Abstract
In this study, we explored older women’s reflections on processes of healing related to childhood sexual abuse (CSA). We aimed to answer questions about how childhood trauma was integrated into the life story and to identify factors or coping strategies that aided, or hindered, healing. Participants within this study included 12 women who were aged 60 or older and had reported CSA as adults at the beginning of the research project, 25 years prior. Qualitative interviews were conducted exploring women’s reflections on the place of CSA in their lives over time and factors the participants thought were helpful or unhelpful in being able to come to terms with the abuse. Data were analyzed using thematic analysis, which resulted in three themes related to processes of healing. The themes identified were need for resolution, thinking about it differently, and developing agency over disclosure. The findings show that some form of resolution was needed for the women to recover and move on from their experiences of CSA. The two key strategies used to reach this resolution were reframing their experience or drawing upon positive life philosophies. Decisions around disclosure were also an important part of the healing process, with the women developing an agency over if, and how, they talked to people about their experience. Those women who were not able to make sense of their experience continued to be influenced by the negative feelings and memories associated with the experience. Our findings have implications for health professionals working with those who have experienced trauma. They demonstrate that there are a number of ways that people heal from trauma and find personal resolution across their lifespan.
Childhood sexual abuse (CSA) is a traumatic event linked to a range of negative psychological symptoms. Despite the trauma of CSA, over time, some people experience a reduction in the negative psychological symptoms. Researchers have explored healing in the aftermath of CSA using quantitative and qualitative methods and framing it through a range of different theories. Yet, few studies have focused on older women’s experiences of CSA. With increased life expectancy in high-income countries, it is particularly important to understand factors contributing to well-being in older age. This article adds to the current body of research using qualitative methods to explore the processes that allow people to heal from CSA over a lifetime. Importantly, we include participants who prospectively reported CSA 25 years prior to this study. To our knowledge, this is the first qualitative study to explore women’s healing from CSA using a longitudinal design.
Research shows the trauma of experiencing CSA is associated with an increased risk of a broad range of negative outcomes. Common outcomes associated with CSA include low self-esteem, depression, anxiety, and suicidal ideation (Easton et al., 2019; Fergusson et al., 2013; Filipas & Ullman, 2006; Krayer et al., 2015; Ligiéro et al., 2009; O’Brien et al., 2007; Sigurdardottir et al., 2014). Experiencing CSA can also affect survivors’ ability to form relationships with others (Easton et al., 2019; Filipas & Ullman, 2006; Krayer et al., 2015; Ligiéro et al., 2009; O’Brien et al., 2007; Sigurdardottir et al., 2014) and is associated with an increased likelihood of problem alcohol and drug use (Fergusson et al., 2013; Filipas & Ullman, 2006).
The debilitating impact of CSA is a common narrative; however, this narrative has been critiqued by researchers. Dominant narratives of CSA construct child victims as sexually innocent and CSA as so traumatic it invariably influences the rest of a victims’ life (Woodiwiss, 2014). The dominance of trauma narratives limits how survivors of CSA can interpret their experiences and the way their experiences are interpreted by others. Authors who critique trauma narratives acknowledge the variation in both experiences of abuse along with recovery from it (Brison, 1999; Hunter, 2010; Tener & Murphy, 2015; Woodiwiss, 2014). Research exploring the impacts of CSA supports this notion of variability, identifying a range of factors that can influence the impact of CSA. These include the type of coping strategies used by the survivor along with conditions under which the abuse took place (Arias & Johnson, 2013; Draucker & Martsolf, 2008; Easton et al., 2019; Filipas & Ullman, 2006; Willis et al., 2015). For example, coping strategies associated with poorer long-term outcomes include withdrawing from people (Easton et al., 2019; Filipas & Ullman, 2006; Krayer et al., 2015; Ligiéro et al., 2009; O’Brien et al., 2007; Sigurdardottir et al., 2014), using alcohol and drugs, or engaging in dangerous sexual practices (Fergusson et al., 2013; Filipas & Ullman, 2006). Those who use these types of behaviors as a way to address their trauma tend to exhibit more negative symptoms including posttraumatic stress disorder (PTSD) and distress (Filipas & Ullman, 2006; Willis et al., 2015).
