Child abuse and the church: a call for prevention, treatment, and training.

Vieth, Victor I. ; Tchividjia, Basyle J. ; Walker, Donald F. 等

Child abuse is both a sin and a crime. In this article, we present a call to the global Christian church to prevent and treat child abuse, and to train professionals across disciplines to do so. Vieth discusses effective child protection policies in churches. Among other recommendations, he encourages consultation with child protection experts, thorough screening of child workers, and accountable supervision of children in church. Tchvidjian examines cultural aspects of missions organizations that contribute to the abuse of children in the mission field. He suggests that missions organizations who have failed to protect abused children in the past placed their reputation above child protection, failed to treasure children, and believed in God-sanctioned power and control of missions workers. Knodel reviews the efforts of Christian organizations to prevent the trafficking of children worldwide. She finds effective advocacy occurring across the globe but among Christian organizations that are rarely tied to any specific denominational support. Next, Walker reviews evidence-based treatment recommendations for children and adolescents. Trauma-focused CBT is a leading empirically supported treatment for child abuse. Recently, efforts have been made to sensitively integrate faith into TF-CBT. Vieth then discusses effective church responses to allegations of abuse. He suggests suspending the activities of a church worker when allegations are made against him or her in addition to informing the police. Tchivdjian coneludes by discussing the mission and vision of the GRACE foundation--a multidisciplinary Christian nonprofit organization dedicated to protecting children from child abuse and treating children who have been abused.

"... deliver us from evil" (Matt. 6:13)

In this article, we present a call to the local and global church to prevent, respond to, and train others to comprehensively address child abuse. In making this call, we review child abuse prevention policies for churches and faith based organizations. We then discuss institutional factors involved in child abuse prevention globally among missionary organizations, and highlight efforts to prevent child trafficking among international Christian organizations. Afterward, we review spiritual issues that arise for children who have been abused, and discuss spiritually integrative treatment options for children. Next, we suggest ways in which churches can respond pastorally to disclosures of abuse by children. We conclude by discussing the work of the Godly Response to Abuse Within a Christian Environment (GRACE) organization, a multi-disciplinary, faith-based organization dedicated to training professionals across disciplines to prevent and treat child abuse in churches and Christian faith-based communities.

Preventing Child Abuse Within the Local Church Although churches are increasingly implementing policies to protect children from abuse, the policies adopted are often inadequate and of limited value. In order to make the policies as effective as possible, I (Vieth) have proposed the following six guidelines (sec Vieth, 2011, for a review).

Consult With at Least One Child Abuse Expert in Developing Child Protection Policies

Church leaders need to realize that few insurance companies have a vested interest in investigating, prosecuting, or otherwise treating sex offenders. The primary interests of insurance companies are in limiting liability. As a result, we encourage faith leaders to consult with their insurance providers without limiting the development of their child protection policies to the recommendations made by their insurance companies. In addition, we urge church leaders to contact law enforcement, prosecutor offices, and sex offender treatment providers and ask these true experts to assist in developing policies on child abuse. Making these contacts in advance will also assist the church or other faith institution in working with these very departments if and when a case of child abuse arises within a congregation.

Understand that Insurance Providers and Some Law Firms Have a Vested Interest in Preventing Future Abuse--and Keeping Quiet About Past Abuse

Insurance companies and some law firms have a vested interest in primarily considering the future, not past, incidences of child abuse. This is because preventing future abuse limits liability for churches and insurance providers. As a result, many insurance companies and their lawyers have a vested interest in avoiding detecting past incidences of abuse because they believe that doing so will increase exposure of liability to their clients. This is also why, when past abuse is uncovered many insurance companies and some law firms encourage churches to maintain silence and limit internal investigation.

The danger of limiting the investigation. Some law firms also recommend that when churches conduct internal investigations of abuse, they limit their investigations to only those children who have already reported abuse while excluding other potential victims or other people who may have knowledge of what happened. This policy is inconsistent with best practices for child abuse investigators proposed by the National District Attorneys Association's National Center for Prosecution of Child Abuse. Elsewhere, I (Vieth) have suggested that limiting an investigation is problematic for several reasons. First, many victims delay disclosure, and do not disclose until asked. As a result, many children who may have been abused in such situations will not have the opportunity to disclose the abuse. In addition, this policy is also problematic because it limits the ability of churches to fully assess the extent of damage caused by offenders in situations in which at least one incident of abuse has been reported. Some law firms also recommend against interviewing potential victims on the grounds that it may "re-injure" them to discuss their "sexual past".

However, Vieth (2011) suggests that failing to conduct a full investigation into allegations of child abuse actually increases liability on the part of churches if the decision to do so results in a child abuser continuing to have access to children. Furthermore, failing to conduct a full investigation also sends a disturbing message to the church body that its leadership is more interested in maintaining a public image than in helping the children who were abused.

Limit the Opportunity for Sex Offenders to Access Children

Many youth organizations have prevented the abuse of children in their care simply by limiting the access of potential offenders to boys and girls. When churches or other faith institutions remove the opportunity for sex offenders to have privacy to commit offenses, it becomes difficult for the offender to succeed. At a minimum, then, faith institutions should have the following policies, taken from Vieth (2011) in place:

Two-deep leadership. Ideally, children should always be supervised by at least two church workers. When a child is removed from a group for a legitimate reason, the child and worker should remain within the eyesight of at least one additional worker or volunteer.

Respect for the child's privacy. Child workers should avoid watching children undress in locker rooms, showers, and bathrooms.

Separate sleeping accommodations. Separate sleeping accommodations should be maintained on overnight trips. If an adult has a legitimate reason to enter children's sleeping accommodations at night (as in the case of illness), then two adults should enter the sleeping area together and document the reason for doing so.

