Theoretical and Therapeutic Aspects of Extrafamilial Child Rape in the South African Context: A preliminary exploration

Theoretical and Therapeutic Aspects of Extrafamilial Child Rape in the South African Context: A preliminary exploration

Lewis, S. (1997). Theoretical and Therapeutic Aspects of Extrafamilial Child Rape in the South African Context: A preliminary exploration. Paper presented at the Centre for the Study of Violence and Reconciliation, Seminar No. 5, 28 May 1997.

 

Seminar No. 5, 1997

Theoretical and Therapeutic Aspects
of Extrafamilial Child Rape
in the South African Context:
A preliminary exploration

Presenter: Sharon Lewis

Sharon Lewis is a former Researcher at the Centre for the Study of Violence and Reconciliation.

This research was supervised by Gillian Eagle who is Acting Head of the Psychology Department at the University of the Witwatersrand.

The author would like to acknowledge the Trauma Clinic of the CSVR for assisting with access to subjects, and the child therapists, Michelle Whiteside and Marilyn Donaldson, for assisting with data collection.

Date: 28 May 1997

Venue: Sir Herbert Baker Restaurant, Johannesburg, South Africa

Abstract

The subjects in the study consisted of a group of ten South African latency aged victims of extrafamilial rape and their mothers.

General observations indicated that most of the rapes occurred in the child's everyday environment and were characterized by the rapists' use of threats and violence against the children and their families. Children in the study presented with features of Posttraumatic Stress Disorder, and appeared to be at risk for secondary traumatization during the process of disclosure. The mothers' own stress response, which included feelings of fear, helplessness and vulnerability, led to self doubt regarding their efficacy as parents. The ineffectual response of the South African Police Service was a another factor that hindered recovery.

The mother's attributions concerning the rape incident were explored, with a focus on causal attribution and perceptions of the significance of the rape for the child's future. In terms of causal attribution, the children's main concern seemed to be fear of future harm. They did not appear to construct the event in a detailed way. The majority of the children were aware that peers had been similarly victimized. None of the mothers demonstrated overt indications of blaming the child for the rape. However, it was clear that they were influenced by prejudicial rape myths and on a more subtle level their responses indicated some ambivalence about their child's role in the rape.

With respect to perceptions of the significance of the rape for the child's future, on a verbal level the children did not evidence problematic attributions, but it seemed that internally, issues around disruption of identity and feelings of powerlessness may have been engendered. The results obtained from interviews with the mothers were in agreement with the literature pertaining to rape survivors, and victims of trauma, that indicates that the occasion of being a victim of a trauma somehow taints or stigmatizes the victim.

Implications of the findings for clinical practice are elaborated.

Introduction

The term "culture of violence" has been used to describe the excessive social, political, criminal and domestic violence in South African society (Simpson, 1991). Within this context, the effects of violence on children has become a topic of increasing concern. In particular, violence against women and girls in South Africa has been described as "endemic" (Vogelman & Eagle, 1991). Sexual violence has become so widespread that it is increasingly considered normative rather than deviant (Simpson, 1991). Vogelman and Eagle (1991) assert that rape is at the forefront of violence against women in South Africa. Similarly, in 1990, Sandler and Sepel asserted that child sexual abuse has emerged as one of the most common forms of child abuse.

Despite the extent of this problem, there appears to be a dearth of literature on this subject, particularly within the South African context. The study had two primary exploratory aims. The first was to provide a brief description of the nature of the extrafamilial rape incidents experienced by the children, and subsequent symptomology in the first three months after the trauma. This includes an overview of the demographic details of the children, their families and the perpetrators, and an exploration of children's patterns of disclosure. The second aim was to explore the construal of the rape incident by mother and child with particular emphasis on causal attributions of mothers and children and perceptions of the significance of the rape for the child's future.

The research has a social-psychological emphasis, which overlaps with clinical concerns. It is hoped that in providing more insight into psychological aspects of this trauma the study may assist in developing improved and informed therapeutic services for these children and their families. The data was assessed qualitatively, and supplemented with descriptive statistics. Feminist theories of rape were drawn on to provide a background for the understanding of the prevalence of rape, and common societal reactions to victims of this crime.

As an introduction to the research topic, the paper provides an overview of the current psychological literature in the area of child trauma, and specifically extrafamilial child sexual abuse. The psychological sequelae of childhood trauma, particularly in the latency period, and the significance of maternal reactions for the victim's psychological adjustment will be explored. The effects of prejudicial societal attitudes and rape myths on victims of this trauma comprise an important aspect of this discussion. Aspects of construal of the trauma which have been identified in the literature as particularly relevant to the trauma of rape are: attributions of causality and the significance of the event for the individual's self-perception. These will be focused on in the literature review.

Definition of Extrafamilial Childhood Rape

Child sexual abuse can be broadly defined as:

Any sexual activity, whether it be ongoing or a single occurrence, ranging from sexual overtones to sexual intercourse, between a sexually maturing or mature person and an unconsenting or consenting child who is cognitively and developmentally immature. This pertains whether or not the perpetrator has himself/herself committed the sexual act or has permitted or encouraged the child to indulge in any sexual activity, for example child prostitution. (Sandler & Sepel, 1990, p. 213)

Child sexual abuse can be divided into two broad categories. Incest, or intrafamilial sexual abuse, refers to sexual relations between a child and an older family member, extended family member or surrogate parent figure; while extrafamilial sexual abuse is the term used to describe cases where the perpetrator is not a member of the child's family (Sandler & Sepel, 1990).

The current research is concerned with cases of child sexual abuse which constitute extrafamilial child rape. For the purposes of this study, this is defined as: sexual intercourse between a female child (between the ages of seven and eleven) and a postpubertal male, who was not part of the child's immediate or extended family, and who was at least five years older than the child. Although extrafamilial child rape is not limited to the abuse of girl children only, it appears that the majority of victims of this type of violence are female (Vogelman, 1990;Vogelman & Eagle, 1991). In some of the cases that were included, the extrafamilial rape was limited to an isolated episode, while in others it consisted of repeated assaults.

Incidence of Extrafamilial Childhood Rape

According to official South African Police Service (SAPS) statistics, in 1996 there were a total of 13 859 reported extrafamilial rapes of children (individuals below the age of 18) in South Africa (SAPS, Telefax Communication, 1997). Statistics of the SAPS Child Protection Unit reflect an increase in the numbers of reported extrafamilial rapes, with a total of 10 037 reported extrafamilial rapes in 1995; and 7 559 in 1994 (ibid). In part, this increase may reflect increased public awareness of child abuse, which in turn leads to increased reports of this crime (Mail & Guardian, 9-15 February, 1996). However, these numbers indicate only the number of cases handled by the Child Protection Unit, and not cases handled by other units and/or other police agencies, or those cases that go unreported. In reality statistics in the area of violence against women are extremely difficult to establish with any accuracy, mainly because of under-reporting (Russell, 1991; Vogelman & Eagle, 1991). Consequently, although the SAPS statistics give some indication of the extent of the crime, they may reflect patterns of reporting, rather than actual incidence. The National Institute for Crime Prevention and Rehabilitation of Offenders (NICRO, undated) estimates that only about one in twenty rapes are reported to the police. Reasons for under-reporting include: the acceptance of this type of violence as normative by individuals and authorities; lack of confidence in the police; the shame experienced in describing assaults, particularly of a sexual nature; economic dependence on abusers; fear of reprisal by the perpetrator; and difficulty in obtaining convictions (London Rape Crisis Centre, 1984; Vogelman, 1990; Vogelman & Eagle, 1991).

In South Africa, as is the case worldwide, the actual prevalence of child sexual abuse remains uncertain (Black et al., 1994; Wyatt & Peters, 1986). In terms of violence against women and children in the South African situation, Vogelman and Eagle (1991) write:

What statistics are obtainable seem to indicate that such violence is at least as high as in other parts of the world, and often far higher. It is generally established that the incidence of violence directed at women in particular tends to reflect the general level of violence expressed in any society. South African society in all its heterogeneity is an extremely violent society with levels of violence increasing rather than decreasing. It is not surprising that in this context violence against women is prevalent. (p. 210)

Rape Promoting Factors and Rape Myths

The psychological literature on rape highlights the importance of prejudicial, stereotyped or false beliefs about rape, rape victims and rapists, in creating a societal climate that is hostile to rape victims – most of whom are female (Brownmiller, 1975; Burt, 1980). The following are some of the most common of these rape "myths" (Burt, 1980; Koss & Harvey, 1991; Vogelman, 1990):

    1. Rape is a sexual act perpetrated for sexual gratification by men who have lost their self-control in the face of women's sexual provocation.

 

    1. Women encourage rape. The assumption is that women imply consent to sexual relations, and in this way "invite" the rape. This is linked to the myth that "only bad girls get raped".

 

    1. Women derive sexual enjoyment from being raped.

 

    1. A woman was not really raped if she does not fight back.

 

    1. Women falsely accuse men of rape to make trouble for them, and to protect their own virtue retrospectively.

 

  1. Rapists are always strangers.

These rape myths reflect the prominent cultural view that rape is essentially a sexual act, as opposed to an act of violence. Although it is clear that the desire for sex is part of the rapist's motivation, rapists also use sex to fulfil non-sexual needs, such as the need for power, the need to dominate and the need to reaffirm masculinity (Vogelman, 1990). Feminist analysis of violence against women maintains that such violence demonstrates a general devaluation and objectification of women that is expressed in its most extreme form in acts of violence (Vogelman & Eagle, 1991).

Research into the effects of these rape myths suggest that they serve to deny or reduce perceived injury, and to blame rape victims for their own victimization (Burt, 1980; Lerner, 1970). The widespread internalisation of these myths decreases social censure for rape, and makes it more difficult for a rape victim to be seen as a victim of violence (ibid). Persons close to the female rape victim may be subject to the same prejudices and mythologies around rape that are held by the general public.

Although there is little research pertaining directly to the influence of these prejudices on child rape victims, it is hypothesized that the societal prejudices embodied in the rape myths described above may impact on the aspects of construal of rape that are focused on in this study: perceived causality, and perceptions of the significance of the rape for the child's future. The influence of societal construal may be directly processed, or may be influenced by the interpretations of significant adults in the child's environment, who will also reflect attitudes borne out of their own socialization. The possible influence of these rape myths will be referred to throughout this paper.

Psychological Sequelae of Childhood Trauma

Current evidence indicates that children who have experienced extrafamilial rape may show symptoms of PTSD, including exacerbated fears, anxiety, sexual problems, difficulty in social interactions, depression and low self esteem. The literature also indicates that sexual abuse of a child constitutes a major risk factor for later psychopathology. The long-term effects of child rape and sexual abuse that have been documented include: depression, guilt, negative self perception, distorted beliefs, problems in intimacy and interpersonal relationships, sexual difficulties, self destructive behaviours such as alcohol and drug dependency, relationship problems and a tendency to re-victimization (Browne & Finkelhor, 1986; Cahill, Llewelyn & Pearson, 1991; Eth & Pynoos, 1986; Jehu, 1988; Russell, 1986). However, not all children exhibit impaired functioning and there does not appear to be a consistent pattern of deleterious symptomatology (Ligezinska et al., 1996)

Factors that have been examined as potential predictors of outcome in sexual abuse cases include: characteristics of the abuse; caretaker support; and attributions of the child victim. Research concerning the relationship of abuse characteristics to symptomology has produced contradictory results. Some authors have reported that abuse severity (such as intrusive acts, duration and/or force) is positively correlated with the development of significant symptoms in the victim (Adams-Tucker, 1982; Friedrich, Urquiza & Beilke, 1986; Mannarino, Cohen, Smith & Moore-Motily, 1991); whereas others have reported mixed or negative findings (Gomes-Schwartz, Horowitz & Candarelli, 1990; Hazzard, Celano, Gould, Lawry & Webb, 1995; Wolfe et al., 1989). In current literature, attributions of the child victim, and the support by the victims's mother or primary caretaker are identified more clearly as important predictors of outcome in child sexual abuse cases (Adams-Tucker, 1982; Conte & Schuerman, 1987b; Everson, Hunter, Runyon, Edelsohn & Coulter, 1989; Gomes-Schwartz, et al., 1990).

Taylor (1983) in her theory of cognitive adaptation to threatening events proposes that the construal of meaning is an important component of the adjustment process. The search for meaning is defined as an attempt to understand the significance of the event, and is exemplified by the results of an attributional search that attempts to explain: (i) the cause of the event; and (ii) the significance of the event for the individual's future. These two dimensions have been found to be crucial in the responses of adult rape survivors, and they will form the basis of the discussion of the construal of the rape incident by children and their mothers.

