The following is a transcript of a live presentation given at Brigham Young University on October 24, 2002.

The topic of my talk is “Coping with the Aftermath of Abuse.”  I’m going to focus primarily on coping with the aftermath of sexual abuse.  I hope that those who are survivors or victims of physical or emotional abuse can also relate to some of the things I’m saying.  The way we cope with abuse is fairly general, but it seems like there’s a lot more literature about coping with sexual abuse, so I chose to focus my topic on that.

            You’re all probably here today because either you or someone you know has been or is the victim of sexual abuse or abuse.  Talking about abuse is really a difficult topic and talking about sexual abuse is even more difficult because it’s such a sensitive topic.  There are so many effects of sexual abuse; the response can be so personal.  The road to recovery and healing can be a long and painful one.  So depending on where you are in the recovery and healing process for yourselves right now, I’m aware that just listening to a talk can sometimes elicit painful feelings.  I’ve attended some of these sessions in prior years and have noticed that it’s not unusual for people to be sitting in the office and tear up and become emotional, so I’m hoping if that happens to you, you can feel comfortable enough to stay here and listen to the talk, but if you get overwhelmed, we’ll understand if you have to walk out, as well.

            My real hope for this morning is that as we discuss how we can cope with the aftermath of abuse, we can all feel some hope, that we can feel spurred on to take action either in our own healing or to help others with their healing.  The theme of this conference is hope, and I’m hoping that we can keep that going.

            What I’m going to do this morning is divide my topic into two parts.  I’m going to talk about the effects of abuse, or sexual abuse, and then I want to spend a fair amount of time, hopefully most time, talking about recovery, healing, and a little bit about resilience.  But first I’d like to give a few personal observations.  As I’ve hinted, I don’t have any easy answers to give you about how to cope with the aftermath of abuse.  But I have seen courageous young women work very long and hard to recover from the effects of abuse, and I’ve seen them in the process of healing and recovery.  Now notice I don’t say “cure.”  Using the medical model of “cure” when we’re talking about something like a psychological process just doesn’t do justice.  You can’t cut out the effects of abuse.  You can’t take a pill, even home remedies, herbal teas, all the kinds of stuff that sometimes we try to use to heal ourselves--I don’t think there are any easy cures.  But I think there is, and I want to stress this, there is recovery and there is healing.  To me in some ways maybe that’s better than a cure.  I first started working with victims of sexual abuse actually when I came to BYU in 1983.  My clients came in with depression, anxiety, problem relationships with either parents or boyfriends, emotional problems, problems concentrating in school, or any kind of problem you could think about.  I found that many of these people that came in for other issues were also victims of sexual abuse.  And at the time, this was not an area that I’d had a lot of training in.  But I began to learn from these young women, and I’m indebted to them for what I’ve learned and what I’ve been able to study and learn since.  Mostly I learned from these young women about the terrible effects of the aftermath of abuse.  I found women who could courageously tell their story about abuse for the first time.  But I also found people who were paralyzed by its effects and could not even begin to tell their story.  I’ve heard about almost all of the symptoms that I’m going to talk about today.  I also saw these same young women begin to heal and recover and find hope.  Sometimes the healing started in individual therapy.  Sometimes it started in groups with other sexual abuse survivors, and sometimes from a combination of the two.  One thing I learned that’s really had an impact on me as a therapist is the great power of group therapy in dealing with sexual abuse.  In 1983, the counseling center started some groups for victims of sexual abuse and currently I facilitate the sexual abuse group there.

            When a person is ready to participate in a group, it can be a powerful source of support and understanding and acceptance.  I’ve observed young women come into the group feeling so alone, so stigmatized, so afraid of being judged, that it takes some real pushing on the part of me and other therapists to get them to come into the group.  But I’ve also seen it’s not unusual for somebody to come in the group the first time, look around the group and say, “Well, I would have never thought you were sexually abused.  You look so normal.”  We often joke and comment in our group that we’re the most normal people on campus.  And I think that’s a healthy thing to be able to say.  In these groups I’ve seen young women take great risks to share painful or shameful experiences with great fear that they’re the only one who has this problem, this habit, this feeling, this experience.  But as I’ve watched in groups I can honestly say I can’t think of a time that somebody has shared something in a group without somebody else in the group having experienced that same thing, or without an overwhelming outpouring of understanding and support.  These can be some pretty terrible things that people risk to share.  I’ve seen people do one-eighties once they’ve been able to share things.  They’ve been able to totally turn themselves around.  So, while groups aren’t for everybody at all times, group therapy can do some things that individual therapy can’t do.

