Helping Our Kids Heal From Sexual Abuse

Children who have been sexually abused can heal. Join our conversation with Dr. Eliana Gil to learn how. Dr. Gil is the founder of the Gil Institute for Trauma Recovery. She specializes in the assessment and treatment of trauma in children, especially those who have been sexually abused. She is a Licensed Marriage and Family Therapist, a Registered Play Therapist Supervisor, and a Registered Art Therapist.

In this episode, we cover:

• What type of abuse is considered “sexual abuse”?
• Parents often don’t know before fostering or adopting or taking in their grandchild that the child has experienced sexual abuse. What behaviors might indicate that a child has been abused sexually?
• What kids are at greatest risk for being sexually abused? 
• Brief refresher on typical psycho-sexual development in children without abuse and how sexual abuse can alter this.
• How does the impact of the abuse differ on the child depending on their relationship to the abuser?
• Children can and do heal from sexual abuse. 
• What are the long-term impacts of having been sexually abused?
• Not all kids who were sexually abused become sexual abusers. Is there research on this? How common is this?
• Guilt because they may have enjoyed part of the experience—physically or the attention.
• The presence of a supportive adult who believes the child can make a difference in how a child recovers.
• How should a parent respond if a child discloses sexual abuse?
• How can parents help children heal from sexual abuse?
• What protective factors in children or families make recovery more likely?
• What are some practical tools and talking points to assist a child in the re-learning of healthy boundaries and expressions of healthy affection? 
• How to find a therapist to help a child heal from sexual abuse?
• What safeguards should a family have in place when accepting placement of a child who may have been sexually abused? How to protect other children in the home?

Transcript

Please pardon any errors, this is an automated transcript.
Dawn Davenport  0:00  
This is Creating a Family talk about foster, adoptive and kinship care. Welcome back to our regular listeners. We would not be where we are without you, and we are really appreciative of your continued support and a special shout out of Welcome to our newbies. We are happy you've joined us. We hope you will subscribe and so buckle up and get ready for a great show. I'm Dawn Davenport. I am the host of this show, as well as the director of the nonprofit creating a family.org Today, we're going to be talking about a subject near and dear to my heart, and that is helping kids heal from sexual abuse. We'll be talking with Dr Eliana Gil. She is the founder of the Gil Institute for Trauma Recovery. She specializes in the assessment and treatment of trauma in children, especially those who have been sexually abused. She is a licensed marriage and family therapist, a registered play therapist, supervisor and a registered art therapist. Welcome Dr Gil to Creating a Family.

Speaker 1  1:02  
Thank you very much. I'm very happy to be here. This is

Dawn Davenport  1:07  
a subject that I feel so strongly about, that we as families can be instrumental in helping children heal from sexual abuse. So let's start by talking about what type of abuse is considered sexual abuse? It may seem like a simplistic question, but I think it's not clear exactly what we would include within the term sexual abuse.

Speaker 1  1:31  
Yeah, and I think that in part, it's a little bit unclear because sometimes the state defines them a little bit differently, but sexual abuse is any kind of crossing of a boundary where the intent of the offender is basically to gratify him or herself sexually. But I think of it always as a broad continuum of behaviors that can be hands on, so that there's touching and kissing and fondling, sometimes there's penetration and so all of those kind of hands on behaviors can occur. And at the same time, there's other behaviors, exposing children to pornography, having sex in front of the child, that don't necessarily have that hands on component, but can be really confusing and unsettling to children who don't know exactly what's going on. There was the addition of sexual exploitation, and that means kind of the trafficking of children, the prostituting of children. So that was included at some point. And this has been my experience with these definitions, as they start in a narrow way, and then as we get more and more familiar through the reporting process with what's really happening out there, it gets expanded. So for example, at the beginning, sexual abuse was always thought to be between an adult and a child, and now there's been a lot more kind of discussion around older children being capable also of sexually abusing younger child, or even children the same ages kind of sexually abusing each other. So there's a lot of interesting nuances. And I think thinking along that continuum is probably the best thing to do.

Dawn Davenport  3:09  
It is not atypical at all for same age children to engage in sexual exploration. And so how is that distinguished? If we're saying that sexual abuse can happen between same age children, I can see how, especially if one has has power in some way over the other one is that the defining differences that one has power. You

Speaker 1  3:34  
know, it's a very complicated issue at times to try to figure out what exactly is going on between kids, but I think of it as first of all, thinking about the age difference between the two children and whether they're developmentally at the same place, emotionally at the same place, and what that age of difference is like, if it's within two years, you're usually talking about peer exploration, if it gets to be beyond that And it's six years difference. Now we have someone with more knowledge, and that can be problematic, all

Dawn Davenport  4:06  
right, and parents often don't know prior to fostering or adopting or taking in their grandchild that the child has experienced sexual abuse. So what behaviors might indicate to them that a child has been abused sexually.

