1. Defining Child Sexual Abuse By Perpetrator Style: Long Term Effects on a Woman’s Sexual Functioning Karen M. Anderson

2. Understanding the Mind of the Sex Offender Salter hypothesizes that for a clinician to effectively treat an adult survivor of CSA they should have an understanding of the mind set of the sex offender. ( Salter, A. C. (1995). Transforming trauma. London: Sage Publications.) Salter breaks down into two categories; sadistic and non-sadistic offenders. 2.5% of all offenders are sadists, those who derive sexual gratification from the power and control they exhibit over their victim from fear, terror and humiliation they inflict. 2-9% of these sadistic offenders target children and adolescents. Grooming offender if turned off by pain and prefers to manipulate a child into sexual activity through cycles of trust and betrayal

3. How Can It Help You As A Clinician Salter’s Rationale: Gives you the ability to understand how certain behaviors or thought processes may have manifested in your client Three beliefs that the client holds about themselves: they are worthless, they enjoyed the abuse, and they are responsible for it. THIS is the internalized voice of the offender that was projected onto the. Easily accepted because children’s beliefs about who they are and what they feel are dramatically influenced by feedback from their environment.

4. Why Does the Child Internalize this? “The question of why the victim internalizes the perpetrators attitudes and beliefs, and cognitive distortions so readily is simply answered. There is no competition” This leaves the child with no choice but to share the reality of the abuser, if not the child is left to a reality of their own, unconfirmed by those around them. Salter, A. C. (1995). Transforming trauma. London: Sage Publications (p.104)

5. What Do We Know About Child Abuse? Cuts across all demographic groups of the American population 28% of girls in the United States will be sexually exploited at least one before the age of 14 (Berman, L. A., Berman, J. R., Bruck, D., Pawar, R. V., & Goldstein, I. (2001). Pharmacotherapy or psychotherapy?: Effective treatment for FSD related to unresolved childhood sexual abuse. Journal of Sex & Marital Therapy, 27(421-425). Courtois suggests that 20% of women will have experienced incestuous abuse at least once in their lifetime (Courtois, C. A. (1988). Healing the incest wound. New York: W. W. Norton and Company.) 4.5% directly involve the father or the stepfather ((Berman, L. A., Berman, J. R., Bruck, D., Pawar, R. V., & Goldstein, I. (2001). Pharmacotherapy or psychotherapy?: Effective treatment for FSD related to unresolved childhood sexual abuse. Journal of Sex & Marital Therapy, 27(421-425). There are approximately 39 million child sexual abuse (CSA) survivors living within the United States. ((2007). Darkness to light: Confronting child sexual abuse with courage. Retrieved November 15, 2007, from http://www.darkness2light.org/prevention/prevention.asp )http://www.darkness2light.org/prevention/prevention.asp

6. Correlations of sadistic versus non-sadistic CSA on a woman’s sexual functioning I could not find any studies that directly separated out a woman’s sexual problems from CSA based on perpetrator style. Research on psychological adjustment correlates CSA with: Somatization Obsessive compulsive behaviors Interpersonal sensitivity Depression Anxiety Hostility Phobic anxiety Paranoid ideation Dissociative experiences (particularly with physical as well as sexual abuse) Stress/PTSD

7. Long-term Sexual Problems Women CSA Experience Maltz and Holman in Incest and Sexuality mention symptoms that were found in over 60% of the women who presented for therapy regarding incest concerns. Presented in most to least prevalent: Lack of arousal Low arousal Confusion about the normal sequence of dating and sexual behavior Difficulty setting limits Aversion to specific sexual acts experienced during incest Forcing self to have sex

8. Treatment Approaches Most treatment approaches are housed under Sexual Dysfunction not CSA specific Courtois’ Healing The Incest Wound for clinicians. Characteristics and dynamics of abuse  Characteristics and Dynamics of abuse, Symptoms and after effects, Outline for goals and treatment  Recommends Annon’s P-LI-SS-IT model and treatment and Maltz and Holman Maltz and Holman Incest and Sexuality. Focuses their attention on the direct impact to a woman’s sexuality.  Steps of Annon’s P-LI-SS-IT model – permission, limited information, specific suggestions, intensive therapy  Sensate focus not specific enough, use Weeks and Gamescia (2002) specific for women  CAUTION – to not revictimize the client be watchful of 3 areas  (1) identification and expression of repressed anger  (2) control of the initiation and pacing of the sensate focus exercises  (3) guilt associated with sexual pleasure Maltz, W., & Holman, B. (1987). Incest and sexuality. Lexington: Lexington Books. Courtois, C. A. (1988). Healing the incest wound. New York: W. W. Norton and Company. Weeks, G., & Gambescia, N. (2002). Hypoactive sexual desire. New York: W.W. Norton & Company.