Breaking the last taboo: sexual abuse by female perpetrators
This article is written for women and assumes a male offender, however SECASA acknowledges that both men and women can be survivors of sexual abuse and that offenders can be male and female.
By Renee Koonin
This article appeared in the Australian Social Work journal, Volume 30, No 2. May 1995. This work is copyright material and is reproduced with the kind permission of the Author and the Publisher. No part of it may be reproduced in any way without the written permission of the Author and Publisher.
In the past two decades the truth about the sexual violation has been spoken over and over. Finally, the magnitude of this problem is being recognised. Volumes have been written about the prevention of and intervention in child services (although inadequate) have been established. Sexual abuse, and sexual abuse by women until recently, has been treated as a taboo subject. The knowledge that the overwhelming proportion of child sexual abuse is perpetrated by males left the issue of female perpetrators unexamined. Having only recently made progress in a hard-fought battle to place gender and male power at the centre of an analysis of sexual abuse, practitioners and theoreticians are understandably reluctant to focus any attention on female abusers. However, it is now becoming clear that a significant minority of victims are abused by women and it is essential that no child should be silenced by ideology which denies the reality of abuse by females. This article examines the controversies surrounding the issue of female sexual abuse and the struggles which we have in confronting this abuse. An explanation of sexual abuse by women within feminist understanding is proposed. Current evidence on the prevalence of female sexual abuse and characteristics of perpetrators is outlined. Practice practitioners working with child victims or adult survivors are explored.
A few years ago, it would have been unimaginable to publish a paper on childhood sexual abuse by female perpetrators. Political and practice imperatives urgently focused attention on the predominance of male abusers, and concepts of power and patriarchy, as we sought to understand and intervene in childhood sexual abuse. This analysis remains of paramount importance for work in childhood sexual assault, yet the context has altered sufficiently to allow my willingness to write such a paper. What has changed? Renee Koonin is a Lecturer in the Department of Social Work and Social Policy at the University of Sydney.
First, I have developed a deeper understanding of my own experience and its political implications. I am an incest survivor. When I recalled that I was sexually abused by my stepfather as a child, I was devastated, but I was, not surprised. When I remembered that my mother had also abused me sexually, my world fell apart. Nothing I believed, none of my work as a social worker, educator and activist had prepared me for this truth.
A feminist understanding of incest and childhood sexual assault, gained from my years of practice and research as a social worker and academic, led me to maintain my focus on the abuse of male power as the cause of my predicament. I labelled the intense and different feelings I experienced about my mother's abuse as personal and idiosyncratic, and felt even more isolated as I felt more shame, more responsible for having been a victim of such a rare occurrence as sexual abuse by female perpetrators. That was until I met other women who were victims of sexual abuse by their mothers, grandmothers, aunts, sisters and female cousins and carers. My personal experience was also shared.
At the same time as I began to realise that my experience was not unique, emerging research confirmed that sexual abuse by women may well not be as infrequent as we have previously understood. While the majority of sexual abuse is perpetrated by male offenders, our responsibility to child victims and adult survivors of female offenders means that we dare not overlook this significant minority.
Finally, and most importantly, I believe that an exploration of sexual abuse by women provides an opportunity to enhance our comprehension of sexual abuse and that this is not contradictory with a feminist analysis. Such insights will ensure appropriate help for adult survivors and the children for whom we care. There are both children and adults who are disbelieved when they first disclose sexual abuse by a woman. Clearly, practitioners face uncertainty and discomfort as so many of their fundamental beliefs are challenged. In spite of these difficulties, theory and practice lessons need to be drawn from our experience.Return to top
What is sexual abuse?
Sexual abuse is defined as sexual contact, ranging from fondling to intercourse between a child in mid-adolescence or younger and a person at least five years older (Briere 1992, p. 4). By implication, sexual abuse occurs when a person is involved in sexual activity that they do not comprehend and to which they cannot give informed consent. Children should never be regarded as being capable or sufficiently comprehending of giving consent. (In NSW the age of consent is I6 for girls and boys.)
In essence, sexual abuse is 'the exploitation of a child for the sexual gratification of an adult' (Fraser in Renvoize 1993, p. 34). The South Australian Government Task Force defined child sexual assault as 'the imposition of explicit sexual activity of a child who lacks the power and authority to prevent being coerced into compliance (cited in Renvoize 1993, p. 34). Such abuse can take many forms including exposure, fondling voyeurism and exhibitionism to oral sex, sexual intercourse (oral, anal and vaginal) and involvement with pornography and child prostitution. With respect to sexual abuse by women any of these acts other than penile penetration is possible. Digital penetration and penetration with objects does occur.