            I want to acknowledge in this talk that I’m indebted to several authors.  I’m going to borrow heavily from the book, The Right to Innocence: Healing the Trauma of Childhood Sexual Abuse by Beverly Ingall.  This is a really readable little book.  It’s got some really good ideas of things you can do.  Another book is Surviving Childhood Sexual Abuse by Carolyn Ainscough and Kay Toone.  And then of course a lot of people have considered The Courage to Heal by Ellen Bass and Laura Davis their sexual abuse bible.  I know people in the group have used all of these books.  Some parts of them are good, some parts you want to gloss over.  Some people, when they have a problem, find it helpful to pick up a book and go to the section that addresses what they’re dealing with at that time.   A lot of these books have stories in them.  Reading other people’s stories can sometimes help people begin to think about their own story.  But sometimes reading stories can be almost overwhelming, so again, I would encourage you if you’re dealing with an issue like sexual abuse that you don’t try to go it alone.  Try to do it with therapists in a group or something, but books can also be very, very helpful. 

            Now I want to talk about the aftereffects of abuse.  I was making long lists of aftereffects of abuse, and I thought, “Oh, I’m going to try and categorize these,” because I was coming up with huge long lists, and then I looked in Beverly Ingall’s book, and she had all of the things that I had on my list nicely categorized into six major categories, and so I thought, “Ha, that saves me some work here.”  You see damages to self-esteem and self-image, relationship problems, sexual problems, emotional problems, difficulties in expressing emotions and emotional problems, and then sometimes physical symptoms, psychologically based physical symptoms, or even illness. 

Let’s just start by talking about damages to self-esteem and self-image.  Obviously many things on this list can be symptoms of other things as well; these don’t have to be singular to sexual abuse.  This list will give us a framework. 

Feeling ugly inside, feelings of worthlessness, feeling that you’re in the way, a tendency to over-apologize. A lot of times victims of abuse feel that it’s their fault, and develop a way of apologizing for a lot of other things that happened in their life just because they feel guilty.  Feeling that you’re stupid, a failure, a loser.  This relates to what I said about people coming into the group and looking around thinking, “Oh, you don’t look like you were sexually abused.”  Sometimes we have in our heads a different picture of what we look like; if we see ourselves as a failure, a loser, or whatever, we may think that everybody sees us that way.  But when we look at other people, we don’t see them as failures or losers or stupid.  Guilt feelings and feelings of shame.  This is one of the most difficult aspects to our self-esteem to overcome.  Again, a tendency to blame yourself for whatever goes wrong.  Often, especially if abuse happens when a person is small, they don’t have the cognitive capacity to see the perpetrator as anything but all good—the perpetrator could be a parent, or a sibling, or any number of people.  And so often what happens is victims start to blame themselves and they start to think there’s something wrong with them.  The perpetrator may have even told them that there’s something wrong with them. 

Another effect of sexual abuse is the inability to complete tasks.   If someone is really committed to beginning to work on recovering from sexual abuse, it may interfere with the ability to take 20, 16, 14, 12 credits at BYU, because it takes a lot of emotional energy.  So if you have the inability to complete tasks, talk with a therapist about what you might be able to do to accommodate. 

There is also a tendency to sabotage success, a tendency to be victimized by others, and feelings of helplessness.  The list could be longer.  You could be sitting there thinking, “Well, I don’t feel like I have very good self-esteem, and that wasn’t on the list.”  No list is exhaustive, but I want you to think about some of those things.

            The next category is relationship problems—very significant.  As I said, many times people come into therapy because they’re having a lot of difficulty relating to other people, especially when they get to the college years and want to start dating and want to start having boyfriends and they didn’t realize they had so many fears or difficulties communicating or difficulties trusting.  Relationships are really affected in a major way by abuse.  Of course the first one is difficulty trusting others.  I don’t think I’m telling any of you anything new.  Being distant or aloof.  A lot of times the way that victims of abuse survive is by keeping themselves inside, protecting themselves from others; they can develop a whole way of interacting with others which may be superficially friendly on the outside but sort of distant and aloof.  Sometimes people who have been abused have a tendency to seek out people who are sort of destructive.  Sometimes because people feel--these kind of go together--so isolated and alone, they have difficulty having empathy or concern for other people.  Difficulty with physical affection is very common for some victims. 

