Secondary survivors of trauma : a research portfolio on the experiences of non-offending caregivers whose children have disclosed sexual abuse

Background: Non-offending caregivers (NOCs) of children who have disclosed sexual abuse have a vital role in supporting their child post-disclosure. Nevertheless, research indicates that NOCs experience clinically elevated levels of distress, which may impact their ability to support their child. Despite this, services have been found to often overlook the support needs of NOCs and there are gaps in the literature around NOCs' own experiences and distress post-disclosure. This research portfolio aimed to address these research gaps in two parts: 1) a systematic review investigating what key factors have been found to be associated with NOCs' psychological distress; and 2) a mixed-methods empirical paper exploring NOCs' post-disclosure experiences, with secondary aims to investigate their help-seeking experiences and the psychological construct 'mentalization' in this population. Method: A systematic search of quantitative literature was conducted to identify papers exploring the association of key factors, such as psychosocial, environmental, personal, familial and abuse-related characteristics, with NOCs' psychological distress. An appraisal tool was used to assess the quality of the studies. The empirical paper adopted a predominantly qualitative mixed-methods design which primarily involved an in-depth exploration of the post-disclosure and help-seeking experiences of NOCs via interviews, with mentalization being measured via a questionnaire. Grounded theory was used to integrate these findings into a model illustrating the themes derived from the data. Results: The systematic review indicated that psychological factors, such as cognitive processes, as well as social and environmental factors, such as social support, had the most evidence for being associated with distress. The evidence was weaker and the findings were more contradictory for the associations between other factors and psychological distress, including NOCs' abuse history, abuse-related factors, and child and parent characteristics. The empirical study's grounded theory model centred around core categories of NOCs' perceptions of feeling out of control and isolated. These linked to other themes around the parental role, including parental self-efficacy, as well as the importance of feeling listened to and supported by the wider system, including services. Quantitative mentalization scores were linked with emotional expressiveness in interviews. Qualitative themes related to mentalization were indicated to be linked to NOCs' distress in the more immediate disclosure aftermath. Conclusions: While tentative inferences can be made from the systematic review about the most important factors associated with NOCs' distress, methodological issues in the studies made it difficult to draw firm conclusions. For example, the predominantly cross-sectional nature of studies and their exploration of factors in isolation meant that a more in-depth understanding of interactional processes over time was not possible. The grounded theory model suggests that NOCs have complex multifaceted experiences post-disclosure, characterised by interacting processes linking to their distress. These are not fully accounted for in existing theories of secondary traumatization. Clinical and future research implications are discussed.