Speaker 1  4:21  
There are some behaviors that are commonly associated with sexual abuse. So I will start by saying that the whole range of fear and anxiety might be something that parents see, that these children become withdrawn, they're inhibited, they're uncomfortable, they don't reach out to peers, they don't have social relationships. So fear and anxiety can be one of the ways that you can start determining that there's something going on with the child. In addition, sometimes children really shut down, and so they get depressed, and sometimes they start talking about suicide at very young ages, and they don't actually use that word, but they'll say things like a. Wish I could go to sleep and never wake up, or I wish I could be invisible, or I wish nobody could find me, and things like that. So that depression and sadness, again, unusual for a child to have, you would have to explore why. And then the big one, I think, that's a predictor of sexual abuse, oftentimes, is inappropriate sexual acting out by very young children. In other words, they're using language that kids their age shouldn't know and their peers probably don't know. Everything becomes a little bit sexualized. Their drawings are sexualized, their language, and sometimes they start reaching out to other kids and wanting to pull their pants down, and there's an aggressive quality to what they're doing. I think oftentimes this is post traumatic behavior, that kids who are worried about what's going on and are having that experience of trauma tend to sometimes kind of reenact. Sometimes, if they started, it feels like I'm more in control than if somebody's victimizing me, and other times, I think it's purely post traumatic stress that it just becomes unbearable, and so they end up kind of repeating the sequence of the thing that's most on their mind. That's a big one to me. And then kids who dissociate might be the last category I would be interested in. And these are kids who just seem to rock in place, stare into space, can't seem to connect with another human being, don't make eye contact, prefer to kind of withdraw. So those are the big things that I would be looking for with kids. And again, I just want to back up to fear and anxiety. I talked about some of the ways that kids might react, but it's dysregulation as well. It's not being able to control behavior, their own behavior, or their own emotions. All of that can be a package of symptoms that you can look at and go something's wrong. We need to look further.

Dawn Davenport  6:53  
What about extreme modesty, which is kind of the opposite of of acting out in a sexualized manner? But what about a child who would go the opposite direction, which is, you know, extreme modesty, not wanting anyone hiding in a closet to change clothes and locking doors and things like that.

Speaker 1  7:11  
Yeah. I mean, that definitely could be a signal of something. It's interesting. Developmentally, kids are very disinhibited early on, three to five, five to seven. But there comes a time when suddenly that privacy takes over. You can walk in to a child's room at seven years of age and they go, Mom, get out of here. I'm getting dressed. So all of a sudden that privacy issue becomes relevant to kids maybe going to school or having social relationships. So if you had a child who was extreme, then again, you would want to kind of understand a little bit more of why. Okay, kids are unique. So, I mean, these are general things, right? And then we have to explore exactly,

Dawn Davenport  7:50  
yeah, that would make sense. So what kids are at the greatest risk for being sexually abused? You

Speaker 1  7:58  
know, it's interesting. I was thinking about that question it depends on the gender. So it turns out that little boys are more at risk of being abused outside the home, and so little boys between the ages of seven and nine appear to be really at a great risk from pedophiles, from people out there in the world, soccer coaches or or anyone who's really in a position of caretaking children, whereas little girls are much greater risk to being abused within the home by fathers, mothers, grandparents, cousins, uncles, whatever. And so it's kind of interesting, but I do think it's any vulnerable child. I think it's any child that gets targeted for whatever reason, you know, and sometimes offenders target children that they see alone, that they see without a parent checking in on Why aren't they coming in from playing outdoors, or children that don't get picked up or, you know, pedophiles. Look, there's even a book for pedophiles on how to find vulnerable children. I read that once, and it was so gross and disturbing that this information is shared, you know, among people who are offenders. So they're really out there looking for targets, children they see alone in a theater, they see alone in a game, sporting shop, or whatever it may be, and also any other vulnerability, children that have physical disabilities, sometimes, unfortunately, are targeted. So you know, with offenders, it kind of covers the whole gambit in terms of what might be to them vulnerable, but especially little kids, for example, who can't report out verbally. And a lot of offenders know that children under the age of four usually can't testify in court, and so they think that's a safer thing to do. So it's kind of gross to think about that children are COVID for very specific reasons, and

Dawn Davenport  9:50  
you're speaking right now primarily of outside the home. But as you said, inside the home, it's being a child and female. Yeah, there's. Risk, yep,

Speaker 1  10:00  
and I think that again, hopefully by now, the education that we've put out there about sexual abuse is helping on some level, but there still seem to be so many adult parents and or caretakers who cross that boundary, who end up kind of viewing the child in a particular way, or think that the child is being seductive to them, because they come and sit on their lap. And so there's a lot of kind of misperception, I think, about what kids are doing. I mean, we still have people who think a 13 year old who's wearing little clothing is somehow being seductive. And so there's that kind of attitude that we really have to combat, that children aren't out there looking for sex. You know, in terms of sexual development, it's very gradual, and so kids become interested and have curiosity and start exploring gradually as they get older and affected by their peers as well.

Dawn Davenport  10:57  
That is a great lead into I wanted to do kind of a refresher on typical psychosexual development in children without abuse, and then contrast that to the development of the typical and I realize Each child is unique, but let's say the typical interference with sexual development that sexual abuse can cause. Because one of the concerns I have is that I hear parents who, let's say, they see a 10 year old who is is masturbating, and they think that has to be a sign of sexual abuse, when, in fact, masturbation is not atypical. But parents are uncomfortable with that. Therefore they assume that any form of sexual exploration is a sign of abuse. So I think it's helpful to talk about what is typical developmentally and then contrast that to how sexual abuse interferes with that typical development.

