Reavey - Curing women: child sexual abuse, therapy and the construction of femininity

Curing women: child sexual abuse, therapy and the construction of femininity 

by Paula Reavey & Sam Warner


In this paper we draw on post-structuralism to critique mainstream, self-help and feminist approaches to understanding child sexual abuse and its effects. We argue that dominant theories of child sexual abuse are imbued with often unacknowledged assumptions regarding gender sexuality and mental health which constrain our ability to support women who have experienced child sexual abuse. Whether ‘personal problem’ (as in mainstream texts) or social issue’ (as in some feminist texts), narratives of child sexual abuse often too readily disregard that which they are set in opposition to. Our aim here is to disrupt such dichotomous frameworks in order to interrogate the constitutive effects of regulating the debate in this way. We explore the ‘othering’ of women survivors of child sexual abuse in order to explicate the ways in which theories of abuse both rely on and reproduce normative understandings of women and femininity. We examine the meanings of survival and argue that ontological narratives of survival, gender and sexuality should be replaced with epistemological concerns. We conclude that absolute versions of experience and identity, in theory and practice, must be rejected in favour of a more socially located understanding of individualised narratives of child sexual abuse.  


Child sexual abuse is a relatively common experience which has become of increasing concern to the general

public through the productive effects of women’s activism around sexual violence, statutory investigations

and subsequent public inquiries; and the media's prurient reportage of sexual stories. 1  The late twentieth

century witnessed a growth in confessional culture, and the mapping of personal concerns across the public

spaces of film, television, newspapers and novels.  The belated recognition of the relative frequency of

childhood (sexual) abuse and a concomitant concern with the traumatic effects of such abuse is to be

applauded.  However, it is our contention that the roots of our talk about sexual abuse circumscribe how we

can theorise child sexual abuse, and its effects, in ways that negatively constrain our ability to support women who have experienced child sexual abuse.  This is because a too-ready acceptance of a shared understanding of 'the effects' (of child sexual abuse) also institutes a shared understanding of 'the cure' (that is,  recovery from child sexual abuse, and hence obscures the multiple and contrasting ways in which women may (re) negotiate their lives.  As such, we argue that the ways we discuss child sexual abuse and its effects are not   neutral, but are imbued with often unacknowledged assumptions which can be socially and historically located.


The (re) emergence of child sexual abuse as a socially relevant area of concern has instigated the growth of a

therapeutic industry to address the individual effects of child sexual abuse.  Both within statuatory provision

and within self-help and feminist contexts a wide range of theories and practices has been documented.  In

this paper we argue that many of these documented approaches provide insufficient guides to therapy.  This

is because of the tendency of both mainstream and self-help texts to focus too narrowly on the personal

effects of child sexual abuse, and because feminist texts can focus too widely on child sexual abuse a social

problem.  In practical therapeutic terms our argument is that such discourses fail to engage with survivors

of abuse, due to the former's lack of socio-cultural sophistication and the latter's all encompassing representation of gender structure.  Reducing abuse to either personal effect or social problem constrains our ability to understand child sexual abuse and 'women' by predetermining what counts as the relevant field of interest. 'Personal' and 'social' explanations of child sexual abuse are, therefore, implicated in the social construction of taken-for-granted representations of the (sexually) abused subject (in this case 'woman').


We note that the opposition between personal and social effects is an artificial construct that fails to capture the multiple ways in which practitioners move between different narratives of concern in respect of women and child sexual abuse. We recognise that many contemporary accounts of personal distress do not simply neglect ‘the social’, but situate such distress in terms of actual trauma. However, our aim here is to illuminate that, even when the social is raised as a determining effect in privatised distress, the personal may still become a fixed metaphor despite continuing fluctuations in social context. Indeed, such accounts of past trauma become fixed as metaphors of self that fail to explore the relational, and fully social, aspects of what can end up being perceived as internalised and fixed identity. Hence, our aim in this paper is to explore how personal and social narratives function as oppositional discourses that individual practitioners can draw on at different times. Thus, our focus is on the narratives themselves, and the discursive effects of framing understanding in this way, rather than the practitioners who may use, and move, between them.  


We aim to interrogate, and remain suspicious of, both grand narratives of gender (often associated with feminist and social theories of abuse) and individualistic discourses (often associated with medical and psychological understandings of abuse). Our aim is to situate such knowledges in order to make explicit the productive effects of the normative assumptions that are embedded within discourses of child sexual abuse, women’s sexuality, identity, pathology and the construction of survival and recovery. A further aim of this paper is to make visible the discursive mechanisms through which ‘the truth’ about child sexual abuse is regulated and maintained, and which serve to prescribe the boundaries of therapeutic concern and, hence, which can act to predetermine ‘the cure’. Drawing on post-structuralism,2 our aim is to formulate a critique of dichotomous frameworks that can restrict concern to either personal effects or social problem. From a post-structuralist perspective ‘experience’ is understood to be constructed through institutionally sanctioned discourses rather than something that is simply represented through personalised talk. As such, it is necessary to examine how experiences and effects (of child sexual abuse) are actively produced, rather than simply represented, in mainstream, self-help and feminist texts on the subject. Our objective is to scrutinise the assumed experience of child sexual abuse in order that the normative injunctions concealed within are made visible.3  


We bring together two contrasting accounts of treatment in order to develop a critique of the normative assumptions underpinning some therapeutic work undertaken with women around traumatic experiences  of childhood sexual abuse. We draw on research regarding therapeutic and everyday stories of child sexual abuse and women's sexuality4 and research regarding women in high security hospitals and child sexual abuse.5  Our aim is to explore the common threads underpinning these seemingly socially diverse therapeutic practices. We demonstrate how normative discourses of women are widely accepted and institutionally implemented and examine how ‘abuse and trauma are laced with gender meanings’.6 We also demonstrate that trauma talk is a way of producing male-female relations, imposing a highly charged set of meanings on them.7 Our aim is to deconstruct these contrasting accounts of therapeutic intervention in order to develop a situated understanding of personal effects that rejects the opposition between personal and social in favour of viewing the personal and the social as being immanently constructed. We, thus, provide an alternative reading of psychological, self-help and feminist theories of child sexual abuse and its effects, and a critique of the implementation of institutional, academic and everyday discourses on women and sexual abuse. We begin by examining the pathological construction of women survivors as different and/or special. We develop our critique to explore the relationship between discourses around child sexual abuse and the regulation, and production, of normative femininity. We interrogate the meanings of survival and problematise ontological narratives of survivorship and womanhood. Finally, we provide a brief account of a socially situated therapy framework.  