Latency

A child's response to a traumatic experience is related to the developmental phase in which the child is involved, and symptom presentation may vary according to age (Eth & Pynoos, 1985; Lewis & Sarrell, 1969; Terr, 1990). This study focuses on children in the latency phase, which is defined as beginning at age five to six years, and lasting until age eleven to twelve years (Kaplan et al., 1994). During this period, children begin to develop organized, continuous memories, rather than the piecemeal, episodic memories of the preschool years. As a result, in later years, there is a memory link to this era (Stone & Church, 1957). Development during this phase will shape the child's experience of and reactions to the trauma of rape.

Latency aged children have been documented to have visualized or otherwise repeatedly perceived memories. Terr (1991) asserts that children often belatedly construct a reason for the occurrence of the trauma, or a way that the disaster could have been averted. Pynoos et al. (1987) refer to this process as "cognitive reappraisal". Children who have found reasons to explain why they suffer often attribute blame to their behaviour or their character, and feel intensely guilty (Terr, 1991). In view of the widespread internalisation of the rape myths described above, the experience of self blame may be exacerbated in victims of rape. As a result of the acquisition of operational thought, school age children can also imagine ways to alter the outcome of the trauma through denial in fantasy, and they may devise inner plans of action covering a period of time after the traumatic incident (Eth & Pynoos, 1985).

School-age children may experience many of the cognitive difficulties described in adults, including general numbness, non-responsiveness, concentration problems and a concomitant lowering of intellectual function. These cognitive disruptions are most apparent in a decline in school performance. Eth and Pynoos (1985) hypothesize that these problems derive from the intrusion of memories and thoughts connected to the traumatic event causing the child to be distracted from an academic task; the development of a cognitive style of "forgetting" associated with an inhibition of spontaneous thought, which serves to dispel reminders of the traumatic event; and the interference of a depressed affect on mental processes.

Most childhood traumas also shatter what Lifton and Olson (1976) call the "shield of invincibility" or Erikson's (1963) concept of "basic trust". Latency aged victims of trauma are also at risk for developing trauma-specific and other fears, and changed attitudes about people, life and the future. Whereas untraumatized children usually display almost limitless ideas about the future, traumatised children often evidence a foreshortened future perspective and are acutely aware of their own vulnerability (Terr, 1991). The resulting perception of vulnerability frequently manifests in preoccupation with the fear of recurrence of the trauma. A primary emotional response of rape victims is the fear of future rape (Burgess & Holmstrom, 1974).

Eth & Pynoos (1985) state that school-age children exhibit behavioural changes after a trauma, and may seem different and inconsistent. Otherwise well-behaved children can become irritable, rude and argumentative, while normally outgoing children can become passive, inhibited and withdrawn. The child may vacillate between unprovoked outbursts of aggression and avoidance of conflictual situations. Peer relationships may suffer as a result. Play and behavioural reenactments are frequent manifestations of childhood trauma. Posttraumatic play, defined as repetitive, unsatisfying play involving traumatic themes (Eth & Pynoos, 1985); is a common form of repetitive behaviour (Terr, 1981). Children are usually unaware that their behaviours and physical responses repeat something of the original thoughts or responses to the trauma. Reenactment and play sequences become more elaborate and sophisticated as the child grows older, and school age children may involve their friends in re-dramatizations and trauma related games (Eth & Pynoos, 1985).

For the latency age child, the trauma may constitute an intense perceptual experience, where all sensory modalities are involved, and the child is strongly aware of autonomic arousal and other bodily sensations. Children in this age group are especially susceptible to the development of psychosomatic complaints such as stomach aches, headaches and other bodily discomforts (Eth & Pynoos, 1985; Krystal, 1978).

The above discussion of the effects of childhood trauma in latency indicates that common responses involve cognitive, emotional, behavioural and somatic symptoms. These symptoms may also be influenced by maternal reactions to the trauma, as discussed below.

Implications of Maternal Reactions to Childhood Trauma

Recent literature in the area of child trauma identifies parents as important mediators of trauma in their children. The response of adult caretakers to victimized children has been described as critical to children's perceptions of the experience and eventual recovery (Anthony, 1986; DeFrancis, 1969; Elwell, 1979; Maclean, 1980). MacLean (1980) and Benedek (1985) emphasise family dynamics and intrapsychic functioning of parents as significant factors in the formation of PTSD in children, and Eth and Pynoos (1985) assert that the resilience of adults around the child seems to ameliorate stress in traumatic situations. The findings of Punamaki and Suleiman (1990), in research related to civil conflict, indicated that maternal coping responses had a significant impact on the way in which children were able to cope with stressful situations.

With reference to sexual abuse, it has been argued that the family's reaction to the discovery of the abuse strongly affects the impact of the abuse on the child (Pelletier & Handy, 1986). Elwell (1979) and Schultz (1973) assert that the family is likely to be the most powerful potential source of support available to the sexually abused child. One of the key factors in the child's recovery is that parents behave in a way that gives the child a sense of being protected and supported (Everstine & Everstine, 1989; Katan, 1973; Wyatt & Mickey, 1987). Lovett (1995) found that perceived warmth and affection of the mother correlates with improved competency in the abused child. The role of a supportive mother has also been highlighted by Pellegrin and Wagner (1990), who refer to the importance of the mother in believing the child's account and complying with treatment recommendations. The opportunity to express feelings about the trauma has also been identified as an important aspect of the recovery process (Silver & Wortman, 1980). The parent must be able to integrate the experience without demonstrating too much anxiety to the child. If supports are unavailable or negative, this may be more distressing than the initial victimizing experience (DeFrancis, 1969; Elwell, 1979).

Research findings in the area of child rape, however, indicate that some aspects of parental responses to child rape survivors may be problematic, and that the survivor's problems may be exacerbated by destructive interactions with others (Davis, Brickman & Baker, 1991). Significant others may be uncertain as to how to react to victims, and unsupportive behaviour can include withdrawal, criticism, ineffective help, excessive help or inappropriate help, as well as guilt and feelings of ambivalence toward the child (ibid; Everstine & Everstine, 1989; Regehr, 1990). Wyatt and Mickey (1988) document non-supportive reactions which include the victim being ignored or punished by parents or other adults to whom the incident is disclosed.

McFarlane (1994) also indicates that family members are likely to experience secondary traumatization as a result of the child's trauma, and that this reaction impacts on the child's recovery process. Burgess and Holmstrom (1974) found that family members of rape victims often experienced somatic reactions such as sleep and eating disturbances, tension headaches or fatigue. Psychological reactions such as guilt, anger, feelings of loss of control, and intrusive thoughts and generalized fears were also present (ibid). Thus parents themselves may manifest a post-traumatic stress response, and consequently be emotionally unavailable to their child as a result of their own distress. This in turn may exacerbate the negative consequences of the trauma for the child (Udwin, 1993; Vanderkolk, Perry & Herman, 1991).

Construal of Extrafamilial Child Rape

Causal Attribution

According to attribution theory (Heider, 1958; Kelley, 1973), people have a need to explain the events that occur in their world, particularly when something unusual, unwanted or unexpected happens (Janoff-Bulman & Frieze, 1983; Weiner, 1983; Wong & Weiner, 1981). There is much evidence that people do have a need to make causal attributions following traumatic events (Frazier & Schauben, 1994; Joseph, Brewin, Yule & Williams, 1993; Wong & Weiner, 1981). The nature of a person's explanation for an event seems to have important consequences for how he or she will respond to that event (Abramson, Seligman & Teasdale, 1978; Bulman & Wortman, 1977; Janoff-Bulman & Frieze, 1983; Joseph, Yule & Williams, 1993; Kelley, 1973; Morrow, 1991). As discussed earlier, although exposure to a traumatic event is the necessary etiological factor in PTSD, causal attribution and attributional style are possible contributory variables in the severity and persistence of posttraumatic symptoms (Joseph, Yule & Williams, 1993).

Some victims view their adversity as due to causes external to themselves, while others explain their victimization as due to personal behavioural or characterological factors (Morrow, 1991). Events can be attributed to causes in the environment, aspects of the traumatic incident or the underlying disposition of the person (Gulotta & Neuberger, 1983). Morrow (1991) found that the type of attribution made is critical, with subjects making internal attributions (i.e. engaging in self-blame) reporting the lowest self-esteem and greatest depression (ibid).

(i) Children's attributions

Research in the area of rape indicates that one of the most common causal attribution responses to rape is self-blame (Burgess & Holmstrom, 1974; Libow & Doty, 1979). It appears that self-blame – a common internal attribution in victims of rape, appears to be detrimental to the individual's psychological recovery. Although findings have been contradictory, the current literature suggests that any form of self blame is likely to be associated with increased trauma post-rape and thus may be considered to be maladaptive (Conte & Schuerman, 1987; Frazier, 1990; Hill & Zautra, 1989; Katz & Burt, 1988; Meyer & Taylor, 1986; Shapiro, Leifer, Martone & Kassem).

Although self-blame is common to most trauma victims, it may operate more strongly for survivors of rape, because of the existence of rape myths. Although the belief that the woman may have invited the attack, has produced little sympathy in the past for the adult rape victim, the very young or very old are seen as less subject to this prejudice (White & Rollins, 1981), possibly because they are viewed as having less agency. Hazzard et al. (1995), report a correlation between caretakers' attributions of blame to the child, and the children's own attributions of self-blame: greater self-blame was found in children whose mothers tended to blame them for the sexual abuse. This finding emphasizes the importance of parental attributions in influencing children's attributions of blame for the abuse.

(ii) Maternal Attributions

The findings concerning the attribution of blame to the child rape survivor vary, and it seems that parents exhibit a wide range of responses. In a study of adult rape survivors, Emm and McKenry (1988) found that parents placed the blame on the rapist, and most of them defined rape as an act of violence. In a vignette study conducted by Waterman and Foss-Goodman (1984), it was found that respondents attributed significantly more blame to 15-year old victims than to either seven- or eleven-year old victims. Collings and Payne (1991) also found evidence for the prediction that older victims would be held significantly more responsible for the abuse. The relationship between victim and offender has not been found to be significantly related to respondents' attributions of fault to victims or offenders (Waterman & Foss-Goodman, 1984). Research indicates that the major reason for fault attribution to the victim is the perception of insufficient resistance on the part of the victim. Also using vignettes, Broussard and Wagner (1988) investigated the effects of victim resistance on the amount of responsibility attributed to child victims of extrafamilial sexual abuse. The findings indicated that attributions of responsibility were significantly related to victim resistance, with children who were encouraging being seen as most responsible, passive children less responsible, and resisting children as least responsible. Summit (1983) asserts that, like the adult victim of rape, the child is expected to forcibly resist, to cry for help and to attempt to escape. In contrast to this expectation, the normal reaction of the child is not to use force to deal with overwhelming threat, but to submit quietly, seldom with protest or outcry, and to keep the abuse secret (ibid).

Thus the literature indicates that sexually abused children are often regarded as collaborators in their own abuse (deYoung, 1982; Finkelhor, 1979); and that attributions of responsibility for both incest victims and victims of extrafamilial rape are, to a large extent, influenced by expectations of child self-protection (Broussard & Wagner, 1988; Summit, 1983; Waterman & Foss-Goodman, 1984). The unrealistic nature of such expectations, in view of the age and power differential that characterizes child sexual abuse, does not appear to be a consideration for the respondents in these studies. The results of these vignette studies, however, pertain to strangers' opinions of the situation, and it is unclear whether maternal responses would follow the same pattern.

In summary, there are indications in the literature that children may engage in self blame, while parents appear to vacillate in their response to child victims and the kinds of causal attributions they make are largely unknown.

Perceptions of the Significance of the Rape for the Child's Future
(i) Children's perceptions

The view of the self as positive is an important perception that may be shattered by a traumatic experience (Janoff-Bulman & Frieze, 1983). The experience of rape involves a disregard of the child's wishes, and a loss of control over his or her body, factors which are fundamental to a sense of self (Wheeler & Berliner, 1988). As victimization activates negative self images (Horowitz, Wilner, Marmar & Krupnick, 1980), the experience may impact on perceptions of the child's identity.

Although a number of previous studies have found that sexually abused children as a group do not evidence self-reported symptoms (Einbender & Friedrich, 1989; Gomes-Schwartz et al., 1985; Mannarino, Cohen & Gregor, 1989), clinical experience also indicates that abused children may develop unique attributions and perceptions related to their victimization experience that are not addressed by symptom-oriented measures (Mannarino, Cohen & Berman, 1994; Morrow, 1991; Sgroi, 1982). These attributions and perceptions include feeling different from peers, blaming themselves for the abuse, feeling that other people no longer believe what they say, and reduced interpersonal trust. These feelings may stem from the victimization itself (for example, victim blame statements made by the alleged perpetrator), or post-disclosure negative reactions by family members or others. These attributions and perceptions may affect the type and severity of psychological symptoms that sexually abused children exhibit (Mannarino et al., 1994).