There are inherent risks involved in discussing child sexual abuse by female perpetrators. Acknowledging abuse by women may be used as all excuse to deny the gender bias in sexual abuse (Forbes 1992-93). Critics of the organisers of the National Conference on Female Sexual Abuse held in London in March 1992 were concerned that the debates would serve to turn the clock back to the time when professional literature on child sexual abuse looked only at individualistic and unthreatening theories of the causes of abuse. This psychiatric, psychological and family dysfunction literature either ignored the preponderance of male abusers, or sought to argue that the evidence was coincidental, inaccurate or incomplete. We are reminded that it was not until feminists forced the issue of male power into the analysis of child sexual abuse that the central significance of gender was gradually acknowledged (Kelly 1988-89).
Thus, there is concern that any attempt to remove the spotlight from male abuse serves the political ends of providing fodder for what 'many policy makers, professionals, researchers and journalists urgently want to hear and believe' (Nelson 1992), Critics view any emphasis on female abusers as part of the effort to revert to a gender-neutral theory and practice of child sexual abuse (Forbes 1992-93) and a clumsy effort to reemphasise mother blame and collusion. Media coverage of the London conference which referred to the so-called 'discovery' of sexual abuse by women as the 'tip of the iceberg' was extensive (Heath 1992., Laurance 1992; Marchant 1992:D Nelson 1992; Nelson and Oxford 1992: Sharpe 1992).
In this respect, fears that a broad discussion of sexual abuse by women will be used to deflect attention from the abuse of power by men are well-grounded.
In response, those who argue that attention must be focused on patriarchy are accused of not being willing to hear the truth, and of distorting evidence to support ideology (Forbes 1992-93). As a counter offensive, the political credentials of those who urge that sexual abuse by women be placed on the political agenda are challenged. Further, there is the question of why any attention should be paid to the small minority of female abusers, when resources must urgently be focused on the victims of childhood sexual abuse 95 per cent of which is perpetrated by men.
I acknowledge these controversies and conflicts and have seen the debilitating effects of such polarisation on children's services, women's groups and adult survivors of sexual abuse. The National Conference on Female Sexual Abuse resulted in an almost complete breakdown in communication between research, training and service organisations which call themselves feminist and other service providers who are speaking out on female sexual abusers.
To date in Australia we have managed to explore this issue without the same degree of divisiveness. The challenge to focus our energies on effective analysis, intervention in and prevention of child sexual abuse remains.Return to top
'Unspeakable acts': Struggling to face the issue of abuse by women
The difficulty women (particularly) face in confronting the issue of sexual abuse by females is easily understandable when we see how readily the 'women do it too' argument is used to deny the central importance of abuse of male power in sexual abuse (Crisp 1991). Liz Kelly (1991) coined the term 'unspeakable acts' to illustrate our silencing of these issues. Yet, she argues, that if we fail to develop feminist perspectives, we hand over the issue to those professionals who deny the central significance of gender in sexual abuse and the media, and through our silence, continue the conspiracy to fail those who have suffered at the hands of women. It was in fact a small group of feminist women who first tackled the issue of sexual abuse by women at a conference in London in 1990, although they requested no publicity (Kelly 1990).
Women in society are the carers and protectors. To accept that some women also abuse sexually is therefore difficult Kelly (1991) argues that in developing an understanding of women's oppression we are engaged in a process which includes documenting the forms and extent of male violence and revaluing women. These, and other factors, led to an idealisation of women and their relationships'. While privately we know the gap between our ideals and capacity to live by them to speak publicly is threatening in the extreme. Yet, failure to name and confront issues of power among women has led to the downfall of many women's groups, campaigns and relationships. It is in the interests of women and children to confront the issue of abuse by women.