Between authenticity and pathology: child sexual abuse and the construction of ‘different’ women  

The 1980s and 1990s marked a significant departure8 from feminist socio-political campaigns regarding the sexual abuse of women and children, in order to pursue more ‘liberal’ and ‘humanistist' issues associated with interiority, recovery and self-actualisation.9 The aim of the growing therapeutic and self-help movements was to provide not only a voice for women survivors; it was also to reveal a unified traumatic tale of psychic damage. The clinical and self-help focus was the identification of a discrete and post traumatic event which, through explication, would lead to the recovery of a more authentic, that is pre­traumatic, self.10  There is a tendency in mainstream psychological accounts to focus on restoring women to an assumed norm of mental health, or in the case of self-help to treat women’s experiences according to humanistic ideals.11  In self-help texts, abused women are rendered distinct in relation to non-abused women who are seen to develop normally and naturally.’12 Hence, such theories of child sexual abuse serve to police the boundaries between abnormal women and normal women through an unproblematic construction of abused women as essentially ‘different’ women.  


Hence, both academic and self-help texts on child sexual abuse often attempt to ‘capture’ the effects of child sexual abuse as inevitable long-term damage. This is in terms of the nature of the survivor’s problems with relationship issues, including those pertaining to sex, as well as personality and psychic development.’13 In capturing ‘effects’ in this way, certain discursive functions (hence, social actions) are performed in relation to gender and womanhood. For example, by focusing on symptoms, effects or damaged ‘selves’, clear distinctions between so called ‘normal’ women and women with an ‘a-typical past’ are forged. Women survivors, thus, appear to walk a completely developmental path to womanhood,14 using a ‘different language’15 and possessing clear ‘erroneous cognitions’.16 The language of sexual ‘dysfunction’ (a psychiatric classification), widely cited in the academic and clinical literature on sexual abuse, further leaves the territory of female sexuality as a naturalised site and concentrates on the dysfunction of the individual. Consequently, literature on relational and symbolic aspects of sexuality for abused women is extremely rare.17  Indeed, a paper attempting to address relationship issues in relation to women survivors refers to their sexuality acting like a ‘contagion, a virus’ that contaminates the relationship and renders it dysfunctional.18 In this portrayal of female sexuality, traumatic experiences are constructed as being virulent and women as malignant. In this reading, the traditional depiction of active male sexuality is polluted and submerged by the intensely dysfunctional and passive nature of the survivors’ sexual concerns. The presentation of the victim or survivor as the sole agent responsible for relationship difficulties further obscures the productive role of other socially situated factors which additionally impact on survivors’ abilities to negotiate an abused and feminised identity in the context of ‘marriage’ and romantic love.19 In fact, it may be dangerous for women to remain the target of intervention for relationship difficulties when relationships, necessarily, involve more than one person.  


Hence, although psychotherapy has been found to increase assertiveness among women survivors,20 it has also been found to increase undermining behaviour,21 resentment and physical abuse by male partners.22   Unsurprisingly, requiring a male partner to change without addressing the interpersonal and socio­cultural context of sexual relations has been reported to exacerbate already unequal power relations in (hetero)sexual relationships.23  The inter-relational nature and negotiation of power within sexual relationships, as well as the cultural currency of heterosexuality, therefore, requires further examination. Consequently, focusing on individual women renders ‘the relationship’ a blank and untheorised site in which victims and survivors then pollute and contaminate the territory of sex and love.24   The psychological literature also frequently refers to the ‘inner’ damage caused as a result of sexual abuse and, depending on the particular psychological model adopted, subsequent problems faced by women are understood in sanitised psychological and psychiatric categorisations, as opposed to contextualised narratives.25 Women’s lives thus become propelled away from a socially situated understanding of abuse and life experiences and reconstructed as clear psychologised examples of ‘faulty cognitions’, ‘unconscious compulsions to repeat the abuse’, or an ‘inability to maintain relationships’.26 Such texts, rooted as they are in individualised pathology often imply that the psychological effects of child sexual abuse can be abstracted from a social and cultural analysis. As Kitzinger argues, psychological and self-help approaches which individualise ‘treatments’ for the effects of abuse can often obscure politically transgressive and feminist concerns.27 When women disclose abuse, there should be some ‘awareness that such disclosures get co-opted into a discourse that renders them a-political’.28 This is because the connections between (abuse of) power and (any) sex are obscured and women who remain angry about their abuse risk being pathologised rather than supported.29 As such, years of political campaigning on behalf of victims or survivors have been ingested as ‘personal’ and hence ‘pathological’, through the acceptance of women’s authentic voices. The ‘treatment’ of abuse by the media, psychologists, self-help texts and therapists, therefore, renders ‘experiences’ of abuse as ‘other’ in relation to normative practices and ‘by worshipping the authentic voice for its own sake, have contributed to an essentialising of the feminine as victim and have participated in the loss of the political meaning once associated with voice’.30  Hence, speaking out about child sexual abuse generally, and participating in therapy specifically, may simply increase the regulation of women’s lives rather than offer them a re-negotiation of their experiences and a partial liberation from the fixity of abuse and the assumedeffects of trauma.31  


Combining difference and distinction: child sexual abuse and the construction of ‘special’ women  