In contrast to coping strategies that can perpetuate distress, researchers have also identified behaviors and coping strategies that are linked to recovery. These include finding a way to think about the abuse differently (Arias & Johnson, 2013; Krayer et al., 2015; Perrott et al., 1998; Willis et al., 2015), taking control of the traumatic memories (Draucker & Martsolf, 2008; Ligiéro et al., 2009; Simon et al., 2010), and talking about the experience (Anderson & Hiersteiner, 2008; Draucker et al., 2011; Easton, 2013; Jonzon & Lindblad, 2005; Tener & Murphy, 2015). People who engage in these coping strategies tend to have higher levels of self-worth and agency (Arias & Johnson, 2013).
Talking about traumatic experiences has been identified as a particularly important step for being able to heal from the aftermath of CSA (Anderson & Hiersteiner, 2008; Brison, 1999; Draucker & Martsolf, 2008; Easton, 2013; Harvey, 2000). There are a number of theories that attempt to explain the importance of talking about traumatic events. In particular, account making theories of trauma posit that those who do not talk about their traumatic experience are forced to view this experience through their original account of the event. In the case of CSA, the original account is often one supplied by the perpetrator and is likely to include aspects of victim blame. By talking to others about their experience, survivors gain access to different perspectives. These alternative perspectives can help survivors of trauma shift the attribution of blame from themselves to the perpetrator (Draucker & Martsolf, 2008; Easton, 2013; Harvey, 2000). Talking also acts as a way to process the event (Anderson & Hiersteiner, 2008; Brison, 1999; Draucker & Martsolf, 2008; Easton, 2013; Harvey, 2000), whereby retelling of the event gives the survivor a sense of authority and control over their memories (Brison, 1999; Easton, 2013). External validation in the form of others believing their experience is also an important aspect of disclosing traumatic experiences (Brison, 1999; Easton, 2013; Harvey, 2000).
The ability for survivors to make sense of their experience through disclosure depends on the response they receive (Jonzon & Lindblad, 2005; O’Brien et al., 2007; Tener & Murphy, 2015). Positive responses to disclosure can play an important part in the recovery process (Jonzon & Lindblad, 2005; Tener & Murphy, 2015), but those who receive negative reactions to disclosure often report more negative psychological symptoms (Jonzon & Lindblad, 2005). Negative responses to disclosure may also reduce the likelihood of further disclosure. If account making theories are correct, this would mean those who have a negative experience with disclosure might be less likely to recover from CSA.
Along with disclosure, researchers have also identified other characteristics that can affect the severity of the negative symptoms of CSA. Abuse characteristics including identity of the perpetrator and frequency of the abuse affect the severity of psychological symptoms (Fergusson et al., 2013; Filipas & Ullman, 2006). Abuse by a known perpetrator involving penetration and occurring a number of times is associated with poorer psychological health (Fergusson et al., 2013; Filipas & Ullman, 2006). Other studies draw attention to the impact of coping strategies on psychological outcomes (Jonzon & Lindblad, 2005; Perrott et al., 1998; Simon et al., 2010; Willis et al., 2015). For example, those who do not find a way to make sense of their CSA and instead avoid or suppress the abuse memory tend to have poorer psychological health than those who are able to work through it (Perrott et al., 1998; Simon et al., 2010; Willis et al., 2015). These findings suggest that while initial abuse characteristics might influence the severity of negative symptoms, there are behaviors survivors can engage in to help them recover from abuse.
Age is another factor that influences psychological health. Among the general population, psychological well-being reaches the lowest point between ages 45 and 54, thereafter steadily improving (Blanchflower & Oswald, 2008). Consistent with research on well-being, studies find that those in older age brackets have lower levels of mental disorders than younger cohorts (Jorm, 2000; McEvoy et al., 2011; Sunderland et al., 2013). Although the negative impacts of CSA can last across the lifespan (Draper et al., 2008; Ege et al., 2015; Fergusson et al., 2013), recent research demonstrates that CSA survivors also experience psychological benefits associated with aging (Easton & Kong, 2017; Rapsey et al., 2019). The better psychological health of adults at the end of middle age and into older age might be explained by skillful emotional regulation along with memory biases that favor the recall of positive compared with negative memories (Charles & Carstensen, 2010; Charles et al., 2003). The lower levels of negative psychological symptoms within older adults suggest that this group might be the most likely to have healed from the negative impacts of CSA. Older adults, therefore, present a promising study population for exploring processes that enable healing as well as differences between those who do and do not heal from CSA.