Speaker 1  11:54  
Yeah, and I think that even just before we kind of get into some of the specifics I can give you just to understand that there's not a lot of research on this, and that parents are not often reporting things that they see, or sometimes they, you know, don't understand what they're looking at. But yes, it's very interesting to me, for example, the zero to three years of age. It's all sensory. Everything is about touching yourself, touching parts of your body. There's a lot of exploration that goes on. So you could see a little two year old kind of reaching. If you're changing diapers, they reach for their genitals right away. And so there's nerve endings there. Sometimes it can feel interesting, and it's also being covered up all the time, and at the same time they're being cleaned. And so kids can kind of get interested masturbation peaks between the ages of three and five, and so kids kind of discover their bodies and start kind of touching, and there's maybe some sensations that they find interesting or pleasurable. I think we tend to think with adult sexuality in mind, and really it's not it's sensory. It's just exploratory. It's my body and all the different things that my body can do. But kids do tend to be interested in kind of self exploration for a period of time, and then what happens at five is that it doesn't mean that masturbation stops. It means they go to school, and now there's boundaries, and now there's teachers saying don't touch yourself there, or moving their hands if they do, or his hands if they do. And there's a little bit more of boundary guidance about what you can do, how close you get to people, how much you can touch people. And so that's what starts happening. And so masturbation kind of continues, but again, not like we think of masturbation that ends up in an orgasm and is done in a particular way, but kids are just kind of feeling themselves out, and they have some interesting physical sensations. There's periods of inhibition in children where they don't want to be seen, and they don't want their bodies seen, their periods of disinhibition like that. At some point in teenage years, they're much more comfortable exposing parts of their body with nudity sometimes. I mean, I was just at the beach, and it's amazing the small pieces of fabric that people wear on their bodies. And these are mostly teenagers, you know, and they're comfortable with their bodies and then. But everything is a gradual interest, gradual exploration, and eventually, as they get into social relationships with other kids, then they start kind of holding hands, maybe, or they start putting a hand over the shoulder. So everything kind of takes its time. I think it's when we see kids who suddenly do things that most children, their ages wouldn't know about. That's when we stop and kind of take a look at what's going on. And in addition to that, when it's extreme interest, you know, we're wondering, well, Where's that coming from? That every drawing they make is a penis, let's say, or every every sentence they make is somehow sexual, or that they're. There's provocative kinds of interactions going on. Where is that coming from? So there was a study that was done on sexually abused children and compared to non sexually abused children quite a long time ago, by Dr Friedrich, but I remember clearly that he said one of the things that you will tend to see in sexually abused children is explicit knowledge. In other words, details. They can view where the penis goes and what it does. They can talk about ejaculation, and these are all things that kids shouldn't know about, right? So that was the first finding, is that sexually abused children are much more explicit and also more persistent. So with a child who hasn't been sexually abused, they could see a movie and get interested momentarily, but it kind of dies down. But with children who've been sexually abused, something else is driving the behavior, the confusion, the feeling of unsettledness, the traumatization, and so there's much more extreme and visible repetition of things that, again, they shouldn't know about, shouldn't be doing, shouldn't be asking about, and things like that. So that's important to keep in mind. And then I think there was one other finding that just, I'm just remembering sexually abused children can actually stick things inside their vaginal and anal openings with much more regularity, because if, if kids have not been sexually abused, they may, at the age of two, like, put something in there, and it hurts as they back off, and then that just extinguishes itself. But with kids who've been sexually abused, that inserting of objects may be a real indicator that something is wrong. A little girl of three who would just pack toilet paper in there. And eventually she was taken to the hospital, and they'd remove the toilet paper and send her home. And eventually someone said, Wait a minute, there's something wrong here. And as I did therapy with the child, and she was stuffing puppets with toilet paper. She said, Now nothing fits. Now nothing gets in. And so she was basically blocking her vaginal area from any entry. And again, this the three year old. So these are the kinds of things that can happen where you're just going this is really strange and weird, and it has to mean something, and it usually does. It usually means the child's been exposed to something that's been inappropriate. Does

Dawn Davenport  17:28  
the impact of abuse differ on the child depending on the relationship to the abuser, whether it is a stranger, whether it is their father or their mother, or whether it's, you know, an older brother, three years older, that type of thing. I

Speaker 1  17:45  
do think that it's really important to understand that it's a double edged sword when the child is sexually abused in the context of a loving relationship, quote, unquote, because then what's happening is the child is learning simultaneously, people who love you hurt you, people who love you make you feel uncomfortable, people who love fuse you or make you scared. And so that correlation then begins to get established, that people who love you, this is what they do with you. And so I think it's really important to kind of just step back and understand that kids need to make sense of all this and daddy or mommy being one way at night, and then they go to the breakfast table and they act like everything's fine. It's so weird. And so there's a lot of having to negotiate that you love the person, but you don't like when they do touching things to you, or when they touch you in a way that makes you feel uncomfortable. So it's a really interesting thing to watch kids kind of try to figure that whole thing out. They're loyal to the person they love, and at the same time, they want to withdraw from the person who's hurting them. And you know, sometimes kids don't think of it as hurting, because maybe there's no physical pain initially, but they do think about emotional hurt, and so they think that makes me feel weird. That's funny. I didn't like it, whatever. That's an important feature.