The attention paid to abuse as a unifying signification of women’s difficulties with sex has not simply

originated in mainstream accounts of ‘trauma’, it has circulated in a number of socio-political projects32 as

well as therapeutic settings. Women’s stories of abuse, told either in public arenas or private consultations,

are readily embraced as trans­parent personal testimonials and serve as literal and unifying narratives of

female sexual difficulty.33 This forecloses ‘alternative readings of female disturbances of desire’34 common to

many experiences and accounts of women’s sexuality. Although we do not deny that child sexual abuse can

give rise to psychological distress, the issue we dispute is the way abuse is isolated (and rendered

ontologically distinct from other forms of sexuality). What is important (and a point of criticism) is that the

body is treated as if it exists outside of discursive constitu­tion, as if it were outside of the definition of the

relations of power. When a person is sexually abused, they do not become ‘outsiders’ to sexuality and

subjectivity, because they are always already constituted within the available discourses on sex and

subjectivity and the experi­ences of all sexual actors.35 The naming of the victim of child sexual abuse

inaugurates that person into that identity. It additionally mobilises the performative use of ‘gender’ as a

defining feature of the way in which ‘experience’ and identificatory practices are understood, and played out,

in everyday life.36  Hence, identities associated with child sexual abuse also function to concretise so-called

normal (and unequal) gender relations between men and women.  


Radical feminist theories of child sexual abuse, which centralise patriarchy as the defining construct in abuse, are also immersed in gendered dominance-submission binaries. Child sexual abuse, from such perspectives, is understood as an extreme expression of normative heterosexual relations, predicated on male aggression and female passivity.37  Although such ideas can provide useful ways of accounting for generic patterns of male-female relations, they fail to account for the shifts and movements women and men make in the moments of their (sexual) relationships and therapeutic encounters. Our aim, here, is to make a discursive intervention into representations of women's subjectivities in such therapeutic encounters.  


When power is regarded as unitary sovereign power (patriarchy), we fail to attend to the subtle ways in which power is embedded within social practices and social discourses. This then obscures the ways in which knowledge, as a form of disciplinary power, constitutes and produces particular versions of subjectivities (as women, as victims, survivors and so on). Child sexual abuse constructs a particular version of womanhood that polices the boundaries between abnormal women and normal women through an unproblematic construction of abused women as essentially ‘different’ women. Yet, such cultural constructions of feminised victims also serve as reminders that femininity, per se, equates with powerlessness. Hence, difference is an unstable property that can only be read through the lens of abuse. Passivity, in ‘ordinary’ women, may be precisely the characteristic that confirms normality. Thus, those personality characteristics which seemingly differentiate abused women from non-abused women are meaningless, unless such identifications have already occurred.  


Once inaugurated into the abused identity, women’s behaviours and feelings may then be defined, and distilled, as different from the norm. When such behaviours and feelings stretch the boundaries of normative femininity too greatly, women may also be theorised as being so ‘special’ they must be kept separate from the norm. Because the negative effects of child sexual abuse can be extreme: sometimes women display behaviour that is deemed to pose such a danger, either to themselves or the general public, that they may be excluded from community-based care. Because extreme behaviour such as fire-setting, aggression, and  self-injury is so compelling, the reasons women act in the way they do can become lost as containment becomes the focus of concern. Once the chains of meaning are severed, women’s behaviour can appear to be meaningless and, therefore, such women may appear to be simply, and symptomatically, ‘mad’ and/ or ‘bad’. And when ‘madness’ and ‘badness’ are internalised to women, and behaviour can no longer be socially located and, thereby, understood, such behaviour can only be read as dangerous, that is unpredictable and out of control. This serves as the justification for incarceration and exclusion from society. As such, visible excess becomes the focus of concern and (mandatory) containment replaces treatment as the prime intervention. 38


Women in psychiatric inpatient care are at increased risk of sexual and physical abuse from other clients and members of staff.39  Personal efficacy decreases whilst powerlessness increases. Women are then confronted with the same issues regarding abuse and powerlessness which may have contributed to their distress in the first place. These women, reproduced as mad, through systems that individualise inappropriate practice through narratives of psychopathology are, thus, propelled away from society and further into the belly of the psychiatric beast. They may then find themselves contained within high security mental hospitals or special hospitals as they are euphemistically called.40  These ‘special’ women contravene the accepted limits of normative femininity. Such women may be pathologised as being ‘too feminine’, in terms of their internalised aggression, or ‘not feminine enough’ in terms of their externalised aggression. Women’s strategies of survival become narratives of personality disorder or mental illness, and the social production, and hence maintenance, of both internalised and externalised aggression is obscured. Such women are contained within actual and virtual prisons whose architects fail to acknowledge that such constraints actively reproduce the psychological (and sometimes actual) conditions of abuse, and hence maintain women’s symptomatic behaviour. Madness, badness, and dangerousness become internal properties of such women, rather than being understood as social practices produced in present, as well as past, (abusive) relationships.  


From these perspectives, then, so-called abnormal childhood experiences can be understood to be instrumental in the development of mental disorders and abnormal personalities. Specifically, child sexual abuse can be used to explain abnormal dissociative states associated with particular psychiatric disorders, such as post-traumatic stress disorder (PTSD), multiple personality disorder (MPD) and borderline personality disorder (BPD). With the exception of PTSD, which was heavily associated with post-war trauma, these psychiatric classifications are predominantly female disorders (over 90 per cent). Although the gendered nature of these disorders and their ‘discovery’ in therapeutic settings has not been explicitly theorised, when sexual abuse was suggested as a cause, therapeutic recognition of this disorder amongst women soared beyond recognition.41 With the exception of some writers,42 the psychologisation of  abuse-effects obscures the role of gender (even though many studies have used women only participants), treating gender only as a variable or a redundant ‘fact’. Hence, ‘difference’ may transmute, through diagnosis and inappropriate intervention, into something ‘special’ via the productive effects of narratives of madness; badness and dangerousness. Whether different or special, women who have experienced childhood sexual  abuse are embodied as pathological, Such narratives not only function as boundary markers between normality and abnormality, but serve to construct femininity itself.  