Limit, if not prohibit, events at a worker's home. In one case that I (Vieth) am aware of, a youth minister had a party at his home with children in which all the children joined him in a hot tub where he taught some of them how to masturbate with the jets on the hot tub. If there is a legitimate reason for hosting an event at a worker's home, an additional worker should be present.

Appropriate attire. Adult workers and volunteers should wear appropriate clothing at all times. It should seem obvious, but activities such as skinny dipping during church outings should always be prohibited. Eliminating sexually suggestive or otherwise inappropriate apparel or behaviors also serves to limit the opportunity for sex offenders to initiate sexual discussions.

Sexual jokes, comments, or behaviors around children should be strictly prohibited. In one case, a "Christian" teacher told the boys in his care about the frequency he had sex with his wife on his honeymoon. In a similar case, one protestant worker at a church boarding school hosted a pizza party in which the invited adolescent girls were "accidently exposed" to his pornography collection. Elsewhere, Vieth (2011) proposed that there are two practical, compelling reasons that behaviors such as these should be strictly prohibited and result in immediate discipline. First, sex offenders use behaviors such as these to initiate sexual conversations with children in the hope of engaging in sexual activity. Second, sexualized behaviors such as the ones described create a climate that makes it much more difficult for abused children to disclose their victimization.

Maintain windows and open doors. Churches are encouraged to have an open door policy for instances when teachers or other adults need to be alone with children. In addition, churches should also maintain windows on doors so that other people can see what is happening in a particular room.

Conduct a Background Check and Oral Screening of Workers and Volunteers

Although a background check is important, it will only reveal those who have been convicted of a crime against a child. This is problematic because most sex offenders, even some who have abused hundreds of children, have never been charged, much less convicted, of a crime. Accordingly, an oral screening of faith workers and volunteers should also be conducted. There are a number of articles and materials available to assist the church in conducting such a screening (Vieth 2011).

Preventing Child Abuse Among the Global Church

In this section, we discuss efforts to prevent child abuse occurring in the Global Church. We begin by discussing lessons learned from failures to prevent child abuse in missionary contexts. Afterward, we highlight efforts being made by Christian missions organizations and churches to prevent child trafficking occurring around the globe.

Institutional Centered Missions and the Protection of Children

During the past eight years, GRACE has had the opportunity to assist Christian institutions in addressing their mishandling of past abuse disclosures. The focus of these investigations has primarily involved child abuse on the mission field where missionaries have abused children of missionaries. These investigations have provided GRACE an unprecedented and unique exposure to the common problems inherent with preventing and responding to child abuse on the mission field.

In this section, I (Tchividjian) identify three types of institutional cultures within missions that commonly contribute to a failure of protecting children, and to the failure of responding properly to abuse disclosures. (1) These areas of missions culture must be transformed if the mission field is going to fulfill its God given mandate of sharing and demonstrating the Gospel to all peoples, including missionary children and their families. (2)

Culture of Ministry--Protecting Reputation with Walls of Silence

Missionary organizations are not exempt from the sin that inflicts many Christian institutions, the sin of institutional self-centeredness. The stated purpose of most missionary organizations is generally centered on reaching peoples with the Gospel. Unfortunately, as the institution grows and develops, its purpose often becomes less about the Gospel, and more about the sustained existence of institution. This purpose is usually rationalized with an implicit philosophy that the reputation of the Gospel rests upon the "successes" and "failures" of the organization.

Institutional centered cultures often place institutional reputation over individual value. To this end, institutions commonly erect three walls of silence upon learning of allegations related to child abuse. The first wall silences members from even mentioning allegations of abuse. This institutional directive is often under the guise of preventing "gossip: when oftentimes the real reason is the institution's desire to protect its status and reputation amongst its members. A culture that silences its members from speaking with each other about suspected abuse is one where abuse will almost always flourish.

The second wall of silence is one that exists between the institution and local authorities. This wall often results in the refusal of the organization to report suspected abuse to authorities of the host country. This failure to report is often premised upon the institution's concern that such a report could compromise its reputation, and may result in the organization being ejected from the host country. The commonly stated rational for this concern is that being removed from the country will result in the waste of invaluable capital, resources, and human lives, which have been invested into the particular mission field. The spiritual rationale often stated for such silence is that the removal of the organization will result in fewer conversions and more eternally lost souls.

The third wall silences the disclosure of suspected abuse on the mission field to the supporters back home. I (Tchividjian) am aware of one case in which a missionary confessed to sexually victimizing a child on the mission field. This perpetrator was sent home with a letter sent to the supporting and host churches explaining that his premature return home was based upon a "moral indiscretion." Most interpreted "moral indiscretion" to mean an adulterous affair, not child sexual abuse. Failure to disclose the truth about abuse on the field to institutional supporters is often driven by the organization's concern for reputation within the Christian community.

Not only do these walls of silence communicate utter worthlessness to those victimized, but they also enable the continued victimization by missionary perpetrators. If the abuse is never discussed amongst the members, reported to local law enforcement, or disclosed to institutional supporters, the abuser is free to move from institution to institution, mission field to mission field, victimizing and destroying children along the way.

Ultimately, a culture of ministry that is centered upon the institution will go to great lengths to protect its reputation. Consequently, the value and protection of the individual is compromised for the "benefit" of the institution, which always leads to tragic results.

Culture of Service: Failing to Treasure Children

There is a story about the late American evangelist D.L. Moody who arrived home late one evening from preaching a revival service. As the tired Moody climbed into bed, his wife rolled over and asked, "So how did it go tonight ?" Moody replied, "Pretty well, two and a half converts." His wife smiled and said, "That's sweet. How old was the child?" "No no, no," Moody answered. "It was two children and one adult! The children have their whole lives in front of them. The adult's life is already half-gone" (Stafford, 2007).

