Impact of Childhood Abuse on Adulthood

This assignment examines the profound and lasting impact of various types of childhood abuse—sexual, physical, and emotional—on individuals as they transition into adulthood. It delves into the psychological, social, and medical consequences of these traumatic experiences, highlighting the increased risk for mental health disorders, relationship difficulties, and physical health problems in survivors. The assignment also discusses evidence-based interventions and treatment modalities aimed at mitigating the long-term effects of childhood abuse.

Running head: COUNSELLING
Scenario 1- Sexual abuse
Name of the Student
Name of the University
Author Note

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Executive summary
This case study deals with the case scenario 1 where Mary who is currently of 27years old
has reported to her general practitioner that her current life is getting affected due to a
traumatic incident in her childhood. She was continuously sexually abused between 10-14
years of age by her cousin. However, having a supportive family and with few sessions was
counselor she was bit stable to put aside the traumatic life event and move forward though
she has low self-esteem and her proneness towards perfectionism. Everything was going well
until when her boyfriend started discussing to move together in one apartment. Sexual abuse
is not totally about sex but it is also about the abuser trying to gain control over the victim.
Survivors of the sexual abuse face long-term mental and physical problems. However,
counseling and therapies are of great help to Mary in setting herself free from the repressed
memory of the trauma she has.

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Table of Contents
Introduction................................................................................................................................3
Discussion..................................................................................................................................4
Mary’s mental state................................................................................................................4
Issues related to mental health of Mary.................................................................................6
Counseling for Mary..............................................................................................................9
Therapies..............................................................................................................................10
Conclusion................................................................................................................................12
References................................................................................................................................14

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Introduction
Sexual abuse is any kind of sexual violence, which can be rape, childhood
molestation, incest or any other similar form of forced sexual contact. However, sexual abuse
is not only about sex rather it is a venture to try to gain control over the victims. Life of the
sexually abused can be saved if they are given immediate assistance. Along with it therapies
also helps those victims overcome their trauma of sexual assault in the past. There are also
some victims who may need long term support which in a way beneficial to those survivors.
However, sexual abuse of children can take many forms and may involve behaviors where
there may be no physical contact like revelation or voyeurism. The most common cases are of
children who are sexually abused before the age of 18years. This type of act mainly occurs
due to sexual attraction towards children and because the offender tries to gain control over
the victim who is a child. Maximum of the time it is found that the child is either threatened
or manipulated by the offended to prevent themselves being disclosed (Mrazek & Kempe,
2014).
The government is also changing their laws related to sexual abuse constantly and so
the feelings of the survivors of the sexual abuse are given more importance than the laws.
However, about 93 percent of the children who are sexually abused remember their attackers
and one third of them are from the victim’s family. Thus, the programs through which
children learn that they have to be careful in front of strangers cannot really help avert all
kind of abuses. In maximum of the cases, it has been found that the child victims do not tell
anyone about the trauma they are experiencing or have experiences due to fear or
manipulation by the offender. However, recovery for this type of a trauma is possible now
days if consulted an experienced and skilled therapist. The effective therapies for sexually
abused victims are exposure therapy, eye movement desensitization and reprocessing therapy

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(EMDR) and cognitive behavioral therapy (CBT). Apart from the therapies, awareness about
sexual abuse is also important so that being a part of the rape culture can be avoided
(Smallbone, Marshall & Wortley, 2013).
Discussion
Mary’s mental state
In this scenario, the client Mary has been referred for counseling sessions due to her
issues that she has been facing as informed to her general practitioner. She further reported
that her cousin between ten to fourteen years of her age use to repeatedly sexually abuse and
the outcome is the mental health problems that she has been facing now. Mary copes up well
with the trauma earlier when her parents got to know about it and supported her, prosecuting
her cousin. She was also given few counseling sessions at that time and as a result, she was
adjusting well keeping the traumatic thoughts aside. However, some problems were
persisting, as she could not move to another city, which she planned to join university there,
difficulty engaging in any kind of intimate relationships, continuous low self-esteem and
proneness towards perfectionism. Mary is 27years old now and has moved to a new flat
nearby her parent’s residence and she is in relationship. Everything was going well until
presently when she and her boyfriend started discussion that they should move in together.
Then onwards Mary is much stressed, depressed, having extreme headaches which is
affecting her work life from where she has been taking long sick leaves.
However, from the scenario now comes the role of the therapist when working with
this type of clients. Therapists role are very important, as they have to believe that is
unbelievable, think that is unthinkable and they must learn to keep aside the ease of the
illusions that everyone wants to hold about the world and humanity people are residing.
However, this factor is very must essential in the part of the therapist to have a confrontation