The greatest obstacle to women confronting the issue of sexual abuse by women is the belief that this challenges feminism. Kelly (1991, p. 15) argues that 'feminist analysis of men's violence is only fragile if it is underpinned by essentialism: the belief that aggression is inherent in men. Masculinity and femininity are culturally and historically variable constructs which individuals fit more or less comfortably'. A structural analysis of society examines the use of force and coercion to maintain power, whether the source of that power is gender, race, class, sexual orientation, physical or mental health. This force is frequently socially legitimated. A structural analysis provides the tools to explore women's access to and use of violence, but this exploration has been largely avoided. Following this argument, 'the most likely targets for violence by women are children; the only social group over which women have socially legitimated power' (Kelly 1991, p. 15). The sexual realm is an area of power for men. Women acting out violently, sexually, are acting out against the social construction of femininity, against all expectations, hence the outrage attached to female perpetrators of' sexual abuse.
Young (1993) argues that an analysis of power is only a partial solution to understanding sexual abuse by women while validating all feminist claims about the position of women in society. She asserts that some women, within the limited power that they have, can be 'abusive, vicious, cruel, possessive, domineering, violent, manipulative, aggressive, dishonest, self-deceptive, and criminal' (Young 1993, p. 14). While this is behaviour may be a reaction to patriarchal oppression, we need to ensure that our theory does not excuse adult women from responsibility for their actions.
To those who argue that because some women abuse children sexually we should now consider gender to be irrelevant and ask, instead 'Why do people do it?' I offer Carol Anne Hooper's (1989, p. 26) telling response: 'Would anyone argue that because both men and women do housework, gender is irrelevant in either its distribution and meaning? But this must not be used as an argument to avoid the evidence of sexual abuse by women. If we continue to do so, we are open to accusations by survivors that we will not listen. We will silence children and leave the ground vacant for anti-feminist theory and practice. It is possible to recognise that some women abuse sexually, without losing sight of the fact that the majority of sexual abusers are men. It is then feasible to explore that which is common and different between sexual abuse by men and women and consider whether the understanding we have of male sexual abuse is relevant to women.Return to top
Current evidence on sexual abuse by women
The information we have about women who sexually abuse is extremely limited, partly because of fewer numbers and partly because we do not have the rich literature of survivors' accounts that exists in the case of those abused by men. Published accounts of sexual abuse by women include SOW (Schreiber 1973), When You're ready (Evert and Bijkerk 1987) and Ordinary Wonders (Green 1992).
Current statistics indicate that sexual abuse by females is rare. David Finkelhor and Diana Russell (1984) estimate that five per cent of abuse of girls and 20 per cent of abuse of boys is perpetrated by women. A section of the 1990 report of the British National Society for the Prevention of Cruelty to Children (NSPCC) stated clearly that their figures did not support the tip of the iceberg debate on women abusers. Russell (1984) examines a range of self-report studies which indicate that 27 per cent or less of boys and ten per cent or less of girls were sexually abused by a woman. There are exceptions that reveal a higher incidence but in each case the data are not generalisable (for example, studies of the childhood experiences of incarcerated sex offenders) or the original data have been lost and the validity of the analysis questioned (Russell 1984). Terry Macdonald Director of Child Protection Services at the Adelaide Children's Hospital estimates that ten per cent of the children they see have been sexually abused by a woman (Crisp 1991). Hanks and Saradjian (1991) report on seven studies which indicate a much higher percentage of female abusers (ranging from 25 to 60 per cent), but in these cases the population studied was a clinical sample of imprisoned sex offenders, incest offenders, serial rapists and male adolescents attending a health centre (Hanks and Saradjian 1991).
There is a word of caution necessary in discussing sexual abuse by Women. In examining any research, it is vital to consider language and definitions clearly Forbes 1992-93). Some studies include abuse by girls under the age of I8. While this abuse is no less damaging for the victim, to call a child of seven or eight a perpetrator presupposes knowledge, intent and comprehension beyond her years. Further, what constitutes abuse must be examined and some researchers extend definitions of abuse far beyond that presented in this article (Forbes 1992-93). One strategy used to exaggerate the prevalence of abuse by women is to point out that they have access to children in their care and it is alleged that everyday actions such as having the baby sleep in her bed, or touching the infant's genitals while changing a nappy may be abusive. (Crisp 1991; Groth 1979). Groth (1979, p. 192) concluded that sexual victimisation of children by women may not be as infrequent an event as might be supposed from the small number of identified cases' in spite of the fact that he encountered only three women out of 253 adult offenders in his professional work prior to 1979. These allegations are disputed by Finkelhor and Russell (1984). Russell (1986; 1984) further challenges the notions that sexual abuse by women is underreported because it may be perceived as less abusive than that perpetrated by men; that women mask abusive behaviour, that it may be unmeasured and unnoticed, less likely to be reported, and that because males are more frequently the victims, they are less likely to disclose.