Constructing femininity and defining the ‘Other’: child sexual abuse and the limits of normality  


Abused women may be classed as ‘different’ (away from the norm). and/or ‘special’ (mad, bad or dangerous) according to their individual inability to be contained in ‘normal’ practices of gendered identity. Dominant and traditional mental health models (including -biological, cognitive, behavioural and psychodynamic approaches),  whilst focusing on individual pathology, often rely on global and stable assumptions around gender or fail to provide an account of gender (see above). Hence, abnormality is both individualised, yet also defines what it is to be ‘everywoman’ and ‘everyman’. Because a gendered discourse of mental health and disorder is naturalised, the production of gender through practices of therapy is achieved with­out explicit theorisation. Thus, theories of mental disorder both rely on and reproduce normative understandings of sex and gender.  This is reflected in those approaches to ‘treating’ child sexual abuse which aim to reintegrate men and women patients back into heterosexuality.43  Women’s intra-psychic lack of power or low self-esteem (often identified in their relationships with other people) is often solely attributed to their experiences as a child, obscuring the role of current relationships and glossing over the engendering of subjectivity.44  As argued, women’s socially embedded stories of self are contained within psychological/psychiatric narratives that reduce women’s survival strategies to being simple signifiers of extant mental disorders. Such diagnostic categorisation fails to capture the multiple strategies women use and the many situations they survive ‘within’.45  


The effects of child sexual abuse are, therefore, personalised or attributed an ‘inner quality’ which often overshadows other factors, not least factors identifying them as women — their position as sexual beings, their gender, race, able-bodyness and social standing. All these factors — which impact on individuals and their means of survival —have often been neglected by psychology, or are seen to play a cursory role in mental health.  Additionally, not only does a too ready focus on past misfortune obscure the contributory effects of present abuse, it also invokes the need for 'expert' intervention.  Hence, the cataloguing of psychological and psychiatric symptomatologies transfers political concerns over sexual abuse and violence into the realm of authoritative and often therapeutic (recuperative) discourses. 46  As already argued, to speak about victimisation and to disclose abuse is never self-evidently transgressive. 47  Discourses of abuse and victimisation are constitutive of how we make sense of women and can often serve to 'perpetuate images of women as weak, passive, and asexual and images of men as sexually driven, unstoppable, and potentially dangerous'. 48  Such accounts re-produce normative ways of understanding not only abuse but (hetero) sexuality and relationships in general.  By assuming an individual is showing 'signs' of child sexual abuse, the 'inside' or 'pre-discursive' personal self is preserved, according her a self-evident status as 'the abused'.  Outside of this, women who do not show these signs can remain in the category of 'non-abused', and hence serve to represent the epitome of naturalised femininity.


Whether 'different' and/or 'special', abused women are (re)produced through shared narratives which rely on culturally prescribed assumptions of normative femininity.  Representing survivors as 'other' renders opaque the culturally salient ways of understanding all forms of sexual development wherein 'much of the complexity of the [sexual] mind - with its imaginative, symbolic capacities - is rendered away in a one-dimensional tale of feminine innocence lost and regained'. 49  It is necessary, therefore, to situate vulnerability as a socially located (albeit often feminised) practice, rather than a constituent feature of personality, experience and identity.  This is about disrupting absolute versions of self and experience, which are recalled through our present circumstances as well as through our understandings of the past.  The foundationalising of femininity is managed through the reiteration of certain norms, where sex and 'pathology' (resulting from the abuse) can be posited in naturalised terms.  Reconstructing femininity as an achievement, however, is useful:  for example by examining how child sexual abuse is performed in relation to 'cited' damage (sex/gender identity and behaviour), it is possible to explore how gender is implicated in this construction by tracing what it (re) iterates (women's greater susceptibility to damage and women's physiological propensity for damage, etc).  The 'construction' of women, sexuality and pathology through the citation of childhood sexual abuse is not attained at the level of the 'subject' (a personification) but:  

[through] a process of materialization that stabilizes over time to produce the effect of boundary, fixity and surface we call matter. 50

Performance, as citation, produces subject categories therein, and fixes them into already established identity categories (fixing femininity, women’s bodies). The consequences of which position women survivors as constructed (through their damage and experience as an abused child) and leave other women as naturally feminine, because they have been left to develop normally.51  Yet, the citation of the body as the most ‘significant’ surface (for reasoning) reiterates the female body as a natural site of sexual development (in the absence of abuse) but also re-iterates the damage which prevents that normal and natural gender functioning (when abuse has occurred). The production of women who have experienced childhood sexual abuse as differently constructed serves to shore up natural categories of gender by fixing the limits of essentialised normality.


Women survivors, themselves, may internalise their constructed difference by referring to their bodies, their chemistries, their inability to be ‘like other women’ and their bodily visibility as victims.52  This has also been found in therapeutic talk, where abuse is used to fetishise the body and create ‘the appearance of a victim being victimised by her own body, a body that, like her perpetrator, has somehow turned against her’.53  Women may then view their bodies as ‘different’, as ‘chemically charged’ and ‘damaged’54 or, indeed, ‘special’.  Women may, therefore, link their bodies to ‘signs’ and ‘cues’ which ignite sexual responses (usually in men), thus enabling myopic connections to be drawn between themselves as female targets in the past and present. The female body thus becomes an object of scrutiny (as dysfunctional, as contagious); just as she was left damaged by past abuses, in the present she is no longer a ‘good’ body.55  Such discourses not only render past abuse and present sexuality more feasible subject matter for discourses of illness and cure,56 they also reinforce culturally potent stories surrounding heterosexual desire, where women’s bodies are viewed as inherently seductive. For example, in tales of women survivors of child sexual abuse being re-victimised in adulthood, men's sexual agency is often absent, yet the notion that women survivors unconsciously 'choose' to be re-abused is common. 57  Additionally, women in secure mental health facilities may have all of their relationships scrutinised because their apparent toxicity renders all of their relationships, sexual or not, suspicious.  Women may then be penalised for the reluctance to associate with men, yet be pathologised when they appear to do so too readily. 58


Thus whilst abuse constructs particular (negative) versions of identity, psychological theorising is implicated in the reproduction and maintenance of individual and internalised narratives of pathology.  More than this it sets up predetermined templates of 'recovery', of normative heterosexuality, and thereby prefigures what a 'cured' woman may look like.  As such, whilst such narratives are felt to be personal, they share common threads.