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of self at a deeper level so that they are willing to listen to their client’s painful situations so
that they realize that in this world there is nothing that one individual cannot do to another.
From the therapists’ side there are certain basic requirements that must be followed are their
openness as well as readiness to challenge as well as confront the private blocks. Therapists
must have the ability to hear the frightfulness of abuse, to indulge and stay with the emotional
pain. There must be frankness from the therapist’s part when talking about sexuality so that
the client also feels comfortable. Apart from all these, adequate support is needed from the
therapist’s side. First, a rapport needs to be established between the therapist and the client so
that a bond of trust and care can be developed so that the client feels the comfort when facing
the truth of her abuse. However, there are certain limitations and boundaries to this
relationship established. While dealing with this kind of clients it is the foremost role of the
therapist to encourage their clients so that they can take the control of their therapies in a
positive manner. In many cases, it has been seen that if the therapist frames the normality and
appropriateness of the answers to the victims then they feel greater relief from the fear of
going mad. There the steps that needs to get involved with dealing with clients like Mary in
order to help her recover and heal from the trauma of being abused. Those steps are as
follows:
 Catharsis- after the establishment of a trusting and caring bond it is important that the
victim get a change to come out with all the repressed material she has about her
trauma. This can be very painful re-experiencing the trauma all over again by
recalling it so at this very time a strong support from the therapist’s side is needed as
the client can regress to states of doing childlike behavior and experience strong
immense changes that they feel within themselves that actually make them stressed of
going insane. Thus, therapist needs to be skilled enough in the areas of regression and

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cathartic works so that they can help the client with firmness and show them support
(Webber & Wilmot, 2012).
 Cautious analysis of relationships- after catharsis the next step will be an analysis of
the relationship the client has with her family members. This will bring out the
problems related to adult relationships, trust, intimacy and fear from people.
However, the challenge lies here where the victim needs to go towards a healed
normal person to survive with a deeper responsibility for them (Kemp et al., 2014).
 Reintegration of sexuality- towards the end of the therapy the sexuality needs to be
healed that has been damaged during sexual abuse. Sexual education is important, as
there can be ignorance or resistance to information on the victim’s part. This part
mainly focuses on the basic education, an investigation on sexual topics, and recovery
of the body, fun, nurturing and self-care (Morales et al., 2016).
Issues related to mental health of Mary
Sexual abuse actually make the victims acquire the feeling that their bodies are not
their own and thus, the feeling of shame, depression, guilt and terror occupies them (Nelson,
Baldwin & Taylor, 2012). According to the client Mary the mental health changes that she is
facing are as follows-
 Depression- the feeling of hopelessness, despondency and the diminishment in the
victim’s self-worth is created when there is loss of bodily independence. These
feelings however, guide the victim towards depression that might range from mild to
severe level of depression. In case of Mary, depression was one issue that was
troubling her. It is very common that people who are sexually abused in their
childhood are prone to depression in adulthood Traumatic experiences in childhood
often changes the structure as well as chemistry of the brain thus, making the victim
that is Mary over here become sensitized to stress thus, Mary becoming overly

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responsive to the environmental pressures. However, small amount of stress makes
the brain outpour stress hormones and these hormones act in a direct way to produce
the behavioral symptoms of depression (Gould et al., 2012).
 Anxiety- anxiety in normal individuals do not have any clear cut source of arousal but
in case of sexually arouse anxiety comes from the loss of one’s own bodily
independence and the fear of getting sexually abused again. Many victims develop
Agoraphobia and do not want to leave their houses due to fear, others may get panic
attacks (American Psychiatric Association, 2013).
 Attachment disruptions- the most challenging part for both children and others who
have been sexually abused are to form vigorous attachment with others. In case of
Mary, it is seen that because of her experience of childhood sexual abuse thus, she is
experiencing an insecure pattern of attachment in her adulthood. She is even
struggling with getting intimate with her boyfriend. Due to attachment disruptions, the
victims are not that eager to build any kind of close relationship with the opposite sex
(Wortham, 2014).
 Triggers- any stimuli that are matching with the offender can make the survivor
remember the abused they had experienced. Triggers are thus, the stimuli. Most
common triggers are violence, later abuses or intense discussion related to the abuse.
 Headaches- there is a recollection of the trauma even after many years and thus the
fear of disclosing the secret of being abused brings the victims nightmare and thus,
they suffers from sexual anxieties which further fuel muscular tension and emotional
stress which uplift chronic headaches or migraines (Afifi et al., 2016). Mary because
of her being experiences maltreatment as a child as the emotional and physical abuse
that she has gone through made her experience severe headaches in her adulthood.