Dawn Davenport  19:07  
Let me take a moment right now to remind you that we need your questions to be sent in for us to answer on our weekend wisdom podcast. Weekend wisdom podcast is weekly. It is short, usually five to 10 minutes, and we devote each episode to one question that our audience has sent in. So please send us your questions to info at creating a family.org or if the app you're using to listen to this podcast allows you to send us a message, we can receive it that way as well. Again, it's info at creating a family.org and now back to the show. So we've talked about the impact of sexual abuse. Can children heal from this? That's

Speaker 1  19:55  
the best part of this. This is happening to young children who are learning a. Lesson, as it were, and that can be unlearned, and they can begin to have new experiences where things are not complicated or confusing, where people are consistently empathic, where caretakers come in and now they're providing consistent care, and they pay attention to the kids, and they listen to them, and they see them and they value them, and that's a corrective experience. So I always feel so optimistic about children's ability to repair, because I know that in the context of a reparative experience, things will heal, and they will be put in the background, they will be put in the past, and children will figure out how to explain that to themselves. So I have lots of little kids who end up saying things like, I love my daddy. My daddy has a problem, and he has a touching problem, and he needs help with that so he doesn't do it again. And that kind of understanding, that kind of narrative, then makes it clear that the child was not to blame the child's not at fault. These events and consequences didn't happen because of what the child did or didn't do. It's about that other person. So to me, part of that reparation is helping the child get to that kind of narrative meaning that lets them off the hook. So it wasn't about me, I didn't do anything. This is about the other person. They need to learn something different, and then the child continues to move ahead. Kids are so receptive to warmth and trust and they want positive relationships. They seek them out. And so it's really beautiful to see when kids are capable again of receiving that which is being offered to them through a foster parent, through a kinship relationship, or whoever might be available, and now they have an attachment opportunity, and that's the beginning of restoration of everything. If kids can feel like they're really being cared for by someone else, they're important to someone else, they mean something to someone else, and

Dawn Davenport  21:58  
that there are safe adults who will care for them in a way that is appropriate. One of the I won't say it's a pet peeve, but it's certainly a soap box of mine, is that children who have been sexually abused are some of the hardest to find foster parents for if it's in the record and acknowledging up front that a lot of times that type of abuse is not reported enough that a child gets into a safe environment where they can start disclosing, or there's an adult who is noticing behaviors, as you've described, that are outside the norm, but it's almost as if we are revictimizing these children, because foster parents and adoptive parents and even kinship parents are often sometimes afraid to adopt these kids because they are afraid of the long term impacts. So I want to turn now to talking about the long term impacts. And the first one, and the one that is, I think, universally, the most feared by adoptive and foster and kinship parents is that the child who has been sexually abused will become an abuser. Has there been research on this? And if so, how common is that? Yes,

Speaker 1  23:07  
and I do think that initially, when children are being sexually abused and are in the experience of it and can't quite get themselves out, or don't know how to do that, or who to talk to, or whatever, then they're acting out behaviors can be their way of talking. When I've worked with foster parents, when they get ready to receive a child who's had a history of sexual abuse, I always talk about this fear, because it's it's common for all of us to think weird situation this child's been sexually abused, I wonder if they're going to do something to one of the kids in the house. The other thing is, the foster parents often worry, what if this person reports abuse? What if child says something happened and it didn't? And so there's all of that. And so I talk a lot about this, and I try to encourage people to understand that the acting out behaviors are simply question marks. They're simply a way of asking, Are you going to do the same thing to me? Are you going to hurt me? Is this going to happen in this house? And it's kind of a way to try to make yourself safe. And so if a child cozies up to a foster parent and starts rubbing his knee or something like that, which could happen and has happened for that foster parent to know, oh, teaching opportunity. You know, I'm an adult, safe, appropriate male. Great opportunity to say, You know what your hands need to stay on your body, and my hands will stay on my body, or maybe even possibly, you know, you're sitting a little bit too close, and I like you to move over. You could still see what we're looking at together, but you need to move a little bit over, because I like to have a little bit of distance between myself and other people. It's just a wonderful opportunity, because now the child's unlearning something they've been taught, and they're now receiving new information in a loving context. So you don't say anything you know. You get away from me, or you're being strange, or don't do that weird behavior. You don't do that. You just say, oh, you know, here's what I'd like you to do. And responding appropriately is so important. So I like to have all of these discussions. And yes, there's a risk factor involved. And there's a risk factor involved in almost anything we can do in our lives. You know, there's some little risks we take when we fly somewhere else. So, I mean, I think we just have to manage those risk factors. And so if there are young children in the home, you want to monitor this for a period of time. You want to have regular weekly meetings where you talk about what is and isn't appropriate. You know, we all teach kids the rules about not running into the street within the house. You know, also three kinds of touches, right? There's like, touches that are wonderful and loving and supportive, and that's usually done when people love each other in a family. But then there's also ouch touches, you know, that's hurting, touches that are physical, pulling your hair, pushing someone, hitting someone. And then there's the touching of private parts, and these are things that we don't do. And private parts are called private for a reason. You know, you cover up those private parts so you want to keep them safe. So all of these are things that foster parents can do, make it matter of fact, respond in kind of appropriate limit setting ways that the child can understand without making them feel bad, and eventually they get it. It might take a little time, but every time it's a question, it's a question of, Am I safe with you? Is this going to be okay? And that's with the adults. With the children you do really have to monitor, because sometimes they've learned to do things and so sometimes they just want to repeat them. And that could be post traumatic stress related, or it could be an opportunity for mastery, you know, like somebody did that to me, but I'm not going to let them now. I'm going to do it to someone else. You go from victim to victimizer, and there's something for some children that gives them a little bit of relief doing that however, they're also exposing other kids. So we can't really allow them to do that. We have to give them alternative ways of kind of showing what might be on their mind or what questions they have. When