Too often, the missionary culture views children in the same manner as Moody's wife. Instead of treasuring children as God does, Christian institutions often consider their value as secondary to that of adults. (3) As a result, the organization often finds itself overlooking the most basic needs of children, all the while busy tending and caring for itself in "spreading the Gospel". This devaluing of children often leaves them exposed to indescribable harms that have physical, emotional, and spiritual consequences. Wess Stafford, President of Compassion International, perhaps puts it most accurately when he writes, "Small, weak, helpless, innocent, vulnerable, and trusting, they are waiting victims for our simple neglect and most evil abuse. No matter what goes wrong, the little ones pay the greatest price." (Stafford, 2007, p. 2). Almost equally as tragic and damaging as the perpetrated abuse, is the institutional-centered response in protecting itself at the physical, emotional, and spiritual expense of the abuse survivor. Victims and loved ones discover that their abuse concerns are marginalized, and their cries of pain are silenced, or simply ignored. These souls grow up having lost all ability and hope to believe and trust in anyone or anything, including themselves. The physical and emotional wounds of such an institutional centered response to abuse are deep, and oftentimes destructive.4 However, it is the spiritual damage caused by such institutional-centered behavior that is perhaps the most lasting and complex. When a child is raised in a culture that teaches him or her to love Jesus, as well as to trust and obey his or her elders, the betrayal of that trust by an elder who professes to love Jesus is indescribably scary.

All missionary perpetrators damage children spiritually. Some find it impossible to have any meaningful form of religious faith, while others have walked away from the faith community with a hatred of God. One abuse survivor told us, "Adults were God at [mission field name], and God was cruel." Another was more explicit about the spiritual damage caused by the institution's failure to protect children and stated, "Because of [name of mission organization], I absolutely despise anybody who calls themselves a Christian." Oftentimes, the institution-centered response to abuse contributes to survivors giving up hope in God. One such survivor stated: "[I] ... have no desire to share the gospel. [My] ... experience with [mission field name] has destroyed any spirituality that I had with Christianity. [I] ... would like to have something to share with [my] ... children besides Santa Claus ... [I] hope [I] ... will understand God one day."

Culture of Field Leadership--Power and Control "Sanctioned" by God

Abusive power structures often lead to environments where abuse is both tolerated and even sanctioned. Oftentimes, the power and control of the field leadership parallels that of a pastoral staff, a congregational board of Elders, a set of church Deacons, an employer, a local civil government, and a family chieftain, all in one.' Thus, they are often given final authority and control on matters of family, church, and state, which in a sinful world are best not aggregated into the hands of one committee. What is most harmful is that such total power and control is usually justified as being sanctioned by God. (6) In claiming to speak for God, leaders effectively place themselves over Scripture by becoming its sole authoritative interpreter. When the word of men becomes the very Word of God, Christian faith and life take a decidedly legalistic and destructive turn. Such a leadership culture eventually results in an environment where authority is seldom questioned or challenged. Passivity and unquestioning obedience are seen as faith; challenging leadership is still seen as rebellion and unacceptable. A field leadership structure that has such total authority, combined with a culture that de-emphasizes the value of little ones, creates an unsafe environment for children, and one in which little, if any, action is taken when abuse disclosures are made. (7) In such an environment, leadership decisions related to children are often based upon what is best for the institution, not the individual. On one particular mission field, the leadership warned parents against the idolatry of putting their own children at the center of their worlds and thereby making them into little gods. (15) Perpetrators that are "useful" to the mission will often be quietly moved to another area of service, while the child and his or her family are admonished to remain silent about the matter for "the sake of the Gospel." Any concerns raised about such an admonishment are interpreted as rebellion against God, resulting in the child and family being ostracized, or simply removed from the mission field. Tragically, all too often abuse survivors and their families comply with the self-serving instructions handed down by leaders that they have come to accept as speaking for God. (8)

Conclusion: The Need for Gospel Centered Change

The stated purpose of most missionary institutions is to communicate and demonstrate the powerful and redeeming truth of the Gospel. Tragically, all too often many institutions find themselves contributing to the physical, emotional, and spiritual destruction of the human soul, especially the souls of children. At the heart of this issue is a fundamental failure of many Christian organizations to understand and grasp the full truth and centrality of the Gospel. Ultimately, the great heartbreak of an institutional-centered missions culture is that it is an attempt to rob God of his sovereignty and glory by attempting to "protect" and "control" identities, reputations, and possessions. This is in direct contravention of the Gospel. A. Gospel-centered institution embraces the blessed reality that its identity is in Christ alone, and its reputation and all that it possesses belongs to God. Gospel-centered leadership recognizes and embraces the reality that the institution does not belong to the institution, but to the God who breathed it into existence. Therefore, a Gospel-centered mission organization has incredible freedom to expend itself in protecting children, regardless of the costs or consequences. A Gospel-centered culture confesses, confronts, and exposes sin without fear of the earthly consequences. A Gospel-centered institution does not fear vulnerability and weaknesses, knowing that Christ was vulnerable and weak on our behalf. A Gospel-centered institution embraces truth and transparency, understanding that Christ is truth and light and has achieved victory over darkness because of His willingness to hide nothing on the cross. Gospel-centered cultures acknowledge God's holiness, His sovereignty, and our dependence upon the power of the Gospel. A Gospel-centered culture will drive individuals and institutions to obey the God-ordained civil authorities who are charged with protecting our little ones and punishing those who harm them. Lastly, a Gospel-centered institution will stop at nothing in welcoming children into the arms of Jesus. Gospel-centered cultures are healthy and safe environments, not because they are good, but because they embrace the reality that it is not about the institution, but all about the righteous and merciful God of the institution who gave Himself up for us. A Gospel-centered missions organization responds to the Gospel by loving, cherishing, and protecting children even to the extent of self-sacrifice. Only such a Gospel transformation will bring both missionary kids and missionary institutions into the arms of Jesus.