Disrupting ontology:  situation women's identity and trajectories of survival


In radical feminist discourse, the cultural constraints operating to define femininity and (child) sexual abuse are presented in terms of the role of heterosexuality and the powerless position of women and children's sexualities. 59  Hence, radical feminists have attempted to understand women's behaviour in terms of a global power operating over women.  According to many feminist discourses, child sexual abuse is understood as a tool of patriarchy in the service of men, in that the rape of some women and chidlren keeps all women and children feaful. 60  As such, some feminists have been sceptical of treating child sexual abuse as a mental health problem, as the 'personal remains personal' and the political becomes subsumed. 61  However, by describing abuse as 'social' (that is patriarchal) 'woman' as a category becomes fixed by this social analysis of male power.  Power, then, becomes something that operates ' over' women (guided by the structural machinations of patriarchy).  However, according to Foucault, power operates in relation to (amongst other operations) knowledge, and it does not 'reside' in one unifying and unidirectional structure but exists in many forms of social relationships and networks of knowledge that produce a particular (and constraining) version of reality.


By adopting the stance that explains abuse survival in individualised terms or in terms of social theories of gender, false distinctions get made between persons and society.  More than this, a static and unitary version of ‘woman’ is set up: a version which women ‘identify’ with but, we argue, does not in itself exist. Women may then be recognised through practices of abuse and intervention, and multiple ways in which they attempt to survive their lives are re-presented as disorders of the body and mind; as diagnostic categories or as symptoms of disorder and dysfunction. Survival then becomes ontological manoeuvre rather than a situated action. Treating identity as stable, and survival as ontology, prescribes the ways women may find to live their lives and functionally secures a fixed path to recovery.  


Although some feminist writers have problematised the shift feminist theory, from identity politics to a ‘romance with epistemology’,62 we consider the shift to be one which is useful and a necessary strategy of intervention in academic and everyday discourses. Our aim is not to replace ‘useful feminism’ with ‘abstract theory’; rather, we aim to understand the workings of power within the complex movement of language (which in turn constitutes practices, as well as theory). We need to resist narratives in which women’s strategies of survival become ontological stories of pathological being, through which gender is naturalised as the grounds on which diagnosis may proceed.   


It is self-evident that experiences of trauma will give rise to distress. When experiences of abuse continue over time children and adults must find ways of surviving not simply the physical act of abuse, but the continual emotional assaults on their sense of self. The ‘mind­fuck’ is the tactic through which the ‘body-fuck’ is actualised and acquiescence assured.63  Tactics of survival, immanently produced through the tactics of abuse, may then extend, just as the ‘mind-fuck’ perpetuates long after the ‘body-fuck’ has ceased. It is no wonder, then, that women may continue to use these same survival strategies when they once again feel powerless and ‘wrong’ in some way, for example at other times of crisis, such as hospital admissions. Women’s survival strategies become conflated as symptoms of pathology, and diagnosis further confirms women as ‘out of control’ and powerless Women’s survival strategies are then treated as separate objects of therapeutic concern, divorced from that which is being survived.  Women's reasons for behaving in the way they do get lost because they are assumed rather than sked after.  Women are then responded to as categories or types, and survival becomes an ontological narratiave of pathology.   Hence, unitary versions of survival get set up by the tendèncy of psychology to locate survival in ‘individual/personal’ problems. 

 We argue that the notion that there is an ontological ‘woman or 'survivor’ should be rejected. In therapy and treatment, we would argue that the ‘problems’ potentially faced by survivors should be read as identifications as opposed to ‘beings’: as if ‘being’ were determined by gender. Rather than viewing women’s response to abuse as a definitive or as an individual ‘reaction’ or ‘symptom’, we put forward the notion that ‘identifications’ take place; identifications that can be read as culturally available stories, as opposed to extant categories of pathology or gender. For example, male survivors often ' identify’ feelings of powerlessness,64 and therefore, identify with feelings of femininity because of the culturally prescribed association between sexual victimisation, powerlessness and femininity.65  Hence the identification and the relationship between the person and their problem are of interest, not an absolute version of gender. Exploring the identifications made by survivors and professionals allows for a thorough deconstruction of ways of ‘knowing’ women survivors in order to show how ‘gender’ gets reproduced in categories of abnormality and normality and categories of psychopathy. An analysis of abuse survival can then be opened up to include all women who have found it difficult to speak: such as women of colour, working-class women and dis-abled women. In other words, we should always be aware of different women’s capacity to speak and the legitimacy given to their voice.  


Survival, then, is a powerful narrative in work around child sexual abuse. Understanding survival as strategy, rather than ontology, enables a focus on contextualised relationships, and a valorisation rather than a pathologisation of women’s means of coping. As such, survival is as much about surviving sexual abuse as surviving the normative assumptions which are embedded within the gender-saturated narratives of normality which frame received notions of what constitutes ‘the cure’. When gender is assumed, the gendering process is obscured. ‘The cure’, then, produces and reproduces self-disciplining subjects and the sex/gender matrix is reiterated and reinstalled.  