Dawn Davenport  27:13  
we look at adult predators, pedophiles, are they more likely to have been abused sexually?

Speaker 1  27:21  
Yes, I have read statistics on this that are retrospective. In other words, you end up with a sex offender in a group therapy program, and this pretty high, about 80% to 90% is last I checked. Will tell you that they had some experiences in childhood that were sexually abusive. The difference is, they didn't get any help, and nobody stopped them, and so they kept doing it. When you keep repeating a behavior, it gets reinforced over and over and over again, and then there's no accountability, and now it becomes something that you kind of takes over all their thinking and feeling. And so yes, that is true. However, what we don't have is prospective data, like let's take a look at 1700 sexually abused children. Let's follow them throughout their entire lives and see what percentage of them become offenders. We don't have that data, but we have it retrospectively, so I think we have to be careful about it. I never assume anything. I don't assume because someone's been abused, they're going to abuse. But I also always have that in the back of my mind that I don't want to put them in harm's way. I don't want to neglect that possibility. Sometimes people think boys are more likely to repeat than girls, and that's not always true, so we have to give education to both genders so that they're aware of what that means and what it could involve, and all of the above. So it's a it's a very interesting and important topic, and I love that you're talking with people about it, because sometimes they just want to take kids in, and they haven't thought through all these different parts, and they need to stop a little just, just pause and reflect and hopefully, then take the child with an understanding they didn't have prior,

Dawn Davenport  29:07  
go into that with your eyes wide open, and have safeguards in place. We're going to talk at the end about specific safeguards. You've already mentioned a couple. So what are some we just talked about the, I think, the greatest fear that parents have about the long term impacts of having been sexually abused, and that is acting out sexually against another, becoming an abuser. But what are some of the other long term impacts that sexual abuse can have on a child? Yes,

Speaker 1  29:35  
and I think that I'm going to go back to those things I mentioned before, the fear and anxiety. So now you have children with fear and anxiety and showing it in a particular way. But now, if that's never been dealt with and kind of been put on the side burner, eventually, that can really become debilitating anxiety where adult survivors don't leave the house and now with burn. Actual working some of the people that I know are just choosing to stay at home. They don't really want to interact with anyone else. It only feels safe when I'm at home, behind closed doors, sometimes with the shades drawn. So fear and anxiety, inability to sleep from nightmares and night terrors, I mean, so it has different manifestations. The second category being depression. There's a study that was done called aces that I'm sure everyone's familiar with, the adverse situations in childhood, and it appears that many people actually have many adverse experiences as they're growing up, and this can cause, therefore, an expectation that nothing's ever going to change, that people are are never going to really want to be with you or love you. And so depression sets in. And now, with depression comes cutting, alcohol abuse, physical ailments, and in addition to that, suicidality can be much higher in adults who have experienced sexual abuse then, especially again, without any intervention whatsoever. I think the good news now is most kids who are sexually abused are going to get some help along the way, but that was not true in the old days. I hope

Dawn Davenport  31:13  
you're right, if it's reported, and yes, I think clearly if it's reported, but I suspect there's still a lot of sexual abuse that goes on that is unreported. I

Speaker 1  31:23  
agree with you, and again, that's the educational piece. Just to finish off on that thought before I go away, on the sexual behavior problems that children might have now, you have people who are sexually abused to have developed almost like phobias, disinterest or promiscuity. I had a girlfriend of mine, a professional colleague of mine, who did a study on exotic dancers, and I think her finding was like 93% of them had histories of sexual abuse. And then when you do the anecdotal work, what they say is, I want sex to be my strength, and I want to be the one who decides what I'm going to do and not do. And so they feel a tremendous amount of power on the stage with their sexuality. And so that's one extreme, and then you have the other which they're phobic. They don't want to be touched. They don't touch themselves. They're asexual. There's all kinds of sexual disorders associated also with sexual abuse in childhood, and then dissociative kinds of behaviors where people are kind of in and out of reality, and they prefer to kind of be in their own little world. And so again, you get this picture of a struggle, and you get this picture of everything feels challenging in a social arena, in a in a work arena, in personal arenas, in relationships in particular. So all of those are things that can visit. I think we're in a in a stage right now. That's interesting, because it's amazing that Bessel van der Cookes book on trauma the body, Keeps the Score. Yes, has been so popular and so well received by so many. So it gives me kind of a little bit more of an optimism that people are now interested. They're hearing things, perhaps for the first time. They're understanding that things that happened to them weren't normal, and that some of the problems they have may be associated with that. So I think this is good and keeping that education out there. And of course, as you just said, we're also still concerned with the cases that aren't reported, because a lot of people don't want to bring things out into the open, or have their neighbors mad with them, or make a mistake, report it and then have somebody find out it was. I mean, there's all kinds of fears associated with that. So we still have a ways to go, but I'm feeling optimistic of late that people are so interested in this topic and so many more people are experienced, well trained to provide services for trauma,

