Sexual Abuse in Sport and Ethical Dilemmas for the Sport Psychologist

Brief History

Sexual exploitation was acknowledged and the devastating consequences recognized when it was explicitly prohibited by Hippocrates circa 400 BCE. The Hippocratic Oath for Physicians stated: “Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief, and in particular of sexual relations with both female and male persons, be they free or slaves.”

Yet sexual exploitation and abuse remain a problem today in the healing and mental health professions, as well as in sport, 2,400 years after the Hippocratic Oath. In psychology, sexual exploitation has been mentioned only since the 1970s when sexual relationships were first prohibited in the American Psychological Association’s (APA) ethics code and later in the ethics codes of all of the mental health professions. Subsequent revisions of the APA code expanded the prohibition on sexual relationships to include students, supervisees, and even family members of clients.

Introduction

Although progress has been made, survivors of sexual abuse in sport are struggling to be taken seriously, and psychologists are beginning to understand the complicated ethical, clinical, and performance issues that are created.

The first gymnast to accuse USA Gymnastics team doctor

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Larry Nassar stepped forward in the late 1990s. Yet it took over 200 survivors coming forward with their stories almost 20 years later for Nassar to be prosecuted. For most of those 20 years, the survivors who did come forward were silenced and mocked by the gymnastic leadership organizations; the survivors had to endure not only seeing Nassar every day but seeing him glorified and praised. This kind of treatment is not uncommon in sexual abuse scenarios. The judge in the Nassar case allowed seven full days of emotional victim statements. Many of these women had reported the abuse. Their statements detailed the ways in which they had been ignored or brushed aside by organizations that included USA Gymnastics, Michigan State University, and the USA Olympic Committee (Eric Levenson, “Larry Nassar sentenced to up to 175 years in prison for decades of sexual abuse,” CNN, January 24, 2018).

As a result of these high-profile cases, awareness has grown and reverberations are still being felt. Michigan State University’s president and the athletic director both resigned, and criminal charges are being brought against a former dean. This was detailed in an article in The Chronicle of Higher Education on March 27, 2018, entitled “Lurid Charges Against Ex-Dean Mark a Disturbing Turn in Michigan State’s Nassar Scandal.”

Sexual Abuse in Sport

Sexual abuse in sport, like elsewhere, is built on a foundation of manipulation, fear, and an imbalance of power. The statistics on the issue are startling: out of every 1,000 rapes, 994 abusers will walk free; 1 in every 6 women have been the victim of an attempted or a completed rape; and 1 in 33 men have been the victim of an attempted or a completed rape. These statistics, although shocking, are not completely accurate as a majority of sexual abuse cases go unreported (Rape, Abuse, & Incest National Network, 2017).

Sexual abuse is one of the most taboo topics in sport—so taboo that cases were not acknowledged until the late 1990s. Sport researchers reported being threatened with legal action for attempting to address the issue in the mid-1990s. Researchers were blacklisted for tainting the good name of sport, as was reported by Celia Brackenridge in a book chapter in Researching Women and Sport, entitled “Sexual Harassment and Sexual Abuse in Sport” (1997, 126-141) However, due to the recent victims who have stepped forward, the topic is starting to receive the attention it deserves. Clinicians, consultants, and sport psychologists must be aware of

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the potential ethical dilemmas that could arise; this begins with first understanding sexual abuse.

Dimensions of Sexual Abuse

Sexual abuse is built on a foundation of fear, manipulation, and an imbalance of power. With this combination the abuser gains control over the victim, thus ensuring their silence. The abuser is almost always an authority figure: therapist, physician, priest, teacher, or politician. In sport, the abuser may be a coach, team doctor, or athletic trainer.

Most often there are two different layers of a power imbalance that occur. The first is when the abuser begins manipulating the victim under the guise of being in love. An example of this was detailed by world champion swimmer Ariana Kukors. After being groomed by her coach since the age of 13, Kukors found herself in a position where she was not only consistently abused by her coach, but she also emotionally relied on him for everything. She said, “He made me feel special; the chosen one in some ways, both in and out of the pool, and I was swimming better than ever” (Ariana Kukors, “My Story,” February 9, 2018, retrieved from https://www.arianajkukors.com/mystory/).

