A QUALITATIVE STUDY OF SEX ABUSE SURVIVORS' EXPERIENCE OF CONFRONTING THE PERPETRATOR by DONA JUNE ROUSH, B.A., M.L.A., M.Ed. A DISSERTATION IN MARRIAGE AND FAMILY THERAPY Submitted to the Graduate Faculty of Texas Tech University in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY Approved December, 1998 ACKNOWLEDGMENTS How many people does it take to raise and nurture a Ph.D.? It takes a loving partner, a supportive family and a whole department of encouraging faculty members. Most of all, it takes the loving care and guidance of God. There are so many people who deserve thanks for guiding me through this dissertation process. First and foremost, I want to thank Dr. Karen Wampler, my major professor and friend not only for miraculously steering me through the dissertation but also for her support and encouragement throughout my doctoral training. She was the first person I talked to in this program, and I became an instant fan. My God has always taken care of me even when I was not aware of Him, and He gave me the perfect advisor in Karen. Her insight, expertise, and sense of humor saw me through. I am so thankful to the other members of my committee: Dr. Richard Wampler, Dr. Tom McGovem, and Dr. Madoc Thomas. I frequently tell people that I have the greatest advisory committee ever, a committee that truly want me to succeed and to produce a quality dissertation; they are the best. Richard, thank you for your wonderful sense of humor that helps me put things in perspective and not to take myself so seriously. Madoc, there aren't enough words to thank you, not only for your help and support on the dissertation but for being my first mentor m the program and giving me that extra boost of confidence I needed. Your support, given during one of the dark moments of my life, can never be repaid but only passed on. Tom, doesn't God have a great sense of timing? He put you in my life at just u the right time. I needed to hear you gentle but firm admonition to "just get there and write it," even when I felt I didn't have it in me and could not go on. Thank you! I would also like to thank all of the therapists who worked so diligently to find participants for this study. Fortunately, most of them have long memories and have not forgotten what it feels like to shake the bushes for a sample. One therapist in particular deserves special thanks. Dr. Ann Noble. Not only did Ann give me names of some great participants, she kept the phone lines hot when I would call her asking questions and pickmg her brain. Ann, the help was invaluable, but the moral support and friendship you have given me from my first day in the program is beyond value. Sometimes the behind-the-scenes people get over-looked when it comes to extending thanks, and I could not have written the dissertation without the magic work by Carol Roberts and her crew in the interlibrary loan department at the Tech Library. I have no idea how she did it, but Carol found some pretty obscure material for me. Great work everyone! I must thank my mother and daddy for their unwavering (well, almost unwavering) support for my decision to quit a perfectly good job and pursue a doctorate in Marriage and Family Therapy (you are going to do what??). They bit their tongues, held their silence, and even told me they were very proud of me. To them I owe my love of knowledge and learning as well as my life-saving sense of humor and my firm trust in God. There must be acknowledgement to those who are no longer here physically but who are alive in my heart, my grandparents, Margaret and Elmo Duke. My grandmother whispered in my ear to "study those books," and backed it up with so much love and some Ul cash too! She put me through two master's programs and almost the entire doctorate. Just before my granddad slipped away forever into his Alzheimer's Disease, one of the things I remember is how excited his voice sounded when he talked about my graduating. I miss them both. I received tremendous support from my dear friends Mona and Susie, who took me in off the streets, fed me and offered lots of TLC and moral support. Good friends like these two do not come along very often, and I am so glad they are in my life. I have to say thank-you (and what an anemic word that is) to a group of people who told me one March evening 14-1/2 years ago that I did not have to live that way any more; there was a better way. I thank all of them who came before me and were waiting for me when I got there. I thank of the Yanas, who meet on Tuesday morning who are there for me now. They are my life support group. I cannot repay any of them but I can be there ready for others who will