Thank you so much for tuning in again to Lessons from the Playroom Podcast. Listeners, this is a really important conversation that we are about to have, and I am super excited to have Sueann Kenney-Noziska with us. She is, in my opinion, the expert in the field on working with children who have been sexually abused.
And I’m so honored, first of all, Sueann, that you’re here for this conversation. This topic, listeners, has been the most requested topic over the years. For those of you that have sent in, emails have sent in, we want to know more.
And so to finally be able to bring you Suanne just feels like a gift to be able to have this conversation for you and Suan with you. So for those of you that do not yet know Suanne, and you will hear very clearly at the end of this conversation, let me tell you a little bit about her. She’s a licensed clinical social worker.
She’s a registered play therapy supervisor. She specializes in work with abused and traumatized children, adolescents and their families. She owns and operates her own private practice.
You’re in New Mexico. Is that correct? Yes, Las Cruces, New Mexico. Las Cruces, New Mexico.
And also part of her community’s multidisciplinary team. Well, that’s a mouthful of a word, isn’t it? On child abuse, suanne is internationally recognized for her work. She has developed tons of trauma informed interventions.
She has testified as an expert witness. She’s contributed to multiple publications on and on and on. She’s trained professionals.
And the first time that I saw Suanne was Suanne on the main stage keynoting, the association for Play Therapy conference. And I went, wow, this woman is fantastic. So heads up for you who are listening, who maybe want to bring training on this topic into your organization, or you’re looking for a phenomenal keynote.
You’re about to have a conversation with someone right here. That’s a great possibility. So, Suey, thank you again for joining and having this really important conversation with me.
You’re very welcome. I’m glad that we’re discussing this because it’s just such a heinous victimization for children. And we want to make sure that when we’re interfacing and interacting with kids and teenagers that have been sexually abused, that we have good information not just for our treatment, but good information to talk to the parents and the children and the teenagers about as well.
Yeah, absolutely. Before we jump into the discussion on how to or your advice or what to think about, tell us a little bit about how long have you been in practice, and these children clearly grab your heartstrings in a pretty significant way. So maybe tell us a little bit about you in your journey and why you love working with this population and why you’ve decided to specialize this in our field.
So when I was getting my master’s degree at San Diego State University, california’s association for Play Therapy had their conference down at San Diego State, and I saw Janine Shelby present, and I knew. I was like, boom. That is it.
That is what I want to do. And so I was exposed to her work and then got exposed to Ileana Gill’s work, and it led me to working for the Department of Mental Health in Southern California once I had graduated. And nobody wanted to work with little ones, and nobody wanted to work with trauma.
And so low man on the totem pole. That was my caseload. The young, traumatized, sexually abused kids, and I found my way to play therapy and have just been down here.
I’ve had my private practice here since 2008 and have done this type of outpatient work since 1998. And it is a labor of love. There are days I feel like I’m beating my head on a wall, and then there’s other days I’m like, yes, we had a breakthrough.
So definitely a tough population. Yeah. I find that there are so many play therapists that are afraid to work with this population.
I don’t know if you find that also, but almost like, not so much the fear of supporting the child, but the fear of supporting the child in the system and having to navigate the system and deal with the system. I’m curious if you experience that also or if you find when you’re doing trainings that, I don’t know, maybe speak a little bit to what comes up in us as play therapists when we think about, I’ve got a kid that’s been sexually abused on my caseload and normalize this a little bit for play therapists, I still will struggle with it. There’s cases where I’m like, I feel like I’m treading very lightly, especially when kids are involved in the system.
And the multidisciplinary team that I’m on, MDT, we are the decision makers of that system in the community of Las Cruces. So it’s the district attorney’s office, it’s our law enforcement, it’s Child Protective Services, it’s our children’s advocacy, it’s myself. And we’re trying to minimize that trauma, but it’s so difficult to maneuver those systems.
