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Discussion Guide for 'Great Photo, Lovely Life': A Documentary About a Family Affected by Child Sexual Abuse

By Elizabeth Letourneau, PhD, director of the Moore Center for the Prevention of Child Sexual Abuse at the Johns Hopkins Bloomberg School of Public Health

Note: Below are resources from the Moore Center for the Prevention of Child Sexual Abuse.
You are invited to learn more about the Moore Center and their commitment to ending child sexual abuse. 

For people affected by child sexual abuse, feeling heard, seen, and supported by family members is among the strongest predictors of recovery and well-being. Conversations about child sexual abuse can also help to keep children and teens safe from experiencing or engaging in harmful sexual behaviors in the first place. So, if you are considering talking with family members about your own experiences, about their experiences, or about child sexual abuse more generally, my colleagues and I applaud you and want to support you in having these important conversations. 

In Great Photo, Lovely Life, the people affected by child sexual abuse experienced victimization (including the director Amanda Mustard’s older sister and mother), perpetrated harm (Amanda’s grandfather), were complicit in harm (Amanda’s grandmother), and experienced the extended emotional fallout of abuse (Amanda). Some fell into multiple groups. Amanda’s mother was a victim of child sexual abuse and was viewed by her oldest daughter as complicit in that daughter’s abuse. It is to each of these groups that we refer when talking about people affected by abuse. 

Talking with family members about abuse can result in intense feelings, from acceptance and affection to acrimony and anger. We designed this guide to help make this conversation go as well as possible. There are entire books focused on how to have difficult conversations (here’s a review of several) and on child sexual abuse (I am co-authoring an upcoming book on the topic with Great Photo, Lovely Life producer Luke Malone). We don’t pretend to cover all the ground or to have all the answers. I do hope these suggestions help get you on your way.

Images courtesy of HBO Documentary Films, GREAT PHOTO, LOVELY LIFE: FACING A FAMILY’S SECRETS, an Ark Media Production.

Images courtesy of HBO Documentary Films, GREAT PHOTO, LOVELY LIFE: FACING A FAMILY’S SECRETS, an Ark Media Production.


Before starting the conversation, consider these questions: 

  • What do you hope to get out of the conversation? What would “success” look or feel like? Consider both concrete outcomes, such as “My abuser acknowledges what he did.” And less tangible effects you might achieve even if the concrete goals don’t pan out, such as: “I feel proud of myself for breaking the silence.”
  • Who do you want to include in the conversation and what do you hope they will get out of it?
  • What are the main issues or points you want to make? Limit yourself to just two or three to focus on in an initial conversation. Consider writing them down and practicing for a calm and clear delivery. 

Now consider these strategies for a successful conversation:

  • Avoid surprising people—let them know what you want to talk about or at least that you would like to talk about a potentially difficult subject. This could be in the form of an email, text, or letter if that helps to get the ball rolling.  
  • Request to meet soon, so as to not leave yourself and others in anxious limbo.
  • If possible, meet in a way that you can see one another so you can respond to non-verbal as well as verbal cues.
  • Schedule the meeting at a time and location that assures everyone’s full attention and privacy. 
  • If you are worried that someone will become physically or emotionally abusive, do not invite that person or do not schedule the meeting. Consider working with a therapist or mediator on how best to move forward, but recognize that if you disclose child sexual abuse they may be obligated to report it. 


During the conversation, consider using these strategies: 

  • Try to take your time and act calm, even if you are nervous. 
  • State what you hope to get out of the conversation and then discuss your main points or issues. Use your notes if helpful. 
  • If people try to interrupt, ask them to wait until you are finished.
  • Make sure to leave time for people to respond to your points and to raise their own. 
  • Do not interrupt when others are speaking.
  • If you feel uncomfortable, consider taking a brief break. 
  • If you feel unsafe, consider leaving the situation. 


After the conversation, consider these strategies:

  • Take a moment to recognize the courage and strength it took for you to start the conversation, no matter how things turned out.
  • Engage in some self-care, such as talking with a supportive friend, taking a walk, or meeting with a therapist. 
  • Determine what, if any, next steps to take. Most importantly, if you know or suspect that anyone who remains under the age of 18 was, is, or could be abused, you or another adult must alert the authorities if the situation has not already been reported. It is also useful to alert the child’s non-offending parent(s).
  • For anyone else affected by child sexual abuse in your family, consider providing the resource guide that accompanies this discussion guide.
  • Reflect on what you achieved with the first conversation and whether a second conversation would be helpful. If so, try to arrange it. It might not be easy, but you have already demonstrated your courage and strength by having the first meeting.