The Global Church's Response to Child Trafficking

Around the world, organizations, individuals, and communities are becoming increasingly aware of the issue of human trafficking. This injustice affects approximately 27 million people worldwide, and one million children globally, and has sparked a worldwide campaign of awareness, advocacy, prevention, and treatment for victims, survivors, and at-risk individuals. The global church has also stepped in to assist in the campaign against trafficking in many different capacities. In this section, I (Knodel) highlight various efforts that churches and Christian organizations are undertaking globally to prevent the trafficking of men, women, and children.

February 26th, 2012, was declared "Freedom Sunday" by 5,000 churches across 100 countries that have united for the worldwide cause of justice. Through the organization Not For Sale (NFS), these churches all committed to a day of worship and awareness for victims of trafficking. In support of NFS, many church members "Fasted for Freedom" throughout the Lenten season to raise funds for NFS. Churches and other religious institutions can join Not For Sale's Underground Church Network to fight for the eradication of human trafficking.

With a goal to prevent child sex trafficking and restore hope to its victims, Agape International Ministries (AIM) began working in Cambodia in 2005 to combat child sex trafficking. Several years after International Justice Mission raided a village brothel in Svay Pak, Cambodia and shut it down, AIM transformed the property into a community center, named Rahab's House, in 2007 to provide education, health care, Biblical teaching, and support to the village. One of the programs at Rahab's House is Kid's Club. Kid's Club is a daily program run by one of AIM's Cambodian pastors along with other young adult disciples. The program provides Khmer and English literacy lessons, life skills lessons, worship music, arts and crafts, and a snack for over 100 children each afternoon. In June of 2010, a community school opened its doors to approximately 200 students and began teaching Bible lessons intertwined with the Khmer curriculum of literacy, math, life skills, and ESL. In addition to meeting their educational needs, AIM also provides a healthcare clinic every Tuesday and Thursday afternoon. With limited, expensive amounts of healthcare, anywhere from 300-400 people flock to the clinic each month to experience the tangible love of Christ through this ministry.

On Sundays, Rahab's House becomes a church for the local community, teaching Christ-centered, Biblical principles. According to its website, the church has rescued 16 girls directly from sex trafficking. They have also freed 12 children and 8 adults from labor trafficking. In addition, the Church has helped several young men leave the trafficking business, and one man, who previously owned a brothel, has stopped selling underaged girls for sex. AIM also runs The Lord's Gym, an outreach ministry for traffickers in Svay Pak. The gym is a free workout center where the staff develop relationships with traffickers and are able to share the truth about Jesus Christ and the salvation He offers.

Other ministries also provide community outreach programs similar to that of AIM. Such programs include the Heart Drop-In Center in Northern Thailand (Supporting Heart), The Volunteers for Children Development Foundation in Thailand, World Relief in Cambodia, and the United Methodist Committee on Relief in Armenia.

Christian organizations and churches are also raising awareness and equipping communities and individuals with the education and resources to fight the problem themselves. In addition, helping build up local commerce in order to decrease poverty and, along with it, the need for prostitution and trafficking, provides long-term, positive change. An example of these efforts takes place in the country of Haiti. The child trafficking industry in Haiti currently affects as many as 300,000 children. Typically these children, called Restaveks, are sold by their parents to wealthier, urban families who promise to provide food, shelter, and education in exchange for service. However, a majority of these children are made into slaves, are forced to work continuously, are abused, and are kept from receiving the nurture and education they were promised.

Beyond Borders leads efforts in Haiti to raise awareness about the Restavek problem and to educate Haitian families about the dangers of selling their children. They have developed radio programs to raise awareness about the risks children face when they are sent to live with others, as well as the obligation adults have to protect children from harm. The organization also equips Haitians to recognize and build upon their own strengths so they can organize and facilitate dialogue among neighbors about the trafficking problem. In addition to developing an approach to empower rural communities to stop the flow of child servants, they also help parents to retrieve the children they already sent away. In addition, Beyond Borders supports Sustainable Livelihoods, an endeavor that empowers Haitians to work and provide for themselves and their communities. This movement provides sustainable agriculture training and sets up working partnerships between Haitian artisans and other individuals where they can sell their artwork at fair prices.

Global outreach ministries also conduct research and training (in both the United States and other countries) to better equip individuals to advocate, to raise awareness, and to organize preventative measures against trafficking. For example, AIM conducts anti-trafficking training for groups and churches, equipping them with strategies to defeat sex-trafficking in their cities. Mending the Soul provides trainings in their community-based model of care and healing. In a related vein, Justice Ventures International (JVI) conducts research and documents the best practices to train practitioners and policy-makers in effective strategies to eradicate injustices. World Relief Cambodia conducts community level training and awareness in five provinces in Cambodia. The United Methodist Committee on Relief (UMCOR) also holds training for its members, especially for United Methodist Women (UMW). The United Methodist Church's "Protection Project" offers training about human trafficking and practical suggestions for how members can take action in their own communities. The workshops also teach members how to identify where trafficking victims may be working and how to work effectively with local law enforcement. In addition, the organization Live2Free has developed College Campus Kits to give to students who would like to raise awareness and funds for the goal of eradicating trafficking.

Another prevention approach involves reforming legal systems to protect children from trafficking. JVI supports three local justice ventures in northern India who are working with lawyers to bring about the rescue and rehabilitation of hundreds of victims. These local justice ventures also fight for the arrest and conviction of traffickers as well as work toward other positive legal changes to help victims. JVI is present in China as well, analyzing strategies for working together with the Chinese government to create greater consequences for offenders. Beyond Borders also has ongoing objectives to reform the Haitian legal system so that laws include specific protections for Restavek children. UMCOR also provides information and training on how to advocate for better laws related to trafficking, such as laws and plans for the development of shelters and programs for victims.