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 Low self-esteem- Self-esteem is an important issue for those who have been abused
by a child. In this case, of Mary who is also constantly dealing with low self-esteem
actually developed it back when abused as a child. This is mainly because as a child
when abused after her several attempts she was unable to stop the victim, which made
her ashamed, helpless and incompetent. Thus, these feelings are carried with her into
her adult life and as a result reflected as her low self-esteem.
 Perfectionism- In relevance to Mary’s case, it has been found that she had developed
a tendency towards perfectionism and that is because this quality indicates that Mary
is in pain and is less probable to show their pain to others. Research has further
indicated that people associated with this type of behaviors are highly correlated to
anxiety, depression, stress and a high risk of suicide.
 Intimate relationship- Mary’s trust is broken once when abused in her childhood
because of betrayal of trust and contraventions of personal boundaries. It is natural
that her internal working model has disrupted because of the fear of being exposed,
which used to create a sense of shame, guilt and confusion in her. This however, in
her adult life has affected Mary to understand and interpret the motives and behaviors
of others and they way she handle the stressful events of life.
 Stress- Mary who has become sensitive to stress is due to her abused in her
childhood. The stress that has been the outcome of the persistent abuse may have
changes the script of the brain so even small amount of stress activated a hyper
arousal response that can further result in hyperactivity, sleep disturbances, conduct
disorders, memory and learning problems (Sugaya et al., 2012). This sensitivity of
Mary towards stress can increase the risk in a whole agenda of stress related diseases
that involves heart disease, cancer and even infectious diseases.

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 Repressed memories- Keeping away the painful memories out from the
consciousness happens automatically as an involuntary mechanism because forgetting
the childhood sexual abuse is an unconscious blocking that is deeply seated (Herman,
2015). In Mary’s case, it has been seen that whenever the memories of her abuse
haunted her she use to push them aside. However, it can be said that Mary mainly put
those memories aside because they are unconsciously blocked because its association
with high degree of stress or trauma. However, the memories are not recalled but
Mary but it is very clear that those memories are affecting them consciously
((Lamoureux et al., 2012).
However, sexual abuse not only has psychological scars but they leave a long lasting
health issues. Victims may get bruises, severe cuts, sprained or fractured bones and torn or
injured genitals. There are also chances of sexually transmitted infections that many victims
do encounter with and others may become pregnant. Victims also experience disturbed health
like chronic pain, sexual dysfunction, fertility issues, and reduced immunity and many other
unknown aches, pains and illnesses (Frühauf et al., 2013).
Counseling for Mary
From the point of view of counselor when dealing with a client like Mary it can be
said that counseling is by far the effective factor. Counseling can be a great platform for those
adults who have survived sexual abuse in childhood. It may be that the survivor first time
reveals the incident of the abuse to her counselor. Victims mainly repress their incidents of
being sexually abused and when they finally reveal it to the counselor, they actually feel
immensely relieved. It is difficult for the victims to trust anyone. Being abused in the
childhood, when they grow up they somewhere lose their confidence to trust people to avoid
any kind of dangerous situation or any abusive relationship. However, counselors are trained
to be dependable with respect to maintain confidentiality and reliability. Thus, when the

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victims experience a trustworthy experience with the counselor they starts to rebuild their
capacity of trust to other human beings. After abused in childhood, when they grow up they
get an intense feeling of shame that remains with them throughout. Counselor is never
judgmental and so when the victim narrates her story to the counselor they started viewing
things from a different angle altogether. It is the counselor’s responsibility to make the
victims realize that children cannot be blamed no matter how convincingly the abuser told
them they are. Thus, slowly they also feel that they were young as well as vulnerable when
the incident took place. However, when the victims hear from an expert that their experience
is very typical they finally feel released from shame, guilt rather feels of anger, and grief can
replace it, which the counselor helps to manage safely (Champion & Collins, 2012).
According to Fergusson, McLeod & Horwood, 2013 said that childhood sexual abuse
is a traumatic life event where the negative outcomes increase with the severity of abuse.
There have been many cases where victims have faced abused in romantic relationships and
physically abused in childhood. However, the most pathetic of them all is sexually abusing
children. To overcome the trauma, fear and guilt the victims are given certain therapies that
can bring them immense relief. Any form of abuses has a negative impact on the victim’s life
and so they are often found experiencing emotional as well as psychological problems. Thus,
depending on the assaults the treatments also varies and the common therapies and its
importance are described below.
Therapies
Recovery is possible for Mary as well who have survived sexual abuse. Therapist who
has experience of dealing with clients of sexual abuse can understand sexual trauma and their
effects better and can give proper guidance to victims of rape and other kind of sexual abuse.
However, the most important predictor of recuperation of the victim is their relationship with

