Working with child sexual abuse: A systemic perspective on whether children need to tell their therapist details of the abuse for healing to take place

As clinicians working with children who have been sexually abused we have observed that many children choose not to give the therapist a detailed account of their abuse.(1) Our hypothesis is that whether or not children tell their story to the therapist hinges upon several factors: whether they have been believed by their significant (non-abusing) carer(s); their developmental stage; the therapeutic context; and whether they feel their therapist is available to hear the distressing details of the abuse. We explore this through two case studies and conclude that while children's ability to use therapy is affected by multiple factors - societal, cultural, personal, life histories and beliefs about the value of therapy - telling their therapist the details of their abusive experiences is not necessarily a part of effective therapy.