Responding to Survivors of Abuse

Survivors of childhood abuse often experience conflicting spiritual experiences after the abuse occurs. Some survivors turn to God for help in coping with and making spiritual and emotional meaning of the abuse. Other survivors turn away from God or organized religion. Many survivors live a spiritual life somewhere in between these experiences, unsure of what to make of them. A fairly substantial body of research exists regarding the impact of childhood physical and sexual abuse on survivors' personal religion and spirituality. We recently reviewed 34 studies reporting on a total of 19,090 adult participants reporting retrospectively on their experience of childhood abuse and changes in their personal religion/spirituality during and after the experience of abuse (Walker, Reid, O'Neill, & Brown, 2009). A number of findings emerged from this review, but we focus on three key findings here for the sake of discussion. First, the majority of studies suggested that survivors of child abuse experience damage to their faith, as a result of the abuse = 14), however; many studies (N = 12) suggested that the participants experienced a combination of simultaneous increase and decrease in different aspects of their personal religion and spirituality. For example, it is common for some people to report turning to God for support after abuse but distance themselves from organized religious activities, or vice versa. It is also common for people to seek God's help in dealing with abuse while also questioning how God could allow the abuse to occur in the first place.

Second, when abuse decreases personal religiousness/spirituality, it appears to do so by specifically damaging the individuals view of and relationship to God. In the set of studies Walker et al. (2009) reviewed, across studies, a number of survivors reported that they were distrustful of God, felt more distant toward God than non-abuse survivors, and believed that God was harsh and critical to a greater extent than people who had not been abused. In addition, a number of participants also reported that they wondered if God still loved them after abuse had occurred.

Third, among studies that examined the relationship between abuse, religion/spirituality, and mental health outcomes, those participants who maintained some connection to their personal faith (even if it was damaged as a result of abuse) experienced better mental health outcomes compared to adult survivors of abuse who did not. Most striking was a study conducted by Doxey, Jensen, and Jensen (1997). They surveyed a total of 652 women, and compared the relationship between religious involvement and depression among religious women who had suffered child abuse, non-religious women who had suffered child abuse, and religious women who had not suffered abuse. Doxley et al. found that religious women who had suffered abuse experienced better outcomes than religious women who had not suffered abuse if they maintained a high degree of religious involvement in organized church activities (such as communal worship and participation in the life of a church). This suggests that, for some survivors of abuse, churches have the potential to be a significant source of healing. In considering these findings, Walker et al. (2009) made several recommendations for psychotherapists addressing spiritual issues when working with both child and adult survivors of childhood abuse.

Recommendations for Addressing Spiritual Issues with Survivors of Child Abuse

Maintain an Initially Supportive but Neutral Stance Toward Spirituality and Religion

First, they suggested that psychotherapists initially maintain a supportive but neutral therapeutic stance with respect toward client spirituality and religion. Such a stance is particularly important when clients express negative feelings about God or their organized religion early in treatment. A case example taken from Walker, Reese, Hughes, and Troskie (2010) illustrates such a stance. In that article, one of the psychotherapists (Walker) initially asked a child client if he had talked to God about the abuse that he had suffered, and the client responded by saying that he wasn't sure if God could help him. This particular client's mother also reported that, although she continued to attend church, her son had stopped attending. Later, as the client worked through the abuse in treatment, he eventually made peace with God and returned to church.

What does a supportive but neutral therapeutic stance look like? I (Walker) am encouraging psychotherapists to avoid discounting clients' religiousness in cases like this, or, alternatively, to "jump in" and attempt to convince the client too quickly that they should work out their spiritual struggles. On one hand, it would be easy to prematurely dismiss the importance of clients' religious issues in treatment when clients initially state that such issues are not pertinent or that they do not wish to discuss them. Alternatively, some therapists may experience countertransference reactions in varying degrees of intensity when confronted with the possibility that their clients are cutting themselves off from God and/or contemplating leaving the churches they were raised in. Maintaining an initially neutral but supportive stance toward clients' religiousness requires the ability to hold the tension between several competing directions for treatment. These include the possibility (and hope) that clients will revisit their relationship toward their congregation and relationship to God later in treatment. This also means simultaneously respecting survivors' rights to hold their current feelings toward God and organized religion, as well as supporting their autonomy in choosing a treatment direction. Holding this tension can be difficult for some therapists. Practically speaking, this approach is therapeutically warranted given the results of our research review suggesting that abuse survivors experience changes in faith over the course of their recovery.

Be Prepared to Respond to Spiritual Issues Raised by Child Abuse Survivors

Psychotherapists should also be prepared to respond to spiritual issues raised in psychotherapy by survivors of child abuse. As the Walker et al. (2009) review suggested, and as we have presented throughout this article, abuse survivors are likely to present with spiritual struggles related to feeling let down by God, anger toward God, and questioning how God could have allowed the abuse to occur. Abuse survivors may also feel conflicted about participation in organized religious activities and question whether other congregants can understand their experience. Incest survivors in particular may project their relationship with their abuser on to their relationship with God. As a result, psychotherapists should openly explore clients' God image and, when necessary, confront distorted God images using loving images of God from the Bible. As they indicated in their review, some authors have suggested that female survivors of abuse that was committed by male perpetrators may be helped by reading passages in the New Testament that highlight the various roles that women played in Jesus' ministry and His love and respect for them (Kane, Cheston, & Greer, 1993). Kane et al. further suggest that women survivors of childhood sexual abuse may be helped by considering feminine aspects of God, and points out that the Greek feminine noun Sophia is a linguistic source for the Holy Spirit.

