is not incest. • It is not incest if there was no vaginal or anal penetration. • Incest
only happens to girls. • If the childhood sexual assault did not involve overt ...
CHAPTER 16 Adolescent Survivors
LEARNING OBJECTIVES: Understand the characteristics and extent of sexual assault experienced by adolescents. Describe some specific circumstances and issues affecting teenagers. Explain ways to be helpful to teens who have experienced sexual assault or abuse. Understand the legal considerations that may come up in serving adolescent survivors.
Adolescents who have survived a recent sexual assault or were sexually abused as children have different needs from adult survivors. They usually are reluctant to seek healing services. The rape crisis counselor needs to be knowledgeable about the particular concerns, life circumstances, and realities of teenagers, to encourage the adolescent survivor who does reach out for assistance to stay engaged and benefit from rape crisis center services. The Adolescent Years Generally, adolescence refers to the period of time from the onset of puberty until a young person moves into adulthood. Developmentally, some 13-year-olds may not be mature enough to be treated as adolescents, while some 18-year-olds may actually be more like young adults in their behavior and thinking. During the period – overall, from about age 12 to 19 – there is a wide range of developmental stages in cognitive, emotional, and behavioral characteristics. Throughout adolescence, teens in the American culture are typically engaged in a process of forming their own identities independent of their families, influenced to a large degree by their friends and by popular media. They are also influenced by internal hormonal activity causing rapid and sometimes mind-boggling growth, bodily transformation, and emotional mood-swings. Teens often are torn between maintaining allegiance to their families, and experimenting with new and sometimes disapproved behaviors. They may alternate between the poles of hating their parents one minute and desperately wanting parental attention, approval, and affection the next minute. Many teens display an air of smugness and bravado – despite feeling extremely insecure, worrying about what others think of them, and wondering about the meaning of life. It is during this already confusing and emotionally difficult time of life that many young people confront the problem of being sexually assaulted or abused. Types of victimization include stranger rape, acquaintance rape, incest, childhood sexual abuse, and other forms of sexual assault, such as molestation and attempted rape.
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Regardless of the type of assault, it is highly likely that an adolescent will know his or her attacker.1 Boys as well as girls can be victimized; it has been estimated that one out of every twelve rape victims is male.2 Males have been found to be much less likely than females to report having been sexually assaulted or raped.3 Indeed, adolescents in general are highly reluctant to disclose or seek help. Myths and Misconceptions To help adolescent survivors, the rape crisis counselor should be aware of common misinformation about sexual assault and abuse. (See Chapter 1: Understanding Rape – Myths, Facts, and Realities.) Among the misconceptions particularly pertinent to teens – and often believed by them – are: Myths about Rape: • • • • • • • • • • • •
It is not rape if the victim was not physically harmed or threatened with a weapon. It isn’t rape if the victim has been dating her or his attacker and been sexually intimate with that person in the past. Rapists are individuals with uncontrollable sexual urges. Rapists seem obviously abnormal to others. Anyone can resist being raped if she or he really wants to. If a person starts making out with someone and they both get sexually excited, and then she or he wants to stop and says so, it’s not really rape if the other person forces sexual activity. Girls often mean “yes” even though they say “no.” A boy can’t be blamed for forcing sex on a girl who is dressed provocatively, flirts with him, and/or lets him pay for the date. People who were drunk or high when they were raped are at fault. If a boy or young man is sexually assaulted by another male, then the victim must be gay. Only homosexual men rape boys. A male cannot be raped by a female.
Myths about Incest: • • • • •
Incest is when a father rapes a daughter; forced sexual activity with other relatives (mother-daughter, father-son, mother-son, etc.) is not incest. It is not incest if there was no vaginal or anal penetration. Incest only happens to girls. If the childhood sexual assault did not involve overt physical force, it shouldn’t be emotionally traumatizing. If the victim experiences any sexual pleasure, then she or he is partly to blame for the incest.
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• •
A child may be targeted because she or he is very pretty, is dressed in a way that is sexually appealing to adults, or engages adults in a “flirtatious” way. If someone does not disclose incest or abuse when it is happening, then she or he is at fault for it continuing.