Disrupting absolute versions of self and experience:  reconstructing the practices of therapy


Attempts have been made to redress the bifurcation of the personal and social by some feminist psychotherapists, 66 some narrative therapists67 and in particular, visible therapy. 68  Visible therapy specifically merges post-structuralist thinking with a commitment to feminist analyses of power relations in society.  There is, therefore, growing discontent among a variety of clinicians and therapists over the way in which psychological distress is pathologised.  There is an emerging critique of the modernist depiction of 'self' as something which has a 'core' a 'centre' or a 'trueness' 69 and which, as such, limits the multiple ways women may negotiate their stories of self.  Feminist concerns regarding the need to socially situate women's distress about gender and other forms of oppression (such as disability, race or social poverty) have, to some extent, been incorporated into the male-stream, as trauma work becomes an increasing focus of therapeutic intervention.  However, whilst social trauma is increasingly recognised as a precursor of mental distress, the predominant interventions with so-called 'severe and enduring mental illness' remain physical, in terms of the (enforced) prescription of medication, sectioning, and, finally, containment within secure mental health facilities.  In this sense, there can be no recovery at all, only the maintenance of distress through psychiatric categorisation, and the actual obfuscation of the social roots of disorder.  


The aim, therefore, is to develop frameworks for practice that not only disrupt normative trajectories of recovery within talking therapies but can also disrupt more physical forms of (therapeutic) regulation as well.  IT is necessary, therefore, to reject classification of women abuse survivors/victims and/or psychiatric patients as the starting point for intervention because the stabilising of disorder has already been reproduced.  As such, we argue that when working with women in therapy, 'absolute' versions of women, embodiment and femininity must be rejected.  Instead, an examination of the ways in which women take up identifications requires further work:  this includes exploring how women might invest in particular versions of their past abuse and present adulthood.  The task is then to contextualise those identifications in wider social discourses, enabling a personal story to be explored in a situated way.  Rather than assuming any kind of ontological category, we suggest a reconstruction of 'women' and child sexual abuse in epistemological terms.  The ways people come to know themselves can then be understood as flexible, situated, and open to challenge and resistance.  This also requires that the contributory affects of our interventions should remainopen to ongoing scrutiny.  If this reflexiivity is not made paramount then women' s individual narratives of past abuse can be used to deny how present relationships, in life and therapy may function to maintain women in disorder and misery We must, therefore, remain mindful that remembering is an active process, and at the past can only ever be constituted through present concerns.70  Abuse, gender and sexuality are ‘co-dependent’ discourses whose naturalised effects require examination and explication. This can only be achieved through making their operations visible.  


Drawing on feminism and post-structuralism Warner71 theorises a framework for therapeutic practices with women who have experienced child sexual abuse, termed Visible Therapy.72   Objectivism and relativism are rejected as providing poor guides for conducting therapy because it is argued that it is only through situating our knowledges precisely that more liberatory therapy practices may be developed.  Such an approach examines the embedded assumptions produced through abuse and which serve to construct children’s experiences of that abuse. Children are inveigled into silence and acquiescence through widely available narratives of childhood, gender and sexuality which position children as responsible, yet entirely powerless. It is only. through situating and explicating the operations of power that the authenticity of experience and identity may be questioned and women’s ongoing positioning as guilty victims may be challenged.  Hence, as argued, the focus is not on who women ‘really are’ but how they come to know and be known through practices of both abuse and therapy.73 This, then, is about making the tactics of abuse and therapy visible. Problems are not located within individuals, but rather within the narratives which situate both past and current relationships but which, through reiteration, obscure their own social production. Such an approach provides the rounds for progressive practice because it militates against the instillation of naturalised subjects and, hence absolute and invariant trajectories of recovery.  


The aim is to explore how abuse sets up negative versions of self and experience in order that different versions of self and experience can articulated and embodied.74  This is not to replace one version of reality with another, but to engage with the multiple and shifting way people have of narrating their lives. Disrupting identity through visible therapy means that narratives of women’s pasts may no longer foreclose their futures.75 Rather, the ways in which women connect past and present versions of self may be explored as concurrent stories that constrain the ways in which women, and others, come to understand who women are and what women do. This approach, then, aims to explicate the ways in which women remember their past abuse and explore the means through which they manage to survive. Hence, the focus is on the psychological tactics that ensure silence and acquiescence, and the survival strategies they invoke, rather than the physical. acts of abuse. This requires moving beyond stories of psychological damage to articulate the many creative and courageous ways that children, and adults, find to negotiate the limited bounds of abusive relationships. This articulation is crucial as it locates the ‘effects’ of abuse within social relationships, both past and present, and hence, challenges the too ready internalisation of pathology within women. ‘Severe and enduring mental illness’ may then cease to be the final account of women’s stories of self and experience and child sexual abuse may cease to be the defining feature within women’s narratives of their lives. This also requires that ‘risk’ is understood as a social practice, rather than as a constituent of particular individuals. Women do not go out of their way to develop risky coping strategies, but may be constrained, physically, socially, and structurally, in the choices they have.76   If we risk nothing, we maintain women as disordered, because we cannot risk the possibility of recovery.  


Conclusions: multiplicities and commonalities  


Whether we talk about women in secure mental health facilities, women in the community or women in therapy texts, such narratives are littered with received understandings regarding normative femininity. Hence, whilst many traditional and feminist accounts of women and child sexual abuse can act as oppositional narratives, in so doing they functionally reiterate sex/gender as the foundation for, rather than the productive constraints of, the debate. Woman, then, is a socially constituted object: she is ‘cured’ when re-covered with the gloss of femininity or recovered from the patriarchy through the min­istrations of feminism. As Kelly et al have argued, the notion of a ‘cure’ for the negative consequences of sexual abuse is fictional, in the sense that ridding oneself of the ‘negative’ effects of abuse is never final or complete:  

 The medical metaphors of ‘healing’ and ‘recovery’ offer a false hope that experiences of abuse can be understood and responded to in a similar way to illnesses; where both symptoms and case can be ‘got rid of’ if one simply find the right treatment.77  

Yet 'recovery’ is a necessary narrative within progressive mental health ices.78 This is because without the notion of ‘recovery’ we are left a maintenance model of intervention that fails to accept that people can, and do, change. When we fail to accept this, we create mental health services that constrain and control people, and thereby reproduce the conditions of abuse which then maintain people in their misery.  Recovery, then, is a disputed term that needs socially situating. But we need to do more than simply ‘recognise’ the impact social structures because therapists need to trace the complexities of individual survival strategies through  having detailed conversations in therapy. This, then, is about engaging with personal narratives in a situated way, whilst remaining suspicious of grand narratives of gender, disorder and survival.  