While it is essential to work with the most recent available research and not inflate figures through dint of emotion or ideology, it must be remembered that a couple of decades ago, abuse by men was considered rare. At least we have to be open to the possibility that sexual abuse by women may be more prevalent than we currently understand, and hence provide the opportunity for disclosure (Renvoize 1993). Is there any evidence to challenge current thinking on the prevalence of female sexual abusers?
It was courageous women speaking out about their abuse as children that first alerted us to the staggering incidence of sexual victimisation of children. Similarly, adult survivors of sexual abuse by women are coming forward, saying that until now they have felt doubly silenced. After the National Conference on Female Sexual Abuse in London, the radio program, 'This Morning' opened a hotline inviting callers to talk about abuse by women. In one day, they received over 1,000 calls, 90 per cent of whom stated they had never told anyone (Elliott 1993). In April 1993, a television program called 'Unspeakable Acts', was screened by the BBC. The Broadcasting Support Services Helpline received I60 calls by women abused as children by females immediately after the screening. National self-help groups for survivors of female abuse have been established in America and the United Kingdom. Closer to home, a group for women abused by females in childhood was established after the Incest Confest held in Sydney in July 1992. None of this gives us incidence or prevalence figures, but we are hearing from people who were silent until now.
Is there any direct evidence from children that the incidence of sexual abuse by women may be higher than we currently believe? ChildLine is a national helpline for children operating throughout the United Kingdom. In the seven years since the organisation was established, 300,000 written case records have been documented. There are 2,700 calls received daily and it is estimated that 10,000 calls per day do not get through. Of these calls, 15 per cent relate to reports of sexual abuse of which ten per cent of children report a female as the abuser. In the period April 1990 and March 1991, 8,663 children rang ChildLine about sexual abuse. Of these, nine per cent reported a woman as the perpetrator with boys more likely to be abused by women, one per cent of girls, 12 per cent of boys (Harrison 1993).
Christine Lawson is critical of the research into female sexual abuse. She asserts that the survey approach may be an unreliable method of assessing repressed experiences, and that most of the documented cases come from clinical literature. She argues, therefore, that prevalence studies must be designed specifically to address the diversity of behaviours surrounding the experience of this abuse (Lawson 1993). Finkelhor (1979) agrees that surveys which ask specific questions about female abuse yield a higher prevalence rate than general questions. Renvoize concludes that 'although most of the material presently available shows that comparatively few females are involved ... it seems just as likely that the truth about female abuse may be very different. Just as the late 1960s when Henry Kempe wrote about what was then called "baby battering" and no one wanted to accept that mothers gentle Madonna figures that they were could possibly ever deliberately harm their own children, so today there is the same reluctance to believe that mothers could sexually abuse their own offspring. ... Now, many years on, it seems possible that [we] ... may have to accept that perhaps as much as 25% of sexual abuse is directly committed by women' (Renvoize 1993, p. 115). It is essential in this debate not to make unsubstantiated claims about incidence or prevalence and some evidence is contentious (Forbes 1992-93). What is vital is that our research and practice is conducted in such a way that we do not close off potential sources of information.Return to top
What do we know about women abusers?
Again, because of fewer numbers, knowledge about women abusers is sketchy and frequently contradictory, so it is difficult to draw conclusions. Kathleen Faller published a study on 40 women, 14 per cent of abusers seen in one program during 1978-87. Her research revealed a different pattern of offending than that found for men. Nearly three quarters of the women abused alongside men (compared with 18.5 per cent of men in this category). In 24 of the 29 cases, the children's report of the abuse suggested that the men had initiated the abuse, that the children experienced the female abuse as less intrusive and/or that the women did not want to participate in the abuse. However, Faller cautions us about accepting the leadership role of the male unquestioningly. Children evidence more emotional distress in recounting instances when women abused them, and since over three quarters of these women were the child's mother, it was possibly more threatening to admit that their primary nurturer was an abuser. Fifteen per cent of the women who abused were single mothers who were defined as 'merged' with their children, relating to them as surrogate partners, and ten per cent defined as psychotic (Faller 1987). Kelly (1991) questions whether these latter two categories are acceptable forms of explanation, since they have been rejected for men. Does pathologising women make them less responsible? Faller includes adolescent abusers in her study which, I would argue, requires separate analysis and discussion. Only one of the women who abused was a non-custodial abuser. Thirty-four (85 per cent) of the women were mothers to at least one of the children they abused while 55 per cent abused only their own children. The 40 female perpetrators abused 63 victims, with twenty-four (60 per cent) victimised two or more children (Faller 1987).
