Sexual harassment is a challenge for both developed and developing countries worldwide (Drobac and Russell, 2020). Although the exact number of victims is still unknown because of a lack of accurate reporting (Stoltenborgh et al., 2011), sexual harassment is comparatively a gender-specific issue as the majority of cases are women (Essar et al., 2021). Studies have debated that sexual abuse in early life is significantly associated with the psychological and economic burden on the individual, the family, and the community. Previously, sexual abuse and associated challenges were primarily managed by cognitive behavioral therapy (CBT), and medications had a secondary part (Hetzel-Riggin et al., 2007). However, the effectiveness of these interventions has only been tested in individualistic cultures, namely, the West. Pakistan is a Muslim country and, culturally, it is expected from the young generation to control their sexual impulses and actions. Moreover, the conversation on sexual issues is marked with shame and denial.

Pakistani culture is characterized as a collectivistic one that prioritizes establishing harmony in the whole family over the needs of one person even if the matter is as sensitive as sexual harassment of minors (Tang, 2002). If the report of abuse apprehends a breakup in the family structure or brings a bad image to the family, the disclosure is discouraged. The help of mental health professionals is only sought when victims show extremely severe emotional/behavioral symptoms, significant academic decline, self-harm or suicidal tendencies, or symptoms of conversion disorder, such as feeling supernatural possession accompanied with loss of consciousness. At times, families of victims are unaware of the abuse, and perpetrators are often within the family which further complicates the management.

The ultimate goal of a therapist is to help the victim move forward with effective coping mechanisms of survival from the past experiences, and it is done by drawing the client’s attention to the strengths and innate capacity to adapt which ultimately induces hope and optimism (Zadafshar et al., 2021). Consequently, self-esteem is improved, and academic and social activities are reestablished and reassimilated. The sole purpose is to empower the survivor to consider future possibilities of living a better life. Simultaneously, the therapist is required to involve the families in aiding to adjust the client to traumatic experiences. However, in this case report, the family was not approached due to the cultural restrictions and the client’s present ability to share the trauma. It is interesting to know that researchers have found scenarios in which the client was able to move forward from the trauma, without any professional help taken (Hetzel-Riggin et al., 2007). The resilience of a person plays a significant role in determining the prognosis of a client. In this case report, we opted for an individualistic approach with a cognitive-behavioral approach (McDonagh et al., 2005) to manage the reported presenting complaints of the client, and positive adaptation to the trauma was followed. Although trauma-focused CBT (TF-CBT) is a family focused approach, family dynamics in a collectivistic Muslim society, such as Pakistan, are different, and elements, such as shame and guilt, have to be addressed in the families which takes comparatively longer duration and energy of the survivor. A positive therapeutic alliance is proposed to be as operative as an emphasis on narration in transitioning the survivor to adaptive functioning.

Problems reported by the client were getting sexually harassed by a brother-in-law, difficulty in maintaining academic challenges, having a communication gap with parents, having fear of getting harassed again, and having difficulty in handling own anger from the past 7 years. When asked about her daily routines and likes and dislikes, it was stated that “I love watching cartoons, TV dramas of family TV channels and playing video games online.” She had no more than two friends at school but even with them, she shares limited information about her feelings. The client was seemingly good at understanding the educational concepts and reported I learn things quickly in class if I am not stressed but when thoughts of past harassment are triggered, I start forgetting things in class and at home. She had a sharp memory and sense of humor that could be highlighted as some of her strengths because she kept sharing new jokes that she read in the daily newspaper or heard from someone in class. In the future, the client aims to do a Nazra course (learning Quran from a mosque) but when inquired about the inspiration, she said, There are no boys in this field, and I will be safe. The client belonged to a middle-class family based on 3 members who were her parents and herself. The mother of the client is uneducated, whereas her father had passed his graduation when he got married. The client reported, My father takes all the decisions at home, and everyone is scared to disobey whatever he says and sometimes I cry while hiding but eventually do what pleases him. The client’s family is highly attached to Islamic institutions and preaches religious teachings. Her father always had people come to their home and sit in the drawing room, and most of those people were men; therefore, the client mostly stayed in her room instead of roaming around in the house. The client’s father is a 61-year-old man who was a retired government school teacher and her mother was a housewife. Sister-in-law and brother-in-law were married by the father’s choice. The client reported, My father never listens to me and gives me a shut-up call because my brother-in-law has told him that I am a disobedient girl and words of men are trusted more than girls in my home. The client’s father is the only earning hand in the house and pays for all the members of the house, while the brother-in-law does not have a job and there is no other man in the house. The client reported that her early education was given by her father that was based on Quran and Sunnah. At the age of 4 years, she was admitted to the school near her house. The client is reported to be a good student and fast learner until she passed 3 classes. Then, her performance started to become average.