Next are secrecy, evasiveness, and a tendency to withhold information from others.  Secrecy is the very thing that is so emotionally damaged, but it’s the very thing that just goes hand in hand with abuse, especially sexual abuse.  There aren’t perpetrators out there who abuse people and then say, “Oh, go and tell other people.”  It’s just the opposite.  Nobody says, “Well, you better tell your mom about this, or you better tell your dad about this.”  It’s just the opposite.  “You’d better not tell anybody; if you tell anybody, I’ll kill you.  If you tell anybody, something’s going to happen to your family.”  I mean, there can be all kinds of threats and manipulation.  “If you tell somebody, they won’t believe you.  If you tell somebody, they’re going to think you’re bad.”  I mean, the list can just go on and on, so most victims are very secretive about what’s going on with them.  There can also be a tendency to give yourself away.  This may sound kind of odd, but I think relationship problems can go both ways: either people can withhold, or they can do too much.  They can not even know what they want and just focus totally on the other person and try and accommodate them all the time.  Often victims of abuse--I’m sure I’m not telling you anything new--have difficulties with authority figures.  In the LDS culture that can mean Church authority figures.  If you’re working with the recovery and healing process, and you’re going to be dealing with the bishop, it is really important—and I don’t know how you might do this—to find a bishop who’s going to be a positive role model and authority figure.   If the perpetrator of abuse was someone who seemed to be a worthy priesthood holder, this can really negatively affect the victims views of bishops, church authorities, parents, et cetera. 

Difficulty communicating desires, thoughts, and feelings to others.  And difficulty receiving from others.  Often victims are helpers.  They like to help other people, but they have a much more difficult time letting people help them.

            Sexual abuse can cause sexual problems.  People can suffer from a lack of sexual desire or not be able to express their sexual feelings.  People can have sexual dysfunctions.  They might be unable to enjoy certain types of sexuality, even affections, things like that.  In some cases, people might have problems with their sexual identity.  I don’t have any hard data on this, but women are not the only people who are sexually abused.  Men are also sexually abused and often men are sexually abused by other men, and this can raise questions for them about their own sexual identity.  And this can be very, very troubling.  Sometimes when people are sexualized very early, it can lead to sort of promiscuous behavior.  People can be sexualized, and they think that’s how they relate to people.  So you can have people on both ends of the continuum.  You can have people have so much difficulty accepting themselves as sexual people and are afraid of any kind of relationship, and on the other hand you can have people who are sort of driven toward that.  And then you can have everything sort of in between.  The next: attraction to illicit sexual activities.  This can be related to promiscuousness or pornography, which seems to be endemic in terms of how people are dealing with sexual issues today.  Some people can find themselves angry and disgusted at any display of affection.  Some are uncomfortable around people who display affection and sometimes people can even become angry that people can do this.  Some people can use sex as a manipulation to get relationships.  And some people can also get involved in sexual addictions.

            Now I want to concentrate on emotional problems.  The first symptom that Beverly Ingall lists is intense anger and rage.  Often this is not the first thing you see from victims, however.  A lot of times, and I’m going to talk about this when we get to recovery, anger and rage are buried.  But it’s not uncommon to see mood swings.  It’s not uncommon to see chronic depression.  It’s not uncommon to see tremendous amount of anxiety.  Another emotional problem can be dissociation.  This is a defense mechanism that many victims of abuse use.  People will talk about just trying to block everything out.  People will talk about feeling like they’ve left their body and they were watching this happen to somebody else.  People will be totally dissociated from the feelings they had at the time.  This can be a very difficult thing to deal with.  Some people can develop extreme fears or phobias.  Many people might have sleep disturbances.  Some people might have addictions to alcohol, or drugs.  Some victims of sexual abuse will have addictions to food.  Sometimes they feel like if they gain weight and they’re not so physically attractive, then maybe this abuse will stop.  People can develop obsessive-compulsive behaviors, excessive worrying, rituals about doing things, or eating disorders.  I’m not saying that abuse is the only cause of eating disorders, but you can see that these things can apply to a lot of other things.  Flashbacks and hallucinations can be very common emotional problems, and I’m going to talk about these more when I talk about recovery, because often when we begin to recover and we start telling our story and we allow ourselves to remember, part of the reason that this stage is so difficult is often it can be accompanied by flashbacks and visual memories, physical memories, and that can be very, very distressing.  Sometimes people are afraid that they themselves are abusive.  Sometimes people engage in self-destructive behavior.  It’s not uncommon for victims of abuse to self-destructive behaviors like cutting and things to sort of numb themselves from emotional pain.