I find in particular my most challenging cases are cases involved with the legal system where there’s a criminal pending charge or a trial pending trial against the alleged offender. So then of course, there’s extra care in regard to working with that child. Is that child going to have to testify? What is that testimony going to look like? And also in the CPS system where we have reunification, not necessarily between the offender of the sexual abuse and the child or teenager, but sometimes with the non offending caregiver.
So for ease of presentation, I’m going to refer to the offenders as males, to victims as females, and the non offending caregiver would be the mom. And we know that the opposite is true. We know that women also are offenders, males are also victims, and non offending caregivers can also be men.
But it’s just for ease of presentation. But we’ll often see situations where these non offending caregivers moms either should have reasonably known this was going on, or they did know they had walked in on it, or the kid had told them about it and the mom did not act in a protective way. And so when we’re talking about reunifying victims with these non offending caregivers, that can be a dicey system to maneuver as well.
And then, of course, it impacts how directive I’m going to be in the work that I’m doing. Whether or not we can have a child that does a play narrative like a five year old through their play does a narrative, or they need to sit down and actually do a verbal, like that trauma narrative because they have to testify in court or because there’s going to be reunification. And even being in this field for 25 years and an expert, there are still cases, like I said, that I tread a little bit slower and easier with in regard to my play therapy approaches.
Yeah, for me, one of the pieces that I have found in my work that’s been confusing are those times around role confusion between when the system wants me to be an investigator versus being the play therapist. I think that’s an important distinction for play therapists to understand what their role is. Will you talk a little bit about what the role of the play therapist is when they’re working with sexual abuse? Being very clear about our role is essential not just to the therapy, but again to that system.
So we are not forensic, we are not fact finding, and we are not investigative. Our job is to integrate that trauma and reduce any symptoms that are going on, whether that’s anxiety or post traumatic reactions or depression. So we need to be clear in particular with the other professionals involved with the case, but also with moms.
It’s not uncommon for me to have a child refer to me and for the parent or caregiver to say, I want to find out what happened to my child exactly. Well, yeah, we may never know exactly what did or didn’t happen, but we can have healing through trauma informed therapy even if we don’t get factual information from the child. So if a child ends up through some type of directive, play based intervention saying, I remember the abuse happening in the bedroom when there was blue carpet, it’s not relevant to her healing whether or not the carpet was really blue or not.
Now, from an investigative standpoint, that’s really important. Was there blue carpet in the room she’s describing? Did she even live in that house during the time frame? But again, that’s fact finding, that’s investigative. So I’m very clear that that is not the role that I’m operating in.
It’s very standard for me to get releases up front to speak to law enforcement or the forensic interviewer and or the district attorney’s office as more preemptive strike so that I have full information when working with a child. But at the same time, it allows me to be clear what we do in therapy is not evidence of childhood sexual abuse. And on the flip side of that, Lisa, it’s important for us to avoid situations where well meaning professionals and or caregivers refer the child because they want us to find out if they’ve been sexually abused.
They want it ruled in or out. Again, that’s investigative. That’s not the purpose of treatment.
Yeah, I think this is so huge for play therapists to understand, because at least I know in Colorado, this area, plus making referrals for suggested parenting time are two of the biggest sort of places where play therapists get caught and find themselves in really hot water. Legally is putting on the investigator hat and then starting to make recommendations and not staying in their role of I’m here to help the child heal. And I love that you are reinforcing that.
We may not ever really fully know what happened, but that doesn’t mean that healing still can’t happen. Because I think sometimes play therapists, we really want to know. And even if the system isn’t saying you need to investigate, I think sometimes that can come up in the play therapist around.
But I want to know, right? I want to know. I want to make sense of this. And I just appreciate that you’re really highlighting this as an important piece of the work that when we’re working with sexually abuse on our caseload, this is a really important piece.
And I think it’s particularly, at least for me as a clinician, it’s particularly important because we have this emphasis on trauma narration, which we commonly associate with TFCBT. Like that is what we need to do is we need to help them narrate the trauma. Now, some of the current studies actually say if you are trauma informed, you are doing types of trauma narration all throughout treatment.