In this study, based on research that shows improving psychological resilience during this life stage, we explore the narratives of women at the end of middle age and in older age. Participants were asked to reflect on the place of CSA in their adult lives, including the ways in which they were able to heal, or were impeded in healing, from the experience of CSA. We used a longitudinal design to investigate healing from CSA in a sample of women who first reported experiencing CSA 25 years earlier. A longitudinal design is important because we know from cross-sectional, quantitative research that older people are substantively less likely to report experiencing CSA (Draper et al., 2008). It may be that the smaller number of older participants who reported CSA in cross-sectional research were more likely to be those for whom CSA was most salient and for whom the negative effects of CSA were most persistent. In recruiting women who had first reported childhood abuse 25 years earlier, we hoped to include women for whom memories of CSA no longer occupied a prominent role in their lives.
Method
Ethical approval was granted by the University of Otago Ethics Committee, Health. This study is part of a larger project, the Otago Women’s Health Survey, which began in 1989 with a randomly selected urban sample of New Zealand women. Two follow-up interviews were conducted in 1995/1996 and in 2013/2014. The initial study is described in more detail elsewhere (Martin et al., 1993).
Recruitment
The participants for this study were selected from the pool of participants who took part in the third follow-up interview in 2013/2014 and who had agreed to be recontacted for any subsequent interviews. Women who were 60 years or older, had reported CSA in 1989, and were living within traveling distance of the University were invited, by letter, to take part in a qualitative interview. The first 14 women who agreed to participate were selected.
Participants
The participants ranged in age from 60 to 80 years with an average age of 71. Most were married or in a long-term relationship (n = 10), three women were widowed, and one woman was separated. Six women reported having a paid job; of those, three worked less than 5 hours a week. All of the women reported being satisfied or very satisfied with their work. Five women reported doing voluntary work and three of these women were also in paid work. Most women (n = 10) reported having good or very good physical health. Nine women reported that they had sought professional help for emotional reasons at some time in their life. Ethnicity data were not collected for this research, and we reflect on the limitations of this in our discussion.
Procedure
Interviews took place at the University of Otago in 2016. Participants were contacted and interviewed by the same female researcher who had conducted the most recent follow-up interview in 2013/2014 and was therefore known to participants. Interviews were approximately 60 to 90 min long. The interviewer asked open-ended questions beginning with general questions on life satisfaction and good and bad events over the life course before focusing on the CSA experienced. Open-ended questions about the experience of CSA were used to ask participants to reflect and discuss the place of CSA in their early life and currently in older age, how their experiences may have changed over time, what was helpful/unhelpful, whether they thought resolution had been reached, what helped with resolution, or what difficulties they might still encounter. The interviews were transcribed verbatim and any identifying information was removed. The names presented with the quotes in the “Results” section are pseudonyms assigned by the researchers.
Analysis
The interview transcripts were analyzed using Braun and Clarke’s (2006) guide to thematic analysis. The analysis was a focused inductive analysis centered on processes of healing from CSA. Key research questions included the following: What effects has CSA had on the participants’ lives? What role does the participants’ experience of abuse play in their current lives? What has helped them heal or move on from their abuse? What is the place of CSA in their life story? Has their perception of their CSA experience changed over time? Analysis was done using a constructionist epistemology, which allowed consideration of the role subjectivity and societal norms played in the women’s understandings of their experience (Braun and Clarke, 2006). The analysis was primarily conducted by the first author. The first step of analysis involved reading through each of the interviews and highlighting all sections relevant to the aims of this research. After the first reading, initial notes about content were made. Following this, all of the interviews were read again and relevant sections were labeled with codes. The coded extracts were then sorted into categories with similar meanings to develop initial themes. At this point in the process, there was a discussion between all authors about the initial themes. All of the data were then reread to check the consistency of initial themes across the data set as well as to refine themes and the content within them. The three initial themes were refined based on this rereading and theme names were developed. Analysis resulted in three themes related to the women’s process of healing from CSA. The themes are presented in the following section accompanied by quotes.