These myths can be extremely influential on adolescents who are unsure of themselves and dependent on the opinions and ideas of others. The misinformation is sometimes reinforced by specific cultural and religious beliefs that are intended to promote appropriate behavior and good character, but in reality may have the negative side effect of isolating adolescents who have been victimized. Teens’ Lives In addition to myths, adolescents are also highly influenced by other circumstances of their lives – namely, friends and peers. Teens also are concerned about measuring up to their families’ expectations. Their changing bodies are of great concern, and many teenagers worry that they are developing abnormally. Adolescence often is a time of sexual experimentation and exploration. Because this is relatively new to them, many teens are at risk of confusing rape or sexual assault with “normal” experimentation. For example, a teen may label a violent assault as merely an “unpleasant” sexual experience, chalking it up to lack of experience or believing the perpetrator’s definition of what happened. Adolescents who are exploring or struggling with the issue of their sexual orientation may be even more vulnerable to confusion about when sex is consensual and when it is forced. Another major factor in teens’ lives in general, and their sexual lives in particularly, is the use and abuse of drugs and alcohol. Because these substances can lower inhibitions, potential rapists are more likely to actually commit rape and sexual violence.4 Adolescents who are intoxicated or under the influence of drugs are less likely to read warning signs or make sound judgments about situations where they might be at risk. One study estimates that 75 percent of men and 55 percent of women involved in an acquaintance rape had been drinking or taking drugs just before the attack.5 Adolescents are also at risk of turning to alcohol or drugs as a way of coping with having been sexually assaulted.6 (See Chapter 22C: Coping Patterns of Sexual Assault Survivors – Substance Abuse.) Teenage survivors struggle with issues of self-esteem and self-worth, questioning if they somehow deserved the abuse or are now contaminated or devalued by it. These feelings of worthlessness and dirtiness can contribute to an adolescent’s putting herself or himself at greater risk for harm through substance abuse; increased sexual activity, including promiscuity and prostitution; or risk-taking behaviors, such as driving too fast. Studies indicate that adolescent girls with a history of sexual abuse are at risk to become sexually active earlier than other teens; not use contraceptives or protection; and have their children at greater risk of abuse.7
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Adolescents struggling with sexual assault issues also are at risk of self-injury, such as cutting or burning; suicidal thinking, gestures, and attempts; and developing eating disorders, such as anorexia, bulimia, or overeating.8 (See Chapter 22B: Coping Patterns of Sexual Assault Survivors – Eating Disorders, Chapter 22D: Coping Patterns of Sexual Assault Survivors – Self-Inflicted Violence, and Chapter 24: Suicide Prevention.) Other concerns may be increased social and family isolation, general acting out, and lower school performance. Many teens struggle with other issues as well such as living in poverty or high-violence neighborhoods, being discriminated against due to race or ethnic background, or being lesbian or gay. Teens who routinely encounter discrimination and disrespect in their lives may not even consider reporting a sexual assault or seeking help, because they feel they will not be believed or will be blamed for what happened. This can be said about teens across all socioeconomic and racial lines. They also may be reluctant to seek help if they think they will bring their families to the attention of authorities, such as children of undocumented immigrants who fear their families will be reported to immigration authorities, or a teen who worries that disclosure will result in the state’s involvement with the family and perhaps her or his removal from the home. If a teenage girl comes from a family where there are strict cultural or religious rules, she may be reluctant to disclose an acquaintance rape due to worries that she will be blamed or that her “lost virginity” will be seen as shameful. Similarly, a boy may be reluctant to report an assault, particularly one perpetrated by another male, for fear of being labeled as “gay” or “weak” by family members or friends. How Teens Come for Services Adolescents often approach rape crisis center services cautiously. They may call and ask questions about how confidential services are, or for definitions of rape, sexual assault, or incest. They may say they are talking about a friend. A male caller may want to know if a guy can be raped. Perhaps the caller will want to know if it is possible to go to a hospital or clinic for medical treatment without having parents find out. Sometimes a teen will be worried about a friend who was (or is currently being) abused or raped and who now is depressed, not coping well, or even suicidal. Parents may call because their teenager has disclosed a rape or abuse and is now refusing any help. Other callers may be teachers, community youth workers, advisors, school nurses, or doctors who want to refer a teen who has disclosed an assault or abuse. The adolescent’s disclosure may be direct, or indirect (such as by asking about tests for pregnancy or sexually transmitted infections and then admitting the concern is due to a recent assault).