            And lastly, physical problems.  People can have all kinds of somatic symptoms: headaches, stomachaches, irritability.  There could be all kinds of things.  Some people tend to be accident-prone.  So, the aftermaths of abuse.  It’s pretty overwhelming, isn’t it, when you think about it?  It’s really overwhelming.  But I want to spend the rest of the time giving you some hope.

            Beverly Ingall identifies seven steps in the recovery process: facing the truth, releasing your anger, confronting with facts and feelings, resolving your relationships, rediscovering yourself, self-care, and forgiving yourself.  So you can see the last three are targeted specifically at some of the self-esteem issues and emotional problems--the rediscovering yourself, self-care, and forgiving yourself.  If you want to know more about these, I really highly recommend that you purchase this book, because in addition to talking about these, Beverly Ingall has some really nice exercises that you could actually practice on your own to do some of these things.

            Facing the truth.  What does this mean?  It means facing the truth that you were sexually abused, that it did happen, and that it isn’t your fault.  Many times people survive sexual abuse by denying and numbing themselves.  But I do believe, along with Beverly Ingall, that in order to really recover and heal, you have to move out of denial and numbing to face the truth.  You need to move beyond all the lies and deceptions, the secrets, and the manipulations that I talked about before.  Now how can you do this?  You can begin to tell yourself the truth.  And how might you do that?  You might write some things down.  You can allow yourself to remember the truth and stop the denial.  Now this stage can be a very, very painful stage.  If you begin to face the pain of remembering, as I said before, I would recommend that you do these seven steps in therapy with somebody, because often when you allow yourself to face the truth and remember this can bring on flashbacks, intrusive thoughts, and lots and lots of emotion.  And there’s other factors of facing the truth that can be really, really difficult.  Face the truth about the perpetrator.  This can be so difficult because the perpetrator can be a parent, a father, a sibling, an uncle, a grandfather, a cousin, a neighbor, a brother, a good friend.  Most often, sexual abuse is done by somebody that the person knows and is in somewhat close proximity to.  So often part of the reason we get in denial is the ambiguity of the question, “How could somebody who I went to for love and affection, who gave me love and affection and attention in other ways, how can they do this?”  Often we have really conflicting feelings about perpetrators: love, hate, anger, sadness.  We want to take care of them, we want to protect them--there can be a whole range of things there.  Also--and this can be a really, really difficult issue--Beverly Ingall talks about not only facing the truth about the perpetrator, but facing the truth about your mother.  I see some heads nodding.  Often victims of sexual abuse are not sure, especially if it was done by a brother or somebody in the immediate family, whether their mother knew about the abuse or not, and this can also affect a person’s relationship with their mother.  We’ll talk more about that when we talk about confronting with facts and feelings.

            The next one that Beverly Ingall talks about is releasing your anger.  I think anger can be your strongest ally in recovery, but for many it’s the most difficult emotion to feel and express.  Part of the reason for that is the person has felt such fear and shame that they’ve sort of blocked out the anger.  As human beings, we have incredible capacity to block out things, to suppress things, to repress, to deny or forget, or to displace.  Sometimes we can displace our anger and it comes out in other ways.  We need to understand that often anger get suppressed or repressed because of the complexity of the relationship with the abuser.  If it’s somebody close to us, there are other dimensions to the relationship that can just be incredibly confusing depending on the age at which the abuse took place.  I’m just going to give one example.  Perhaps the abuser was an older brother who a young child really looked up to and liked.  Maybe this older brother made this person feel special in a lot of ways, but also sexually abused this person and hurt this person.   You can see the incredible complexity in trying to put this all together and understand it.  Plus as LDS people, we’re so programmed not to express anger that when the second stage is releasing anger, we may feel like it flies in the face of what we’ve been taught about being open and loving towards other people.  We’re not talking about expressing your anger in destructive ways; we’re talking about getting in touch with your anger, getting things out so that you don’t have to feel fear and shame inside.