It is clinically reported that many abused children feel different from their peer group and perhaps even stigmatized, especially if they perceive negative reactions from others who learn about their abuse (ibid). In addition, self blame may result from perpetrator statements that they were at fault, or their own observations that they did not do enough to prevent victimization. This self-blame for the abusive experience can lead to more global personal attributions for negative events. Many sexually abused children may also be subjected to additional emotional distress if their disclosure is not believed by family members or authorities. Over time these feelings may generalise to more global perceptions of reduced interpersonal trust and lower perceived credibility (ibid). It is interesting to note that Mannarino et al.'s subjects consisted of victims of both intrafamilial and extrafamilial sexual abuse, ranging from genital fondling to vaginal or anal intercourse, and that the above findings were consistent across all groups.

In overview, in terms of children's self perceptions it seems that over time, attributions about the self develop which involve a perception of vulnerability and a stigmatized, negative self-image. These self-perceptions may also reflect maternal perceptions, which in turn may echo some of the societal prejudices toward rape victims. Research examining maternal perceptions will be discussed in the following section.

(ii) Maternal perceptions

Van Scoyk et al. (1988) found that child rape survivors' feelings of being damaged physically and emotionally echoed parental concerns about sexual development and the stigma of rape. The idea that children who are sexually abused are somehow ruined for life was found to be a pervasive belief shared by all parents (ibid). In the South African context, community leader Mary Mabaso, in an interview with sociologist Diana Russell (1991), encapsulates some of these views concerning child sexual abuse:

We are afraid we will never have the mothers of tomorrow. We are afraid that when these children get married they might not even bear children. And marriage without children is a divorce at the end of the day. The whole life of the poor child is damaged and there is no future for her. If people know a girl was raped, no-one will marry her. And others can now come and rape her because she has been raped before. She will never be safe. It is not a healthy thing to be sexually abused because at the end of the day you might become abnormal. You might be a cripple because some of your organs have been worn out before their time. (p. 12)

As indicated, the crime of rape is heavily connected with prejudice, stereotype and myth. As a result of these myths, rape has been stigmatized as shameful for the victim (Mio & Foster, 1991). There may be feelings of grief or anger over the fact that the victim has "allowed herself" to become "devalued or damaged merchandise", and such responses may reinforce the victim's sense of humiliation and devaluation (Silverman 1978). Regehr (1990) asserts that "A sexually experienced child is a troublesome paradox. A victim can become a focus for conflicts, ambivalence, guilt, and fear that the parent has regarding human sexuality" (p. 114). Thus rape can be seen as distinct from other types of trauma, for example, motor vehicle accidents, which are viewed as less contaminating.

Methodology

Given the paucity of research in this area, the research design of this study is an exploratory field study (Katz, 1953). The methodology of this study is to a large extent based on the hermeneutic tradition, in that the subjects gave an account of their experiences and perceptions, and their subjective perceptions formed the central data of the study (Banister, Burman, Parker, Taylor & Tindall, 1994; Colaizzi, 1978).

Subjects

The subjects comprised ten mothers of children who had been victims of extrafamilial rape. The study was confined to subjects with working class, African backgrounds. This appears to be a socio-economic group where children are extremely vulnerable to this crime:

While rape is a phenomenon not linked to any particular population group, the incidence of rape may not be evenly distributed throughout the population. There is some indication that township living conditions (e.g., poor lighting, lack of public transport, etc.) may exacerbate the likelihood of rape. (Vogelman & Eagle, 1991, p. 211)

The inclusion of children from different backgrounds or geographical regions would also have increased the methodological complications of the study.

In all but one case, the mothers and their children were resident in Soweto. The mothers tended to have similar economic and marital status and occupations, and the average age of the mothers was 37 years. The occupations of the mothers typically consisted of clerical work. Three mothers were unemployed and seeking employment. All subjects were members of a Christian denomination. Although English was not their first language, all of the mothers included in the study spoke English fluently. The subjects in the study tended to have multiple problems. Most of the households were single parent families, headed by the mother. In terms of the fathers, six did not live with the mothers and their children, had minimal or no contact with them, and did not provide financial maintenance. In two cases, the fathers were deceased. One of the two mothers who was married, reported that her husband was physically abusive toward herself and her children.

The child subjects in this study were all in the latency age-group. This age group is believed to be strongly influenced by maternal perceptions and behaviours (Kaplan, Sadock & Grebb, 1994; Lovett, 1995). The data was obtained within three months of the rape incident, as this time period corresponds to the diagnostic criterion of acute Posttraumatic Stress Disorder, which specifies that duration of symptoms will be less than three months (American Psychiatric Association, 1994).

Table One
Demographic Details of Subjects
 
Age of Mother
(Years)
Age of Child
(Years)
Residential
Area
Home
Language
Mother's
Employment
Marital
Circumstances
138
9
BraamfonteinZuluResidence WardenSingle mother
231
6
MeadowlandsXhosaClerical workSingle mother
326
6
MeadowlandsSouth SothoUnemployedSingle mother
444
7
NalediTswanaUnemployedSingle mother
540
10
KlipspruitZuluCatering workMarried
639
6
MeadowlandsSouth SothoCredit ControllerSingle mother
741
9
MeadowlandsTswanaHousewifeMarried (father physically abusive)
827 (aunt)
11
NalediZuluUniversity studentAunt: unmarried, no children
Mother: widow, father deceased
950 (grandmother)
8
MeadowlandsNorth SothoHousewifeBoth mother and grandfather are
single parents
1034
11
MeadowlandsXhosaUnemployedSingle mother (father deceased)

Data Collection

In order to ensure informed consent, a brief description of the study was provided by the child therapist at the conclusion of the initial contact with the parent. Permission was requested from the mothers and children to be involved in research aimed at examining the effects of child rape in order to increase understanding of the impact on children and mothers. The respondents were advised that they could terminate their participation in the research at any time, and that refusal to participate would in no way jeopardise the therapy offered to them at the Clinic. Confidentiality was assured. The mothers who agreed to participate were asked to sign a consent form. With the exception of one mother, all the mothers who were approached agreed to the interview. The respondents seemed interested in the study, and eager to talk about their perceptions of the event and comfortable for their children to take part. After the interview, many of the mothers expressed relief at the opportunity to talk about their experience of the trauma.

The researcher conducted an audio tape-recorded interview with the mother, within the first three sessions of the child's therapy. The interview chosen for this study was the structured interview, where the interviewer is allowed some flexibility in wording of questions and probing (Kerlinger, 1986). The interview consisted of closed ended questions to obtain demographic information; and open ended questions to explore the nature of the rape incident and attributional issues (such as the mother's understanding of why the rape happened, her perception of the role played by her child, and her beliefs around the meaning of the rape for the child's future).

The length of the interviews was on average 40 minutes. The researcher then addressed any concerns raised in this material, and the remainder of the interview was conducted as a general debriefing interview, according to the trauma counselling model utilised by the Trauma Clinic. Issues that were raised by the mothers included: their own reactions and difficulties subsequent to the rape, and ways of understanding and coping with the child's posttraumatic stress symptoms. The mothers were also offered the option of further debriefing sessions. This framework enabled the Trauma Clinic to provide an additional service to mothers of child rape survivors, who were not routinely offered counselling services. It was also hoped that the therapeutic nature of the intervention with the mother would indirectly benefit the child participants.

Data Analysis

The most applicable methods of analysis for this study were thematic content analysis and basic descriptive statistics. The units of analysis used in this study were themes and the thematic analysis of the data followed the procedure detailed by Colaizzi (1978). For ethical reasons, pseudonyms have been used in quotes and when discussing case material.

Results

Description of Extrafamilial Rape Incidents

In terms of location of the rapes, or where the children appear to be vulnerable, five children were raped in the school grounds, or on their way to or from school. Two children were raped by their next-door neighbours. According to the mother's description, the majority of the perpetrators (six cases) were men between the ages of 16 and 21, often attending school themselves. The remainder were older men, who were unemployed (four cases). In three cases, more than one child was involved in the rape, and in two of these cases, there were multiple perpetrators. The quotes that follow provide some examples of the rapes that the children experienced, as described by their mothers.

Nomsa, aged nine years, was raped by the nephew of her mother's boyfriend (aged 21 years):

On her way to school he called her into a shack, telling her he was going to give her "extra lessons". He gave her books, raped her, gave her "lessons" and schoolwork to do, and then raped her again. He threatened her with a gun, and also gave her dagga. This would happen for two months. (Interview One)

Thembi, aged seven years:

She told me that this guy he was usually around the school. They thought he was there to fetch his younger sister, and then on that day she was playing with her friends and he came along. So it shows that the other friends knew about him because they ran away, and when it seemed that she was not running too, they called her and told her to run. They said come run, here's the man again, and by then it was too late. He undressed her and lay on top of her. She was screaming and he put his hand of her mouth, telling her to stop or else he would kill her. And, even after he was finished he was satisfied of what he was doing, he told her not to tell anyone because he will be back. And this time it is going to be more painful and she will end up dead. So she kept quiet, until that day on the 28th. … Well, she said it happened twice, it happened twice. Ja, well he is a high school student and it is a distance from where the boy attends school to this other school. It shows that he has been doing this for quite some time unnoticed, by the mere fact that the minute that he showed up on that day, the other kids started to run. (Interview Two)

Sibongile, aged seven years:

The boys came into their classrooms there was no teacher in the classroom, just children, and they forced the two children to lie down and they told them to take out their panties, and they put in their penis. Then there were three boys, the other one was holding a knife and telling them that he would throw them out of the window if they don't do it. (Interview Four)

Thandi, aged 11 years:

When she used to come back from her school, that there was a guy used to accompany her back. He would sort of threaten her, to kill her and on several occasions he had a gun with him, threatening to shoot both her and her mother, so it happened for quite a some time. (Interview Eight)

Table Two
Overview of Circumstances of Rape Incidents
 
Perpetrator
description
No. of
Children
No. of
Perpetrators
Number of
Incidents
Location
Use of Weapons &
Nature of Threats
1Nephew of mother's
boyfriend (21 years)
1
1
Numerous incidents over
two months
On her way to school, in
a shack
Rapist carried a gun
2High school student
1
1
Unclear: possibly Two
incidents
School premisesThreatened to kill her;
cause her more pain
3Unemployed neighbour
3
1
Unclear: numerous incidentsNext door houseThreatened to beat
her and break her
neck
4Young men*
2
3
One incidentScool premisesThreatened to throw
her out of the window
5Young men
1
1
One incidentFamily member's house,
during a funeral
Unknown
6Unemployed neighbour
1
1
One incidentNext door houseTold child that the
police would kill both
himself and the child
7Young man, frequents
their street
1
1
One incidentBehind shopsSlapped her,
threatened to kill her
8Young man
1
1
Unclear: numerous incidentsOn her way back from
school
Threatened to shoot
child and her mother
9Young men
2
2
One incidentSchool premisesHit child in stomach
10Unemployed man (living
in the area
1
1
One incidentPlay area next to her
house
Restrained her hands

These descriptions provide insight into the extent of the violence and trauma experienced by the children. All of the rape incidents were characterised by the rapists' use of threats of violence and/or death against the child, and often against their families. This appears to be one of the reasons why the children were extremely anxious to conceal the rape incident. While it is difficult to identify consistent patterns in the attacks, it is clear that most of the rapes occurred in the child's everyday environment and usually during the day time. The rapists appear to have been opportunistic in preying on child victims and in most cases seem to have relied on an element of surprise. In this respect it is clear that the incidents cannot be construed as seduction "gone wrong", and that these extrafamilial rapes may differ from incestuous abuse. These descriptions would tend to confirm the feminist perspective on rape, construing attacks as involving abuse of power and aggressively motivated.