Dawn Davenport  33:48  
right? And I think perhaps the reporting is quite different, whether it's sexual abuse that happens within the home or sexual abuse that happens with a predator outside the home. And honestly, kids who are in foster care are more likely to report it because there is a safety in the fact that they have been removed. I would suspect one of the long term impacts that we read about is guilt. The child will feel guilty because they may have enjoyed part of the experience. Maybe it's just the attention they were getting, or maybe the fact, especially as they are older, I mean, touching your private parts is a pleasurable thing, and so there was pleasure associated. And there's also they likely have been told that they were part of the decision to do this, that they were provocative, or that they wanted it, or whatever. And that's so confusing, because, yeah, there's a part of them that might have enjoyed it, but children can't give consent. 13 year olds don't give consent, you know, so nonetheless, but it seems to me that that is a particularly problematic long term impact to carry with you

Speaker 1  34:58  
absolutely. Lee, and I cannot really tell you how many women, especially, come in with this incredible guilt that they made their father touch them, or that they were provocative in some way, provocative in some way, and the guilt of perhaps not telling someone that they should have and they didn't, they didn't stop it because, yes, all of that. I mean, it's it's incredible, and there's a lot of shame associated with sex, yeah. And so those two issues in treatment are the two most persistent areas that we have to keep working on and kind of revisiting it, looking at it from different angles, helping people understand that they were children when this happened. I sometimes say to people, how, how old were you? Then to a six year old, and then I have them go look at a six year old. Just find someone that's six years old. Look at them. Observe them. Do you think that that child would have the wherewithal know that that was wrong, or to go against the wishes of a parent? Just, just remember that it's not you as an adult. This is thinking about something that happened when you were very young and had vulnerabilities and limited resources, limited understanding, limited perception. So we keep working on that until people it has to fit for them, it has to resonate at some point like I'm beginning to get it, I'm beginning to understand. And it's a slow process. I think it takes quite a while because it's so private, and they've been holding it as a secret, yes,

Dawn Davenport  36:27  
exactly, exactly, and it's built up exactly. This is such an important interview, I hate to interrupt it, but I do want to let you know that creating a family has a newsletter. It is monthly, it is e newsletter, and it is free, and we have curated the best of what we have found that month to help you in your parenting. AND you can subscribe at creating a family.org/newsletter now back to the interview. I want to move now to talking about helping kids heal. This is a particularly important because our audience, our foster, adoptive and kinship families and the presence of one caring adult can make all the difference. One supportive adult can make all the difference in the world and how a child recovers from sexual abuse. And so our audience are the, we hope, are, the one caring adult, the one supportive adult. So what can parents do to help a child who's come into their home, or, let's just say, any, I mean, it could be, even be biological families, where one of the parents finds out that the other parent has abused, or that an uncle has abused, or are the child has been abused outside the home. What should a parent respond if a child discloses sexual abuse?

Speaker 1  37:57  
I think that if a child discloses the best response is to thank the child for telling them and letting them know what's going on, not to ask a lot of questions, because sometimes, when we hear something, we want to know the when, where, how and how. Many times that's really a forensic interview. But I think just feelings and anything the child wants to offer about what they felt, how it feels to have told what they thought might happen if they told and then to provide an empathic response and just say, thank you so much for telling me this is really important. You need to understand that this was not something you did, but something that someone else had a problem with. And so those the kinds of messages you want to do and and just be present and matter of fact and patient and empathic. I think the most important thing, the most important tool we have, is ourselves and our willingness to be with something difficult, our willingness to hold whatever the experience is that they're giving us without running away or getting scared. And if you if you do feel yourself getting that way to simply say, give me a few minutes. I really just I I'm surprised by what you've said. I appreciate so much that you're trusting me with it. Give me two seconds to just kind of try to understand what you're telling me, and just sit with the child, and then when you feel like you could kind of take a few deep breaths and then just say, thank you so much. And I just want you to know that it's wrong for any adult to do that to a child, and that it has nothing to do with you. It really has everything to do with them and what was going on in their mind, mistakes they made with their behavior. But I think the most important thing we can do as I mean, I think of myself as part of a treatment team alongside the foster parents or the caretakers, the kinship family members available to us, and all I'm trying to do is say the technique isn't as important as. You being present and empathic and consistent and just patient and not reactive, but responsive. And there's a difference between those two things that kids don't need at that point to deal with your emotions about what they've told you, or your fear or your worries. They need someone to hear them, so you just want to make sure that they believe that they've been heard, and that's important. Sometimes I'll just repeat. So let me get this straight. So what you're saying is this, and you told me this as well, so that's what's happened. Yes, okay, great. I just want to make sure I'm understanding what you're telling me and how important it is for me to listen and and to just again. Then when you repeat, it's kind of like and just to make sure you know this is not about you. This is about so just consistency, empathy, patience and again, no reactivity, much more a responsive thing. And sometimes after you do that initial holding them in place. Maybe you want to rock them for a while, sing a song together, just be nurturing and empathic. At some later point, you begin to give education. You begin to give information. So you know, if a child goes and hits another child, you can stop them and hold their hands and say, I know you learned that hands are for hitting, but really they're not. So I know you've learned this, and so you're there's probably going to be times when you think it's okay, but really it's not. So I can see you were angry at your brother. Let's talk about how to do that differently. And you kind of interrupt. And any of those behaviors, to me are questions. If a child throws something at me in the middle of a session. I think it's a question. I think they want to know, am I going to hurt them? Is this a safe place? Can they show themselves to me? And so I will stop, and I will say, you know, I noticed that you threw something at me, and I want us both to be safe in here. So that's not okay for you to do, but I can see that there's something you want to share with me, or there's some way you want to connect with me. So let's just sit and do something and then you go on to something else. So you set the limit in a kind way, and it's also with the understanding that they're doing that because they're asking something. And I think that can be important.