Discussion Guide for Parents

Conversations between parents and their children about sexual abuse are actually protective. For example, research has shown that teens whose parents talked openly about online risks, provided guidance on whether and when to share personal information online, and who remain open to questions, were less likely to experience online exploitation and abuse. On the other hand, teens whose parents did not engage in these conversations but simply restricted and monitored online access were more likely to be targeted for exploitation or abuse.

Photo of Amanda Mustard and her mother looking at a series of photographs on a table.

As parents, it’s never too early or too late to start these conversations with children. However, the earlier the better, to lay the groundwork for successful communication. In this video, I provide some tips for talking with children about child sexual abuse. Here are some more recommendations:

  • Starting in infancy, parents should use correct labels for all body parts. Using euphemisms to cloak penis, vagina, breasts, and butt is problematic for two reasons. First, euphemisms convey that these body parts are embarrassing, dirty, or bad and should not be mentioned. Second, euphemisms rob children of the language they need to communicate with others. All of which means that abuse or problem sexual behavior can remain undetected.
  • Once children start being left in the care of people other than parents, whether in or outside the home, parents should be alert to potential signs of abuse. These include changes in their child’s mental and physical health and well-being, mood, personality, and behavior. If parents notice something, they should ask their child clear and concrete questions to determine if someone is hurting them, such as “Has anyone touched your penis/vagina or made you touch theirs?” Children often fail to disclose abuse to vaguely worded questions such as: “Has someone touched you in a way that made you feel uncomfortable?” 
  • But what if there are no changes to signal that something is awry? Many children don’t display obvious emotional or physical distress early in the process of being abused or being groomed for abuse. What I’ve done as a parent is to question my children a few times a year—mostly randomly—and ask if anyone has tried to touch their butts or penises (both my kids are boys) or asked them to touch others’ penises, butts, or vaginas. Asking these questions matter-of-factly, much like asking them about their day at school, can help increase disclosures.
  • If the answer to questions about abuse is “yes”, it is absolutely key for parents to:
    • Respond calmly—children often blame themselves and stop talking if a parent gets upset.
    • Believe their child—adults who abuse children often tell their victims that no one will believe them.
    • Reinforce that their child did the right thing by “telling” and promise to make sure the abuse will never happen again.
    • Contact a local child advocacy center to investigate further (see Resource Guide for how to locate a nearby child advocacy center). 
    • If your child was abused, show them love and support and ensure they and you receive evidence-based family therapy such as Trauma-Focused Cognitive Behavioral Therapy (often provided by child advocacy centers).
    • If your child has engaged in problem sexual behavior against another child, show them love and support and ensure that they and you receive evidence-based family therapy such as Cognitive-Behavioral Therapy for Problem Sexual Behavior (sometimes provided by child advocacy centers; also see the Resource Guide for information on the National Center on the Sexual Behavior of Youth).
  • Lastly, recognize that neither victimization nor perpetration should derail your child for life. With love and support most children affected by sexual abuse will achieve their full potential. 

Information About Child Sexual Abuse

All of us want to be informed when it comes to sexual abuse—to protect ourselves and loved ones from experiencing abuse or engaging in harmful behavior—yet outdated myths and stereotypes can get in the way. The more accurate information we have the more effective we will be at preventing abuse from occurring in the first place. Here, then, are some key points to better understand sexual abuse and why it occurs.

What is Child Sexual Abuse? 

The Centers for Disease Control and Prevention define child sexual abuse as the involvement of a child (a person less than 18 years old) in sexual activity that violates the laws or social taboos of society and that the child:

  • Does not fully comprehend
  • Does not consent to or is unable to give informed consent to, or
  • Is not developmentally prepared for and cannot give consent to

Abuse also involves the creation, distribution, and use of illegal images (child sexual exploitation materials) and online child sexual exploitation.

Some states and other jurisdictions criminalize all sex that involves one or more people under the age of 18; some criminalize all sex that involves one or more people under the age of 16; and some exempt mutually desired sex between close-in-age teens. All states criminalize sex between anyone 17 or younger and close relatives or adults in positions of authority.

Facts and Figures

  • In the U.S., about 25% of girls, and 5% of boys will experience sexual abuse prior to age 18. Globally, about one in nine children will experience child sexual abuse.
  • Abuse that involves penetration is much less common than other forms of abuse, although both types can cause serious harm.
  • Most abuse is committed by people well-known to the child. This is true even for online abuse and exploitation.,
  • Abuse is most often committed by other children under age 18—in the case of hands-on offenses 70% or more are committed by other kids. Once convicted, the vast majority (97%) of these youth will never receive another sex crime conviction.
  • Even among adults, once convicted most (80-90%) will never receive another sex crime conviction.
  • Although sexual attraction to children, aka pedophilia, is a risk factor, about half of abuse is committed by people who do not have strong sexual attraction to children. 
  • Likewise, many people who have sexual attraction to children choose to keep children safe by never acting on those attractions.
  • Abuse is associated with increased risk for myriad mental health outcomes (such as depression and post-traumatic stress disorder), health risk behaviors (such as smoking), and physical health outcomes (such as cardiovascular disease and some cancers). Importantly, not all survivors experience long term harm.
  • Abuse is also associated with increased risk for negative educational and employment impacts and lower lifetime earnings. 