Results
This section begins by providing contextual information about the impact CSA had on the participants’ lives. Following this, three themes about processes of healing are presented. For most of the participants, their experiences of CSA had impacted them at some point during their lives. Many of the women described the impact CSA had on their perception of themselves and others. Some of the women saw themselves as partially to blame for the abuse, which impacted their sense of self. For example, Ruth’s sense of self was impacted when she attempted to determine why she was abused. “Sometimes in the back of your head you always wondered. Did I dress appropriately? Did I, did I do something to basically tickle his fancy?” Other women described how the CSA affected their self-esteem. “The childhood abuse probably made me feel a wee bit worthless. No is that the right word . . . a wee bit soiled.” (Meredith). The CSA also made many of the women cautious of other people. One way this perception presented was in a wariness toward men. For some of the women, their caution was specific to older men, “But I was always very wary around older men” (Beatrice). Other women felt like the abuse affected their relationships more generally, making them closed off to all people; “Well, for me, um, after all of that carry on, well, um, it was like, um, couldn’t trust anybody.” (Rebecca). Overall, the abuse appeared to prompt many of the women to be particularly cautious about who they trusted. Despite the trauma of CSA, most of the women within this research had reached a point where they had healed from their experiences of CSA and it no longer played a large role in their lives: She said “oh, you must feel really bad . . . blah blah blah,” and I says “no, actually.” I said “I’m not a victim anymore. I’m a survivor.” And I said “I’ve come back here to make new memories and happy memories.” And that’s exactly what I’ve done. (Rebecca)
These women talked about having “normal” lives and described a range of things that made them happy including their children, their husbands, and their jobs. Judith provides an example of someone who was satisfied with all three. “My husband’s great, our kids are good, our grandchildren are lovely, and in the first part my paid employment I enjoyed and was satisfied by, um, my volunteer work . . . I enjoy and I’m satisfied.”
The focus of this article is processes that enabled or inhibited participants to live satisfying lives despite the trauma of CSA. Analysis produced three themes around the women’s process of making sense of the abuse: need for resolution, thinking about it differently, and developing agency over disclosure.
Need for Resolution
Most of the women described that the abuse no longer evoked frequent or overwhelming emotions; however, three of the women described still feeling anger about the event. This anger appeared to be linked to these women’s perception of the abuse being unresolved. Beatrice explained how she had been unable to move past the abuse in her childhood because her abuser faced no consequences: I’m just still really angry that he got away with what he did, with no consequences for him. Whereas I now still relive a lot of it and I would just like to have seen him be punished or whatever in some way. (Beatrice)
For Beatrice, the absence of justice increased the ongoing distress she experienced from the abuse she relives on a regular basis. Beatrice talked more specifically about how her anger at the absence of justice had intensified with her older age: I’ve found as I’ve got older, I’ve seemed to have a lot more, maybe anger and I feel quite vengeful at times and there is nothing I can do about changing what happened in childhood. And I feel like I want someone to be punished but I know that that is not going to be a happening thing so . . . yeah I reflect back on that and things that I’d expected of my parents maybe that they let me down and I never ever had an opportunity to discuss anything, especially with mum. And it’s too late now to . . . so it’s like a lot of unfinished business with my feelings. (Beatrice)
For Beatrice, the sexual abuse from her childhood was still a dominating part of her life as it still felt unresolved. She felt let down by a number of people and never got a chance to talk to these people about her experience. The absence of justice left Beatrice feeling trapped in her unresolved feelings about the event. Jane described a similar sense of injustice, which plagued her at times: If I think about it, now and again, as I say, you know, and it’s not very often, but that’s probably when it would, ah, have the most impact on me. He got away with it, I guess, and that is the thing, you know. (Jane)
For these women, the absence of justice affected their ability to move past the event as they felt like there was no definitive resolution. The absence of resolution meant these women continued to experience negative feelings and anger, whereas the person who abused them faced no repercussions. Although none of the women in this study had formal justice (where the perpetrator was prosecuted), some of the women found other ways to achieve resolution. These alternative routes to resolution are explored in the following theme.
Thinking About It Differently
Many of the women had learned to view the abuse differently. Although the specific ways each woman enacted these strategies differed, they appeared to play an important role in them being able to heal from their experiences of abuse. There were two key strategies the women used to think about the abuse differently. These two strategies are covered in the subthemes reframing the experience and drawing upon positive life philosophies.