Dawn Davenport  42:16  
Are there protective factors, either in children or in families, or both, that make recovery more likely.

Speaker 1  42:24  
I think children being seen and heard and valued, where they're not in a situation where they have to defend themselves, explain themselves, but they're just accepted and nurtured. I think those things can really help with kids not taking things on to themselves and believing that they've done something wrong and kind limit setting that's an important piece of parenting children anyway, they need to have some kindness, some wisdom, and know when it's a good time to do education and when it's not. Sometimes kids, they're so emotional, they don't hear they just need help, and other times you know that they're present and that there's an opportunity that's called a teaching moment, and then you take that, you know, yeah, and foster parents can say, I've worked with lots of other children who've had these issues, and that would be accurate.

Dawn Davenport  43:17  
One more interruption before we get back to Dr Gil, and that is to tell you about our free courses. We have 12 free courses that are for people who are actively parenting. They could be adoptive parents, they could be foster parents, they could be kinship parents. We do have certificates of completion for these courses, if you need them. They are one hour. They're just terrific courses. We thank jockey being Family Foundation for their support in bringing you these courses. You can access them at Bitly, slash, JBf. Support. That's B, i, t, dot, l, y, slash, j, b, f support. And now back to Dr Gilmore. What are some practical tools and talking points to assist a child in relearning healthy boundaries and relearning expressions of healthy affection? You earlier used the example of a child who is rubbing her foster father's knee or sitting too close or sitting on the lap in a way that is too close or I mean, sitting on the lap is a fairly common thing, but there are some behaviors once you're sitting on a lap that feel uncomfortable for the Father. So what are some practical things that parents can take from this to say we need to help this child relearn some healthy boundaries and healthy expressions, healthy affection. What can we do? What are some practical tools?

Speaker 1  44:47  
I think for me, it's always been important to do something concretely for the child to learn. For example, I sit within a hula hoop and I'll put another hula hoop down for the child to sit and. My first way of talking about what boundaries are, that we have these invisible lines between us as human beings, and that we don't just jump into somebody's space when we don't know them, or hug someone we don't know. And so just learning about what physical boundaries are, and that we stay within our own spaces, and we don't walk into other people's spaces. And really, they shouldn't walk into our spaces. And if you don't have a hula hoop, you can use, you know, tape, just make a circle and have them sit within the circle,

Dawn Davenport  45:30  
or even the old fashioned carpet squares. You know, they're kind of, they're a little small, but yeah, they were bigger, absolutely.

Speaker 1  45:36  
And again, the idea is to name the behavior that's inappropriate, to name it, set the limit, and then provide an alternative. So that, to me, is the most important piece. If you say to them, it's not okay for you to hit or hurt me. But when you want to connect, we have lots of different ways we can connect. We can sit down and do a drawing together, and we can have a conversation together, and we can go do play together, or whatever it may be, those are the things really name it when you sit, we need to have a little distance. You're a little bit too close right now, and that doesn't feel comfortable for me. So what I'd like you to do is move over a little bit, but I still want to be connected to you, so maybe your chair and my chair can touch at the corner or something. So you gave them that, and you want the alternative to be there too, so they don't start thinking they've done something wrong or there's something wrong with them, because there isn't, and it's repetition too. I mean, I have little kids where I have to repeat something. I had a little boy would grab my breast to say hello, and every single time I would say to him, it's not okay for you to touch my breasts, and I won't touch you physically on your body. However, I can tell you're trying to say hi, so we can slap five, or we can wave, or we can shake hands, all those would be an okay way touching my breasts is not I had to say that I think 15 times before the child finally you could see him. He would go to reach over, and then he'd withdraw, and then he'd go, Hi Eliana, and he would shake hand. But it took a really long time, so we have to be patient. It's not a one time thing, and they get it, and they they keep asking the same question over and over again. It

Dawn Davenport  47:18  
took a long time to damage these kids, it's going to take a long time to help them heal as well. Yes, well said, yeah. So how do we find a therapist to help a child heal from sexual abuse? Because not all therapists are are comfortable, are qualified, right?