Actively Confront Religion-Related Distortions Stemming from Child Abuse

Finally, as a broad treatment issue, psychotherapists need to be particularly aware of, and actively confront, religious distortions stemming from religion-related abuse, in which aspects of survivors' religiousness were used to perpetuate the abuse itself. For example, some parents may justify physical abuse by quoting Bible verses that are taken out of context. Furthermore, some sexual abuse survivors may have been abused by clergy or by teachers in religious institutions. Walker, et al. (2010) presented a case study in which one school aged girl was raped by her father and then told that God would hate her and that she would go to hell if she ever told anyone about the abuse. Psychotherapists need to listen for distortions of religion such as these and be prepared to actively confront them during treatment.

Evidence-Based Treatment Options for Treating Child Abuse

Psychotherapists have a number of evidence-based treatment options available for addressing childhood abuse among both adult and child survivors. In secular child treatment settings, Trauma-Focused Cognitive Behavioral Therapy (TF-CPT) has emerged as a leading, empirically supported treatment for child abuse (Cohen, Mannarino, Deblinger, & Berliner, 2009; Cohen, Mannarino, & Deblinger, 2012).

Trauma-Focused Cognitive Behavior Therapy for Children and Teens

TF-CBT has multiple treatment modules, summarized using the PRACTICE acronym. According to Cohen et al. (2009), the PRACTICE acronym stands for Psychoeducation, Parental treatment, Relaxation, Affective Expression and Modulation, Cognitive Coping Skills, Trauma narrative and cognitive processing of the trauma, Invivo desensitization to trauma reminders, Conjoint parent-child sessions, and Enhancing safety and future development. Prior to beginning treatment, clients are assessed in one or more assessment sessions. These sessions typically focus on gathering information about the trauma itself, including: what kind of abuse was committed, who committed the abuse, the relationship of the perpetrator to the child, whether the abuse was of one form or multiple forms (i.e., physical abuse or physical and sexual abuse), whether it was a one time or ongoing event, and the length of time of the abuse was committed. Psycho-therapists also typically assess post-trauma sequelae such as depression, anxiety, Post-Traumatic Stress Disorder, as well as symptoms requiring imminent care, such as psychosis or suicidal ideation.

After the assessment sessions are completed, as a manualized treatment, TF-CBT is often completed in a linear, session-by-session format. However, the modules are intended by their authors to be applied flexibly. As Cohen et al. (2009) point out, depending on the client's presenting problems and coping skills, some psychotherapists may choose to skip one or more of the modules, or move up a module if necessary. For example, in my clinical experience, I have sometimes had clients who want to discuss the abuse that occurred without waiting several sessions to go through other modules to prepare them to do so. Other clients have needed additional help with affective expression and regulation over multiple sessions prior to being able to discuss the abuse. The TF-CBT manual allows this kind of flexibility in responding appropriately to client needs.

Spiritually-Oriented Trauma Focused CBT

For the past several years, I (Walker) have been working to develop a spiritually-oriented or Christian accommodative approach to TF-CBT (Walker et al., 2010; Walker, Quagliana, Wilkinson, & Frederick, in press). This spiritually-oriented approach to TF-CBT assesses the potential role of religion and spirituality in exacerbating or helping to resolve client presenting problems (or both) during the pre-therapy assessment phase of treatment. Then, depending on the nature of the client's presenting problems, their personal faith background, and their current religious and spiritual functioning, we explicitly incorporate religious and spiritual content into each of the TF-CBT modules. Examples of such content are presented in Table 1.

TABLE 1 Comparison of TF-CBT and SO-TF-CBT Modules

Module                   Secular            Spiritually Oriented

Psychoeducation   Focuses on teaching    Suggests normalizing
                  the survivor about     spiritual struggles
                  symptoms and
                  treatments

Parent training   Uses reinforcement     Emphasizes compatibility
                  and time-out           of Biblical directives
                                         with techniques

Relaxation        Teaches deep           Incorporates prayer into
                  breathing and          relaxation techniques
                  progressive muscle
                  relaxation

Affective         Teaches feeling        Incorporates Scripture or
Expression and    identification,        Christian songs or hymns
Modulation        thought stopping, and  for thought stopping Uses
                  positive imagery       religious imagery

Cognitive Coping  Teaches the cognitive  Considers religion-related
and Processing    triangle of thoughts,  cognitions
I                 feelings, behaviors

Trauma            Encourages trauma      Encourages open discussion
Narrative         processing by          of theodicy and
                  discussing the abuse   attributions about God

Cognitive Coping  Identifies and         Emphasizes correcting
and Processing    correct                religion-related cognitive
II                trauma-related         distortions
                  cognitive
                  distortions

Li vivo exposure  Utilizes in vivo       Incorporates prayer and
to non trauma     exposure to reduce     Scripture for coping with
stimuli           anxiety to             exposure
                  non-threatening
                  stimuli

Enhancing         Focuses on safety      Incorporates prayer for
safety/future     skills and planning    coping
development       for coping with
                  trauma reminders

Treating Complex Forms of Trauma in Children

Ford and Courtois (2009) define complex psychological trauma as resulting from exposure to severe stressors that (1) are prolonged and/or repetitive, (2) involve abandonment or harm by caregivers or other responsible adults, and (3) occur at developmentally vulnerable times in a child's life. In this section, we review published treatment considerations for the complex PTSD among children and teens.

Ford and Cloitre (2009) provide best practice guidelines for the treatment of complex PTSD among children and adolescents. As they indicated, TF-CBT remains the best-validated psychotherapy approach for children who have been sexually or physically abused, including those children who have been confronted with multiple incidents of abuse over time. Some children who have been abused repeatedly in the past may not have memory of their past incidents of abuse, may have acute behavioral or other psychosocial problems (such as suicidal ideation or psychosis), or may currently be in caregiver/family placements that are unstable. Ford and Cloitre suggest that such children need alternative treatment to stabilize their current symptoms or living situation prior to attempting trauma processing in TF-CBT.