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How to Help Recognizing – and respecting – the adolescent’s ambivalence, cautiousness, and fears about seeking services will help establish rapport. Adolescents may find it difficult to talk, so let your pace match theirs. If the survivor is somewhat brusque and businesslike, avoid being overly sympathetic in your approach because she or he may not be able to tolerate it. Often with teens, a counseling style that uses appropriate humor and self-disclosure can increase the alliance and advance trust in the counseling the process. An example of self-disclosure might be: “When I was in high school, I had a friend who had been raped who was really worried about getting pregnant (or that her parents would find out, or another issue that seems appropriate). Does that match your experience?” It is also helpful to explore adolescents’ support systems. Do they want a parent or other caretaker to be involved? Are they unsure how to disclose or ask for help? Is a parent likely to be blaming and judgmental or supportive? Is there another adult in their lives more likely to be supportive and understanding? Is there a best friend who can be helpful? Is their cultural or friendship network likely to be blaming and labeling? Does it make sense to stay somewhere else for a while, and, if so, where? These kinds of questions can help an adolescent think about other people who might be a resource during this difficult time. If you are doing face-to-face counseling, consider offering the survivor the option to invite one or several of these individuals in for a session. Similarly, teens often do well in peer support groups, because they are able to share their experiences and come to see that they are not alone. In exploring an adolescent’s support system, be aware of the possibility that the individual’s family or community may have strong cultural or religious beliefs affecting the teen’s willingness or safety in disclosing sexual assault and abuse. Talk with the survivor about these beliefs, and ask how she or he thinks a disclosure will be received. Ask if the adolescent is struggling with self-blame or shame because of beliefs or values she has adopted. It is often helpful for teenagers to know they are not alone in the dilemma. It might be appropriate to say something like, “I’ve talked with a lot of Puerto Rican girls who have the same concerns you do about exposing a family secret, but at the same time I’m also worried about your safety. Let’s talk about this some more.” If the client is a male, let him know that he is not “the only one,” and that he probably knows other boys who have also been abused but who, like he, are very reluctant to tell anyone. It is very important to give information to adolescents. They may convey an air of smugness and act as if they know everything, but the counselor cannot assume this is true. Couch your information in statements like, “You probably know this, but . . . ,” and try to avoid sounding too parental or teacher-like in giving advice. Humor may be helpful in confronting certain statements or attitudes without sounding scolding or authoritarian. Be careful that your humor is used in a respectful way that leads the teen to develop trust in you. Using the term “we” may be helpful to the adolescent who is trying to sound strong but is in fact quite scared; it can convey a sense that you are an ally. 16-5
Chapter 16: Adolescent Survivors
Finally, counselors need to realize that some teens may pace their own decision-making process by calling a hotline or office several times anonymously. For this reason, it is crucial to establish rapport right away, allowing adolescent callers to feel invited to call again when they are ready. This may be difficult for the counselor who is worried about the caller’s safety, particularly if it involves sexual abuse in the home. However, many adolescents are savvy enough to understand the mandated reporting laws and will be careful to protect their identity until they are ready for whatever intervention may take place once they disclose. In those circumstances, a caller may need to be slowly and carefully persuaded to accept help, over the course of several phone calls. Legal Issues: Consent and Statutory Rape Because adolescents are still minors, there are some legal considerations about which the rape crisis counselor needs to be aware. The legal age of consent – meaning that anyone under that age is not considered capable of making a decision to have sex – is 16 years of age in Massachusetts. This legal definition is particularly applicable in cases of statutory rape, in which rape charges can be brought against an individual who has sex with even a “willing” partner who is younger than 16. (See Chapter 20: Legal Advocacy – Helping Sexual Assault and Domestic Violence Survivors through the Criminal Justice System.) Often it is a parent of the minor who goes to the police and seeks to have statutory rape charges pressed against an older boyfriend or girlfriend. In many such cases, the minor considers herself a willing participant; does not see herself or himself as a victim of rape; and resents the parents for using the legal charges to break up the relationship. Rape crisis counselors may receive calls from angry or concerned parents who want to know what options they have to intervene when they think the boyfriend or girlfriend is too old for their teenager. When talking with such parents, remember that the parent is your client. (See Chapter 8: Counseling Significant Others.) Do not try to resolve the matter, but do allow the parent to vent and think about the situation. While age 16 applies to legal concerns such as statutory rape, adolescents are considered minors until they turn 18. Therefore, the State’s mandated reporting law applies to any adolescent under age 18. This means that whenever there is a concern that an adolescent is being abused or neglected by a caretaker, you must initiate a report to the Department of Social Services (DSS); you are also required to report concerns you have about any siblings who are at risk. Counselors should seek supervision under such circumstances and be familiar with their organization’s protocols designed to comply with the law. (See Chapter 15: Child Sexual Abuse.)