Disclosure

None of the children participating in the study disclosed the abuse immediately after the rape in a direct way. It appears, from the mothers' descriptions, that they had begun to suspect sexual abuse after noticing signs of physical damage, such as blood:

I was doing the laundry when I noticed in her panties, a discharge, and then I confronted her. At first she was too scared, but I assured her I won't be angry, she must talk to me, tell me the truth. (Interview Two)

When confronted with the their mother's suspicions, the children tended to fabricate an account of the injuries:

She called: "Mummy, mummy", jumping on the bed, "Mummy come here, come here". I said: "Mpho, but I'm from work, I have to see some things before I can listen to the news". Okay. Then I ignore her, she was jumping, jumping. Before the news started I went to her on the bed, then she said: "Mummy, see my panty is dirty". Then I asked her: "Why?" She said: "I saw it dirty, I don't know". Then I just laid her down, took off the panty, I found that it's really dirty. I said: "But Mpho you have to tell me who did this?" She said: "No mummy, I saw it dirty when I was playing". (Interview Six)

I always took the panty, you know, turning them inside out, and then when I turned Obakeng's panty, I look at it and I saw that, you know, she wanted to wash it but it didn't wash nicely. So I look at this and I see that it's blood. So I call Obakeng, close the door, the toilet door, and ask her: "What is this?" And she said: "That's blood mummy". And I said: "Where does this blood come from?" And she said: "Yesterday I was playing and then I fell on top of a stone". (Interview Seven)

In two cases, the parents were informed of the rape by other adults. A neighbour who had witnessed the rapist absconding from the scene after raping the child in a nearby playground informed one mother about her suspicion of what had happened (Interview Ten), while another mother was informed by the school principal:

When she came home, she was not specific, she was just telling me that she doesn't like that school, the boys they silly, and I did not take any notice. She was just talking, saying: "I don't like that school and those boys they were patting their thighs when they go to tuck shop", and I wasn't sure, and I was just worried … . I asked her: "How old are those boys"?. She said they were high school boys, and I was puzzled – high school boys and pre-school girls. And after that the principal called us and told us, and I was shocked. And then I came to realise that she was trying to tell me that. (Interview Three)

A disturbing finding was that in two cases, physical punishment was used to coerce the child to disclose the rape:

She said nothing has happened to her. Then I said okay let's go to the doctor, and when I go to the doctor he told me that she was abused … then she just give him some tablets. She told me that time when we come back from the doctor, when I'm trying to hit him, I was trying to beat him then she told me that somebody from the family. I just ask her why she didn't tell me at that time. She said she was afraid because we were going to beat her. I was trying to get that, that who have done this. (Interview Five)

Another mother, who became suspicious when she noticed a discharge and blood in her daughter's urine, threatened and physically punished the child to coerce her to disclose (Interview One).

These mothers became angry with the child, ostensibly for not disclosing the abuse. However, this may also imply a less conscious process of anger at the child because they had been raped. Other studies indicate that many children who do seek help from parents report that parents become hysterical or punishing, or pretend that nothing had happened (Finkelhor, 1980), in this way demonstrating the parents' inability to deal with the trauma themselves.

Summit (1983) asserts that child victims of sexual abuse often face secondary trauma in the process of disclosure, when they may be subjected to disbelief, rejection and blame from adults. This form of abandonment by the adults most crucial to the child's protection and recovery, who do not intervene to acknowledge the reality of the trauma or to confirm the responsibility of the perpetrator, may result in feelings of alienation, pain, rage, self-blame and re-victimization (ibid). It is interesting to note that professionals in the area may be aware of the children's unwillingness to disclose, and parents' problematic reactions to disclosure:

He [the examining doctor at Baragwanath] … advised me not to shout at her, not to beat her, I have to sit down with her so that I have to have the information, because if I shout, if I cry, if I do all those things, she'll just fear to say. Because the perpetrators threaten them. (Interview Six)

This pattern of non-disclosure is similar to that documented in a study by Lovett (1995), where findings indicated that even though the majority of the sexually abused children in the study viewed their relationship with their mothers as warm and accepting, less than one-third disclosed the abuse to their mothers. Thus it is possible that even a warm and accepting maternal relationship cannot overcome the power of threats made by the perpetrator. This is critical information for mothers to have, as they often blame themselves when their daughters do not confide in them immediately after being sexually abused. Summit (1983), also asserts that "the average child never asks and never tells" (p. 181).

Finkelhor (1980) documents similar findings, and proposes two reasons for the lack of disclosure. First, child survivors expressed the fear that they would be blamed for what had happened. As discussed above, this fear became a reality for some children in this study. Second, children feared that parents would not be able to protect them from retaliation by the perpetrator. As indicated, all of the children in this study were threatened with some form of violence if they did not co-operate, or if they disclosed:

She said to me: "Mummy, please, if I tell you, don't tell anybody". I said: "Okay", and I was just grinning, so that she can be free. I said: "But why?" She said: "He said I mustn't tell my mummy because then the police will come kill him, and they'll come again and kill me also". (Interview Six)

Because she said to me: "This boy's got a big knife, he's going to stab you", if she can tell. So she was afraid of that boy. He promised to kill her. (Interview Seven)

She was told that if she ever revealed that she would die. So after passing through her father's death, so knew exactly what death was all about and if someone was threatening to kill her again she was afraid she was going to pass through what her father did, the way her father died. (Interview Eight)

In cases in this study where the mothers were primarily supportive, non-punitive and non-blaming of their children this support did not seem to influence the above pattern of non-disclosure. The rapist's threats and child's fear of the rapist seemed to be the most influential factors inducing the child not to disclose.

Symptomology

The child subjects in this study presented with symptoms consistent with PTSD criteria as detailed in the DSM-IV (American Psychiatric Association, 1994). The symptomology also appeared to match Terr's (1991) description of the effects of a single trauma. The children experienced feelings of vulnerability and fears of a recurrence of the trauma or impending danger. They also experienced frequent recollections of the trauma, and various other intrusive symptoms such as nightmares and somatic complaints. Some children began to be fearful of and to avoid men. A frequent observation by mothers was that the children had become oppositional and aggressive – which was an alteration from normal behaviour. This could be related to the displacement of the child's aggression toward the perpetrator, and may also indicate anger at parents for not protecting the child (Van Scoyk et al., 1988). Cognitive difficulties were also evident. The following quotes provide examples of typical symptoms, as described by the children's mothers.

The mothers spoke of depression, mood swings, sleep disturbance, including nightmares, disturbance of appetite, impaired concentration and schoolwork, social withdrawal and fear of men:

She is so touchy, she has lost weight, lost her appetite and at times she is so forgetful, and that worries me a lot. Because from the very first day she has shown signs of an intelligent child, and now after this I can't really know whether she is coming or going. (Interview Two)

She is a very brilliant child but she has changed a lot. She didn't want to do her work any more, you know like colouring, she has got books and everything. She didn't want to play any more. Even if my brother's friends would come, she would get very upset and say why are they here. Tell them to go, I don't want them here, tell them to go. (Interview Three)

She was heartbroken. She was so cross, she didn't sleep well after that. She was scared, talking in her sleep, fighting. (Interview Four)

Another thing is she's now changed to her father. Even my brothers, she doesn't like them as she used to. If I'm around she can go to them, but when I'm outside the house, even if they are inside the house, she stands by the door. She doesn't like to stay with men anymore. She doesn't trust them. (Interview Six)

It was sad you know, she couldn't talk, she couldn't do anything, she was nervous and crying all the time, shouting at her friends, and she never wanted to talk to anybody about it. She just never wanted to say anything. She developed this thing of living in her own world where she would just do things and conclude on her own without consulting anyone. Very much withdrawn. Especially to her peer group, she wouldn't even talk to them, she would rather sit somewhere and watch them playing. (Interview Eight)

The mothers also described precocious sexuality:

Recently, what most of her talking is, is that she has more inspiration on men, handsome guys. And she questions whether, are they going to marry her, and he mustn't be involved with someone before he comes to her. When she talks, she talks as if she is a teenager now, involved in some affairs. (Interview One)

Regressive and oppositional behaviour was also noticed:

It has changed her, because she is very rebellious, very, very, very. She was sweet, but now she is always complaining, she always wants to do the opposite of what I ask her to do. … Even if I can give the baby food before her, she will complain: "Why, why are you doing that? It means you don't love me any more". She doesn't even want to dress herself any more. She says: "Why don't you dress me?" (Interview Three)

In most cases mothers observed and were sensitive to alterations in psychological functioning in their daughters. This suggests that mothers may be useful aids in assessing the impact of rape on children and potentially in mediating some of the child's distress and its symptomatic manifestations. It is interesting to note that mothers reported the majority of symptoms in categories (ii) – (iv), and it would seem that repetitive (or posttraumatic) play (American Psychiatric Association, 1994; Terr, 1991) and trauma specific reenactment were not prominent responses. Thus the symptoms tended to be more "intangible" and did not necessarily clearly alert the mothers to sexual abuse. An overview of all reported children's symptoms follows, according to the categories used in the DSM-IV classification of PTSD:

Table Three
Overview of Children's PTSD Symptoms –

DSM-IV Classification

(i) Persistent reexperiencing of the traumatic event, including intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event:

  • Sleep disturbance (frequently nightmares)
  • Fear of further abuse
  • Fear of perpetrator

(ii) Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma)

  • Fear and avoidance of men
  • Disturbed play
  • Social withdrawal

(iii) Persistent symptoms of increased arousal:

  • Becomes tearful or upset easily
  • Oppositional or aggressive behaviour, "mood swings"
  • Cognitive disturbance: often reflected in a decline in schoolwork and concentration problems
  • Eating disturbances
  • Regressive behaviours: for example, increased dependence on mother

(iv) Other

  • Depressed mood
  • Precocious sexuality

(American Psychiatric Association, 1994)

The mothers in this study also expressed uncertainty about how to behave toward their child after the rape:

It is like I am over protective, they say so. People who are watching me, they say I am over protective. I don't know what approach to use, I don't know how to treat her, how to talk to her, it is awkward for me. And I am always busy, sometimes I come late from school, I sometimes, I am late, I have to clean the house, I have too many things, and still I have to cope. It is very difficult for me. It has changed in the sense that even if we have to say something to her, we have to think twice, so you know, it is not as smooth as it was before. And I think they think I am expecting more attention and I am not, and that eats me. I don't want people to think, to pity me, because it is like ach shame, it pulls me back. (Interview Three)

This mother's own stress levels were high, making it difficult for her to support the child as well as she would have liked to have done. This stress appeared partly to pre-date the rape, but seems to have been exacerbated by the incident. Although posttraumatic stress symptoms in the mothers were not explored, as this aspect did not form part of the interview schedule, it seemed that mothers were symptomatic. All of the mothers mentioned feelings of depression, lethargy, anxiety, and fear. In addition, the fact that their child had been raped, and their own stress response, seemed to lead to doubts about their own efficacy as mothers. As indicated in the literature review, these maternal stress responses are likely to exacerbate the child's difficulty in coping with and recovering from the experience of rape (Eth & Pynoos, 1985; McFarlane, 1994; Punamaki & Suleiman, 1990; Udwin, 1993; Vanderkolk et al., 1991).

Many mothers feared talking to the child about the rape incident, and were unsure if this would be harmful to the child. They seemed to be confused about the symptom presentation, and had particular difficulty in dealing with their child's premature sexualization and aggressive behaviour. In the counselling sessions, it was useful to normalise symptoms, particularly the children's aggression, which appeared to be a main concern of the mothers. Many of the mothers also perceived themselves as stigmatised within their communities. This seemed to parallel their concern about their child being "damaged" in some way.

Police Response

All of the subjects in this study had reported the rape incidents to the South African Police Service (SAPS). And, although this was not part of the original enquiry, the response of the SAPS emerged as an important influence on the family's ability to deal with the rape incident and to re-establish a sense of safety and the perception of a "just world". All of the mothers openly expressed feelings of betrayal and outrage about the rape incident, but were unsure how to channel their anger. These reactions were prominent in the acute phase in which they were interviewed, and seemed to intensify when the police response and investigations were unsatisfactory. For example, often no penalty was imposed on the perpetrator, even in cases where he was apprehended. This aspect of the trauma was exacerbated in cases where the perpetrators lived in the family's neighbourhood, or continued to have access to the school grounds. Even when the perpetrator was identified and charged, he usually remained in the area. Thus the presence of the perpetrator became a constant reminder and source of fear:

Okay we stayed home, I think for about two weeks, nothing happening – the man is next door. Every morning when I take my baby to creche, we – we feel threatened, we were tortured, because Mpho couldn't even play outside the yard. … Ja, but now they say they can't, you know like put him in jail now, they don't do that. … The child saw him every day, you know he runs away and you know, because he is afraid, ja. She say: "Mummy I saw that boy and he look at me very angry". (Interview Six)

This mother also experienced intimidation, in the form of threatening telephone calls from the perpetrator's family. Eventually, she felt that she needed to move to another area to feel safe. Several other families seriously contemplated moving house as a result of their fear of the perpetrator's retaliation. One mother, in desperation, expressed a wish to take the law into her own hands:

This perpetrator is really a threat, the minute they are caught, they are given bail, some of them a bail of R2 000. That is not going to stop him, but he will continue doing it. It was simple the first time he was bailed, then as soon as he is outside he is going to do it again, and then he would make a point he is not caught. And really if something is not being done soon enough to stop this, I think we parents will just have to take the law into our own hands, because we are losing our babies. We are losing our babies. (Interview Two)

The one exception seemed to be the experience of the mother and child in Interview Ten. In this case, the perpetrator was identified by a person living in the area, and the Child Protection Unit (CPU) of the SAPS apprehended and arrested him two days later. He is currently in prison, awaiting trial. The police officer from the CPU also accompanied the child to the district surgeon for an examination. The mother expressed satisfaction with her dealings with the SAPS, and had no complaints.

