**1. Introduction**

The concept of counseling explains how individuals who feel less able to resolve their own problems resort to help in order to solve their challenges [1]. Associated with help seeking is the client's belief that he will receive assistance that will help him understand things that bother him such as complex and confusing emotions experienced during an event (e.g. abuse), receive alternatives, make informed decisions and move on generally in positive meaningful ways. Thus, the chance of successful counseling outcome may be higher, where needed support is provided and children's ability to overcome sexual abuse has been found to be dependent on timely psychological interventions [2].

This study adopts World Health Organisation's (WHO) definition of child sexual abuse as the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. The scourge of child sexual abuse (CSA) has been on the increase world over, Ghana and Zambia inclusive, with millions of children being sexually abused every year. In 2004 WHO reported that the global prevalence rate of child sexual abuse [3] was an estimated 150 million girls and 73 million boys under the age of 18 years who were victims of rape or other forms of sexual violence; that between 1 and 21 percent of women were victims of sexual abuse before the age of 15. By 2010, CSA was estimated at 34.4% of global violence cases [2].

Some of the earliest studies on child sexual abuse in Africa [4] reported on cases of child sexual abuse at a Cape Town Hospital with victims ranged from 2 to 12 years with the majority being females. In Malawi, [5] described 20 cases of child sexual abuse, which were presented at the Department of Obstetrics and Gynaecology, University of Malawi, between 1995 and 1997. Half of the victims were less than ten years old [5]. estimated that these cases were merely the tip of the iceberg, and were reported due to the serious injury caused in the rape of very young children. Research on the occurrence of child sexual abuse by [6] reports that one in four girls and one in ten boys is a victim of CSA**.** In Zimbabwe, CSA studies show that, among unmarried sexually active youths, 52.2% had experienced forced sexual intercourse at least once and 37.4% of the first sexual intercourse was forced on them [7].

Child sexual abuse is recognised as a traumatic experience that can have a number of adverse effects on victims [8] citing [9, 10] and that these children generally reveal significant problems in diverse areas of functioning including but not limited to affect, behaviour, cognition and interpersonal relationships [11, 12].

Research has established a correlation between counseling and other forms of psychosocial support in promoting well-being of people. Although psychosocial supports have been used to investigate individuals' experiences in adverse circumstances, there is a gap in the literature regarding the use of counseling to overcome CSA experiences. While we are inspired by the possibilities offered by the vast literature on CSA, research suggests that psychosocial supports such as counseling services for victims of CSA are unsatisfactory [13, 14] in a number of government institutions globally. A need, therefore, exists for effective treatment through counseling children who have experienced CSA [8]. The purpose of this study, therefore, is to explore how counseling as one if not the most crucial psychosocial support is used to assist victims of CSA in Victims Support Units (VSU) of the police services of Ghana and Zambia.

#### **2. Theory**

We connect our study to the works of [15] on the concept of trauma recovery of individuals to provide the theoretical basis for this work [15] developed a three stage model that has been used to treat trauma survivors during rehabilitation process. The model provides a useful set of goals for treatment providers regardless of theoretical orientation. Herman's model gives an in-depth description of the healing process of people who struggle with a number of problems relating to abusive or past traumatic experiences. The three stages of this process are (1) the establishment of safety, (2) remembrance and mourning, and (3) reconnection. This process is not typically linear; there are often advances, regressions, and impasses. It has, however, been suggested that many people do not complete all three stages during their recovery [16].

#### *Counseling Sexually Abused Children: Lessons from Ghana and Zambia DOI: http://dx.doi.org/10.5772/intechopen.97413*

Establishing safety is the first step in the treatment of trauma because no intervention can succeed without the survivor feeling safe. Safety includes protection from violence and maltreatment by other people, basic needs being met such as medical care, financial security, safe living environments, adequate food and sleep, legal protection, and a supportive social network. Research established that torture and other forms of trauma can cloud an individual's sense of security and safety especially when trauma is experienced in childhood [16, 17]. Re-establishing safety is important in the development of relationships that can be beneficial in the process of recovery for victims of child sexual abuse.

In the remembrance and mourning stage [15] the survivor constructs a narrative of his or her experiences in a therapeutic relationship. This inspires the need for CSA victims to receive counseling on report of abuse. The reconstructive disclosure of traumatic experience has been examined widely in theory and research. Cognitivebehavioural therapy that focuses on exposure to memories and emotions has been found to be a powerful method of treating PTSD with survivors of sexual assault [18].

In the reconnection stage, the focus is on building a future and empowerment. Once the past has been assimilated, the victim can focus on developing a more resilient and complete identity. The trauma victim strives to make a meaningful life through trust and hope that were developed during the first two stages of the recovery. The victim, now a survivor, may have a desire to help others who have been victimised similarly and to prevent future victimisation by raising public awareness through educational, legal, and political activism.

