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.