The second layer is seen in the Larry Nassar case. Nassar used his power and reputation to abuse hundreds of athletes, sometimes even when the athlete’s parents were in the room. Out of the numerous survivors and parents of survivors that stepped forward with their stories, many stated that, although uncomfortable with what was happening to them, they felt like they couldn’t question what Nassar was doing to them. They were told time and time again that Nassar was the best doctor in the country, that they were lucky to have even gotten an appointment with him. Even some who did report the abuse were immediately disregarded because no one could fathom how such a respectable doctor could do something so vulgar to children.

The next factor, manipulation, is why a victim will stay silent for so long. The abuser uses their power to their advantage and to manipulate the victim. Often scenarios of manipulation include the guise of love, convincing the athlete that they are the only one who understands them, that no one else could ever love them, and that no one else could possibly help them achieve their athletic dreams. The key to continuous abuse is isolation. By manipulating the victim into isolating themselves from their family, teammates,

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and friends, the abuser is ensuring that the victim is not only alone in their fight, but will emotionally rely only on the abuser.

The other side of this is the type of manipulation that we saw in the Nassar case. Not only was he manipulating the athletes, but he was manipulating all of the adults he encountered, too. According to survivor interviews, Nassar, as is consistent with other sexual abusers, is not an anti-social recluse. He was seen as a charming, gregarious professional person who couldn’t possibly do anything wrong.

The last dimension of sexual abuse is fear. The abuser uses power and manipulation to inject fear into every aspect of the victim’s life. It is important to understand how powerful this fear is. The prevalence of “shame culture,” where victims are blamed for their abuse, adds to the fear felt by victims.

Impact on the Athlete

Sexual abuse has a lasting effect on its victims emotionally, physically, and sexually. The athlete must cope with the loss of the one thing that they pride themselves on: control over their body. With this loss of control comes a loss of self-identity. When an athlete has spent a majority of their life honing their craft and is suddenly faced with painful traumatizing memories to associate with their sport, it not only results in a loss of identity but the potential to develop other mental illnesses. When the athlete encounters sexual abuse, feelings of shame, guilt, and low self-esteem are extremely common. With the loss of control accompanied by these feelings the athlete is more likely to fall into depression. These feelings are intensified if the athlete “takes part” in the sexual activity, as they are likely to feel higher amounts of shame and self-blame.

Sexually abused athletes are also at a higher risk for the development of an eating disorder. Loss of control over their lives and their bodies enables the athlete to attempt to find control in another way. Often when an athlete develops an eating disorder it is comorbid with over-training. Victims might overcompensate for their feelings by adopting a perfectionism mindset, which could enable them to over-train in order to feel like they have some sense of control in their lives.

In addition, there is also the possibility of dissociation via drugs or alcohol. Disassociation in trauma victims is not uncommon. If the victim feels trapped, they cope by attempting to detach

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themselves mentally from the situation, sometimes using drugs or alcohol as a coping mechanism to numb their feelings. This may spiral into an alcohol or drug addiction.

Ethical Dilemmas for the Sport Psychologist

There are multiple potential ethical dilemmas for the sport psychologist when dealing with sexually abused athletes. The first is competence, and the need to become knowledgeable and educated about sexual abuse. It is imperative for the sport psychologist to keep up with knowledge of relevant research, dynamics, and clinical impact. Along with this is understanding how to manage performance issues, such as deterioration, that may be intertwined with the abuse.

Making decisions about whether and how to report the abuse is essential. Athletes, as in the Nassar case, may be minors, and the sexual abuse may be subject to mandated child abuse reporting, required in every state. If the athlete is an adult, the ideal is to have the athlete report the incident, or give written permission for the treating professional to report. Yet, sexual abuse victims may not want to report. They may not want to go through the re-traumatization of the reporting, investigative, or legal processes; or they may feel they are in love with the abuser. Considerations of confidentiality are vital, yet can be complicated. Another important ethical dilemma is managing informed consent, letting the athlete know the limitations of confidentiality.

A potential ethical and clinical question for the sport psychologist is: who is the client—an athlete, team, or institution? Ethical obligations might appear to clearly define the athlete as the client, yet psychologists must be careful to define obligations and adherence to ethical codes in their contracts with teams or organizations. Where contracts require any type of reporting back to a team or organization, this must be made known to athletes as part of informed consent.

Conclusion

Sexual abuse in sport is prevalent today. There have been great strides to break the stigma, but there is still a long way to go. By being educated, knowing how to balance treatment, addressing performance issues, and being aware of when and how to report the abuse, the clinician can understand and resolve possible ethical dilemmas in the best interests of the athlete clients.

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