Sub-theme 1: Reframing the experience
Six of the women appeared to reframe the abuse. Judith provides one example of how reframing allowed her to make sense of the event: Well, see I wasn’t abducted by that bloke in the park and in fact my cousins in some respects were an advantage because when I was felt up in the tube and all of that, I already had a knowledge of it or a realisation. (Judith)
Judith reframed her abuse by contextualizing it in comparison to the worst-case scenario. By comparing what happened with what could have happened, Judith was able to frame the experience as something that could have been much worse and could have had a much greater impact on her life. Judith also reframed the sexual abuse as providing her with useful tools she was able to use in other aspects of her life. This type of reframing was used by several of the other women; Katherine provides another example: I think I was lucky. It could have been 10 times worse. Maybe that’s why it’s been easier to forget about all of that but I guess that’s why I went away overseas I don’t know. Take yourself away. Go and do different things and have a life. (Katherine)
Susan contextualized her experience of abuse by comparing it to others’ life experiences, suggesting that she was not really any different from anyone else. “Whose life’s perfect anyway, you know? I mean, there might have been some other thing brought about by some other event that wasn’t an abusive event that could have caused some other quirk in my personality” (Susan). Like Susan, Yvonne reframed the event for herself by comparing it to others’ life experiences: Oh yeah, well I don’t even, I don’t even worry about it now because it’s just, I mean I was lucky. I mean I never had any of, you know, things like that happen to me. Not have intercourse or anything like that, I mean it might have been a different story if it had happened, you know. (Yvonne)
Like the women in the examples outlined above, Ruth also reframed her abuse but in a different way. Rather than reframing the event, Ruth reframed the perpetrators: But the empathy towards, um, the perpetrators is, I still think that they have been abused in some way, shape and/or form, to be the way they are and to think that what they’re doing is right. You know, like, they have no conscious conception that, hey! This isn’t right! Just do it. So you, you’ve gotta feel a little bit of empathy there. (Ruth)
By reframing perpetrators of abuse as victims, Ruth was able to have empathy for them. This reframing appeared to allow Ruth to makes sense of why she was sexually abused and to minimize negative feelings she might have for the man who abused her.
Subtheme 2: Drawing upon positive life philosophies
Positive life philosophies were another tool that helped the women make sense of their abuse and think about it differently. Ten of the women within this study talked about positive life philosophies that helped them make sense of their experience. Meredith, for example, described an attitude toward life that helped her move past the negative experience: I mean, we’ve got choices. We can make a big meal out of it or we can think well okay it happened, it was awful but let’s get on with it. And I think that’s what I’ve done with lots of things that have happened to me really. (Meredith)
Meredith framed negative experiences as a part of life and something you just had to move on from. Many of the women applied similar life philosophies to their experiences of sexual abuse. “I’ve got a few problems but you just plod on like everybody does. If you don’t help yourself you don’t get anywhere anyway.” (Elizabeth).
Some of the women attributed time and age as equipping them with the skills and philosophies they needed to move past their negative childhood experiences: For me it feels like an age and stage thing, there’s kind when you get to this age or stage in your life that, um, you kind of feel like you’ve had enough life to have learnt some things about life and what’s important and what’s not important. And I feel at peace about, about where that is. (Susan)
Those women who had made sense of the abuse no longer thought about it often. “So it’s not as if it’s a great boulder in front of me, it’s just a piece of baggage that I carry around. It’s just tucked away in there, really” (Susan). Although their abuse was mostly “tucked away,” they were sometimes triggered by certain topics, “I think that’s behind me, you know, way behind me. Every now and again it pokes its ugly head up because somebody mentions something but other than that, no.” (Ruth). Women that used strategies that allowed them to think about their experience in a different way appeared to be able to leave their abuse in the past. Although CSA was a negative experience that had happened to them, they had found ways to be content in the present.
Developing Agency Over Disclosure
The women within this study demonstrated agency over disclosing their experience of CSA. There was variation in the women’s decisions about when, who, and what to tell others about their abuse. This agency appeared to develop with time, with participants’ initial decision not to disclose being motivated by fear about the potential consequences or lack of knowledge. As women got older, their decision to disclose or not disclose their experience of CSA became a well thought-out decision. The majority of the women did not disclose their abuse until they were adults. Participants indicated two key reasons for not talking about the abuse as children, the era they grew up in and their age at the time of the abuse.