Prevention and Intervention

Child sexual abuse is preventable, not inevitable. There are well-supported school-based programs that prevent the onset of youth problem sexual behavior, including Safe Dates and Shifting Boundaries. There is a growing array of free self-help prevention programs for teens and adults with sexual attraction to children, including Help Wanted, Prevent It, and Troubled Desire.

When abuse has occurred, there are well-supported treatment programs that improve child health and well being and that reduce risk of future harm, including Trauma-Focused Cognitive-Behavioral Therapy (for children who experienced abuse) and Cognitive-Behavioral Therapy for Problem Sexual Behaviors (for children who engaged in harmful sexual behavior). 

Photo of Amanda Mustard with a projected photograph of her grandmother.

Amanda Mustard and photograph of her grandmother.
Source: Amanda Mustard

Resource Guide

There are many resources available for people affected by child sexual abuse. Here we list several long-standing U.S.-based resources, though this is not an exhaustive list.

Moore Center for the Prevention of Child Sexual Abuse

Dr. Elizabeth Letourneau directs The Moore Center at the Bloomberg School of Public Health at Johns Hopkins University. The Moore Center has led efforts to end child sexual abuse since its founding in 2012. The Center’s work is grounded in scientifically rigorous research designed to improve practice, policy, and advocacy efforts. The center’s homepage includes a “Get Support” tab listing resources for people affected by child sexual abuse, including parents and children,,  survivors of abuse, and people concerned about their own thoughts or behaviors. 

The Moore Center also launched Help Wanted Prevention Intervention, a free, online, program for help-seeking adolescents and adults who have sexual attraction to children.

Learn More

National Center on the Sexual Behavior of Youth

NCSBY provides information to teens, parents, and professionals to promote healthier responses to and prevention of youth problem sexual behavior. NCSBY is part of the the Center on Child Abuse and Neglect in the Department of Pediatrics of the University of Oklahoma Health Sciences. The Center provides training to therapists across the U.S. that treat youth who have problem sexual behavior. NCSBY also serves American Indian and Alaska Native tribes.

Learn More

National Children’s Alliance

The NCA is the largest network of child advocacy centers in the country. Child advocacy centers support child abuse victims and their parents and many also provide services to children and teens with problem sexual behaviors and their parents. To find a child advocacy center near you, search NCA’s Interactive Map or Interactive Map of Tribal Coverage.

Learn More

National Sexual Violence Resource Center at Respect Together

Respect Together seeks to create a culture that values and upholds all people being treated with respect and free from all forms of sexual violence and oppression. Within Respect Together, the National Sexual Violence Resource Center maintains a Directory of organizations that lists state and territory resources for people affected by child sexual abuse, including victim/survivor support organizations and local communities of color sexual assault organizations.

Learn More


RAINN - the Rape, Abuse, & Incest National Network is the nation’s largest anti-sexual violence organization. RAINN organizes the National Sexual Assault Telephone Hotline (1-800-656-4673), an online chat service, and a mobile app for survivors. RAINN partnered with The Trevor Project to provide culturally relevant services to LGBTQ+ survivors.

Learn More

Stewards of Children - Darkness to Light

Darkness to Light is an organization committed to empowering parents and all adults to prevent child sexual abuse. They offer a well-regarded single-session training on preventing, recognizing, and reporting child sexual abuse entitled Stewards of Children.

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Stop It Now!

Stop It Now! aims to prevent the sexual abuse of children by mobilizing adults, families and communities to take actions that protect children before they are harmed. Anyone affected by or concerned about child sex abuse can reach out to their national prevention Helpline (1.888.PREVENT), email, and chat services, an interactive Online Help Center, and an “Ask Now!” advice column.

Stop It Now! provides dedicated resources for teens and young adults with questions or concerns about their own or a friend’s sexual thoughts, feelings, and behaviors at What’s OK?

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Violence Prevention at the Centers for Disease Control and Prevention (CDC)

The CDC is the U.S. agency tasked with preventing harm and was among the first government agencies in any country to recognize that violence—like disease—is preventable. The CDC funds numerous child sexual abuse prevention program evaluations. Learn more at their Child Sexual Abuse Fast Facts page.

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