The detailed history revealed, factors that predisposed the client’s trauma, were emotional and communication distance from the family that had worsened her problem. The client has come with problems of feeling fearful regarding her harassment, low academic performance, and grief on losing contact with a teacher who gave her most attention in the class. The precipitating factor, in this case, was the parent’s lack of trust in her and the conspiracy about her character created by her brother-in-law who was himself involved in harassing her. A maintained factor in this case that strengthened the problem was the continuously challenged academic performance of the client.

Figure 1 shows the pre- and post-management ratings for all the presenting complaints were taken based on the subjective evaluation of the client.

In the case discussed earlier, some of the neglected factors that are responsible for determining a positive prognosis of any client with an experience of sexual harassment are discussed. The whole process of therapy consisted of 9 in-person sessions with the client in the school setting. In this process, assessment modalities of a single case study provided in-depth information about the predisposing, precipitating, and maintaining factors of the reported emotional and behavioral challenges. Although scarcely reported, estimated cases of abuse are 9% among girls and 3% among boys worldwide (Barth et al., 2013), but the rate is varying depending on the culture, definition of abuse, and harassment in a certain culture and the research methodologies. Abuse and harassment among children and, especially, girls are extremely underreported (Reitsema and Grietens, 2016).

In Pakistan, sexual harassment and sexual abuse are the lowest recorded crimes. However, as the media highlighted the cases of 6-year-old Zainab, 10-year-old Farishta, and 2019’s Kasur case of 280 abused cases, the public has started addressing these issues in a new light, and victims have started coming out with their verbatims showing an annual increase in reports of child abuse (Abbas and Jabeen, 2021). Factors, such as gender discrimination and lack of awareness about the rights of children, have reinforced the ideology of keeping girls restricted within the confines of their homes to protect them from strangers. However, majority of sexual harassment cases worldwide show the perpetrator to be among close family members (Gekoski et al., 2016). Moreover, in Pakistan, recent research showed the most reported perpetrators to be parents followed by friends and teachers (Abbas and Jabeen, 2021).

The intervention plan of this research was aimed to manage the impact of sexual harassment in the form of passive aggression and guilt, and the associated maintaining factors, such as academic challenges and communication gap with significant family members, namely, parents of the client. The management plan was constituted of trauma-based cognitive and behavioral techniques that are known to be highly effective with cases of sexual harassment (Lewey et al., 2018). The results were noted in the form of subjective reports and the assessment measures, and the problems showed a significant improvement. In addition, pre- and post-ratings were compared, and the results validated the effectiveness of our treatment plan. The follow-up in-person sessions were not continued because the family had to relocate to a different city. The psychologist continued the follow-up with the client through phone calls once a month and, after 3 months, the client was referred to a new school psychologist.

This case illustrates an example that a manualized treatment can be used in a school setting. The psychologist was under the supervision of a trained TF-CBT expert and had more than 4 years of practice in managing sexual abuse. In this case report, TF-CBT to a client was not intellectually mature enough as an adult and emotionally challenged due to past traumatic experience of sexual harassment. This demonstrates the wide applicability of this treatment approach and adds to the pieces of evidence with a diverse clientele. Some limitations were faced during the treatment, given the client’s limited cognitive knowledge. The client faced challenges in understanding some cognitive concepts and their utility, such as thought replacement. The psychologist worked hard and explained the concepts a few times until she understood them. Often the client seemed frustrated or confused but the psychologist encouraged her to take breaks, practice deep breathing techniques, and later review the concepts again.

The practitioners who wish to work with victims of sexual harassment must learn a great deal about TF-CBT. There is a significant need to modify the language used to describe such victims in the cultures, namely, Pakistan. All the terms that degrade the victim or blame the victims must be highly discouraged. A psychologist must view the client as a person in need of growth. The step that is deemed critical for success and most important in this study is the phase of rapport building between the client and the psychologist. Key points to follow to build this rapport and make the client open up are to know the client as a person and understand her likes and dislikes.

The case report intends to propose a holistic approach of dealing with victims of sexual harassment within the family. The case is of great importance as it illustrates a detailed management plan for managing sexual harassment and associated psychosocial challenges in an individualistic culture. The goals of management were to enable the client and deal with traumas of harassment through TF-CBT. Overall, this case study is proposed as an extensive piece of literature providing an effective intervention plan. However, the limitation of this study is limited generalizability.

The datasets analyzed in this manuscript are not publicly available. Requests to access the datasets should be directed to MW, mwaqas@mail.ustc.edu.cn.

The studies involving human participants were reviewed and approved by the Ethics Committee at the Guangzhou University and Institute of Clinical Psychology, University of Management and Technology, Lahore. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin. Written informed consent was obtained from the minor(s)’ legal guardian/next of kin for the publication of any potentially identifiable images or data included in this article.

All authors equally contributed to conception and design, acquisition of data, analysis and interpretation of data, drafted the article for important intellectual content, approved final version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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