La maltraitance sexuelle sur enfant demeure une problématique complexe concernant les volets individuels, familiaux, collectifs et sociétaux. Les chiffres de l’OMS sont éloquents et montrent combien l’abus sexuel de l’enfant existe encore et toujours. Rappelons combien celui-ci constitue un maillon vulnérable de la société susceptible de servir de surface de projections, d’objet de décharges pulsionnelles quand l’adulte éprouve mal-être, frustration et besoin de jouissance immédiate. Quelle que soit la nature de la maltraitance, qu’elle soit physique, sexuelle, psychologique ou qu’elle recouvre les diverses formes de négligence, l’enfant demeure à haut risque de connaître les multiples retombées du traumatisme. Selon les pays, la révélation d’abus portée par l’enfant ou par un tiers sera soit « judiciarisée » soit orientée vers le secteur médico-psychosocial. En 1997, notre ouvrage proposait repères et réflexions sur les aspects d’évaluation et du traitement de l’enfant victime d’abus sexuel et de sa famille. Nous avons estimé opportun, vingt ans après, de réaliser une actualisation des aspects développés en s’appuyant sur quatre axes réflexifs. La finalité consiste à montrer les évolutions de la pratique au regard des transformations intervenues sur bien des aspects et points d’attention que comprend la prise en charge des situations de maltraitance.

Sexual ill-treatment on child remains a complex problem concerning the individual, family, collective and societal levels. In echo, its understanding then its coverage ask for a consideration of the medical, social, psychological and legal levels of every situation. According to countries, the revelation of abuse carried by the child or by the third party will be either « sent to Justice » or directed to the medico-psychosocial sector. In the light of the epidemiological data collected by the WHO, prevalence of the situations of sexual ill-treatment on child remains very important and in spite of the numerous prevention campaigns, awareness-raising and multiple training programs. In 1997, our work proposed marks and reflections on the aspects of evaluation and the treatment of the child, who is a victim of sexual abuse, and his family. We considered convenient, twenty years later, to realize an updating of the developed aspects by leaving a clinical label which, without being paradigmatic, illustrate the topic.

Since “the Dutroux affair” which shook Belgium and bordering countries in 1996, awareness campaigns, trainings intended for the professionals in the sectors of help and care but also of the legal system were born. Techniques and tools were developed to meet the child in his first interest. However, in twenty years, the number of descriptions reaching the specialized teams “SOS-Enfants” did not stop growing. Sexual ill-treatment to the child exists again and again. Let us call back how much this one constitutes a vulnerable link of the society susceptible to serve as surface of projections, as object of impulsive discharges when the adult experiences ill-being, frustration and need for immediate enjoyment. Whatever the nature of the ill-treatment, whether it is physical, sexual, psychological or in terms of diverse forms of carelessness, the child is left to high risk of enduring multiple effects from the trauma. Without being exhaustive, in the light of the clinical label, the discussion will concern four reflexive axes summarized in the work of 1997. The purpose consists in showing the evolutions of the practice with regard to the transformations intervened on many aspects and points of attention which includes the coverage of the situations of ill-treatment.

Societies, families, individuals: today ever, sexuality in its diverse declensions occupies the media ground, representing a gigantic market share echoing the mentalities centered on the body and its image. These aspects are interlinked in the incredible advances of the technologies of communication and information, in their dimensions of ease, accessibility and speed. More than ever, the modern man is snatched in a spiral compound of impulsiveness and immediacy. The psychic construction is dependent on the environment just like this one is influenced by the actions and the language of the man. As our communities modify their way of being, as the individual transforms gradually his vision of the world, patterns of interactions and mechanisms of defense. Echoes on the personalities met on the ground emerge from it logically.

The situations of sexual ill-treatment are complex to dread so much there is good reason considering the speeches, behavior and interactions. The proposed model 20 years ago, which remains relevant, leans on two essential principles. The first one corresponds to the multidisciplinarity and, in corollary, in the co-intervention and in the corporatism. For 30 years, the crossed looks of the various disciplines allow to build the evaluation of the possible materiality of the facts of ill-treatment and their impacts on the young victim and his circle of acquaintances. The second principle includes the methodological aspects of the process given that several diagnostic fields are concerned, each referring to adapted specific tools. Let us browse briefly these by recovering how much the acquired experience during these years showed the relevance of a “flexible and flexible systematization” in the process of investigation. The frame of the care: in twenty years, the landscape of the authorities and the structures potentially involved in the situations of sexual abuse has become complicated. Concomitantly, the professionals noticed a clogging of the general system of help and care so much that the demands exceed the offers in view of the evolution of the individual, family and societal problems. The treatment: it will depend not only on facts of ill-treatment themselves but the traumatic impact on the concerned child and its circle of acquaintances. In this connection, we are confronted with a diversity of demonstrations ranging from an absence of any symptomatology translating an impact strength of the young victim to the appearance of destructive conducts to oneself and/or to others that can lead to the suicide attempt. To remain coherent in the care, there is good reason to know the indications, the limits of every reserved approach by watching the principle of collective complementarity. It is certainly here about a point of evolution with regard to our reflections of 1997, showing all the interest to mobilize the various therapeutic currents to be connected around the child and around his circle of acquaintances.

In order to avoid the effects from a social and economic exposure in the public domain as well as the phenomena of stigmatization, Belgium opted for the possibility and not the obligation to call out to the legal system, by setting up multidisciplinary teams reckoned to estimate and handle the situations of ill-treatment on children. Although it is there, we advocate an individual consideration on the basis of a multidisciplinary reflection and within the framework of a work of network.