Many of the women attributed the era they grew up in as affecting their ability and willingness to tell people about the abuse when they were children. They saw this era as influencing their knowledge and attitudes about sex and bodily functions. “Like I always say it was swept under the carpet in our days. Under floor boards.” (Elaine) “The only single thing she [my mother] ever said to me was ‘you can’t have babies unless you’ve got your period’. And that’s all that I ever learnt about sex.” (Elizabeth). The silence around bodies and their functions contributed to the women’s perception that CSA was something they should not share. This “swept under the carpet” era was contrasted with what young children learn today. The women suggested children today are better equipped with the knowledge and understanding to tell someone if they are sexually abused. “Yes, in today’s world I think it makes a big difference. In those days I just had to you know shelve it. I couldn’t talk about it. I didn’t really know what it was in those days either.” (Elizabeth). These women viewed the increase in knowledge about CSA along with the reduction of stigma around talking about bodily function as increasing the likelihood of children disclosing sexual abuse.
Being a child was also a key factor in why many of the women did not disclose the abuse when it happened. Respect for adults, fear of the perpetrator, and uncertainty about the consequences of telling people affected the participants’ willingness to disclose during childhood. “All I remember is this fear that I didn’t want to tell my parents as it would be too embarrassing and I was scared he would kill me” (Claire). Fears about the potential consequences of disclosing included concerns about themselves (see Claire’s example) and others. Rebecca’s choice not to disclose her CSA during childhood was motivated by her desire to protect her sisters:
The old man said well, if I told anybody that then he’d do it to my sisters as well.
Your father said that?
Yeah, so I didn’t tell anybody because why put them through that as well?
Although Rebecca wanted to protect her sisters from physical harm, other women wanted to protect certain people from the emotional burden of CSA. Ruth provides an example of someone whose nondisclosure was motivated by a desire to protect others from the emotional burden. “So, so yeah, you learn to protect people around you a wee bit, and maybe that’s why we never spoke about anything like that.” (Ruth). For those women whose nondisclosure was about protecting others from the burden of their abuse, their nondisclosure often continued into adulthood. “What good would it do anybody? And the people that abused me are dead. Um, the rest of the family I don’t think would appreciate it.” (Ruth)
A range of reactions were experienced by those who did disclose their abuse. Some women viewed telling people about their abuse as a positive experience. For example, Beatrice enjoyed the opportunity that research participation gave her to talk about her abuse: “I have felt good and sort of safe here [in the research interview] talking about it. It’s like an outlet.” Beatrice’s talk about disclosure appears to align with account making theory. She was one of the few participants who appeared not to have reached a resolution and the only disclosure she had made was in the context of the research interview. Rebecca’s view of disclosure in the interview also aligns with account making theory as she suggested talking to someone was an important part of moving on from the event: I would say to somebody else though, even now, or earlier in the stages of their lives if they haven’t said anything to anybody to do it, because it just ruins your life. If you don’t talk about it, it’ll ruin your life. Yeah. And it will ruin marriages and relationships, so go and talk to somebody about it. (Rebecca)
Rebecca was one of the few women who explicitly talked about disclosure as an important part of coming to terms with the abuse, indicating talking about her experience had been an important part of her healing process. However, disclosing abuse was not always a positive experience; several women described getting negative or unexpected reactions. Yvonne provides one example of this: Yvonne: I did tell my mother once, and she just um, I don’t know whether I got a hiding or not, I can’t remember. [. . .] But I remember she wasn’t very happy with me at all and said that if I went and talked about it I’d go to jail.
Yvonne’s description of her mother’s reaction describes many of the concerns the women in this study had about disclosing the abuse as children. Yvonne was reprimanded and her mother appears to have constructed the abuse as something that should not be talked about. Moreover, her mother indicated that Yvonne herself was at fault, and thus, if she did make a disclosure again, she would risk greater punishment (i.e., go to jail).
Participants’ explanations of disclosure construct it as a complex and personal process. Over time, each women had developed agency over this process. In childhood, disclosure was often ruled by fear about the consequences of disclosure. In adulthood, however, it became an active choice made for individual reasons.
Discussion
In this article, we presented results about processes of healing from CSA. Although CSA remained a part of the women’s life stories, the majority described leading satisfying lives in which CSA was no longer a dominant aspect. Among the unique stories and processes of the women within our research, we were able to identify themes that capture shared experiences in the journey of healing from CSA. Our findings indicate that making sense of the abuse and coming to some kind of personal resolution are important parts of the healing process. Although there appears to be a diverse range of ways to find this resolution, those who are unable to achieve closure appear to remain impacted, to some degree, by negative memories and emotions of the experience into their older age.
