Child sexual abuse is a topic that has received increased attention in recent years. 28% to 33% of females and 12% to 18% of adult males have been victims of childhood or youth sexual abuse (Roland, 2002, as cited in Long, Burnett, & Thomas, 2006). Sexual abuse, excluding inappropriate touching, and other types of sexual abuse are not reported as often, meaning that the number of people who have experienced sexual abuse in childhood may actually be greater (Maltz, 2002). With such a high percentage of people having experienced childhood sexual abuse, it is likely that many people seeking therapy have histories that include sexual abuse. It is critical that counselors are aware of and familiar with the symptoms and long-term effects associated with childhood sexual abuse to help gain a deeper understanding of what is needed in counseling. This report will define childhood sexual abuse and examine the impact it can have, explore the long-term effects and symptoms associated with childhood sexual abuse, and discuss counseling implications. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay Childhood Sexual Abuse: Long-Term Effects and Solutions There are multiple forms of childhood sexual abuse. The abuse may involve the seduction of the child and/or minor by a close relative or it may be a violent assault committed by a complete stranger. Sexual abuse can be difficult to determine because it can take many different forms, different levels of frequency, and the different circumstances that can result from it and the different relationships that can be linked to it. Maltz (2002) presents the following definition: “Sexual abuse occurs whenever one person dominates and exploits another through sexual action or suggestion” (Maltz, 2001a, as cited in Maltz, 2002, p. 321): Any sexual act, overt or covert, between a child and an adult (or an older child, where the younger child's participation is achieved through seduction or coercion). Regardless of how childhood sexual abuse is defined, it generally has a significant negative and pervasive psychological impact on its victims. (p. 33) Most sexual abuse occurs in childhood, with incest being the most common form (Courtois, 1996, cited in Maltz, 2002). The impact of childhood sexual abuse varies from person to person and from case to case. One study compared the experiences of women who experienced sexual abuse by a family member with women who experienced non-familial abuse. They found that women who had experienced abuse by a family member reported higher levels of depression and anxiety when considering the abuse. Other variables found to increase reported levels of distress were experiences involving more extensive sexual abuse, a higher number of sexual abuse experiences, and a younger age during first sexual abuse experience (Hartman, Finn, & Leon , 1987). While the nature and severity of the sexual act may have a more severe impact, many other factors can influence the extent of harm suffered by the victim. Other factors may include the individual's perspective, the internal resources to which the individual has access, and the individual's level of support (Courtois, 1988, as cited in Ratican, 1992). While not all forms of child sexual abuse include direct contact, it is important for therapists to understand that child sexual abuse can take many different forms that sexually exploit the victim and causedamage. The perpetrator(s) may exploit the child by introducing them to pornography, assaulting them via the Internet, or manipulating them to take pornographic photos. Child sexual abuse violates the fundamental rights of a human being. Children should be able to have sexual experiences at the appropriate time of development and under their control and selection. The nature and dynamics of sexual abuse and sexually abusive relationships are often traumatic. When sexual abuse occurs during childhood, it can hinder normal social growth and cause numerous psychosocial problems (Maltz, 2002). Childhood sexual abuse has been linked to higher levels of depression, guilt, pity, guilt, eating disorders, somatic concerns, anxiety, dissociative patterns, repression, denial, sexual problems, and relationship problems. Depression is one of the most common long-term symptoms among survivors. Survivors may have difficulty externalizing the abuse, thus thinking negatively about themselves (Hartman et al., 1987). After years of thinking negatively about themselves, survivors experience feelings of worthlessness and avoid others because they believe they have nothing to offer (Long et al., 2006). Ratican (1992) describes symptoms of depression in survivors of child sexual abuse as feeling down most of the time, having suicidal ideations, sleep disturbances, and eating disorders. Survivors often experience guilt, shame, and self-blame. In many cases, it has been indicated that survivors often take personal responsibility for the abuse. When sexual abuse is committed by a valued and trusted adult, it can be difficult for children to view the perpetrator in a negative light, thus leaving them unable to see what happened as if it were not their fault. Survivors often blame themselves and internalize negative messages about themselves. Survivors tend to exhibit more self-destructive behavior and experience more suicidal ideation than those who have not been abused (Browne & Finkelhor, 1986). Physical problems and eating disorders have also been cited as a long-term effect of childhood sexual abuse. Ratican (1992) describes symptoms of body image problems in survivors of child sexual abuse as related to feeling dirty or ugly, dissatisfaction with one's body or appearance, eating disorders, and obesity. Survivors' distress may also result in somatic concerns. One study found that female survivors reported significantly more medical concerns than those who did not experience sexual abuse. The most frequent medial complaint was pelvic pain (Cunningham, Pearce, & Pearce, 1988). Some symptoms among survivors are often related to pelvic pain, gastrointestinal problems, headaches, and difficulty swallowing (Ratican, 1992). Stress and anxiety are often long-term effects of childhood sexual abuse. Childhood sexual abuse can be frightening and cause stress long after the experience or experiences are over. Many times, survivors experience chronic anxiety, stress, anxiety attacks, and phobias (Briere & Runtz, 1988, cited in Ratican, 1992). One topic area compared posttraumatic stress symptoms in Vietnam veterans and adult survivors of childhood sexual abuse. The study revealed that childhood sexual abuse is traumatizing and can cause symptoms comparable to those resulting from war-related trauma (McNew & Abell, 1995). Some survivors may have dissociated during the sexual abuse episode as a means of protecting themselves when this occurred. it was too much for them to deal with mentally. As adults,they can still use this coping mechanism when they feel unsafe