Trauma counseling is thus, geared towards assisting persons recover from overwhelming stress to functioning productively. This is where the traumatic individuals move from the ability to disclose and be believed to be provided help that empowers and strengthens. Drawing from these theories, the following questions guided the study:


## **3. Methods**

This research was qualitative in approach. Given the sensitivity of the topic, the denial of perpetrators, silence that mostly surrounds the knowledge of the canker, and the stigma often attached to the victims, qualitative methods were deemed appropriate. This study employed the qualitative Narrative Approach (NA) [19] to understand the nature, benefits and challenges of counseling services provided to victims of Child Sexual Abuse. Critical to the NA is active listening and its ability to externalise the problem beyond the person(s) and the world so as to liberate them from the control of the problem and develop power to address them. Thus, through the narrative discourse, individuals can gain the power to address their own trauma by positioning a 'named problem' (e.g. penetration, fondling). The narrative approach that employs disclosure with strong affinity with attending skills such as listening, questioning and probing, resonates well with Herman's stages of recovery from traumatic experiences.

#### **3.1 Setting**

The study was set in the Central Region of Ghana and the Lusaka province of Zambia. Ghana police service in the Central Region has seven divisions,

**Table 1.**

*Reported cases of child sexual abuse in Zambia between 2011 and 2014.*

thirty-two districts and ninety-nine police stations/posts. The Region also has Police Command and Staff College for Senior Officers at Winneba [20, 21]. The Regional Headquarters has 10 DOVVSU units/desks under its command [22]. Available statistics from DOVVSU suggest a downward trend in cases of child sexual abuse since 2002 (from 820 in 2002 to 670 by the end of 2005) though there is doubt about the reliability of these data [23]. The figures quoted by [23] however, were only on rape. A year earlier, [24, 25] reported that the evidence of sexual exploitation in Ghana is significant and that DOVVSU records indicate that every year quite a number of children and adolescents go through series of sexual abuse. They indicated that reported cases of defilement and rape of children and adolescents were: 1001–2002; 905–2003; 930–2004; 937–2005; 1772–2006. In addition to statistical records of reported cases of child sexual abuse, the Central Region was of interest due to recent public outcry of the rise in teenage pregnancy and social media circulations of sexual abuse against school girls (kitchen stool episode).

In the case of Zambia, according to [24], it is alleged that, majority of children who are sexually abused are females. Between 2011 and 2014, Zambia Police Victim Support Unit annual reports show a steady increase in cases of CSA from 1,939 cases in 2011 to 4,039 cases in 2014 (see **Table 1** above: Zambia Police 2011 to 2014 Annual Reports).

#### **3.2 Data collection procedures**

Purposive and criterion-based sampling strategies were employed to contribute to the overall understanding of the topic [26]. In all, 112 participants were recruited from 15 police stations across the Central Region of Ghana and Lusaka Province in Zambia. The criteria for selection were that participants were children, aged between 8 to 18 years, had a history of sexual abuse, reported their abuse to the VSUs of the police and were predominantly English-speaking. In Ghana, the principal researcher and one research assistant collected data while the principal researcher and two assistants gathered data in Zambia. The cases were selected purposively from the police dockets between 2011 and 2016 and victims and their parents located per the address in the dockets. Many victims could not be traced as they have either left their addresses given at the time of the report of abuse or the given addresses could not be traced.

In Ghana, interviews were held with a total of 55 participants made up of 20 girls, 20 officers from seven DOVVSU desks as well as 15 parents. In Zambia, a total number of 57 participants were recruited into the study. This includes 20 VSU officers from 8 provinces, 20 victims and 17 parents of victims.

#### *Counseling Sexually Abused Children: Lessons from Ghana and Zambia DOI: http://dx.doi.org/10.5772/intechopen.97413*

In both countries, we started with engagement of police officers in charge of abuse cases then hooked in children identified and parents. There were initial challenges of recruitment as some identified parents were not willing to participate nor allowed their children to participate. With a lot of sensitization (one-on-one explanations on the challenges of CSA and the benefits of therapeutic methods) on the need to speak about the issue, some parents got involved and allowed their children to participate. Of the 15 parents from Ghana, 14 were females and only one male while parents from Zambia were all females. In all, parents from both countries comprise 25 mothers, one father, and six caregivers. From both Ghana and Zambia, there were no records of counseling services provided to victims though victims records were available.

The interview activities were conducted mostly under trees or nearby empty classrooms around victims' homes and schools. When a victim was identified, the researcher spent time to explain the rationale, and ethical issues of the study to them. In both countries, participants were informed of the purpose of the research and discussed the meaning of 'sexual abuse' to include fondling, touching, forced sex, defilement and sex without consent. Interview questions covered the: a) nature of the counseling services provided and received, b) operational challenges in receiving and providing counseling services, and c) views on benefits of counseling to victims. In all, each interview with victims and parents lasted approximately 50 minutes while that of VSU officers lasted for about 1 hour.

The data collection process took a total of four and six weeks to complete in Ghana and Zambia respectively. Responses of the interviews were manually recorded by the principal investigators. After data were manually written, they were typed and printed out. Data were then cleaned through proof reading and corrections. Manual coding was done to identify confirming and disconfirming themes within and across narratives. The data were coded with acronyms to promote confidentiality and anonymity. Data were thus coded GPO (Ghana) and ZPO (Zambia) for VSU officers and followed by the assigned number of the participant.

Ethical considerations and trustworthiness of the data and research process were achieved through triangulation of data with all three sets of categories of participants. Participants, especially victims and parents, had the opportunity to corroborate or otherwise the statements provided at the VSU offices. By these, data were cleaned and ready for thematic analysis.