So if we’re doing an activity, a play based intervention, and we’re having a child share their feelings about the sexual abuse, that is a form of narrating that trauma. I felt confused. I was really scared.
When I told that no one was going to believe me. That’s part of their story, and we need to be able to hear that, and it doesn’t have to be. It started when I was this old, and it happened in this room, and it happened this many times, and this is how I felt.
We can do it piece by piece in a way that is also appropriate for the child or the teen, so they’re not overwhelmed with processing their trauma and they don’t shut down or prematurely in treatment. Yeah. Sueann, what do you say when play therapists come up to you and say things like, what are the signs I’m doing non directive play? What are the signs in the room? What do I need to be looking for to indicate that there’s been sexually abuse? How do you work with that question when it’s asked to you? Well, that, again, it can be a very slippery slope.
When I work with cases, I do not take cases where there hasn’t been a disclosure. Now, that doesn’t mean it has to be prosecuted or CPS has to be involved, but it means that the kid has to be saying, this happened to me. So then I take what I know about dynamics of sexual abuse.
And fortunately, we have at least in the US, we have a good two solid decades now of research and studies and metaanalysis on the impact of sexual abuse, on the dynamics under which it occurs, such as grooming and secrecy and stigmatization and betrayal. Those are the things that I look for when I’m responding to a child’s play. But I don’t ever take OOH, there’s secrecy happening in the play, so therefore there’s sexual abuse.
Or they show the mom and the dad in the house and they’re having sex, therefore there must have been sexual abuse. So again, it goes back to our earlier talking point of making sure we’re clear with our role. I once received a phone call from a play therapist who wrote a letter, wrote a court report saying, I believe this child was sexually abused based on the following play themes.
And the defense attorney filed a complaint against this therapist, and it was a play therapist. And the play therapist reached out to me and said, what play themes do prove their sexual abuse? And I said, there’s none, because we can get those same themes from a non abused child as well. Same thing with symptoms.
There’s no one clinical profile for victims. And so we know that kids that have been sexually abused wet the bed and have nightmares and have regression. But we also know that kids that haven’t been sexually abused can have nightmares and wet the bed and have regression.
And so one doesn’t equal the other. And being clear in that approach with systems and even the way we’re viewing the play, making sure we’re true to, we’re here to reduce symptoms. Yeah, this conversation is so huge.
Can I share a little play thing that just even highlights what you’re sharing that our listeners might appreciate hearing? Absolutely. So I was working with a client, and in the play, the client had taken some army men and in the play, the army men were attacking each other. But they’re the little plastic army men that are holding the guns and then was taking one of them and was turned one around and seemingly trying to look like it was Jabbing, the sword in the rear end of this other figurine.
Right? So just looking at this, if someone was trying to be an investigator would go, oh my gosh, what does that mean? Oh my gosh, was this client like sexually abused? All of that turns out that this child had a history of constipation and was often taken to the hospital and had enemas. And so I think that just a perfect example of if we just take play in this little tiny snapshot, we can make so much meaning out of it that may not be there. And so I so love what you are saying because I hear an invitation to take a larger view and to back up and remind ourselves that we’re here to help the child heal, not to interpret, not to hyper.
Focus on parts of the play. Not to try to collect data. Not try to because there is so much anxiety in the system that makes us want to do that.
So I just am appreciating this message so very much. It’s interesting because we feel that even I think of a play therapist, not I think I know that I feel that internal pressure sometimes, but we get it from the moms, we get it from CPS, we get it from the judicial system. So this pressure know, find out what happened to the child and rule out sexual abuse or rule it in and it’s just such a slippery slope.
We have to be very careful that we don’t go down that avenue. Let’s go actually into what we do know about sexually abuse a little bit more. Will you share with us a little bit what you know about some of the statistics and just a little bit more about what some of the psychological effects are just so in case our listeners aren’t really fully familiar with that, that they can learn a little bit more? Absolutely.