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Special Confidentiality Concerns Sometimes a caller to a rape crisis center hotline will ask if the call is confidential. This is a good time to describe the exceptions to confidentiality. (See Chapter 25: Privacy Rights, Confidentiality, and Record-Keeping.) Some counselors worry that this will deter the adolescent from disclosing abuse or getting help. However, teens appreciate honesty and straightforwardness about what the boundaries are. If a caller appears to be hesitating about what to tell, it can be helpful to say something like, “You know, you called because you are obviously very worried about what is going on, and I would like to be able to help you. You shouldn’t have to carry this burden by yourself.” Make sure there is a clear understanding of the DSS process and a willingness to explain the procedure to an adolescent. Teenagers are frequently concerned about whether they can receive services without their parents finding out. These types of services can include medical treatment such as rape examinations, testing for infections – including HIV – and pregnancy, abortion, counseling, and mental health services. (See Chapter 18: Caring for the Survivor in the Medical Setting and Chapter 19: Implications of HIV/AIDS for Sexual Assault Survivors.) Policies may vary somewhat in different agencies and organizations. Some hospitals and medical providers consider adolescents to be “emancipated” if they have a concern about sexually transmitted infections or pregnancy, and therefore are willing to do a rape exam and provide other treatment without parental consent. Although a few providers offer these services at no charge, many do not – which means the family’s health insurance company or the parents themselves will need to be billed for such services (unless the teen has his or her own insurance coverage). You should research the regulations of the service providers in your area, so that you can give accurate information to the adolescent client and better advocate for the teen at the hospital or doctor’s office. 1
Mary P. Koss, C.A. Gidyca, and N. Wisniewski, “The Scope of Rape: Incidence and Prevalence of Sexual Aggression and Victimization in a National Sample of Higher Education Students,” Journal of Consulting and Clinical Psychology, 55 (1987), pp. 162-170 2
Department of Justice, Teenage Victims: National Crime Survey (Rockville, MD, 1989).
3
A. Bentovim, “Children and Young People as Abusers,” in Children and Young People as Abusers, eds. A. Hollows and H. Armstrong (London, 1991). 4
A. Nicholas Groth, Men Who Rape: The Psychology of the Offender (NY, 1979), p. 98; Mary P. Koss, No Safe Haven: Male Violence Against Women at Home, at Work, and in the Community (Washington, 1994), pp. 15-16. 5
Robin Warshaw, I Never Called it Rape: The Ms. Report on Recognizing, Fighting, and Surviving Date and Acquaintance Rape (New York, 1988), p. 44. 6
D.A. Merchant, Treating Abused Adolescents: A Program for Providing Individual and Group Therapy, (Holmes Beach, FL, 1990). 7
D. Boyer, “Adolescent Pregnancy: The Role of Sexual Abuse,” Virginians Aligned Against Sexual Assault Advocate, 12/ 3 (Winter 1996), pp. 1-4. 8
Merchant, op. cit.
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