When gender is assumed as pre-cultural and foundational to either political action or the ‘cure’, the gendered and gendering assumptions which are embedded within such texts are obscured. The discursive tracks of gender are (re)covered: lost to interrogation and hence no longer open to resignification. ‘The cure’, so described, contains through the productive constraints of gender as ontology. It is time to give up ‘the cure’ and refuse ontology. Only then can identity be fractured, normative prescriptions resisted and new possibilities for progressive practice imagined.  




1.  See K. Plummer, Telling Sexual Stories: Power, Change and Social Worlds, Routledge, London 1995; S. Warner, ‘Women’s Liberation? Feminist Theory and Therapy for Women’, Changes: An International Journal of Psychology and Psychotherapy, 18,4, 2000a, pp232-243.

2.    M. Foucault, The History of Sexuality, Vol. 1: An Introduction, R. Hurley (trans), Penguin, London 1990; D. Haraway, Simians, Cyborgs and Women: The Reinvention of Nature, Routledge, New York 1991; J. Butler, Bodies that Matter: On the Discurswe Limits of Sex, Routledge, London 1993; J. Butler, Gender Trouble:  Feminism and the Subversion of Identity, Routledge, London 1990.

3.    Butler, op. cit., 1993.  

4.    P. Reavey ‘What Do You Do for a Living Then? The Political Ramifications of Research Interests in Everyday Interpersonal Contexts, Feniminism & Psychology, 7, 1997, pp553-558.; P Reavey & S. Warner, ‘Curing Women: Child Sexual Abuse, Therapy, Embodiment and Femininity’ Paper presented at the British Psychological Society conference: Psycholoby of women’s section, Birmingham University, June 1988; P Reavey & B. Gough,. ‘Dis/locating Blame: Survivors’ Constructions of Self and Sexual Abuse, Sexualities, 3, 2000, pp325-347.

5.    S. Warner, ‘Special Women, Special Places: ‘Women and High Security Mental Hospitals’, in E. Burman, G. Aitken, P Alldred, R. Allwood, T. Billingham, B. Goldberg, A. J. Gordo Lopcz, C. Heenan, D. Marks and S. Warner, Psvchology, Discourse, Practice: From Regulation to Resistance, Taylor and Francis, London 1996a; S. Warner, ‘Visibly Special? Women, Child Sexual Abuse and Special Hospitals’, in C. Hemingway (ed), Special Women? The Experience of Women in the Special Hospital System, Avebury Hants 1996b; S. Warner, Understanding Child Sexual Abuse: Making the Tactics Visible, Handsell Publishing, Gloucester 2000b.

6.    J. Marecek, ‘Trauma Talk in Feminist Clinical Practice’, in S. Lamb (ed), New Versions of Victims: Feminists Struggle with the Concept, New York University Press, New York 1999, p170.

7. Ibid.  

8.   L. Armstrong, Rocking the Cradle of Sexual Politics, What Happened When Women Said Incest?, The Women’s Press, London 1994.  

9.    S. Warner, ‘Women and Child Sexual Abuse: Childhood Abuse and Current Custodial Practices’, in R. Horn and S. Warner (eds), Positive Directions for Women in Secure Environments: Issues in Criminological and Legal Psychology. BPS, Leicester 2000c.  

10. J. Haaken, Ptllan of Salt: Gender, Memory and the Perils of Looking Back, Free Association Books. London 1998.  

11 E. Bass & L. Davis, The Courage To Heal: Women’s Guide to Survival, Cedar Press, Bolton 1988.  

12.  P. Reavey & L. Courtney, ‘Women, Sexual Health and Sexual Abuse: An Examination of Some Apparent Tensions in Individualist Approaches to Self-help’, Mental Health Care, vol 2, pp94-98, 1998.  

13.  FE. Sultan & G.T. Long, ‘Treatment of the Sexually Physically Abused Female Inmate: Evaluation of an Intensive Short-Term Intervention Program’, Journal of Qffender Counselling, Services and Rehabilitation, 12, 1988, ppl3l-143.  

14.      D. Finnev. Reach for the Rainbow: Advanced Healing For Survivors of Sexual Abuse, Changes Publishing, Park City 1990.

15.      C. Poston & K. Lison, Hope for Adult Survivors of Incest, Little Brown & Company, Boston 1990.  

16.  D. Jehu. ‘Sexual Dysfunction Among Women Clients who were Sexually Abused in Childhood’, Behavioural Psychotherapy, 17, 1989, pp53-70.  

17.  Poston & Lison, op. cit.  

18.  C. Maltas & J. Shay, ‘Trauma Contagion in Partners of Childhood Sexual Abuse’, American Journal of Orthopsychiatrv, 65, 1995, pp529-539.    

19.. R. Hare-Mustin, 'Sex Lies and Headaches:  The Problem is Power', Journal of Feminist Family Therapy, 3, 1991, pp311-331; S. Lamb (ed), New Versions of Victims:  Feminist Struggle with the Concept, New York University Press, New York, 1999.

20.  D. Jehu, Beyond Sexual Abuse:  Therapy with Women who were Childhood Victims, John Wiley Press, Chichester, 1988.

21.  B. Bacon & L. Lein, 'Living with a Female Sexual Abuse Survivor:  Male Partners' Perspectives', Journal of Child Sexual Abuse, 5, 1996, 1-16.