Our stats, and I know that this podcast is international, so these stats are specific to the United States. What our statistics suggest is that one out of every ten children under the age of 18 will experience some type of sexual victimization prior to their 18th birthday. And when we look at who the offenders are, 90% of the victimization happens at the hands of someone that child knows and trust and only 10% happens at strangers.
At the hands of strangers. Those are the cases that are sensationalized by the news. Oh, the homeless man in the bushes drinking the cult.
45 grabs a child and raped them. And those are the minority. Those are the anomalies.
90% is somebody the child knows and trusts and has loyalty to. More specifically, if we look at that 90%, 60% are family members, fathers, stepfathers, uncles, teenage brothers, and 30% are neighbors, teachers, coaches, clergy, people, scout leaders, et cetera. It’s one of the reasons that it’s so difficult to disclose sexual abuse.
Because it’s not the stranger, it is my grandpa. And he has two roles in my life. He’s the one that remembers my birthday.
He helps mom pay her rent. He always makes sure that I have a new dress for my school pictures. But he’s doing something that he’s not supposed to be doing to me.
But I love him, and I don’t want him to get in trouble. And if I tell, I’m not sure if people are going to believe me. And so these offenders take on this dual role, which creates so much confusion and loyalty conflicts in children and teenagers.
In terms of disclosing, sometimes the abuse starts when kids are so young that they don’t even realize it’s not supposed to happen. They don’t realize until their school age. And we have those we call them prevention programs, but I like to think of them more as early intervention, the program that goes into the school, and the puppets talk about safe and unsafe touches, and they have the kids draw a picture of a safe person that they can talk to.
And it can be in that moment that a victim goes, oh, my gosh, grandpa’s not supposed to be doing that. I thought that’s what happened in families. When we look at the grooming dynamics, sexual abuse has a very insidious onset.
And I use this metaphor a lot. Kids get sexually abused much in the same way whereby we gain weight. I am not going to wake up tomorrow and be 20 pounds heavier.
That’s just not going to happen. But it’s possible with the holidays and with the new year coming up. It’s possible in six months, eight months, that I’ve gained 20 pounds.
And it’s like that with this grooming for sexual abuse, it starts out with this. It can be something as benign as before. I take you to school.
We’re going to go grab donuts, but don’t tell mom. It’s our special secret. And then it’s the extra long hug or it’s the tickling that goes awry and they brush against the child’s breast.
We’re watching a movie and I’m rubbing the child’s leg, and now I go closer and closer to her vaginal area. So the abuse happens long before the first actual sexual contact. And so then kids find themselves thinking, well, how did this happen? And this must be my fault because I didn’t stop it or I didn’t tell right away.
So we know that there’s a grooming process to victimizations. We also know now that disclosure is a process. Kids generally do not sit down and just give a one story beginning, middle and end of this is what’s been happening a lot of times.
Not only does it gradually fold out, but it happens in hints. So for example, a child might say to their mom, you know, I watched this movie, and in the movie, this girl’s private parts were being touched and the mom’s like, oh, well, you shouldn’t be watching those types of nasty movies. So now the kid knows I’m not telling mom.
So then she says something to, you know, I had a dream that Uncle Johnny was touching my private parts. And grandma’s like, child, you need to get to church more. Those are sinful thoughts.
So now I can’t tell mom and I can’t tell grandma. So I give a hint to my aunt and I say, you know, I have this friend and she told me that someone’s touching her private parts. And the aunt says, oh my gosh, that’s terrible.
It’s not her fault. We need to make sure this stops now. The child knows here’s who I’m going to disclose to, if we even get to disclosure, which doesn’t happen nearly as often as it should, and I’ll talk about that in a second, that disclosure is delayed.
And then just by the way that child gives hints, it looks like the child is lying. They’re not credible. So the child finally says to the aunt, you know, I told you it was my friend, but really it’s me.
So the aunt calls the mom and the grandma and she’s saying, Uncle Johnny did this to her? And mom says, well no, she told me that it was a movie. And grandma says, well, she told me it was a dream. And so just the way the disclosure happens makes it look like this couldn’t have really happened because her story is not straight.
