Beth Docherty is still healing.
It wasn't until she reached her thirties that she felt she had overcome most of the shame and guilt from being sexually abused by a music teacher when she was 15. Even after getting married, she found it hard to have an intimate relationship.
Ms. Docherty, 43, who lives in the North Hills, said though the teacher was charged and convicted, her ordeal was far from over. "You can't just heal from all that pain and all that damage that was done just instantaneously," she said.
The trauma of child sex abuse was on display in a Centre County Courtroom in June when eight victims testified against former Penn State University assistant football coach Jerry Sandusky. He was found guilty of 45 counts of child sexual abuse after a two-week trial and awaits sentencing.
But victims of child sexual abuse, including the 10 who Mr. Sandusky was convicted of violating, face a long healing process.
Experts say treatments for victims of abuse are often effective in helping people come to terms with what happened, but don't erase what happened.
"We're not looking for major breakthroughs. We're looking for the person to be able to function as well as they were before," said Michael Tony, who leads the treatment team at Pittsburgh Action Against Rape.
"We've had victims tell us that this has affected every decision they've ever made -- and these are victims that have thrived," said Alison Hall, executive director of Pittsburgh Action Against Rape.
Signs of sexual abuse in children include anger problems, acting out in school, changes in friend groups, bed-wetting, sexualized play and eating disorders.
"I think the biggest thing that is the most common is a sense of shame," said Mary Carrasco, director of A Child's Place at Mercy, which evaluates children to determine if they have been abused.
"The child feels that they are someway at fault, and they are afraid to tell, and I think you saw that consistently in the [Sandusky] testimony," Dr. Carrasco said. "A skilled pedophile, as this guy undoubtedly was, used this as well as bribes to keep them quiet."
Symptoms of child sexual abuse vary, but victims often experience anxiety, post-traumatic stress, sadness and problems trusting others as they move into adulthood.
One of the most common treatments is cognitive behavioral therapy. Through guiding questions, a therapist allows victims to express what happened to them in a way that helps them conceptualize the events in a way that is easier to live with.
"It involves helping the child to conceptualize cognitively what happened to them and realize they're not at fault," said Dr. Michael Franzen, chief of neuropsychology at Allegheny General Hospital.
"They help the kid develop a narrative and it could be a verbal narrative, a story that they write or a book with pictures only."
Mr. Tony said having children use a sand tray with figures in it to tell the story of what they are going through can be effective in identifying and treating problems.
"Throughout the story I would likely be asking projective questions to try to identify any cognitive distortions," he said. "For instance maybe the child thinks it's their job to make sure everyone in the family's safe or everyone in the family's happy."
"A lot of what we're doing is trying to help a child make order out of chaos," Mr. Tony said.
Ms. Docherty, now a research consultant and president of the Pittsburgh Action Against Rape board of directors, said treatment helped her heal.
"At PAAR, I was able to go in and just talk about what happened. Get [out] all those things that I had never talked about and just talk about it with someone and learn that the way that I was feeling was common," Ms. Docherty said. "I wasn't just alone in feeling this shame and feeling this anger."
Treatment usually takes around six months.
Mr. Tony says it is hard to pinpoint what percentage of the victims with which his team works can be called successfully treated. But he says, "I think we have a pretty high success rate."
Perpetrators of sexual abuse can also be treated.
At Services for Adolescent and Family Enrichment, treatments try to increase juvenile perpetrators' empathy and understanding of their actions through techniques such as writing apology letters. The program also works to increase parents' supervision and understanding of their child's actions.
Treatment can be effective in both juvenile and adult perpetrators.
"There is pretty significant improvement for a reasonable majority. Some subgroups might be harder than others," said David Kolko, a professor of psychiatry at the University of Pittsburgh School of Medicine and director of SAFE, which is a collaboration between the Juvenile Court of Allegheny County and Western Psychiatric Institute and Clinic.
A 1999 study in the journal the Social Service Review found that 30 percent to 40 percent of women -- up to two in five women -- and 13 percent of men -- or about one in seven -- say they were sexually abused during childhood.
But the number of child sexual abuses that are reported to authorities is far lower. Data compiled by the U.S. Department of Health and Human Services show that about one in every 1,000 instances of child sex abuse is reported to child protection agencies.
Publicity, such as the allegations against Sandusky and the subsequent trial, though, can increase the number of reports. Calls to the Pennsylvania ChildLine, a hotline to report child abuse, were up 40 percent when the allegations became public in Nov. 2011, compared to Nov. 2010.
The agency's data are not yet available for June, but Pittsburgh Action Against Rape says its hotline received 20 percent more calls since the Sandusky trial began.
Ms. Hall emphasizes the importance of reporting suspected abuse. "What I would say to parents is make that decision as if it were your own child," she said. "Would you not want some adult to report it?"
Peter Sullivan: firstname.lastname@example.org or 412-263-1939. First Published July 1, 2012 12:00 AM