            The next stage is confronting with facts and feelings; I really like this idea of putting facts and feelings in the same sentence.  I’ve seen people tell horrendous stories about abuse with absolutely no feeling.  On the other hand, I’ve seen people so overwhelmed with the feelings and the pain that they aren’t in touch with what really happened, so it can go both ways.  The recommendation is to actually think about confronting.  In some places people talk about this as telling your story in some ways.  Who might you need to confront?  You might need to confront the perpetrator, parents, or siblings.  How are you going to do this?  You can do it a number of ways: you can do it face to face, you could do it over the telephone, and you could do it by letters.  I think oftentimes writing down things can be a really important part of the process of confronting.  It can help you clarify what really did happen, as well as clarify your own feelings.  What are the important things to tell when you do the confronting?  The important things to tell, and there’s more about it in the book: what they did, how what they did made you feel, how you felt about them then, how you feel now, and how you feel about them now.  This can be a tremendous push to the recovery and healing process.  I worked with one student who came in her freshman year wanting to deal with sexual abuse, got so overwhelmed that she came for a few sessions and left.  About a year later, maybe it was almost two years later, she came back and she said, “I’m ready to work now.  I want you to write me a letter so that I can take fewer credits so I can keep my scholarship because I know this is going to take a lot of time and energy.”  This person was abused by her brother.  She worked for weeks on writing a letter to her brother; it was a long letter.  I share this because it has a good outcome.  She wrote this long letter to her brother, did exactly what this said--told him what happened, was very descriptive about what happened, about how she felt, and was really asking him, “Did this happen the way I thought it happened?  How do you feel about it?” et cetera.  She got a wonderful letter back from her brother; he was actually totally relieved that she had sent the letter.  It had been gnawing at him for years, and they began a kind of reconciliation process.  After she did that, she also wrote a very long letter to her mother, and her mother also reacted quite positively.  This process can take a lot of energy.  I’d like to emphasize that the purpose of confronting with facts and feelings is for you--it is not to change the other person.  One of the things that block many people from confronting is that they think if they confront and the other person doesn’t agree with them, then it’s all in vain.  But the idea is for you to get some personal power back and to accept that this happened to you.  It is out of your realm to change the perpetrator.  If the perpetrator changes--like in this case, the brother acknowledged it, wanted to move on, wanted to have a relationship--that’s a tremendous bonus, but it doesn’t always happen like that.  The secrecies, the lies, the deception can continue, but it’s so important for you to take this step.

            The next step is to resolve relationships.  It’s important for you to determine what kind of relationship you can have either with the perpetrator or with family members that will allow you to remain healthy, okay?  Sometimes people need a temporary separation from their family while they work through these things, or at least not so much contact.  Sometimes people decide they can’t really relate to their family or the perpetrator at all, and sometimes people go for reconciliation.  I think it’s important as you work through this to give yourself some options; the goal of resolving relationships is in the question, “Can I relate to that person and still maintain my own emotional health?”

            The last three here--rediscovering yourself, self-care, forgiving yourself—are very, very important.  Currently Les Miserables is being played at Orem High School, and Jean Valjean sings the story, “Who am I?”   A big part of the opera is him accepting who he was, what he did, what his life is like, forgiving himself, and coming back to some spiritual kind of relationship.  So I think that’s an important thing to think about: how do you want to be?  How can you get rid of many of the negative and self-critical things that you’re saying about yourself?

I’ll touch briefly on self-care.  Probably one of the biggest myths that we have is that if people really loved us, they’d know what we need and they’d just provide it for us.  But the most important thing about self-care is learning to ask for what you want.  And that can be really, really difficult, especially if you think about the effects of abuse that we talked about before.  And forgiving yourself.  This is so important.  Again I think if you really go through these steps, if you confront the truth, if you face the truth, if you release your anger, and if you confront, then you’re going to be 80 percent along the way toward forgiving yourself, because if you start getting that out there you’re saying, “This happened, this person did this, I’m not responsible, I’m angry that they did this,” then you’re not going to be blaming and criticizing yourself.

            I’m going to stop here to allow for a few questions.  I think we’re out of time, and I’m just hoping that some of these things can be helpful.  I want to urge people to feel free to use the services at the counseling center.  Feel free to use the services of Women’s Resources.  There’s a lot of--there is help available, and there is recovery, and there is healing.  Thank you.