Hidden Words, Hidden Wounds: The Challenge of Naming Child Sexual Abuse

‘Childhood should be carefree, playing in the sun; not living a nightmare in the darkness of the soul’

David Pelzer (A Child Called “It”)

Child sexual abuse is a reality that demands attention, yet the very language required to address it often triggers censorship or avoidance, making open dialogue nearly impossible. The process of writing this blog has been particularly striking for us, because the very thing we want to write about, needs to have a presence and yet gets hidden. What we have become aware of is that well‑intentioned posts can get flagged, silencing important conversations. This reveals a profound irony: attempts to speak openly about the sexual abuse of children risk being silenced, replicating the same dynamics of concealment that allow the abuse itself to remain hidden. In both cases, what most needs to be seen is obscured, whether through digital algorithms or psychological defences, perpetuating a cycle of invisibility. The UK Government’s statutory definition of child sexual abuse acknowledges that sexual abuse can occur across a range of forms and contexts. According to the Department for Education “Sexual abuse of children involves the forcing or enticing of a child or young person to take part in sexual activities, whether or not the child is aware of what is happening” (Working together to safeguard children: A guide to inter-agency working to safeguard and promote the welfare of children 2023). In October 2022, the Independent Enquiry into Child Sexual Abuse published its final report making 20 recommendations for reform to improve understanding of child sexual abuse, empower children and young people, create a more protective environment, and enhance the justice system’s response to support victims and survivors. Child sexual abuse can be perpetrated by both children and adults, and the abuse can take place in both intra-familial and extra-familial contexts. Sexual abuse can profoundly affect children’s emotional, cognitive, and social development. What we have come to understand is that the deepest injury occurs when trust is shattered for the child in the very relationship(s) meant to protect them, often leading to fear, anxiety, shame, and low self-esteem, while also impairing concentration, memory, and emotional regulation. Such fragmentation often leads to internalised silencing, where memories, sensations, or emotions are split off. Children may display withdrawal, aggression, or risky behaviours, and struggle to form trusting, healthy relationships. Consequently, these experiences can disrupt attachment, cause difficulties in social interaction, and increase vulnerability to long-term mental health challenges such as depression, anxiety, and PTSD. This form of abuse also influences self-concept, relationships and overall wellbeing with the effects often persisting into adulthood. Working with children who have experienced deep relational harm is among the most important and most challenging roles for therapists and mental health practitioners. To bear witness to the invisible threads of a child’s story means learning to attune not only to what is spoken, but also to the pauses, the gestures, and the unspoken echoes of past harm. Clinically, this requires an awareness of dissociative processes and the subtle cues through which trauma reveals itself indirectly. It calls upon us to hold these hidden strands with steady presence, noticing patterns that weave through our clients’ narratives, validating their reality without rushing them into the open before the child is ready. We take pride in these skills, refined through years of study, reflection, and clinical experience. In these moments, the qualities we bring as therapists become as vital as the techniques we use. And yet, even with this preparation, many of us encounter profound challenges when trying to connect therapeutically with children who have endured sexual trauma. Their pain is often fragmented, hidden, or expressed in ways that can feel contradictory or overwhelming, leaving us to navigate moments of uncertainty as we support them in their journey toward safety and healing. As therapists we can often:

Feel emotional overwhelm when hearing trauma stories
Worry about saying or doing the wrong thing
Experience countertransference, being pulled into dynamics of helplessness, protection, or anger
Struggle with self-doubt about whether we are doing enough

Moreover, children with sexual trauma may oscillate between a yearning for closeness, alongside the protective strategies of defensive behaviours that have helped them to survive. A dynamic which can sometimes blur professional boundaries and make it difficult to maintain clear therapeutic lines. This oscillation reflects the internal push-pull between the longing to be seen and the fear of exposure, a clinical manifestation of the hiddenness that defines much of their experience. Alongside this, the emotional toll of absorbing children’s traumatic experiences can build over time, leaving therapists vulnerable to vicarious trauma, secondary stress, and eventual burnout, reminding us of the vital importance of ongoing support, reflection, and clinical supervision. We must find the space to explore what is unseen in the therapy room, gently bringing it into awareness, allowing the therapist to remain grounded and responsive. Perhaps the challenges we encounter online mirror the delicate dynamics we navigate with children in therapy? Both require sensitivity to what is obscured, and persistence in finding safe, ethical ways to bring truth into view. In summary, as therapists, we are deeply familiar with paradoxes; being fully present to what is painful while holding hope for healing, listening for what is spoken while also attending to what remains unspoken. Writing about our work carries a similar tension. There is a profound irony in needing to bring hidden realities into the light, while at the same time facing systems that push these realities back into obscurity. On social media in particular, we have become aware that even well-intentioned posts carefully worded, respectful, and designed to educate can be flagged or hidden without warning. For professionals, this is not simply an inconvenience. It is a form of silencing that cuts off dialogue, restricts professional exchange, and obscures truths that desperately need to be named. More concerning still, it risks reinforcing the very dynamic our work seeks to undo children’s painful experiences being pushed into secrecy, rather than witnessed and acknowledged. To respond ethically and effectively, we must continue developing language, platforms, and practices that allow these hidden truths to be seen, both in the therapy room and in the wider public discourse. How will you ensure children’s experiences are acknowledged rather than erased?

Authors: Karen O’Neill & Tara McDonald

Published: 6^th October 2025

Reference List: The Report of the Independent Inquiry into Child Sexual Abuse https://www.iicsa.org.uk/document/report-independent-inquiry-child-sexual-abuse-october-2022-0.html Working Together to Safeguard Children: A guide to multi-agency working to help, protect and promote the welfare of children: https://www.gov.uk/government/publications/working-together-to-safeguard-children–2) PIP Solutions: www.pipsolutions.co.uk