In their research into women abusers, Helga Hanks and Jacqui Saradjian (1991 - 1992) identified a number of categories and characteristics of abusers. They may be women who initiate abuse with their own children, women who abuse in conjunction with men women who abuse as part of a married couple, lesbian women, women who abuse children with learning difficulties or disabilities, women who abuse adolescents as well as women who participate in ritual abuse. Common to all these groups is the fact that almost all of them were abused as children and other forms of maltreatment, particularly emotional abuse, are present. Mothers who abuse children commonly see the child as an extension of themselves.
Matthews, Matthews and Speltz (1989, cited in Hanks and Saradjian 1991) found three distinct categories of women abusers in their research:
- Teacher/lovers who are usually involved with adolescent and/or pre boys. They want to teach them about sex.
- Male coerced offenders who initially abuse in conjunction with a male but may later abuse independently. This type of abuser is extremely dependent and non-assertive
- Predisposed offenders who have been sexually abused themselves from a very young age. They initiate the abuse themselves and usually abuse their own children. Their intention appears to be non threatening emotional intimacy.
Jane Kinder Matthews and Ruth Matthews developed a program for working with female child sexual offenders and have analysed their work with 36 participants (Matthews 1993). In common with male offenders, they come from chaotic, abusive backgrounds, feel they do not belong with and have a low status among their peers. They are often friendless, and will do almost anything for acceptance. But there are differences. None of the women they worked with coerced others to offend. They use force or violence less frequently, and to a lesser degree than males, and are less likely to use threats to silence their victims. They found that fewer women deny the abuse initially and are more willing to take responsibility for their behaviour. In contradiction to this, Rina McCary, working in Glasgow, finds that because of women's investment in the nurturing/caring role, denial can be greater. Men generally start abusing at an earlier age (only two of the 36 women with whom they worked acted out as teenagers). Women also tend to act out on themselves via self-punishment and self-destructive behaviour such as starving and cutting themselves, prostitution and placing themselves in very dangerous situations (Matthews 1993).
Knowledge about the responsiveness of women offenders to intervention is also clouded. Reporting on a group work program with six women offenders imprisoned at Styal in the UK, Jane King (1989) concludes that the participants' responses varied from total denial to shame and regret, with commitment to changing their behaviour. Matthews (1993) found that women tend to find it more difficult than men to forgive themselves, and take longer to move out of the shame and guilt. Women's anger towards themselves tends to be more deeply entrenched. They are quicker in developing empathy for their victims.
Understanding that women abuse sexually has practice implications at three levels: primary prevention, work with adult survivors and intervention with children. Intervention with women offenders is a separate topic which is outside the scope of this article. Feminists have been at the forefront in recognising the widespread prevalence of childhood sexual assault and forcing the issue onto the political agenda. Education campaigns need to be maintained and extended. It is essential that the internationally acclaimed prevention campaigns in Australia, such as No Excuses, Never, Ever in NSW, should continue. While the predominance of abuse by men needs to be clearly stated, it is important that public information includes the fact that sexual victimisation by women does occur. We have to use every available means to force abusers to stop, to inform society of the harmful effects of abuse and to campaign for adequate resources. We need to reach all people to inform the community that sexual abuse by women exists. If women are being coerced by men to abuse, they need to feel it is safe to report this. Thus, women's health services and domestic violence services are uniquely placed to assist women and prevent abuse and to make explicit the nature of the abusers' 'past and present relationship with men' (Forbes 1992 p.110). A better understanding of postnatal depression and less idealised visions of motherhood will enable women to express doubts, fears and negative views towards small children more easily. Some women experience sexual responses to infants while breast feeding, yet find they are unable to share this with anyone. Honest, nonjudgmental yet uncompromising discussion of these feelings can help prevent those women experiencing difficulties with boundaries from translating feeling into action. Service providers need accurate information about female sexual abuse, with input from survivors. At the same time, care must be taken to ensure that this information is not misused to blame women, to further the interests of homophobics or to distort the reality that the majority of sexual abuse is perpetrated by men (Young 1993).