In addition, Ford and Cloitre (2009) also present a list of practice principles to employ with children and teens who are specifically presenting with complex trauma:

(1) First identifying and addressing threats to the child's or family's safety and stability as a first priority. This recommendation makes intuitive sense, given that children who have been repeatedly abused may currently be in living situations that are unstable and unsafe.

(2) Creating a relational bridge between the child's psychotherapist, the client, and his or her parents. In making this recommendation, they noted that children are still young enough to be developing working models of secure attachment with caregivers. If the child's caregivers have also been previously traumatized, they may also have difficulty providing a secure attachment base for the child.

(3) Assessment, treatment planning, and outcome monitoring are relational and linked to the child and parent's long-term needs and goals.

(4) Treatment is always strength-based rather than focused on deficits.

(5) All phases of treatment should attempt to enhance self-regulation strategies. This includes affective regulation, bodily regulation, and regulation of consciousness and motivation.

(6) Eventual processing of traumatic memories when the child is ready. This recommendation mirrors treatment guidelines for treating children who have not been repeatedly abused. However, as indicated above, the process itself is different than/from the focus that Ford and Cloitre make by building relational bridges with the child's parents and in the depth and breadth of self-regulation strategies being employed during treatment.

Responding to Allegations of Abuse Within the Faith Community

In addition to reporting an allegation to the police, the church should determine in advance how it would handle an allegation of sexual or other misconduct made by a child in the congregation against another member of the congregation. At a minimum, the accused offender should be suspended from activities involving children until the case is fully considered by the authorities. Even if the authorities decline to prosecute, this may not resolve the matter. For example, there may be credible evidence of child abuse but the government has determined that it cannot prove the abuse occurred beyond a reasonable doubt. It is also possible that the government would decline to prosecute because no crime was committed yet the offender's conduct is deeply concerning.

In one case that I (Vieth) am aware of, for example, a male Christian schoolteacher was discovered to be chatting online with a female student and admitted having sexual thoughts about the girl. Although the church reported the incident to the police, law enforcement concluded a crime had not yet been committed. Although the government may have been unable to take action, the church certainly can. The admission of sexual thoughts about a child and the communication of these thoughts to a girl warrant immediate removal from teaching or duties that places this man in the company of children. Accordingly, even when the government declines to prosecute, the church should fully assess the allegation and take appropriate action.

The National GRACE Center: A Historic Partnership

In the past months, GRACE has worked with three Christian universities: Palm Beach Atlantic University, Wheaton College, and Regent University to begin developing an unprecedented historic partnership that will support, educate, and equip all facets of the faith community in addressing the many issues associated with the epidemic of child abuse. The National GRACE Center will be located on the campus of Palm Beach Atlantic University and will take a leadership role in preparing future Christian leaders and child protection workers to address the sin of child abuse. This will be accomplished by GRACE working with Palm Beach Atlantic University and the National Child Protection Training Center (NCPTC) to develop model undergraduate and graduate programs that will equip Christian leaders and child protection professionals to properly respond to cases of maltreatment, including addressing the spiritual needs of maltreated children. The NCPTC trains approximately 15,000 front line child protection professionals each year. The NCPTC also oversees 20 state and international forensic interview-training programs and has developed and implemented model undergraduate and graduate programs on child abuse at 19 universities, 3 law schools, 2 seminaries, and one medical school. For additional information, see www.ncptc.org.

GRACE will also train Christians who currently serve in the faith community. The National GRACE Center will develop a series of national, regional, and local conferences to train Christian pastors and lay leaders to recognize, report, and respond in a Christianly manner to cases of child maltreatment. Training will also include the development of low cost, if not free, webinars to ensure that appropriate training reaches even the most remote areas of the country.

Providing technical assistance for Christian churches and institutions. The National GRACE Center at Palm Beach Atlantic University will be available to provide technical assistance to any Christian church or organization on individual cases of child maltreatment. It will also assist in developing appropriate church child protection policies.

Developing publications and other materials for Churches. The National GRACE Center at Palm Beach Atlantic University will develop print, online and other media materials that can he used in Christian churches to assist the church in addressing the needs of survivors of child maltreatment.

Equipping the Christian community to address the trafficking of children. The National GRACE Center will assist Christian universities in providing instruction to future child protection professionals on combating the trafficking of children, as well as provide training to Christian churches and organizations on this issue.

Addressing the spiritual needs of Christian child protection professionals. The National GRACE Center will develop a series of training programs and materials to assist Christian police officers, prosecutors, social workers, psychologists, doctors, and nurses in coping with the emotional pain and spiritual struggle of their work.

National Research Center. The National GRACE Center is currently in negotiations to develop The National GRACE Research Center that is proposed to be jointly located on the campuses of Wheaton College and Regent University. The National GRACE Research Center will oversee research projects on the impact of abuse and other trauma on a child's sense of spirituality. The research will assist child protection professionals in assessing the impact of child abuse on a child's spirituality and will assist the Christian community, as well as the faith community as a whole, in responding to the spiritual damage that results from abuse. The National GRACE Center will then incorporate this research into its training programs and publications for the faith community.

Conclusion

What is the Christian community's response when confronted by the prevalence of child abuse in our culture? Are we to respond as the Priest, the Levite, or the Samaritan? Jesus said, "Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these." Tragically, child abuse inhibits countless children from approaching their Savior as Satan uses this sin to drive them from the Church and from the God who loves them. Throughout this article, we have argued that, as Christians, it is imperative that we preach and teach against this sin and that we open our doors and hearts to hurting children everywhere. Our Savior demands no less of us.

References

Cohen, J. A., Mannarino, A. P., & Deblinger, E., & Berliner, L. (2009). Cognitive-behavioral therapy for children and adolescents. In E. B. Foa, T. M. Keane, M. J. Friedman, & J. A. Cohen (Eds.), Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (pp. 223-244). New York: Guilford Press.

Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2012) (Eds.). Traumalb clued CBT for children and adolescents: Treatment applications. New York: Guilford Press.