Findings from this article align with much of the past research about the impacts of CSA. Women within our study talked about the impact CSA had on their sense of self, an impact that is well established in previous research (Easton et al., 2019; Filipas & Ullman, 2006; Krayer et al., 2015; O’Brien et al., 2007; Sigurdardottir et al., 2014). The participants also described the impact CSA had on their perception of others and who they were willing to trust, and this aligns with past research findings showing CSA affects relationships (Easton et al., 2019; Filipas & Ullman, 2006; Krayer et al., 2015; Ligiéro et al., 2009; O’Brien et al., 2007; Sigurdardottir et al., 2014). In line with past findings about coping strategies, we also found many women reframed their abuse or found ways to think about it differently, and this appeared to aide in their ability to heal from the abuse (Arias & Johnson, 2013; Krayer et al., 2015; Perrott et al., 1998).
Our findings are also similar to the findings from earlier research with the current sample. Interviews were conducted in 1995 with 40 participants (Perrott et al., 1998). At the time of the 1995 interview, participants were aged between 29 and 69 with a mean age of 44 (Perrott et al., 1998). Despite the younger age of the participants in 1995, there are some consistencies between the themes identified in the 1995 and our 2016 data. Analysis of the interviews conducted in 1995 also identified variation in the responses to coping with and healing from the abuse. Within these varied coping strategies reframing experiences and comparing their experiences to others as a way to process their abuse were key themes. At the 1995 time point, the participants also talked about controlling who they disclosed their experiences to as a way to protect others. The similarity in the findings from the interviews conducted in 1995 and 2016 suggest that those women who had developed effective ways to cope with the abuse (e.g., reframing) may continue to effectively use these coping strategies across their lifespan.
The findings from this study imply healing from CSA is a complex and individual process. The specific tools for healing differed for each woman, but finding some way to make sense of the CSA appeared to be an important process for healing. Those women who did not find a way to make sense of the experience, or reframe the experience and find some sort of personal resolution, continued to be affected by the traumatic memories from their childhood. Many of the women within this study had made sense of their experience of CSA; however, they made sense of their experience through a number of processes (e.g., reframing it), not necessarily through talking about the experience with others. Account making theories of trauma suggest the only way to process traumatic events and gain access to alternative accounts is by talking about the trauma with others (Anderson & Hiersteiner, 2008; Brison, 1999; Draucker & Martsolf, 2008; Easton, 2013; Harvey, 2000). Our findings demonstrate that talking with others is not the only way to form alternative accounts of trauma. That is, though talking about the experience with others was one way of processing the event and thinking differently about it, there were also other ways the participants developed alternative accounts of their experience. This included reflecting and reframing their experience or seeing the experience through the lens of a philosophical viewpoint. In this way, this study emphasizes the helpfulness of developing alternative accounts of trauma in relation to healing.
The importance of developing a coherent narrative of trauma with some kind of resolution or ending was best illustrated by those women who had not achieved it. The absence of justice or resolution meant that women continued to relive the event and experience ongoing anger. This is an important finding because formal justice is rare in CSA due to low rates of disclosure (Fergusson et al., 2000; Lyon & Ahern, 2009) and prosecution (Cross et al., 2003; Ernberg et al., 2016). Finding other ways for victims of abuse to heal and create a sense of resolution is therefore an important focus for health professionals. Some women in this study provided examples of finding personal resolution even in the absence of formal justice (e.g., by reframing how they viewed the perpetrator).
A unique feature of this study is that the women were selected to participate following their initial disclosure of CSA 25 years prior. As such, our sample might be less likely to have unresolved feelings about their CSA than a sample selected based on contemporary recall of CSA. Due to our sample being women who had historically disclosed CSA, their abuse may or may not be still salient and feelings about the CSA may be resolved or unresolved. This allowed us to capture processes associated with resolution and healing or nonhealing. This sample, where a history of CSA had been identified historically, but was not the reason for recruitment, is not an easily captured sample group and fits best within the context of longitudinal research.