22.  K.S. Reid, 'A Qualitative Analysis of Therapy Effectiveness for Married Female Survivors of Childhood Sexual Abuse:  From the Couples' Perspective', Doctoral dissertation, Texas Tech University, 1993, Dissertation Abstracts International, 54, 4372B, 1993. 

23.  V.M. Follette, 'Marital Therapy for Sexual Abuse Survivors', New Directions for Mental Health Services, 51, 1991, pp61-71.

24.  See Maltas & Shay, op.cit.

25.  Warner, op.cit., 1996a.

26.  Hare-Mustin, op.cit.

27.  J. Kitzinger, 'Sexual Violence and Compulsory Heterosexuality', in C. Kitzinger & S. Wilkinson, Heterosexuality:  A Feminism & Psychology Reader, Sage, London, 1993.

28.  S. Lamb, 'Constructing the Victim:  Popular Images and Lasting Labels', in S. Lamb (ed), New Versions of Victims:  Feminist Struggle with the Concept, New York University Press, New York 1999, p131.

29.  Armstrong, op.cit.

30.  Lamb, op.cit., p131.

31.  S. Warner, 'Disrupting Identity Through Visible Therapy:  A Feminist Post-structuralist Approach to Working with Women who have Experienced Child Sexual Abuse', Feminist Review , (in press).

32.  Including North-American self-help movements - see, for example, Reavey & Courtney, op.cit., 1998.

33.  L. O'Dell & P. Reavey, 'Listening and Speaking:  The Lost and Found Voices of Survivors of Sexual Violence', Psychology of Women Section Review, (in press).

34.  Haaken, op.cit., 1998, p91.

35.  Butler, op.cit.

36.  P. Reavey & S. Warner, op.cit., 1998.

37.  C. macKinnon, 'A Feminist/Political Approach:  "Pleasure under Patriarch"', in J.H. Greer and W.T. O'Donohue (eds), Theories of Human Sexuality, Plenum Press, New York 1983; A. Dworkin, Intercourse, Arrow, London 1987.

38.  S. Warner, 'The Cost of Containment:  Women, High Security Mental Hospitals and Child Sexual Abuse', Forensic Update, 2000d; Warner, op.cit. 2000b.

39.  Warner, op.cit., 1996a, 1996b.

40.  Broadmore, Rampton or Ashworth in the UK.

41.  Haaken, op.cit., 1998.

42.  J. Herman, Father-Daughter Incest, Harvard University Press, Harvard 1981.  

43.   Warner, op. cit., 1996b.  

44.   S. Warner, Child Sexual Abuse and the Production of Femininity’, in E. Burman et al, Challenging Women. Psychology‘s Exclusions, Feminist Possibilities, Open University Press, Buckingham 1996c.  

45.   A. Kamsler, Her-story in the Making: Therapy with Women who were Sexually Abused in Childhood’, in M. Durrant and C. White (eds), Ideas for Therapy with Sexual Abuse, Dulwich Centre Publications, Adelaide 1990; Reavey & Warner, op. cit., 1998.  

46.   Armstrong, op. cit.; Kitzinger, op. cit.; L. Kelly, S. Burton & L. Regan, ‘Beyond Victim and Survivor: Sexual Violence, Identity and Feminist Theory and Practice’, in L. Adkins & V Merchant, Sexualising the Social, MacMillan Press, London 1996; Warner, op. cit.,1996c.  

47.   N. Gavey, “‘1 wasn’t Raped, but ...“: Revisiting Definitional Problems in Sexual Revictimisation’, in S. Lamb, New Versions of Victims: Feminists Struggle with the Concept, New York University Press, New York 1999.  

48.   Ibid., p62.  

49.  J. Haaken, Heretical Texts: The Courage to Heal and the Incest Survivor Movement’, in S. Lamb, op. cit., p22.  

50.   Butler, op.cit., p9, original emphasis.  

51.   Reavey & Courtney, op. cit., 1998.  

52.   Reavey & Gough, op. cit.  

53    Lamb, op cit., p113.  

54    Haaken. op. cit, 1999. 

55.  Haaken, op.cit., 1998.

56.  Kamsler, op. cit. 

57.  Reavev & Gough, op. cit.  

58.  See Warner. op cit.. 1996a, 1996b.  

59.    Dworkin, op. cit.  

60.    Warner. op. cit., 1996c.  

61.   Warner, op. cit., 2000a.  

62.  L Kelly, ‘Stuck in the Middle’, Trouble and Strife, 29/30, 1994, pp 14-18.  

63.  Warner, op. cit., in press.  

64.    Terry, 1984, cited in J. P Mendel, The Male Survivor: The Impact of Sexual Abuse, Sage Publications, London 1995.  

65.  Reavey & Gough, op. cit.  

66.  Eg, B. Seu & C. Heenan keds), Feminism & Psychotherapy, Sage, London 1998.  

67.  Eg, M. White and D. Epston, Narrative Means to Therapeutic Ends, Norton Books, London 1990.  

68.  Warner, op. cit., in press.  

69.    Kamsler, op. cit.; Parker ‘Constructing and Deconstructing Psychotherapeutic Discourse’, The European Journal of Psychotherapy, Counselling and Health, 1998, pp65-78.  

70.  Warner. op. cit., in press. 

71.  Warner, op.cit., 2000b, S. Warner, 'Child Sexual Abuse:  Tactics for Survival - Identifying issues which Contribute to Good Practice', Clinical Psychology Forum, 139, 2000e, pp6-10. 

72.  Warner, op.cit., in press.

73.  Ibid.

74.  Warner, op.cit., 2000b.

75.  Warner, op.cit., in press, 

76.  Warner, op.cit., 2000b.

77.  Kelly et al., op.cit., p94.

78.  Warner, op.cit., 2000b; R. Colman, Recovery:  An Alien Concept, Handsell, Gloucester 1999.

Originally published in the International Journal of Critical Psychology, 3, 2001, Lawrence & Wishart, London.