Doxley, C., Jensen, L., & Jensen, J. (1997). The influence of religion on victims of childhood sexual abuse. International journal for the Psychology of Religion, 7, 179-186.

Ford, J., & Cloitre, M. (2009). Best practices in psychotherapy for children and adolescents. In C. Courtois and J. Ford (Eds.) heating complex traumatic stress disorders (pp. 59-81). New York: Guilford Press.

Ford, J. & Courtois, C. (2009). Defining and understanding complex trauma and complex trauma disorders. In C. Courtois and J. Ford (Eds.) treating complex traumatic stress disorders (pp. 13-30). New York: Guilford Press.

Kane, D., Cheston, S., & Greer, J. (1993). Perceptions of God by survivors of childhood sexual abuse: An exploratory study in an under-researched area. Journal of Psychology and Theology, 21, 228-237.

Stafford, W. (2007). Too small to ignore: Why the least of these matters most. Colorado Springs, CO: Waterbrook Press.

Walker, D. F., Reese, J. B., Hughes, J. P., & Troskie, M. J. (2010). Addressing religious and spiritual issues in trauma-focused cognitive behavior therapy with children and adolescents. Professional Psychology: Research and Practice, 41, 174-180.

Walker, D. F., Reid, H., O'Neill, T., & Brown, L. (2009). Changes in personal religion/spirituality during and after childhood abuse: A review and synthesis. Psychological Trauma: Theory, Research, Practice, and Policy, 1, 130-145.

Walker, D. F., Quagliana, H., Yother, M., & Frederick, D. (in press). Christian accommodative trauma-focused cognitive behavioral therapy for children and adolescents. In J. Men, E. Johnson, E. L. Worthington, Jr & J. Hook (Eds.), Evidence-based practices for Christian counseling and psychotherapy. Downers Grove, IL: Intervarsity Press.

Vieth, V. (2011). Suffer the children: Developing effective church policies on child maltreatment. Jacob's Hope, 2(1), 1-8. Retrieved online from www.netgrace.org.

(1.) This discussion is based upon GRACE investigations and research related to abuse on the mission field, as well as extensive interviews with MK (Missionary Kids) abuse survivors.

(2.) Though there are many missions organizations that have a healthy institutional culture, this section is focused on commonalities GRACE finds within institutions where child abuse and subsequent failed responses have been common. It is the hope of this author that even healthy missions organizations will be able to take away something from this article that will propel them to perpetuate a Gospel centered culture.

(3.) This is completely contrary to how Jesus views and values children. See Matthew 18:3: Truly, Ray to you, unless you turn and become like children, you will never enter the kingdom of heaven.

(4.) GRACE, has found that the catalogue of heartbreak and pain amongst missionary kids who have been abused by an individual and sacrificed by an institution centered culture, is not short: denial, memory loss, depression, guild, feelings of powerlessness, panic attacks, anger, fear, distrust, suicidal thoughts and actions, self harming, eating disorders, substance abuse, sexual experimentation, sexual confusion, sexual repression, running away, turning to the occult, criminal behavior, imprisonment, and even death.

(5.) It is not uncommon for mission field leadership to control1 such matters as ministry assignments, supplies, spiritual formation, public morals, civil crimes, church censures, private property, medical advice, housing, vacations, marriage, children, education, family vacations, and other family matters. Such control often manifests itself in areas with detailed rules on such trivial issues as haircut length, skirt length, blue jeans, music, movies, and Bible versions.

(6.) In describing such an environment, a former missionary once remarked, "Leadership spoke for God. If you disagree, you disagree with God and it's sin!"

(7.) Leadership at one missionary school discouraged children from disclosing abuse to their parents who were serving in outer lying locations, warning them that such complaints would hinder their parents' work and result in souls going to hell.

(15.) Leadership has been known to tell missionary parents that since God sacrificed His only Son, they should be willing and prepared to do the same. This directive is communicated to keep the parents exclusively focused upon the work of mission.

(8.) One missionary mother lamented: "We failed our children by allowing ourselves to be blind followers of mere men. Our children depended upon us for their protection. We abdicated that responsibility all the while thinking we were doing God's will, The children were the innocent ones and God was terribly misrepresented to them by us. We could not recognize Him as the gentle Shepherd calling His lambs to Himself, or that He had entrusted to us the great privilege and responsibility of their care."

Victor I. Vieth

National Child Protection Training Center

Basyle J. Tchividjian

GRACE Foundation

Donald F. Walker

Regent University

Katlin R. Knodel

Regent University

Author Information

VIETH, VICTOR I. JD. Address: National Child Protection Training Center, Winona State University, Maxwell Hall, Winona, MN 55987. Title: Executive Director, National Child Protection Training Center. Degrees: B.S. (Public Administration) Washington State University, J.D., Hamline University School of Law.

TCHIVIDJIAN, BASYLE J. JD. Email: btchividjian@liberty.edu. Title: Assistant Professor of Law, Liberty University. Degrees: BA, Stetson University; JD, Cumberland School of Law (Samford University). Specializations: Labor/Employment Law, Criminal Law, Criminal Procedure, Mediation, Lawyering Skills, Child Abuse and the Law.

WALKER, DONALD F. PhD. Email: dfwalker@regent.edu. Title: Director, Child Trauma Institute, and Assistant Professor, Regent University Degrees: PhD in clinical psychology--Graduate School of Psychology, Fuller Theological Seminary. Specializations: spiritually-oriented approaches to child abuse treatment, spiritual interventions in child and adolescent psychotherapy.

KNODEL, KATLIN R. Address: 1000 Regent University Drive, Virginia Beach, VA 23464. Title: Doctoral candidate in the PsyD program at Regent University. Degrees: BA (Psychology) The University of Toledo. Specializations: Child abuse, international psychology.