Regehr (1990), in her documentation of clinical findings in the area of extrafamilial child sexual abuse, asserts that a desire for revenge or retribution is a common response to the assault of a child. Similar perceptions seemed to be expressed by children:

But even the police have to do something, because she keeps asking: "When are they going to arrest the boy, when are they going to come and fetch me from the school to identify him?" (Interview Two)

Thus the mothers' feelings of helplessness and vulnerability were exacerbated by the perceived lack of, or inadequate response of the South African Police Services. It is documented that psychological recovery from trauma is severely impeded when the source of threat is still in proximity to the victim (Straker & the Sanctuaries Counselling Team, 1987). This situation then begins to resemble the "Continuous Traumatic Stress Syndrome" (ibid). Both mothers and daughters clearly expressed frustration and fear in this regard. In addition, the social sanction of a legally imposed punishment plays a role in assisting victims to recognize the responsibility of the perpetrator and to diminish or minimize self-blame. The fact that the majority of these rapists were not apprehended, or even prevented from intimidating victims has implications for the construal of the rape in terms of social sanction and legitimacy. All of the investigating SAPS officers in these cases were male, and this raises the question of whether there was disinterest in that the perpetrator's behaviour was somehow tolerated, or not seen as particularly "serious" or threatening – particularly in view of the delay in charging perpetrators, who were often easily accessibly and clearly identified. In terms of the perpetrator's act of aggression, and the lack of punishment for this act, this is likely to affect the victim, and their family's, protective belief in the "just world" hypothesis (Janoff-Bulman, 1985). This phenomenon is increasingly pertinent to South African society, where perpetrators are seldom apprehended, and a degree of lawlessness prevails and appears to seriously exacerbate the psychological trauma of dealing with rape, particularly in township environments.

One mother even described her sense of being ignored by the broader society. She had been ostracized by the women's league to which she belonged, as she was not believed and was seen as a trouble maker. She explained how in her anger and desperation she had sent a letter to the Premier of Gauteng:

I even write the letter to Premier's office, asking them what they do? Because what he did on December, premier had a message for the kids, I saw that in Sowetan, then I thought I can use this. He mentioned they are doing this schooling and other things for the children, then I wrote those, and the opposite, that I said What are you doing to the perpetrators of those children? What is your real effort that you show to the perpetrator that you care for the kids? Because we took a person to court – it's freed. Now how is a baby going to go to that free school, to that free clinic and all those things, all those Mandela Sandwiches and others? How will a child enjoy those things if she always see that perpetrator. It's torturing a child. So they replied and say they took notice of that, it's noted. (Interview Six)

This apparently indifferent response, from a prominent figure in the African National Congress, an organization of which she had been an ardent supporter and in which she had placed much of her trust, was particularly devastating for this mother. In some ways this symbolized a loss of hope in any help from state authority, whether it be police or government services.

This section has explored the nature of the rape incidents, and patterns of disclosure and maternal reactions. It appears that aspects of children's disclosure and maternal reactions to this are problematic: children are fearful, and parents sometimes angry and disbelieving. The children's symptoms match those described in the literature on child trauma, and it appears that mothers experience much difficulty in dealing with these, and find them extremely anxiety provoking. The response of the police, and sometimes the broader community, seems to contribute to the mothers' sense of isolation, outrage and helplessness.

Construal of the Rape Incident by Mother and Child

Causal Attribution

In terms of causal attributions, two measures were of primary interest in this study: whether the children and their mothers made any causal attribution for the incident; and the nature of these causal attributions.

Children's Causal Attributions

There was no evidence of spontaneous causal attribution in this study, and none of the children seemed able to formulate any kind of explanation for why men rape. Examples of themes in the therapy suggest that children do not exhibit self blame as a primary reaction, and that their main response was one of fear and feelings of powerlessness. The children's main preoccupation seems to be one of re-establishing control in their lives. For example, much of the play of the child in Interview Six centred around punishing the perpetrator. She expressed much aggression, and wanted to hit a doll, symbolic of the rapist, for long periods of time. The child evidenced no behavioural or characterological self blame. She became very anxious when asked what she did during the rape, and who had she told about the incident, and she explained that she had been extremely frightened as she was threatened with death by the rapist. This fear appears to have overwhelmed other concerns, and causal issues were not considered. Another child became terrified as she told the story of the rape, and almost convulsed in fear (Interview Seven). This child was unable to play in the therapy sessions. She stated that the rapist had threatened to kill her. She knew that he had smashed a glass into another child's face when she had refused to have sex with him. This child also exhibited no evidence of self blame, and explained that she could not scream because she was fearful. One child expressed anxiety about being safe throughout her play. During the session she "looked after" a baby doll and put it in the cot. When she left the session, she instructed the therapist not to let the man near it in the week. Although this child was able to play out issues around protection and containment, she avoided talking directly about the actual rape (Interview Six)

The children's main concern seemed to be fearfulness and fear of future harm. The issue of causality did not appear to be of great importance in the children's play. In the present research, three children were raped together with another child. Seven other children stated that they were aware that other children had been raped:

It happens to other children, it happened to my friend. (Interview One)

On one occasion, the perpetrator had raped the child's friend, and this child also believed that he had done this to other girls. Another child was aware that rapes had taken place at her school:

I think there are others in the school who the boys hurt. (Interview Nine)

The awareness that others have been similarly victimised may partly explain the finding that the children in this study did not seem to exhibit evidence of self-blame. To hear of other rape victims may reduce feelings of guilt and self blame, because such knowledge makes their victimisation a less exceptional occasion. Miller and Porter (1983), with reference to adult rape survivors, assert that the more other women there are who have also been raped, the less unique the occasion of being raped will seem, and the less there will be to personally explain.

However, there may be subtle indications of some vacillation. Children may perceive that their parents may blame them, and be indirectly influenced by this perception. Not one of the children disclosed directly to their parents, apparently primarily as they had been threatened, but two children expressed a fear that they would be punished. Two mothers related their children's statements in this regard:

She said [s]he didn't want to tell us because the father is harsh, he will hit her, and didn't want to tell me because I will tell the father. Okay, the father is so harsh, he uses sjambok a lot – that's why we are all, I am also afraid of my husband. I'm not free with my husband, he's just a harsh somebody. And the child also didn't want to tell because of the father. (Interview Seven)

She thinking was that we were going to hit her, because sometimes if her mother call her: "Granny, she wants to go and hit me". I said: "Why?" "Because at school they told her that the other boy he do something from me". (Interview Nine)

These statements may indicate a fear that the child would be seen as responsible for the rape. One child described herself as fearful and anxious about her behaviour during the rape incident: She stated: "I will never listen to anyone one who wants me to go off with them again." (Interview One). This may indicate some behavioural self-blame. When discussing the reality of the situation, the child said she could not have done anything to stop the man. In play however, she would get the therapist (as the "abused") to call out, run away or fight the abuser. This may indicate a retrospective attempt to gain control over the situation, but also a sense of preoccupation with her own behaviour during the attack (Interview Two). Two other children hinted at their belief about why the perpetrator chose them in particular, and these explanations do indicate some self-blame. One child stated that it was "because I went with him to the car" (Interview Three), while another felt that the rape happened "because these boys don't like us. They always give us problems." In another case, although the child had no conscious causal explanation, she would experience acute shame when her mother told other people about the rape (which she did indiscriminately) (Interview Five).

The data pertaining to the children's construal of the rape incident were collected within three months of the rape incident, and there is also the possibility that more pronounced self-blame may emerge only after this acute post-traumatic stress phase. It may be that at this early stage, self-blame attributions have not yet crystallized, possibly because of the predominance of the fear response.

The original intention of the study was to explore whether the mother's construal mediated the child's own construal of the rape incident. However, data from the child therapy was more sparse than from the direct interviews with the mothers, and this precluded any in-depth comparison of construal in individual cases. Two factors can be hypothesized to account for the limited nature of the child data. First, verbatim responses could not be obtained, as for ethical reasons the interviewer was not able to interview the children directly, but was reliant on information provided by the child therapist. However, a second important factor is that the restricted nature of the children's verbalizations may also be indicative of the symptomology of the child, as their cognitive and verbal abilities may have been compromised by regression in response to the trauma.

In summary, as a group the children presented in a rigid and frozen manner in the therapy, and did not articulate perceptions around causality. The results of this study indicate that latency aged children may not construct the event in an elaborate fashion. The children's emotions seemed to manifest more clearly in the non-verbal sphere, through play, and examples of this kind from the therapy were used to illustrate aspects of construal. In the case of child rape, this research indicates that play and drawing may be useful techniques in the face of traumatic regression, which affects verbal fluency.

Although the majority of children did not engage in a spontaneous causal attributional search, it appears that mothers had considered the question of causality, but had difficulty in formulating a causal explanation, apparently due to conflicting perceptions around childhood and rape victims. This aspect of construal will be explored in the following section.

Maternal Causal Attributions

Although all of the mothers in the research sample were aware that child rape did occur in their communities, they expressed shock and disbelief that it had happened to their child:

Yes, we do hear this on the TV and all, but you know, when it comes to you, you cannot believe that it do happen. Unless you get to know the social worker and they will tell you that it happens every day, every minute, every second of each and every day. (Interview Seven)

As discussed in the literature review, the mothers are immersed in cultural beliefs which imply that a large portion of responsibility for the rape lies with the victim. As a result, it was hypothesized that mothers would have three explanatory options in terms of causal attribution:

  1. To compartmentalize and distinguish between rape of adults and rape of children as different entities, with differing explanations. It was thought that mothers may find it difficult to apply the rape myths to children, as children are not seen as having sufficient agency to incur blame. Levett (1989), in a discussion of the dominant discourses of childhood, describes the belief in the "passive" and "innocent" child. She asserts that children are viewed as "passive" recipients of external forces of adversity (or traumatic events) and of socialization. In terms of this discourse, no account is taken of the child's own agency or of the strategies that may be available to children in different situations. Children are seen to be "innocent" in that they are viewed as representing an inherent goodness which lies at the core of all people. This discourse of childhood may lead the mother to place the blame entirely with the rapist.

  2. Another possibility would be to interpret causality according to the rape myths, and to attribute blame to the rape survivor – in this case the child. In other words, to formulate an alternative explanation for child rape in the same mould as for adult rape survivors.

  3. In view of the discourses regarding the "innocence" and "passivity" of children, and because mothers are likely to continue to be influenced by myths around rape, it is possible that they may then turn to themselves, and engage in some form of self blame.

All of the above formulations were evident in the data, and will be discussed in the following sections.

(i) Attribution of blame to the rapist

When asked directly, none of the mothers in the sample expressed overt evidence of blaming the children for the rape. Blame was placed firmly with the rapist:

No, really I can't blame her, I can't blame her, she was innocent and I tell her not to worry, it was not her fault. (Interview Two)

No, it was not her fault at all. It is just that thug who took advantage of a baby and misused the baby. (Interview Eight)

No. It is not her fault, you can't blame the child because she doesn't know what is that and what to do. You can't blame her, you just blame those who do that thing on the child. (Interview Nine)

The overwhelming response to exploring perceptions around why men rape children was that it was extremely difficult to formulate a satisfactory causal explanation, although all of the mothers had tried to do so. The quotes in this section are infused with expressions of shock, uncertainty and confusion. Causal explanations that were formulated by the mothers for the rapist's actions were varied, with no particular causes predominating. The explanations included sociological factors that are considered important in contemporary rape research (Russell, 1991):

i. The rapist's use of substances:

Others will tell you he was under the influence of liquor, or drugs … I don't really see it as an excuse because whenever a person has a beer, he knows what his intentions are, but they always blame the liquor. (Interview Two)

I think maybe they were under the influence, I think maybe they are taking drugs. (Interview Four)

While many researchers deny that alcohol and drugs cause men to rape, it does appear that these substances undermine inhibitions to commit rape (ibid).

ii. Societal influences such as poor living conditions, unemployment, and subsequent frustration:

Maybe it is frustration or what, I don't know. I can't think. With not working, he is a university drop-out and he is always, we even used to go to him to help us with his school work, so I really don't know, I can't even think what would cause him to do that … even the area that we live in is not ideal for bringing up children. I don't know. (Interview Three)

One mother stated that she felt the absence of the protection of the child's father had left her vulnerable as a single mother:

I think he took a advantage to the situation because at Thandi's place the father passed away in 1991, in August … . And this guy was in the neighbourhood, they just took advantage, because it would not have happened if the father was alive. He was very much responsible for his kids. (Interview Eight)

iii. The rapist having been abused in childhood:

Maybe he might have been abused himself, being a youngster or even as an adult, maybe the situation is at home, it's not right. So maybe he is trying to console himself. But even that, rape is not the solution. (Interview Two)

One mother blamed the rape on the rapists' evil nature:

I think it is just being selfish. They are just being evil, cruel to kids. (Interview Eight)

Another mother expressed a belief that the rapists' fear of contracting AIDS would induce him to choose children to rape as opposed to adult women:

I think sometimes because now … the men see that other people have got AIDS. So young babies haven't got the problem of AIDS. That is why they rape the child. Because before, when I was a little girl, that raping was not around, and AIDS was not around when I was eight/nine – younger than Nomsa. So that is why it causes the rape of small girls – AIDS. That guy, the age of 20/21, they are frightened to go to the big women, they want younger ones. (Interview One)

The following responses indicated the internalisation of rape myths. Rape was seen as a result of the man's uncontrollable sexual urges, and was related purely to sexual needs:

You know I always look at these boys, he has got his girlfriends you know. Like he uses our stretch often, going with these young girls. Now I am asking myself, why did he do this to Obakeng when he's got girlfriends. I just thought that maybe that time, that day, the girlfriend maybe chase him away you know and then maybe that time he wanted to get sex with that girlfriend and then she wouldn't and then he just grabbed Obakeng. I don't know. I really can't say why. Because it's like our men, how can you say: Why is he doing this to other girls whilst he has got a wife? Maybe Obakeng was there by that time you know he wanted to have sex with anybody. (Interview Seven)

You know, I was shocked at that time … why should this man do this to my child? Okay, I said the wife is not here, but there are elderly people that are going around, even at night. He can just stand in the street and get that. I failed to get an answer, I failed. Why, because there are many women trampers that go around at night, even the day – why should they do this to the kids. I can't explain why, I can't really find out why. (Interview Six)

It is because these men have left their wives far away, when they see growing children they get tempted. (Interview Ten)

Two of the mothers implied the belief that the rapist did experience sexual desire for and attraction toward the child:

Maybe he sees that Nomsa is beautiful. And Nomsa is jolly for everybody. Friendly for all. (Interview One)

They doesn't think that is a child, they think it is a big somebody, but it is a child. Even at home there is another gentleman opposite us, he is always there. He always say, ooh, if I was not old I would have married this child. (Interview Nine)

In summary, in response to questioning around causality, none of the mothers expressed overt indications of blaming the child for the rape. The immediate response was to attribute causal responsibility to the rapist, and the various explanations included sociological factors such as substance abuse (alcohol or drugs), poor living conditions, unemployment, and single parent families. Other reasons that were proposed included the rapist's "evil nature", and the fear of contracting AIDS from adult sexual partners. The responses of three mothers reflected rape myths in that rape was seen as a result of the man's uncontrollable sexual urges, and was related purely to sexual needs; and two mothers expressed the belief that the rapist experienced an attraction toward the child.

(ii) Indications of attribution of blame to the child

As indicated above, in response to the direct enquiry about blame, the mothers all indicated that the fault lay entirely with the rapist. However, in view of the literature in this area regarding attribution of responsibility to the victim, it was decided that a direct question exploring the mother's concerns about her child's behaviour was necessary. It was explained that although it is understood that the rapist is at fault, sometimes parents still worry that their child "did something wrong". The interviewer then asked: "Do you ever worry that your daughter did something she shouldn't have?" In response to the question of why the rapist targeted their child specifically, on a more subtle level the mothers responses indicated some ambivalence about their child's role in the situation:

I can't say anything because I'm not sure of that. Wrong? I don't know. I know nothing, because I even asked Tsepiso, that where was the other people at home? Why was that man doing that to you. She said she don't know. (Interview Five)

I can't answer that. I can't answer that. Really I can't answer that one. Always they play here at home, or they are outside the yard, but you know just near the home, so I really cannot see how, or did she did do something wrong or did he see something. I cannot say. (Interview Seven)

Thus although they could not find any direct cause for blame, these mothers found it difficult to give up their doubts in this regard. The search for a causal explanation seems so powerful and so influenced by social beliefs, that these mothers are left with intense confusion. There was also indication of behavioural blame located with the child, in that the mothers implied that the child might have escaped had she behaved differently:

Ja, I thought that she could have run away from him. And like ask him a question, like "Why are you calling me from there?". (Interview One)

I asked her: "Why couldn't you scream?". She said: "Mummy, he closed the window". And then their bedroom is that side and nobody could have heard her. "He closed the window mummy, and he locked the door". And after that he took her, after she was crying, he took her and said "Sit down here and play with Sipho". And I say to Mpho, you know, I used to say: "Don't go next door". She said: "Yes mummy, but I was going to give Sipho this". [Sipho was her playmate, and the child would often share her food with her]. (Interview Six)

Another mother stated that she believed he chose her child because she did not run away like all the other children had done (Interview Two). These results are in agreement with the findings of Summit (1983), and also with those of Collings and Payne (1991) who found that in cases of incest, significantly more causal responsibility was attributed to the victim by others in cases where the victim responded passively.

The inference in the following quote is that the rapist picked on the child in relation to his power, and his belief that he would be able to intimidate her:

Maybe that day his intentions was to do it on her. So, it proves that he is choosing his victims carefully. I suppose that there are older students at that school, so he could have chosen anyone, but he might have been afraid that that girl might tell. (Interview Two)

Other than this one quote, there was no acknowledgement of recognition of power issues by the mothers.

As the following quote indicates, it seems that in the mothers' causal attributions, they vacillate between what is "true" of rape and what they believe to be "true" about childhood:

If it were big women I would think maybe because they were enticing them with their clothes, but these are small girls, I don't know why. It puzzled me. If they were all the same age I would say they were looking at them, and then they teasing or something, but small children like these ones. I don't know. … That's why I am telling you if it was a big girl, I think maybe she was doing something wrong too, but Sibongile is a small girl. She doesn't know anything and those such things. (Interview Four)

This quote demonstrates a clear adherence to stigmatized beliefs around female rape victims, and implies that adult rape survivors play an instrumental role in "tempting" the rapist, through either their dress or their provocative behaviour. The implication also seems to be that if this woman's child were older, the mother's construal of the event would have included some placement of blame on the child. The following two quotes also imply that the mothers' causal reasoning included thoughts around whether the child's sexually provocative behaviour in some way provoked the rape:

Maybe my baby was playing in a way that this man thought of something. But they always play here – okay she can roll on the floor, she can – but I don't see her attracting a man as the baby. She rolls just because she's a baby, she doesn't do that because she knows what can happen, or who can think of something else. (Interview Six)

Kids are innocent. They can't really think, I know what type of kid is Thandi is for a child. I have been visiting her when her father was still alive, even now the way, well mannered kids. They usually go to church and they know really what manners is all about. There are no type of kids who just move around the streets and that sort of thing. (Interview Eight)

As these quotes demonstrate, there seems to be a tension in the mother's construal of the event, resulting from the irreconcilable aspects of the discourse of childhood – one of innocence and vulnerability on the one hand, and societal myths and prejudices regarding rape victims on the other. The stereotypical view of "innocent" children, who are unaware of sexual mores and do not have sufficient agency, seems to act as a buffer against blame being placed on child victims of rape. Although, simultaneously, mothers seem to be able to retain prejudiced views of adult rape survivors. This childhood buffer, however, seems to be less effective in terms of the mothers' fears that the children have somehow been stigmatized and damaged by the rape experience. This aspect will be discussed later in the paper. The following section will address the third hypothesized possibility for the mothers' construal of the rape incident: self-blame.

(iii) Indications of self blame

The majority of mothers did not appear to experience self blame or guilt, as they felt it would have been impossible for them to have protected the child at all times – for example, on the way home from school, or in the school grounds. In one case, the perpetrator had been a known and trusted neighbour, and the mother had not suspected that he was capable of harming her child:

And he is so tactful, he will come here, he has got a very smooth tongue. He will come here and you will feel he is such a person that he cannot do. I mean he was home if he was not working but he was still respected. (Interview Three)

Only one mother expressed self blame directly:

I said – oh, was I irresponsible, was I, is he doing this because he wants to hurt me, is he doing this – you know I said: Why Mpho, why why? … all the questions I ask myself were unanswered. I didn't have answers for my questions. (Interview Six)

The following response proposes that God's will was responsible for the rape:

You know because I'm a Christian, sometimes I thought that, you know, is god trying to show us he is living and we must always pray – or is the type of you know, the sjambok that he's giving us or what. The punishment, or that we must trust in him and then pray hard and all – we mustn't if life's smooth and then forget about, about him. (Interview Seven)

However, as this response implies punishment, it may also indirectly indicate a degree of self-blame.

Regehr (1990) also documents feelings of self-blame in parents. These feelings of guilt may also be reinforced by others who share the belief that in a just world, bad things do not happen to the undeserving, and thus the parents must at some level be at fault (Jones & Aronson, 1973). One mother indicated that she had been blamed by other family members:

Yes I did tell the father and then the father tells granny and when they come they just fight with me, they said I'm careless with my children. Because I can't go with them all the time, even if I'm with my friends must I hold these children they mustn't go and play in the street? (Interview Five)

In summary, it seems that the mothers vacillated between the first and second explanatory options proposed at the beginning of this section. It appears that they do subscribe to the rape myths, and that these are considered in their construal of causality. However, as these myths, which imply culpability and agency on the part of the rape victim, are incompatible with their beliefs around childhood, the child is seen as innocent, although subtle indications of blame were expressed in some cases. It is likely that in the case of an adult woman, the mothers would be likely to turn to conventional beliefs about rape, and attribute blame to the woman; and that although on the whole they tend to absolve children of blame, this implicit judgement may contaminate their response. On some level, however, these contradictions leave the mothers with a vacuum in terms of causal explanations:

Really, I can't understand why, I can't understand what they are looking for, especially innocent kids, even youngsters, and even boys. (Interview Two)

I don't know. I can't say anything because I don't know. I was shocked because I couldn't expect such things like that. (Interview Five)

I don't come up with the right solution. (Interview Seven)

It should also be noted that the sample in this study may have been biased in that these mothers can be assumed to be concerned because, of their own accord, they brought their children to the Trauma Clinic for treatment. Despite implicit and probably more unconscious contradictions of which they did not seem to be aware, overtly, they were non-blaming and placed responsibility with the rapist. However, this may not be a reflection of the general response of mothers. As indicated, in two interviews, a grandmother and an aunt brought the children to the Trauma Clinic, as the mothers seemed not to want to be involved, or to deny the effects of the abuse. Thus there is the possibility that there are mothers who respond in a blaming or disengaged way, rather than in a supportive manner. Even for supportive mothers however, therapeutic intervention seems appropriate to address the more unconscious negative attitudes toward their children. This is also applicable to the perceptions addressed in the following section: perceptions of the implications of the rape for the child's future, where there appears to be more overt negative construal.

Perceptions of the Significance of the Rape for the Child's Future

This aspect of the study explored the impact of the rape on the child's self image and the maternal perceptions of the significance of the rape for their child's future.

Children's Perceptions

On a verbal level, children denied any feelings of change, stigma or anxiety about their future. Only one child was able to acknowledge any change: "Yes, I'm very sad now. I dream about the sad man … so I'm different." (Interview Three). However, on a more symbolic level, their play often appeared to contradict their verbal statements.

On enquiry, one child made the assertion: "I'm no different. Everything is okay." (Interview One). However, the therapist felt that the child's body language did not support this statement, as she appeared anxious and restless, and had difficulty in sustaining eye contact. On enquiry, another subject said that the rape had not changed her in any way, but became tearful at this point. She was unable to conceptualise a future (Interview Four). One child was able to describe difference in terms of symptoms. She described how before therapy she was "sad" all the time, and although she had always enjoyed school previously, she now did not want to go back. (Interview Nine)

In some cases, the child's articulation was contradicted by her behaviour. For example, two children were not able to discuss the incident in any detail in the therapy (Interviews Two, Eight and Ten). One child stated "I'm just the same" (Interview Two). However, later in the session there was much compensatory play from the child regarding the regaining of power, and she engaged in play indicating that she was strong and powerful. In interview case eight, the child denied any evidence of blame and also denied any change in herself. However, any mention of the incident by the therapist was countered with distracting play by the child. This child was extremely anxious in the sessions, and unable to relax. In the first session, she acknowledged that "something sad" had happened to her and she still thought about it. In the second session, she presented as very uncomfortable, and denied any "sad things". Her play was aggressive and often violent. She would not talk about any aspect of the incident. The third session was cancelled as she "ran away" to stop any further discussion. In this case, the rape was compounded by the death of the father in 1991; and the subsequent abandonment by the mother.