or threatened (King, 2009). Dissociation for survivors of childhood sexual abuse can include feelings of confusion, feelings of disorientation, nightmares, flashbacks, and difficulty experiencing feelings. Denial and depression of sexual abuse are considered by some to be long-term effects of childhood sexual abuse. Symptoms may include experiencing amnesia regarding parts of their childhood, denial of the effects and impact of sexual abuse, and feeling that they should forget the abuse (Ratican, 1992). Whether or not survivors can forget past experiences of childhood sexual abuse and subsequently recover those memories is a controversial issue. Some therapists believe that sexual abuse can cause enough trauma that the victim forgets it or represses it as a coping mechanism. Others believe that the recovered memories are false or that the client is being driven to create them (King, 2009). Survivors of sexual abuse may have difficulty building interpersonal relationships. Symptoms related to childhood sexual abuse can hinder the maturation and development of relationships. Common relationship difficulties that survivors may experience are difficulties with trust, fear of intimacy, fear of being different or strange, difficulty establishing interpersonal boundaries, passive behaviors, and becoming involved in abusive relationships (Ratican, 1992). Feinauer, Callahan, and Hilton (1996) examined the relationship between a person's ability to adjust to an intimate relationship, depression, and the level of severity of childhood abuse. Their study revealed that as the severity of the abuse increased, scores measuring the ability to adapt to intimate relationships decreased. Sexual abuse is often initiated by someone the child loves and trusts, which breaks trust and may lead the child to believe that the people he loves will hurt him (Strean, 1988 as cited in Pearson, 1994 ). Kessler and Bieschke (1999) establish a significant relationship between adult women who experienced sexual maltreatment during childhood and victimization in adulthood. Many survivors experience sexual difficulties. The long term effects of the abuse that the survivor experiences such as; depression and dissociative models. It affects survivors' ability to function sexually. Maltz (2001a, cited in Maltz, 2002) provides a list of ten major sexual symptoms that often arise from experiences of sexual abuse: “avoidance, fear, or loss of interest in sex; approaching sex as an obligation; experiencing negative feelings such as anger, disgust, or guilt with touch; having difficulty getting excited or feeling sensations; feeling emotionally distant or not present during sex; experiencing intrusive or disturbing sexual thoughts and images; engaging in compulsive or inappropriate sexual behavior; having difficulty establishing or maintaining an intimate relationship; experience vaginal pain or orgasmic difficulties (women); and experiencing erectile, ejaculatory, or orgasmic difficulties (men; p. 323). A survey conducted on the prevalence and predictors of sexual dysfunction in the United States found that victims of sexual abuse experience sexual problems more than the universal population. They found that male victims of childhood sexual abuse were more likely to experience erectile dysfunction, premature ejaculation, and low sexual desire, and they found that adult females were more likely to have arousal disorders (Laumann, Piel, & Rosen, 1999) . It is significant to point out that although research has shown that they existsignificant relationships between long-term effects variables and childhood sexual abuse, each victim's responses and experiences will not be the same. Although it is often seen as a traumatic experience, there is no single symptom among all survivors and it is important for clinicians to focus on the individual needs of the client. There are many important things for a counselor to consider when helping a survivor overcome long-term effects or symptoms of sexual abuse. The literature regarding the therapeutic process after disclosure is limited and no specific treatment model is suggested (Kessler, Nelson, Jurich, & White, 2004). While no specific treatment model is used for counseling survivors, researchers and clinicians have offered suggestions and important implications for counselors to think about. This part of the paper will explore these counseling implications. Kessler et al. (2004) identified common treatment decision-making practices of therapists treating adult survivors of childhood sexual abuse. Their study revealed that regardless of the treatment modality, therapists found it important to assess the client's presenting problems, the effects the abuse has on their clients' current functioning, and how the client currently copes with the situation. Because clients often have difficulty externalizing abuse, therapists may need to work with clients to increase their ability to accurately attribute responsibility. To help reduce levels of depression and anxiety, helpful goals for the survivor might be to increase their sense of mastery and increase their ability to accurately attribute responsibility (Hartman et al., 1987). The therapeutic alliance is critical to helping counseling survivors feel safe. Survivors of childhood sexual abuse often present with symptomatic problems, feelings, and behaviors that result from the abuse, rather than the sexual abuse itself (Courtois 1988, as cited in Ratican, 1992). Feelings of fear or vulnerability may prevent the client from disclosing their childhood sexual abuse. Relationship-building techniques such as the use of encouragement, validation, self-disclosure, and boundary setting are encouraged to help establish the therapeutic bond. Accepting the survivor's version of their sexual abuse experience is often therapeutic and helps strengthen the alliance (Pearson, 1994). It is important that the counselor gives the client time to build feelings of trust, security and receptivity because sexual abuse is an abuse of power by nature, equality is emphasized as an important factor. It is important to allow the patient to have control over both the speed and direction of the healing process (Ratican, 1992). Client empowerment is a technique used by survivors. Van Velsor and Cox (2001) suggest that it is critical to help survivors process, discover, and express anger because anger can be used to facilitate the client to feel empowered, appropriately attribute responsibility, set boundaries, and encourage self-efficacy and l 'ability. They recommend that the counselor help the client reframe their anger into an emotion they can use to define their rights and needs, explore hidden norms for anger expression among women, and help survivors use their own anger at productive actions and behaviors. Likewise, helping the client acquire skills that will help them discover and develop supportive relationships, especially with a partner, is considered a goal..