A limitation of a longitudinal research sample is the potential impact of the healthy survivor effect. The women that remained within this study over the 25-year period may have been the ones who had best recovered from CSA and had better psychological and or physical health. This is supported by findings from the 1995 interview that indicated those women who reported having worked through the abuse were younger than those who reported that they had not. The 1995 research also identified differences in the original sample and the interview sample, with the interview sample having better mental health (Perrott et al., 1998). Both of these findings suggest those women who took part in the 2016 interview are likely to be those who have healed. Those women who were most heavily affected by CSA may have been more likely to drop out of the research study or have had poorer health outcomes which negated them being part of the sample. In this way, our sample may have been more likely to include women who, for a range of reasons, were able to experience healing; thus, providing the opportunity to explore questions focused on processes of healing. Nevertheless, understanding factors that limit the ability to recover from CSA is equally important in gaining an understanding of the best way to help persons who have experienced CSA. Future research could further explore barriers to healing through the inclusion of a sample of adults who are yet to heal from CSA or for whom the CSA is still salient.
The inclusion of older women is another important contribution to the literature as this is an often overlooked group. It is valuable to explore negative childhood experiences with an older age group to better understand the continued impacts of childhood trauma and how these impacts are mediated or resolved over time. Given that research suggests lower levels of negative psychological symptoms in older age groups compared with younger age groups (Jorm, 2000; McEvoy et al., 2011; Rapsey et al., 2019; Sunderland et al., 2013), this qualitative study on older woman contributes to understanding some of the underlying processes for the reduction in negative symptomatology.
Although not a central research theme, we note that several women commented that they found value in being able to discuss their CSA as part of this study. This is consistent with earlier follow-up research with this sample where, at that time, women who had experienced CSA remembered the first interview as a positive experience, 10 times more often than they remembered it as a negative experience (Perrottt et al., 1998). A wider body of research also finds that, for many people, participation in trauma-focused research can be a positive, or at least, not a negative, experience (Newman & Kaloupek, 2004). This is not to minimize the risks that trauma-focused research carries, such as the possibility of evoking emotional distress and unwanted, painful memories for a small subset of individuals (Newman & Kaloupek, 2004). Thus, we emphasize that it is essential that researchers consider research procedures that support and empower participants with histories of trauma (Campbell et al., 2019).
A necessary limitation of this study is the influence of cohort effects, which may not be relevant to younger cohorts. Participants talked about the era they grew up in as influencing their ability to understand and disclose their experience of CSA when they were children. It is hoped that differences around childhood disclosure of CSA may be different with younger cohorts due to societal changes that have reduced the shame or stigma associated with talking about sexual abuse. The diverse experiences of the participants within the study also act as a limitation. The experiences of CSA range from noncontact single occurrences perpetrated by a stranger, to ongoing abuse by a family member. Although analyzing abuse severity was outside the scope of this study, it is likely characteristics of the abuse impacted the healing process (Fergusson et al., 2008; Filipas & Ullman, 2006). Future research may want to take abuse characteristics into account when analyzing data as this may provide important contextual details in the healing process.
A further limitation of this study was that we did not collect data about the ethnicity of participants. As a result, we cannot make conclusions about the diversity of our sample and if aspects of ethnicity affect experiences of healing from CSA. Along with this, though retrospective data are a strength of our study, our focus on processes of healing is limited by focusing solely on the endpoint of participants’ process of healing. Although our findings indicate that the women had found ways to heal and include reflections on this process, all of this data come from one time point. Future research could use a similar design but collect interview data at different time points over the 25-year period. This would allow a deeper analysis of the processes of change as comparisons could be made between each time point rather than relying on the participants’ self-reflections on change.
This study aligns with previous findings that suggest victims can heal from traumatic experiences like CSA and go on to lead satisfying lives. Specifically, our findings align with previous studies showing that reframing of the event or talking about it help individuals recover from the experience. Overall, the findings suggest healing from CSA is a complex and personal process. Previous research has documented the importance of disclosure for the recovery process. We found that the ability to develop an alternative account of the experience was important and that the women within our study achieved this in a range of ways. Health professionals working with victims of CSA and other types of trauma could apply this knowledge by helping survivors of trauma develop some sense of personal resolution. Although past research suggests talking with others is the best way to do this, our findings suggest that there are also other pathways to achieving personal resolution.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding to undertake this research was received from The James Hume Bequest Fund.