables and charts used in the surveys are also put forth both in the text and in the appendix so as to insure validity to the findings. The findings from the two surveys, especially that shame-proneness and guilt-proneness 4 seem to be highly correlated among those who have been sexually abused, were used in the planning and implementation of the qualitative exploration to follow. Part Five is the largest section in the exploration and consists of 11 chapters. Here the concept and phenomenon of shame is explored through a qualitative study where 19 employees and users of the Incest Centre in Vestfold were interviewed. The interviews were carried out in five focus groups which were interviewed two times, and each interview lasted for two hours, a total of 20 hours. I have also carried out in-depth interviews with four of the participants from the interviews. These four were selected during the focus group interviews because some of the stories that were told needed, in my opinion, further examination. All the interviews were carried out in Norwegian, videotaped and transcribed. First after categorizing the material in the analysis, and quotations were chosen to be used in the dissertation, were the Norwegian quotations translated to English. The categories derived from the analysis are divided in two main groups: self and others. The 11 chapters were created according to the analysis of 633 pages of transcriptions. The relation between shame and self is explored and thereafter shames relation to: other emotions (guilt, anger and embarrassment); self-harming; body; and food. Shame in relation to others (significant others) consists of a discussion of shames relation to: fathers; mothers; brothers and sisters; children; and partners/sex. The results of the investigation seem to show that: shame involves an acutely painful experience; individuals who experience shame will often feel a sense of worthlessness; incompetence; a generalized feeling of contempt for themselves; and these negative evaluations can engulf the entire self. The results also seem to show that sexually abused men and women suffer from the violation of their dignity and not only from the assault on their bodies. At the core of their sufferings; disrespect and humiliation seem to be found. The informants speak of shame, guilt when they describe themselves and portray their lives with words that convey despair and suffering. The blaming and shaming of mothers and children is explored and put forth as one of several findings in the qualitative exploration. Part Six includes three chapters. First, findings from the qualitative exploration are discussed with special focus on the: social self; exclusion; negative self-evaluation; 5 alienation; and the annihilation of trusting relationships. There seems, in my opinion, to be four major findings. First of all, it seems that the concept and phenomenon of shame is often used interchangeably with guilt by those who have experienced sexual abuse as children and seem often to merge into the same emotion. This seems to confirm the finding from the quantitiative study where the correlation between shame-proneness and guilt-proneness was high (r=.68). Second, reports of self-harming and eating-disorders seem in to be more closely related to shame than to the sexual abuse as such. Third, Mother-Blaming and Mother-Shaming seem to be widespread among the participants. Fourth, children and especially those who have experienced being sexually abused seem to suffer from Child-Blaming and Child-Shaming in much the same way as mothers. The blaming and shaming of mothers and children seems to result, in my opinion, in a destructive spiral. Thereafter I discuss what I find to be the possible implications for social work. Special focus is here placed on: inclusion; a positive self-evaluation; taking oneself back; practical wisdom (knowledge); self-knowledge; respect; and recognition. The healing process of shame within the context of sexual abuse is discussed in this part. The interviews seem to imply that helping victims of sexual abuse within the settings of the Incest Centre in Vestfold, demand that social workers: start the helping process where the others are; helping them in their struggle for recognition and respect; offering support; building a trusting relationship; and helping others to create new identities through intersubjective meetings where life stories are met with recognition and respect.