Identification of child abuse by mental health services is important for formulation of the causes of presenting problems and for development of comprehensive treatment plans. A small but growing number of studies suggest, however, that the majority of child sexual abuse cases are not identified by mental health services. A similarly small literature also suggests that abuse survivors are extremely reluctant to spontaneously tell anyone about the abuse, indicating that professionals have a responsibility to ask rather than wait for spontaneous disclosures. The purpose of this study, therefore, was to add to these two bodies of literature with a New Zealand sample. A postal questionnaire was completed by 191 women who had received counselling for childhood sexual abuse. The average amount of time taken to tell anyone about the abuse was 16 years. Only 22% of those who had been in contact with public mental health services had ever been asked about abuse by those services. It was concluded that New Zealand women are reluctant to disclose abuse and that mental health services are, as is the case elsewhere, failing to assist them with this process. The need for staff training is discussed, and an example described.

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Women with histories of childhood sexual abuse (CSA) were asked to describe what was helpful and unhelpful to them in therapy. From 191 completed postal questionnaires, a subsample of 20 participants was interviewed. This paper focuses on three specific areas of therapy raised by interviewees: (1) Establishing a therapeutic relationship; (2) talking about experiences and effects of CSA; and (3) dealing with errors in therapy. Findings suggest that to avoid making serious therapy errors, therapists (1) need special skills to be aware of the dynamics and effects of CSA and of abuse-focused therapy and to deal with abuse-related material, and (2) need to develop an equal and open therapy relationship that includes ongoing consultation with clients about their experiences of therapy. doi:10.1300/J070v15n04_03.

This study reports on a postal questionnaire, conducted in 2004, with female survivors of historic child sexual abuse. The questionnaire explored their experiences of health professionals' responsiveness to disclosure of child sexual abuse history. Of 61 participants, aged between 22 and 65, 69% had disclosed to health professionals. Those who had not disclosed reported that they would have liked to but were not asked about child sexual abuse. Thirty-five percent of participants suggested routine questioning about child sexual abuse. Most participants related a fear of common medical examination procedures to their experience of child sexual abuse, and 64% said this stopped them from attending regular health checks. The current study suggests the development of guidelines for dealing with possible child sexual abuse survivors would be useful for health professionals.

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