And in essence, that’s truly understanding how disclosures happen. There are studies that actually kind of have teased out some of the facilitators and barriers to disclosure, and one of them is age. We’re more likely to get a disclosure the older someone gets, and that includes into adulthood.
There was a study, and I want to say it was out of Switzerland or Sweden, and it looked at disclosures of childhood sexual abuse and it had a sample size of 1000 adults. And the average age at which these victims told about their sexual abuse was 52 years of age. Wow.
Which means they’ve gone their entire life up until adulthood without being able to say, hey, this happened to me. Wow. Without having somebody say, I believe you and I’m sorry and isn’t your fault.
So that’s how powerful these dynamics are. So when we have a child or a teenager in our office and they’ve found it within themselves and through their support system to be able to say, this is happening, embrace that and accept that disclosure and say the things that they deserve to hear. I believe you.
I’m going to take steps to protect you. Thank you for trusting me and telling me this is absolutely not your fault. And you are courageous for telling so powerful.
It makes me think also of the education that’s needed for parents just around how to hold conversations that have a sexual component to them. And how do parents talk about sexuality and talk about sex and things that happened in sexual context in a way that allows for more openness of possibility for asking of questions or like you said, dropping hints. Kids are so brilliant, aren’t they? Just testing the water here and there.
And who can hold this and who’s not going to shame me? And who’s going to kids are so dang brilliant. Yes. And you’re hitting on a point that the studies have actually suggested disclosures of abuse happen in the context of a relationship and a dialogue.
So if we have adults, whether it’s the mom or the aunt or the teacher or the best friend’s mom, that asks a child about their welfare, how are things going? Even if the child is seemingly doing well, in particular, if a child isn’t doing well. Hey, I noticed that you’ve seemed kind of sad lately. Is everything okay? If we check in on kids welfare, we are allowing them, inviting them to say, hey, I’m not okay.
This bad thing is happening to me. So that relationship and that open dialogue is crucial to having these kids and teenagers be able to disclose their sexual abuse. Yeah, absolutely.
As we just moving through this really beautiful conversation, the question I think I want to just keep coming back to is, gosh, I’m imagining a play therapist hearing this. I’m imagining that this is providing some insight and some clarity for them in their own approach and their own work with kids. And then I’m also holding this piece that we talked about at the very beginning of how hard this work is and how emotionally taxing it is for a play therapist because it is so complex and there are so many pieces to hold.
And I want to ask you, how does the play therapist support him or herself? What does the play therapist need to do within themselves to be able to navigate all this? Because it’s so much, so big. Boy, there’s so many layers to that question, and I think we are much better as a profession about talking about secondary traumatic stress, vicarious trauma, compassion fatigue, things that we didn’t talk about in my graduate program back in 1996 and 98. It was believed that if you had countertransference reactions that that meant you weren’t doing a good job.
And now we know if you’re not having countertransference, there’s something wrong. If you can hear these stories and not have something in you, go, oh, that strikes a chord for me, or I’m not sleeping well at night or I know it’s affecting my relationships with my significant other. If we’re not aware of that and we’re just shutting it down, that’s where we start to see burnout.
I think we have a lot of good things in the field. We have more workshops normalizing these reactions. We have more of a dialogue going on.
I know there’s retreats going on. I believe you and Claire Mellanton and Jen Taylor are doing something in San Diego that’s sort of like a rejuvenation for therapists. So I think these types of things are very valuable.
Our support system, making sure we use that support system, whether that’s not working in isolation or making sure that we spend time with our BFF or we’re doing things that remind us life isn’t all about trauma. Because when you’re working with trauma, it’s easy to now everything is this lens of sexual abuse, victimization, betrayal, powerlessness, and that can take over if we’re not, again, really being honest with ourselves, getting supervision, getting consultation, working with a team, using our support system and also working through our own traumatic issues. A lot of people are in this field because we have a history of trauma.