In terms of power issues, one child initially presented as very frightened, and it appeared that the trauma had interrupted her play as she was unable to socialize with her friends. Later in the therapy, she brought a piece of paper to the therapy which appeared to be a "police docket". The child had played a game with her brother, where he was given the role of a man aged 25 years, whose occupation was "drugs". The child had been taking a statement, and had signed her name on the piece of paper numerous times. She revealed that she now wanted to become a police officer (Interview Seven). Hazzard et al. (1995) found that children's experience of powerlessness was the most important variable in predicting overall maladjustment, a finding with important treatment implications.

Despite the frequency of problems reported by parents of sexually abused children, researchers who have questioned children directly have reported no differences between children who have been sexually abused and non-abused children in either their knowledge of sexual practices or their psychological functioning (Cohen & Mannarino, 1988). As a group, children suspected of having been sexually abused did not perceive themselves to be less competent or less accepted (Cohen & Mannarino, 1988; Black et al., 1994; Gomes-Schwartz et al., 1990). Several studies have demonstrated that as a group, these children do not endorse depressive or self esteem problems as measured with global self-report instruments (Cohen & Mannarino, 1988; Einbender & Friedrich, 1989; Gomes-Schwartz et al., 1985). Thus research has been conflictual as to whether sexually abused children manifest some of the self-reported problems believed to be associated with sexual victimization (Mannarino et al., 1994). This discrepancy may be the result of denial on the part of the abused children (Dollinger, 1986; Mannarino et al., 1989), or complicated by the measures or indices used to tap symptoms, and these problems may only emerge later, or only be articulated in adulthood.

The data in this section implies that there may be different levels on which information is processed. While verbally the child may not evidence problematic attributions, internally, issues around disruption of identity and feelings of powerlessness may be engendered. This emphasizes the importance of attending to non-verbal manifestations, such as themes in play, in this age group. It is also significant that despite an apparent absence of self-awareness of difficulties in the children, the mothers had noticed behavioural and other changes which appeared indicative of pathology in the children. Again, much of this alteration was demonstrated behaviourally, as opposed to clearly articulated.

Although the symptoms described in this chapter are similar to those reported in literature pertaining to children who have experienced extrafamilial sexual abuse, there are also notable differences from other published descriptions of post-rape symptomology. One such difference is that children in the present study did not describe the sense of a foreshortened future, in which they did not expect to marry, have careers or live long lives (Terr, 1983). Similar findings are reported by Kiser et al. (1988) in a study of children sexually abused while at a daycare centre. These authors suggest that perhaps in follow up studies, these children will express doubts about their futures, which may in part reflect their parents' worries. Although the children in the present study did not yet appear to have formulated the concept of a future, the mothers of the children raised concerns about the long term effects of the sexual abuse on their children, and these will be discussed in the following section.

Maternal Perceptions

The results obtained from interviews with the mothers were in agreement with the literature pertaining to rape survivors, and other victims of trauma, which indicates that the occasion of being a victim of a trauma somehow taints or stigmatizes the victim. In response to a query about their children's future, it was found that the rape engendered perceptions that the child was somehow damaged, stigmatized and different from prior to the rape. There was a sense of contamination, in that the child, in having been forced to collude in a "bad" activity, had somehow been tainted:

Interviewer: Do you ever think about her future?
Mother: It is the first thing that I have done, because now if her future is, this boy that done this, her future sometimes they have condemned her. (Interview Nine)

Two predominant themes were the fear that the child would be stigmatized because of the rape, and the anxiety that the child would be unable to establish relationships in the future and bear children.

(i) Perceptions of stigma

Mothers expressed a perception that the child would be perceived as different, and victimized by others because of the rape experience:

I don't know how damaged is she. And then how is she going to face the world as some people will be big by then when she's big also, then are they going to call her names? Are they going to avoid her, seeing that, remembering that she, she was raped? Are they going to put this in her mind that she's different from them? (Interview Six)

Her life is different. … Everyone is looking at Ithumeleng, knowing she's been raped. (Interview Ten)

Two mothers attempted to ensure that the child would keep the rape a secret, implying stigma and future victimization because of the incident:

I even told them not to tell anyone, because they will abuse her too. Even if they don't do it physically, they'll do it verbally and then it'll disturb her, so she mustn't say this to anyone. … I won't even tell anyone, I won't even tell Granny about that, if she doesn't want Granny to know. I won't tell anyone. I'll keep it to myself as I have been keeping this to myself. (Interview Two)

I said to him [her]: "Obakeng, if you've got a problem, you see all these mothers here in our area, they won't help you baby. They can even – others will laugh, I'm the only one who can really help you. If you've got a problem Obakeng I'm not going to tell your father, I'm not going to tell your brothers, I'm not going to tell anyone. It will be ours together. If there's something wrong that has happened to you Obakeng, you'll tell me, I won't tell anybody". (Interview Seven)

Another mother stated that she wanted to move home with her daughter, as she was worried that when the child became involved in an relationship as a teenager, people would "talk a lot, and misinterpret the rape into a boyfriend" (Interview One). Similarly, in another case, the mother wanted to move to another area, and to have her daughter change schools, as she believed she would not cope with the stigma of people knowing she had been raped (Interview Ten). These responses imply that the child would be seen in a negative light, and this may be related to some unconscious indications of blame for the incident. There was even a sense that blame from the community might take place retrospectively, placing constraints on the child's expression of sexuality into adulthood.

(ii) Fears about future relationships

A predominant fear about the future was that the child would not be able to establish relationships or bear children. Despite reassurances by medical doctors, this fear was linked to a sense that the child had incurred some internal, physical damage:

I lost hope because I had many plans for her, now I thought maybe, when she reaches motherhood, she won't bear children, she'll have problem with marriage, she'll have problem when it comes to relationships. And I was scared that the guy might have AIDS, or other STDs. (Interview One)

My negative thoughts are she might be sterile, she might have some diseases which are not yet noticed, but can be noticed as she grows older. (Interview Two)

You know, because they are too small and they are, their inside it's not well, they … won't get children or what and then the future it won't be alright. (Interview Nine)

It is difficult to establish how widespread this particular belief is. Staff at the CSVR Trauma Clinic are of the opinion that this is a significant perception in the township.

Another issue was the belief that the child would continue to be fearful of men and sexual relationships:

It has … it has spoiled my child's life. Because, you know, sometimes she sits as if she is worrying, or thinking about that scene. I always tell myself that this has spoilt my child's life because now I am worried whether she will still love boys, or hate them, or never get married and so on. I'm really, really worried. And this thing also comes back to me sometimes when I'm alone, sitting alone – that why should it happen to my child; and will [s]he live a normal life when he grows up. Sometimes I don't sleep, I always think about this. (Interview Seven)

I am worried about that. If she will manage to cope, to make friends with other children because maybe she will think they are all the same. Ja, I think boys, Ja I think boys, ja, her brother can't even touch her. I wonder if she will be affected, if her brain is affected … And if she is damaged? If a boy has damaged her. (Interview Four)

The above findings may be particular to this group of african mothers, as a result of the extremely high value placed on reproduction in the african context. The bearing of children is seen as an essential part of being a woman, and of achieving success as a woman (Ngubane, 1977; Preston-Whyte & Zondi, 1989).

In summary, mothers feared that their children would be damaged physically and emotionally, and expressed concerns about sexual development and being stigmatized. This response by mothers may contribute to the victim's perception that she has been damaged or mysteriously altered by the rape (Burgess, Groth, Holmstrom & Sgroi, 1978), and may even result in the parents feeling reluctant to touch their child (Regehr, 1990). In the nature of the mothers' language, there is a suggestion of a paranoid element in the mothers' concerns about the "contamination" of their daughters. Their concerns appear to go beyond realistic ones, as they had been reassured by medical doctors that their daughters had not been internally physically damaged in any way. Thus it seems that there has been a subtle cognitive distortion, which is driven by anxiety.

The results of this section imply that children who have been victims of extrafamilial rape may be faced with and influenced by the negative perceptions of their mothers with regard to their future development. These maladaptive beliefs may well affect the child's self esteem, as well as the quality of their relationships with their mothers. In addition, it may exacerbate their own sense of having been somehow permanently damaged or contaminated by the rape.

Implications for Clinical Practice

Despite posttraumatic stress symptoms, children appear to have the ability and the motivation to collaborate with an adult in directly confronting the traumatic incident soon after its occurrence (Pynoos & Eth, 1986). Clinical experience indicates that open discussion of the trauma offers relief and does not further distress the child. Pynoos and Eth (1986) view the role of the clinician as an auxiliary ego, to provide the encouragement needed to work through the trauma. As the child begins to establish a sense of mastery in the presence of the clinician, he or she also re-establishes the capacity to engage in interpersonal relationships (Terr, 1990). The therapy can function as a bridge to those caretaking adults available to the child and so open the child to therapeutic influences in his or her environment (ibid). The gains of this therapeutic process may be either jeopardised or enhanced by external factors in the child's social support system. If the social system is supportive and understanding, then "the ego restitution initiated during the [therapy] session can be consolidated and expanded" (Pynoos & Eth, 1986, p. 318). This statement has important implications for working with primary caretakers, both therapeutically and educatively, in terms of how their own reactions to the trauma may be impeding their ability to contain the child's emotions. Thus within any therapeutic paradigm it is important to address not only the child's experience of trauma, but also parental (or in this case maternal) reactions. The following sections will address possible clinical interventions that have been highlighted by the findings of this study. The section below focuses on therapeutic interventions with the child victims, while the following section suggests opportunities for intervention with mothers of these children.

Clinical Interventions with Children

Current treatment for victims of childhood trauma emphasizes therapeutic intervention in which an active therapist focuses the child on resolution of traumatic issues (Milchman, 1993; Sgroi, 1978). This can be contrasted with "unstructured", or non-directive treatment where content is generated by the child. In structured treatment, the therapist's active role facilitates the emergence and resolution of the traumatic issues, and these therapies tend to be short-term, lasting from two months to one year, although clearly, the need for longer treatment is recognised in cases where the child is severely traumatised (Milchman, 1993). This form of treatment is believed to be useful in the South African context, where therapeutic resources are limited, and private treatment out of the reach of the socio-economic group studied in the present research. This section concentrates on structured therapeutic techniques with children that, in view of the results of this study, are seen to be useful.

The findings of this study indicate that for the child subjects, the predominant reactions to extrafamilial rape appear to be: a sense of extreme fear of the perpetrator's reprisal, a preoccupation with a sense of regaining control and feelings of powerlessness. On a more unconscious level, there also seems to be a perception that parents may hold them responsible for the rape incident. Data around self image was not easy to access, but on a non-verbal level it seems there may some anxiety around this theme. More significantly, the mothers' perceptions of their children as somehow stigmatized are likely to impact on the recovery process. In view of these findings, the following recommendations are proposed:

(i) Although children in the latency age group are thought to be more capable of discussing their thoughts and feelings, this research indicates that this is not necessarily the case subsequent to trauma. Consequently, play and drawing techniques may be used to elicit maladaptive attributions about causality and self perception. Through the use of these techniques the clinician may be able to engage the more inhibited or regressed child in an exploration of the events associated with the traumatic experience. As an opening, drawing is also often a comfortable play activity for the child. Drawing the scene of the event may help the child to speak more fully about the event (Pynoos & Eth, 1986). For some children who cannot recapture an entire traumatic experience in words, drawings may unlock a significant segment of the experience. Specific examples of these techniques will be discussed in below.

(ii) Depending on the importance that this assumes for the individual child, changing cognitions about the cause of the event itself, or altering perceptions of the causes of significant events that took place during the rape may be necessary. However, in the acute phase, this research indicates that an important focus may be to address the child's acute sense of fear. Sirles, Walsma, Lytle-Barnaby and Lander (1988) suggest a five part sequential drawing exercise to explore and challenge children's perceptions of themselves and the trauma. Over a number of sessions, the child is asked to draw a series of pictures depicting the following: (i) What was it like before the rape?; (ii) What was it like during the time you were being raped? (iii) What was it like when you told someone? (iii) What do you think your future will be like? This process provides content for the therapeutic process which includes attributions around causality and sense of stigma. These can then be challenged or reframed if maladaptive, and reinforced if they are positive.

Letter writing exercises are another possible technique for addressing attributions, although more dependent on verbal ability. The child may write to: the abuser, parents and other important figures (for example police, or the judge in their case). Children are encouraged to express their feelings, and it is optional whether or not the letter should be delivered. The content of the letters is likely to reflect interaction between the child and her caretakers, as well as attitudes and beliefs about the abuse. Techniques such as letter writing provide an outlet for feelings of injustice, and if the letters are actually sent to prominent figures, this may lead to some sense of empowerment.