Speaker 1  47:36  
You know, I think the best first step to take is to be in touch with either Child Protective Services or child advocacy centers, the ones that do the interviewing process, because they have a list of referrals and so like, if you call our CPS, they'll tell you, Well, if you're looking for sexual abuse treatment, I know of these three or four places, and they sometimes even have contracts with Those places to provide services to kids in their system. So I always start there. You can go to Psychology Today, there are listings from people, and they do list the topic areas they work on. However, in my experience, it's much better to have a verbal interview, because sometimes people say they do something. You start talking to them, and they say, Well, I did see one client last year that had this issue. You don't want that. You want someone who's going to be able to say to you, you know, 60% of my practice is working with sexually abused children or to go to a sexual abuse treatment program when there are a number of those around as well. But you're right, especially with children with sexual behavior problems, it's almost like they're the Forgotten few. Yes, people are much more likely to work with victims, but when they think of a victimized, they immediately assume these are bad kids or they're going to grow up into sex offenders. And we don't have any evidence that shows any of that you know that they're going to grow into sex offenders, but we do have to do interventions and make sure they're safe and monitored. Those treatment specialists are hard to find now they are, yeah, we get a lot of calls for those because they know we do a program with those children. But there are lots of places they turn those children away, which is sad, because really it's the other side of a victim. Yes, miser, often we're

Dawn Davenport  49:22  
re victimizing these kids by painting them as potential victimizers, potential abusers. In the future, we have got to stop doing that. It's very hard to find good therapy, but I very much appreciate what you're saying is that we also, and you have reiterated this throughout, we have to protect children already in the home, as well as the foster parents, but in particular, children who are already in the home, we must protect them because acting out sexually, even whether it is truly. Abuse, or whether it is post traumatic stress or post traumatic trauma that these kids are displaying. Nonetheless, we do have to have protections for children already in the home. So what are some specific things that parents need to know? You've mentioned one, and that is teaching the children already in the home about the three types of touches, and then letting them know that it is not okay, and that if anyone in the home tries to or outside the home tries to touch their private parts or makes them feel uncomfortable, that they should come and tell you immediately that they have done nothing wrong if that happens, and that they need to tell you that is the bare minimum, and we should be doing that anyway. Can you go through the three types of touches one more time? Yeah.

Speaker 1  50:47  
I mean, I think starting and leading the conversation with most touches really good and appropriate. And people who love each other do hug each other, sure and do all of that. And hopefully they're getting a lot of that, you know, more kisses and hugs when they come home, and that's all great. The second is the ouch touching, as they call it in this particular program, and that just means anything that hurts physically, like kicking and pushing and biting and pulling hair. And then the third one is the touching of private parts that should not be happening by older children or by adults or anyone else. So I think those things are important. I think that also monitoring and supervision are really necessary, especially when kids first arrive at a foster placement, because they might feel stress and anxiety about being in a new place. And sometimes when anxiety rises, then there's a kind of a bridge over to other anxious experiences, and it might be fear that someone's going to come in their room. And again, sometimes kids kind of take mastery opportunities. So they said, Well, I'm not going to sit around and wait. I'm going to go into the other kids room. And so they really do need monitoring and supervision. And sometimes, to the extent that people put little cameras up or baby monitors or things like that. You need to take care. Hygiene is important. Kids shouldn't be in the bathroom together. They shouldn't be taking showers together. For children who've been sexually abused, that puts them in vulnerable, challenging positions whenever the community or having to share bathrooms with someone the TV, what they're looking at, because kids now have access to all kinds of things on television and also on social media. And so these children can get into that. And if they get into that, there's so much pornography used by children right now, it's huge. It's huge. And if they get into that and the child's already been sexually abused, then it's kind of reinforcing writing already been exposed to and already learned. So foster parents, again, have to really be cautious without being paranoid. They have to provide guidelines around the use of social media. Make sure they're they're locking up their computers as best they can, making sure they know what their kids are watching, withhold the

Dawn Davenport  53:04  
access to cell phones as long as they can. That's difficult for foster parents, because oftentimes kids come into the home, creating a family online and just teens. I mean, it's younger and younger, but once your kids have access to a connected device, although can then put on the parental controls, if it's not going to be possible to restrict the use of a self because that's where a lot of things viewed incredibly Yes,

Speaker 1  53:32  
it's amazing, and I just think we have to be so careful. And also the video games, you know, some of them are incredibly aggressive, they're violent, they're they're really awful, and kids are killing, and they're killing in particular, and it's desensitizing them all the time through aggression. And in some children, obviously not all you can actually kind of encourage the use of aggression. Again, I'm not saying kids are going to watch it and be violent, but I am saying that for some vulnerable kids, it really does produce enough tension and enough kind of interest that the repetition can occur. So we have to be super careful about that. And

Dawn Davenport  54:12  
that may be something if you can restrict or if you can't restrict it for whatever reasons, then to have it be they play the games in your presence, yeah, and you play exactly, as could say, or you play with them, yes, exactly, so that you could be commenting along the way, which is something that every teen really enjoys, is to hear all the comments that their parents make while they're playing games. Well. Thank you so much, Dr Eliana Gil for talking with us about this really important topic. I truly appreciate your expertise and your optimism. I appreciate both very

Unknown Speaker  54:47  
much. Thank you so much. I appreciate it.

Transcribed by https://otter.ai