And so if you have a history of sexual trauma and then you’re working with abuse and traumatized children, it’s really important that you’ve done your own work. And even if you’ve done your own work, Lisa, you may reach a time in your career where you need to revisit that work because something else is coming up for you. Totally.
So keeping that door open and realizing that’s how you persevere through working with this particular population. Yeah, I just want to appreciate something that I heard you say that I actually haven’t heard someone say before. But it is so true, which is that when we have a high trauma caseload that that begins to filter to how we see the world at large and how we can start to sometimes even have a skewed sense of humanity.
I’ve seen that come up. A skewed sense of reality, sometimes looking for warning signs, how we can start to almost carry the sense of trauma ourselves as we’re moving through the world. The hyper vigilance, the anxiety ourselves.
And I really appreciate that you’ve named that. I imagine that just normalized. That just normalized something for someone that’s listening here.
And then how important it is to do things to remind ourselves that that’s a part of the human experience. It’s not the totality of the human experience. Yes, that’s a good way to phrase that, but it does, it changes our worldview.
And that’s because we’re human. And when we are exposed to human suffering, it’s going to shift our perceptions, our paradigm understanding of the world. And there’s some information out there that suggests as play therapists and when we’re working with children, we’re even more susceptible to these things like compassion fatigue and burnout and secondary traumatic stress because we.
See symbols and metaphors and sand trays and play themes that are graphic in nature. And so, again, we could be even more susceptible than therapists who are using traditional talk therapy and aren’t using play and art and sand the way we use them. Yeah, absolutely.
One of the things that I feel like is a unique thing about a play therapist compared to someone who’s just doing traditional talk therapy is that we’re activating all of our senses in the process, including kinesthetic. If we’re actually in the play, or we’re engaging that piece in a more embodied way, which isn’t something that happens when we’re just doing traditional talk therapy where, yes, we have the visual, yes, we have the auditory, but we can stay a little bit more removed. But when you’re in the play, you’re in the play, and you’re in the play on all levels, and how much further, I think that the play then lands inside of us because our buffers aren’t well, it’s a different kind of a buffering system when you’re in it versus listening.
Yeah, absolutely. I feel like I could just talk to you for hours and hours about this. I want to reiterate, listeners, this is such an important topic, and I am serious.
If you are part of an organization, if you have a conference, if you want more education about this, I’m serious, listeners, I want you to reach out to Suanne and ask for her support. She knows what she’s talking about. And this is a piece of education that’s really important that we all get because we don’t learn about this in graduate school and we don’t go into it at the level that we need to go into it.
Sueann, as we’re wrapping up, what’s your big advice for play therapists who are working with sexual abuse? I think my biggest piece of advice is don’t let there be a disconnect between the play and what the literature is telling us. Turn to that literature, turn to those studies, turn to those metaanalysis, and use that as a way of understanding kids play and how they disclose their sexual abuse and why it may be that their story doesn’t make sense because it’s a trauma story and not a factual story. So really allow the literature to inform the play and don’t disconnect those two things.
That would be my biggest piece of advice. Brilliant. Brilliant.
Well, Sueann, thank you once again. Before we jumped on this, I had shared I felt like this conversation was a long time coming. I’ve also shared this has been the topic that’s been most requested over the years, and I have been waiting for the right person to come on and offer this level of education.
And I’m grateful it’s you. And I’m grateful that you’re sharing this and out there being an advocate for kids because, well, I’m grateful you’re on the planet. That’s what I want to say.
Suanne, I’m really grateful you’re on this planet. I appreciate you having me and what an important conversation this is to have, especially for those of us in the field that are working or potentially be working at some point in our career with victims of sexual trauma. So thank you.
It’s my pleasure to be a part of it. Yeah. Thanks, suanne.
Okay, listeners, hopefully this is just the beginning of a larger exploration for you. Hopefully it’s the beginning of more education and training for you and that some insights, questions got sparked. And wherever you are in the world, I invite you to take a deep breath.
If you are someone that does have sexual abuse on your caseload, I invite you to take an even deeper breath. And all of you, be well. Take care of yourselves.