In summary, the therapist can facilitate working through the trauma by encouraging the child to talk about the experience, and at the same time "cleaning up after" the child (Figley, 1985) by clarifying insights, placing blame and credit more objectively, and correcting distortions regarding negative self perceptions (for example, in terms of perceptions of being different or spoiled, future relationships or physical "damage"). As indicated, most treatment approaches emphasize the importance for the victim of attaining a perspective that attributes responsibility for the rape to the perpetrator instead of to self. These steps are equally necessary with the mothers of victims.

(iii) The literature indicates that children do not necessarily acknowledge PTSD symptoms. These findings were confirmed by this study, where children did not verbalize any of their symptoms. In contrast, mothers were seen to be an important and observant source of information around emotional and behavioural sequelae, and it seems vital to include them in assessing the extent of the trauma. When children are being evaluated for treatment and severity of symptomology, both the child and the parents should be questioned.

(iv) Strategies focused on re-instating an internal sense of safety are vital. Practical measures of ensuring the child is protected from further rapes (for example, accompanying the child to school), or from reprisal from the rapist, are obviously crucial, although they may not always be possible. Information around incarceration of the perpetrator, if this has occurred, may be useful to convey to the child.

Restoring this sense of safety can be linked to educative knowledge and strategies. Ideally, children should know how to recognise abuse, that it is wrong, and who to notify in the event of an abuse incident (Wheeler & Berliner, 1988). Age appropriate sex education can be used to provide the children with correct information and to empower them with knowledge.

Treatment emphasis on self-protection and assertiveness training may offset the child's sense of powerlessness. However, the caution is that this does not somehow convey to the child the impression that she was responsible for preventing the rape. Teaching skills enables children to evaluate situations and meet their own needs more effectively (ibid). Acquisition or strengthening of problem solving, assertiveness, communication and social skills can reduce feelings of powerlessness or isolation. A positive self-image is enhanced and opportunities for positive interactions with others are increased. Children can also be taught to seek out relationships with helping adults (for example, sympathetic teachers) that compete with negative expectations caused by the experience of rape. These skills can be incorporated into the therapy sessions through discussion and role play, or may be most effective in a group setting.

(v) According to the mothers' descriptions of children's symptoms, anger seems to be a significant response. It is necessary to assist the child to understand the origin of these aggressive feelings, thoughts and behaviours, as well as to develop more constructive ways of expressing this anger. Consequences of aggressive acting out behaviour also need to be addressed in an attempt to inhibit and re-channel this behaviour.

(vi) Group therapy may provide a sense of belonging and group identity for those sexually abused children who feel isolated, stigmatized and different from their peers. Sirles et al. (1988), suggest that latency age children be separated into same-sex therapy groups, as due to the sensitive nature of the material discussed, these children are likely to relate more freely and comfortably with same sex peers.

Clinical Interventions with Mothers

Mothers of a child who has been sexually abused by someone external to the family are required to deal with their own reactions to the trauma, while simultaneously addressing the needs of the traumatised child. Findings of this study indicate that at least minimal intervention be offered to caretakers at an early stage. The following interventions may assist mothers in coping with the trauma:

(i) Mothers are likely to benefit from individual trauma debriefing sessions, which also function in a supportive role. Dealing with a child who has been raped is likely to raise many issues for parents, including their own confusion or discomfort with sexuality).

(ii) The mother's construal of the event may affect her ability to provide support for the child. Parents should be encouraged to explore their own attributions around the rape and its significance for the child's future, in order to prevent imposing any negative misperceptions onto the child. If necessary, parents should be encouraged to re-frame their perceptions in a more positive direction in terms of the child's resilience and future recovery. As a result of discomfort with the issue of rape, and the adherence to rape myths, it seems that mothers may create an atmosphere where a child feels it is not acceptable to talk about the experience. This may reinforce the child's sense that something contaminatory has happened, and possibly also increase feelings of damage and stigma. Counselling sessions with the mother may help to ameliorate these issues, and also to ensure that children are able to speak to their parents about any future concerns or abuse.

Mothers may also require an opportunity to vent conflicting feelings in therapy sessions that do not include the child. This research provided some evidence that parents may unconsciously experience displaced feelings of anger toward their children for the abuse, and hold the misperception that the child is in some way responsible for the abuse, and somehow "damaged" for life. These beliefs need to be expressed and if possible dispelled, so that they are not imposed on the child. Education concerning the fact that young children are unable to understand the implications of sexual activity with an adult, and are thus incapable of consenting, is crucial. Parents should also be encouraged to express their feelings of anger toward offenders in treatment, as these feelings may frighten the child further (Regehr, 1990).

(iii) It is important to address uncertainty and confusion about the children's symptoms, as well as ways of coping with these behaviours. In this study, parents expressed considerable relief when provided with information around extrafamilial childhood rape, and the psychological sequelae of this trauma. They also found it particularly useful to explore ways of coping with their child's traumatised affect and behaviour. Information around management of sexualized and aggressive behaviour is likely to provide particular relief. Clinicians need to help parents understand that overprotection further disrupts the child's life and lessens the child's ability to control his or her environment. Children need to feel protected but must also be encouraged to strive for mastery and control on their own (Regehr, 1990). Lamb (1986) discusses the importance of affirming children's sense of power, rather than their status as victims.

(iv) Concerns around the investigatory and judicial process were important sources of concern for mothers. Information around the legal procedure, and exploring ways of obtaining support during this process, may alleviate much of the stress associated with this area.

In terms of primary prevention, increasing parents' sensitivity to behavioural and emotional indicators in their children may help in early identification of as yet undisclosed abuse. Education around the disclosure process is also vital.

(v) If the child perceives a warm and secure relationship with her mother (or primary caretaker), the therapist could also utilise this in the treatment programme, by helping the mother to be a co-therapist for her child, particularly in cases where there is a language barrier between therapist and child. Leibowitz, et al. (1996), based on experience at the Alexandra community clinic, assert that the mother-child relationship can be used as a focus for therapeutic intervention (after the mother's own emotional distress has been addressed), although this assumes a relatively intact and stable mother-child relationship prior to the trauma. In their model, these authors assert that their decision to use the mother as co-therapist was also based on the extent to which the therapist and mother had established a rapport, the mother's confidence in and understanding of the "talking cure", and the degree to which her own response to the trauma had been addressed. This implies that her emotional availability to the child within the therapeutic context was essential if she was to assume the role of co-therapist (ibid). The therapist followed the general model of trauma intervention, communicating instructions and reflections through the mother to the child. The mother was also encouraged to communicate and implement psychological principles related to trauma work beyond the therapeutic context into the home. Mothers were informed of the importance of allowing the child to talk about feelings, and of normalizing these. Teaching the parent the concept of "containment" of the child's feelings may be an important contribution. This involves attempting to explain how to provide a safe "holding environment" (Winnicott, 1982; p. 47) into which the child can express her feelings without fear of critical response, or the mother feeling overwhelmed. The results of this clinical work indicated that through participation in the therapy, the mother was able to develop a realistic awareness of the impact of the trauma on the child, enhance her empathy, and be equipped with the skills required to mediate the child's experience more effectively. Also, the likelihood that the gains made in therapy would be carried through to the familial context and daily life of the child was increased (ibid).

(vi) As is the case with child victims of extrafamilial rape, a mothers' (or primary caretakers') support group may diminish feelings of isolation and stigma, and provide a forum to share coping strategies.

(vii) Empowering mothers to educate their communities about the issue of child rape was another possibility that emerged in the course of this study.

Conclusion

In South Africa, children seem to be increasingly vulnerable to violent crime, and particularly to crimes of a sexual nature. The experience of trauma is likely to overwhelm the coping resources of both the child and her caretakers, and to necessitate therapeutic and systemic intervention. The escalating number of cases of extrafamilial child rape highlights the need for treatment models which are responsive to the needs of victims and their families. In the context of limited therapeutic facilities, strategies are needed which target the psychological effects of such trauma, if possible within shorter term models.

This study has attempted to validate, in a more systematic way, observations that have emerged in clinical experience with victims of extrafamilial childhood rape. One of the aims of the research was to enhance the understanding of the specific nature of the abusive experience, and its impact on child and maternal perceptions. This knowledge will hopefully contribute to treatment interventions for this population.

The paucity of previous academic research, particularly in the South African context, necessitated an exploratory study. The findings of this study should be viewed as preliminary, and as providing some direction for future research. However, although the findings are only exploratory at this point, it is hoped that they will be evaluated in the light of the lack of prior systematic psychological data in the area. The sample in this study was relatively small, and as the mothers were self-referred to the services of the Trauma Clinic, they may constitute a special group within the population of extrafamilial rape survivors. Consequently, some caution should be exercised in attributing these results to the extrafamilial child rape population as a whole. As the researcher is a white female, this may also have affected the data. Respondents may have felt that she was unaware of cultural beliefs, and so not have raised these during the interviews.

The study raised interesting issues with regard to the crime of extrafamilial rape in a South African township context. Most of the rapes in this study were committed by opportunistic youth, such as older high school boys, or unemployed younger men. The rape experiences were extremely frightening for the children as a result of threats of intimidation and the use or threat of violence against the children and their families (including the use of weapons). It was noted that the perpetrators treated the children with a sense of entitlement to use them in a sexual way. There appeared to be a complete lack of empathy for the children, who are used as objects.

Much of the current literature attempts to explain the high incidence of rape as a result of the culture of violence and lawlessness in South Africa, failure of the criminal justice system to deal effectively with sexual crimes; poor socio-economic conditions; difficulties related to the transitional period; and sexist values. Although the above explanations are important components, clinical work at the CSVR indicates that in many instances of rape, there is an added component: the perpetrator's sense of entitlement to instant gratification and release of sexual energies, with little or no ability to delay gratification. Child therapists at the clinic also note that young perpetrators assert that boredom, or the desire to experience sex, is a factor in their reasons for raping. Adults are also seen to engage in rape as a form of release from the monotony of unemployment and poverty. It may be overly simplistic to argue that rape is solely about power and violence, and the nature of human sexuality is an aspect of rape that has not been sufficiently considered.

The study also provided some insight into aspects of the relationships between mothers and daughters. The children's fear of disclosure may indicate a culture where repressive attitudes about sexuality are present, as well as a more authoritarian style of parenting. The children also seemed very compliant, perhaps as a result of this parenting style, and may have found it extremely difficult to refuse to obey an adult command – including that of the perpetrator. There is an expectation of obedience, and township children of the latency age group seem unlikely to question their elders. There also does not seem to be an expectation of receiving support from one adult against another. In addition, because the children feel damaged, the belief seems to be engendered that they are also "naughty" – this too may induce them to believe that they will not receive support from their mothers.

The issue of increasing lawlessness, and the sense that perpetrators act with impunity, as a result of the lack of responsiveness of the police and the judicial system, has the potential to lead to pessimism and discouragement among both victims and mental health professionals. The lack of constructive police intervention (for example, in cases where the perpetrator is known, but not arrested, or is let out on bail), complicates mothers' responses to the children. There was also evidence of intimidation of children and families, and the mothers seemed to have little institutional or social support. In addition, most of the mothers were effectively single parents, and the fathers of the children were not present to provide the mothers with support. Empirical evidence also indicates that the mother plays an important role as mediator of the child's trauma, and that maternal reactions have the potential to be both damaging or supportive. However, support may be impeded by the mother's own stress reaction, and her response to the victimized child may be affected by her construal of the rape, and the internalization of rape myths around causality and stigmatisation of the rape survivor.

The results of this study suggest that it may be helpful to develop interventions specifically designed to decrease children's feelings of terror and powerlessness, to decrease self-blame, and to decrease the mother's blame of the child and stigmatized perceptions of the child's future, in particular concerns and preoccupation with damage to the child's reproductive capacity. Any treatment program should include specific interventions to accomplish these goals as well as addressing other traumatic sequelae.

The research was primarily focused at the level of the individual (both mother and child), as well as at an interactional level, at the interface of the relationship between mother and child. The findings and recommended interventions were also concentrated at this level. However, change and education are also needed at a broader, systemic level, in order to raise awareness of and to ameliorate the high incidence of child rape, and the subsequent effects on victims and their caretakers. Important areas would include continuing social education around the trauma of rape, and the development of strategies to combat secondary victimisation of victims and their families. As suggested above, school programmes educating children about the nature of abuse, and how to obtain help, may also help to empower them. Sex education and consciousness of children's rights, which are more commonplace in Western schooling, would be helpful to parents and children. Greater awareness and research is needed not only in terms of theoretical insight and therapeutic techniques, but also with regards to preventative measures, and broader social awareness.

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CSVR is a multi-disciplinary institute that seeks to understand and prevent violence, heal its effects and build sustainable peace at the community, national and regional levels.

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