come after me. I saved the best for last. If it were not for my life-partner, the dissertation and this acknowledgement page would be moot. I could not have accomplished any of this without her steadfast encouragement, counsel, and love. She was there through thick and thin, through computer crises, quals, deaths, illnesses and cancer. She never gave up even when I knew in my heart that I could not go any farther. Therapists say that usually the wrong people end up in their offices. Well, I say, the wrong person is going to walk across the stage on December 19*^, 1998, but whether she walks on the stage or not, she knows who really deserves this degree. IV TABLE OF CONTENTS ACKNOWLEDGMENTS 11 ABSTRACT Vlll CHAPTER I. INTRODUCTION 1 Consequences of Childhood Sexual Abuse 2 Therapy 4 Confrontation 5 A Closer Look at Confrontation 7 Purpose and Significance of this Study 12 Research Questions 14 n. REVIEW OF THE LITERATURE 15 Prevalence and Long-Term Effects of Childhood Sexual Abuse 15 Depression 20 Substance Abuse 21 Borderline Personality Disorder 22 Sexual Functioning 23 Summary of Long Term Effects 25 General Treatment Modalities for Adult Sexual Abuse Survivors 26 Individual Therapy 27 Group Therapy 29 Group and Individual Therapy 31 Marital Therapy 31 Confrontation 32 The Decision to Confront 32 Why Do Survivors Confront? 33 When Do Survivors Confront? 33 How to Confront 34 Immediate Reactions of the Perpetrator 36 Impact on the Family 37 Impact on the Survivor 38 Use of Qualitative Methodology in Marriage and Family Therapy 41 Conclusion 42 ffl. METHODOLOGY 43 Rationale for and Definition of Ethnography 43 Sample 48 Initial Interviews 48 Additional Subject Recruitment 49 Interview Questions 50 Data Collection 52 Data Analysis 53 Validity and Criteria for Evaluation 56 IV. RESULTS 60 Case Summaries 60 Perpetrators' Reactions to Confrontation 70 No Response 72 Acknowledgement 72 Denial 73 Mixed 75 Survivor's Immediate Reactions to Confrontation 80 Pure Relief 81 Mixed Feelings 82 Pride 84 Negative Feelings 84 Others' Reactions to Confrontation 86 Mothers 87 Acknowledgment/Support 87 Denial/Nonsupport 88 Mixed 88 Siblings and Others 90 Acknowledgment/Support 90 Disclosed Their Own Abuse 91 Effects of Confrontation on Survivors' Relationships 91 Forgiveness 93 Acceptance 94 No Change 95 Ambivalent Feelings 96 Minimal Interaction 98 Worse 99 Cut Offs 99 Marital Relationship 100 Improved 102 Motivations to Confront 103 External Factors 103 SelfMotivated 105 Hopes 109 VI Fears 112 Loss of Financial Support 113 Loss of Love and Emotional Support 113 Loss of Family Member Through Death 114 Fear of Emotional Abuse From the Perpetrator 114 Minimal Expectations 116 Positives of Confrontation 117 Empowerment 117 Validation 121 Survivors' Evaluation of Confrontation 124 Would You Confront Again? Would You Do Anything Differently 124 What Part Did Confrontation Play in the Healing Process? 126 V. DISCUSSION AND CONCLUSION 130 Impact of Confrontation on the Survivor 131 Effects of Confrontation on Survivor's Relationships 13 2 Motivations 135 Overall Results 136 Validity and Reliability 138 Limitations of the Study 140 Implications for Research 141 Clinical Implications 142 REFERENCES 146 APPENDIX 156 A: LETTER TO COMMUNITY PSYCHOTHERAPISTS 156 B; LETTER TO PROSPECTIVE RESEARCH PARTICIPANTS 158 C: A QUALITATIVE STUDY OF ADULT SEXUAL ABUSE SURVIVORS' CONFRONTATIONS WITH PERPETRATORS PARTCIPANT CONSENT FORM 161 D: INTERVIEW GUIDE 165 Vll ABSTRACT Childhood sexual abuse can cause long-lasting and negative consequences for the survivor. As public awareness has been heightened regarding sexual abuse and survivors have broken the silence ^rrounding it, many have sought and received individual or group therapy, or both. Some adult survivors may choose to confront their perpetrators. In this study, confrontation is broadly defined as the survivor telling her abuser in person, on the telephone, or in a letter that she remembers being sexually abused. Clmical and popular literature as well as survivors' reports confirm the fact that confrontation can be a powerful experience. Because of the lack of empirical knowledge concerning the impact of confronting the sexual abuse perpetrator, this study was undertaken so that clinicians might have some other guide in helping their clients decide to confront or not. It was anticipated that this qualitative study would help bridge the gap between clinical practice and anecdotal information about the role of confrontation. This study utilized the inductive methodologies of in-depth interviewing and qualitative analysis for identification of relevant categories and themes.