What does acknowledging that females abuse sexually mean for working with children and adult survivors of sexual abuse by women? First, it is essential to remember that the key issues present in working with sexual abuse by men the feeling of total violation and betrayal of trust are present in those abused by women. The central importance of working to ensure the safety of the child, to regain trust, to enable the victim to break the silence, to be believed, to understand that the abuse was not their fault, to grieve, mourn and express anger is unchanged. In working with adult or adolescent survivors, the issues of self-destructive behaviours, developing self-esteem and personal power, expressing feelings, coming home to her/his body, intimacy, sex and sexuality and parenting all need to be addressed.
What special features need to be considered when working with those sexually abused by women? Children who report abuse by women need urgently to be believed. Sgroi and Sargent (1993) report that a history of sexual abuse by women tends to be disclosed later in therapeutic relationships. They argue that this may be because the victim waits until s/he is feeling safer in the relationship and thus more confident of being believed. On the other hand, some clients do not remember earlier in the process and Sgroi and Sargent propose that the failure of therapists to explore the possibility of' such a history could give an implicit message that such disclosure in unacceptable. Additional shame may be experienced because this type of abuse is 'unusual'. Clearly then, practitioners need to explore whether the client remembers childhood sexual contact from both males and females.
Disclosure and maintaining the reality of sexual abuse is difficult no matter what the gender of the abuser. Sgroi and Sargent (1993) found that it was harder for survivors to hold onto the understanding that their mothers abused them because of the stereotype of the nurturing mother and the cognitive dissonance between this image and the reality of themselves as objects of their mothers' sexual gratification.
The research indicates that many children abused by women are also sexually abused by men. It is thus virtually impossible to differentiate the impact of the abuse by women, and it seems logical to anticipate interactive and cumulative effects of multiple abuses. However, in Sgroi and Sargent's (1993) study, all seven of the adult female clients reported that sexual abuse by a close female relative was the most damaging and shameful form of abuse they experienced, and the opportunity to express this needs to be encouraged. Russell (1986) counters this by arguing that some theorists who believe that the incidence of female perpetrators has been artificially kept down consider that female perpetrators are often considered to be less abusive, and the child may indeed have found the experience pleasurable. The subjective experience of the abuse therefore needs to be explored fully.
For girls abused by women, the differentiation and definition of self becomes exceedingly complex. By powerfully communicating that there is no separation, achieving autonomy is fraught with difficulty. Women survivors report fears that they will become like their mothers, for example dependent on men, abusive towards their children or unable to free themselves of their mother's domination, even when she had died. This difficulty of separating has implications for the child's personal development as an autonomous individual, a partner, a mother or potential mother. Some women avoid contact with women while others spend time in groups of women but avoid intimacy, either sexual or non-sexual. Questions about sexuality are evident and the literature suggests evidence of homophobia in some women abused by women (Young 1993).
Practitioners working with children or adult survivors sexually abused by women need to resolve their own anxieties about female sex abusers. The abuser is often viewed as one-dimensional a demonic monster or a saint by the victim and they need help to accept the abuser as a multidimensional human being, with strengths and weaknesses, who committed a serious offence, and who may be subject to a criminal charge. This is only possible if the worker is able to take this stance.
Group work with girls and women abused by women has particular implications. If the girl is the only one in the group sexually abused by a woman, she may feel even more isolated. Fear of disclosing a taboo topic may make her even more unlikely to talk about her experience. If it is not possible to form a group with more than one girl sexually abused by a female, it may help to include someone physically abused by a woman. It should be remembered too, that girls sexually abused by a woman may also feel particularly threatened in an all women's group at first.Return to top
The way forward
The purpose of this article is to urge all of those working with children and adult survivors of sexual abuse to remember that women can and do sexually abuse. I know this is a challenging fact to confront, I am not wanting to minimise the significance of gender in our understanding of' child sexual abuse, nor distort facts. I simply want us to do all we can to prevent abuse and to allow those who are sexually abused to feel free to speak their truth, to be believed and helped to heal. Kathy Evert (Evert and Bijkerk 1987, p. 175) concluded her autobiography with the words:
I have, with careful help,
reclaimed my soul,
And my responsibility now
Is to go on with my life.
And our responsibility together, you and I
Is to help save as many others as we can along the way.
Clearly, the opportunities for further research and best practice need to be grasped.
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