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the therapist (Kemp et al., 2014).Thus, keeping in mind the client Mary’s condition the
therapies that can be helpful for her are stated as below-
 Exposure therapy- In Mary’s scenario she can be given Expose therapy because this
type of behavioral therapy is for those victims who are resulted in a specific fear after
their sexual abuse. This has been designed keeping in mind that the victims will learn
to manage their problematic fears through it. However, the main goal of this therapy
is to design a safe environment where the client can reduce their anxiety, lessen
avoidance of feared situations and can improve the standard of life of the victims.
However, victims who are scared to visit the room or the area where this incident took
place or fear those people wearing similar kind of clothes like the offender can be
benefited from this type of an approach (Rauch et al., 2012). Thus, this can be helpful
for the client Mary who can reduce her feelings of anxiety and by lessening her feared
situations in life can start tackling to stay alone away from home without being
anxious.
 Eye movement desensitization and reprocessing therapy (EMDR) - this is a kind
of integrated psychotherapy which is designed to treat the symptoms of both trauma
and posttraumatic stress. EMDR sessions however, follow a particular order of phases
and the therapist uses bilateral stimulation as eye movements to guide the client
handle unresolved memories from their unfavorable experiences. This can be use to
confront with any number of concerns and it is also consistent with other types of
therapies. Thus, this therapy uses fine eye movements to guide to rewire the brain and
modify the way the victims processes the abuse (Shapiro, 2014). This kind of therapy
can help Mary to deal with her stress that has occurred due to her repressed memory
of childhood abuse.

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 Cognitive behavioral therapy (CBT)- this therapy is a short term and problem
focused form of a behavioral treatment that helps the victims see the connection
between beliefs, thoughts, feelings and successive behavioral patterns and actions.
Through this therapy, victims get to learn that their own perceptions influence their
responses directly to certain situations. It is not a distinct treatment technique rather it
is a group of therapies clubbed together. Thus, it includes cognitive, dialectical
behavior and rational emotive behavior therapies. For instance Mary from the
scenario discussed above who is afraid of getting into intimate romantic relationship
for which she is having issues as her boyfriend asked her to shift together in the same
apartment. CBT can help her greatly by making her uncover the unconscious thoughts
that are causing her to avoid intimacy, allowing her to work towards a healthy
relationship as well as behaviors (Resick et al., 2012).
However, therapies can guide the victims of sexual abuse to convey and process
unfortunate emotions that are associated with the abuse and develop self-compassion as well
as strategies for self-care so that they can manage moments of emotional overload and learn
trust others again. Group therapy also help Mary by providing her with the social support so
that she can cope with and modify the feelings of shame, guilt and alienation through
interaction with others who have also been through similar kind of experiences. Further, it
can help her regaining her lost self-confidence.
Conclusion
To conclude this report, it can be said that sexual abuse is a kind of sexual violence
where the offender is not only sexually attracted but also trying to gain power on the victim.
The given case study that was selected was that of Mary who was at the age of 10 to 14 years
were continuously sexually abused by her cousin. However, her family was supportive to her

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when they came to know about this and with counseling session, she was able to put aside her
trauma and lead her life. Nevertheless, at the age of 27years, she again felt that this incident is
having impact in her life. Various therapies and counseling sessions are beneficial for the
survivors of sexually abused. However, it has been seen that sexually abused survivors
suffers from both physical and mental health related issues. Mental health issues like
depression, anxiety, PTSD, personality and attachment disruptions, addictions and triggers
are common for survivors who have traumatic experiences of sexual abuse. On the hand,
there are many physical health related issues as well those are obesity, headaches,
Gastrointestinal disorders, Fibromyalgia and Chronic pelvic pain. Heart diseases are also said
to be associated with those who have been victimized being sexually assault.
Counseling and therapies have been very effective as well as helpful for Mary who
have survived childhood sexual abuse and has been repressing the incident and suffering
from extreme pain, guilt and shame. Counselors are experts who have are skilled being
trustworthy; maintain confidentiality and being non-judgmental. Thus, they can help clients
like Mary to regain their trust on themselves and on other human. This support from the
counselor can help the victims getting relieved from the pain. Moreover, they start visualizing
their situation in a completely different way. The therapies that can be impactful on Mary are
exposure therapy, Eye movement desensitization and reprocessing therapy (EMDR) and
cognitive behavioral therapy (CBT).

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