Case Report : The resiliency journey of a Vietnamese female sexual abuse survivor : an exploration in life history [ version 1 ; peer review : 1 approved with reservations ]

Currently, the studies on sexual abuse trauma, and resilience in Confucian survivors are still limited. The purpose of this study is to explore the resilience of Confucian women after sexual abuse trauma to provide evidence to support in counseling and psychotherapy practices. The article describes the resiliency story of a Vietnamese Confucian female survivor who was abused by her brother from the age of 8 to 16. The life history approach used in qualitative narrative research was applied in this study. The researcher identified two factors that strongly influence the survivor’s resilience: (1) the effectiveness of passive education in the general education curriculum is oriented to both competence and quality development; and (2) an authentic understanding of the core Confucian philosophical doctrine: the neutrality and the self-nurture. Based on the findings, we propose a 7-stage flow diagram of a Confucian women's resilience following sexual abuse. These findings provide important evidence-based practice for counselors and clinicians in supporting and intervening for sexually abused Confucian women and contribute to the impact of studies on religious and spiritual factors affecting the resilience of sexual abuse survivors.


Introduction
An overview of childhood sexual abuse Child sexual abuse (CSA) is a crime that happens across countries, races, religions, classes, and cultures and has lifelong effects. CSA includes any interaction between a child and an adult (or another child) in which the child is used for the sexual stimulation of the perpetrator or an observer (Bolen & Gergely, 2014). CSA leaves serious consequences on the victim's mental health, which can have long-term effects without appropriate support and intervention strategies. There have been a lot of previous studies done to understand, support, and heal the sexual abuse trauma (SAT) experienced by survivors. These studies can be divided into three groups: (1)  . It is also important when studying the essence of relationships to consider the cultural, religious, and social factors that influence the survivor's life. This is a research direction that has garnered focus and is carried out in many countries in order to provide the most effective and appropriate solutions for survivors through consideration of religion and spirituality as a means of healing.
On the other hand, studies on the direction of mental health support and interventions for abused children always mention that a counselor, a clinician, or a social worker will be the one to conduct support and intervention for the victim (Dietz et al., 2012; Furniss, 2013). The issue of self-resilience, as well as the discovery of the link between the victim's internal resources and SAT, is an area that relatively few researchers have addressed. Clinical studies on resilience in people who have been sexually abused are still highly subjective. Therefore, there is a lot of debate about in-depth research in this field to provide evidence that will develop mental health support and intervention through diverse perspectives for children who have been sexually abused.
In Vietnam, research on CSA has been limited to presenting the situation (Linh, 2021; Tran, 2020), proposing solutions (Nguyen, 2018), practicing some manipulations of counseling, psychotherapy (Nguyen et al., 2016), and providing social support for victims (Dinh Vinh, 2020), there has been no longitudinal study addressing the long-term effects of CSA, or in-depth research on the psychological development, the essence of psychological phenomena in adults who were abused as children. Therefore, conducting a longitudinal study to understand the psychological transformation of CSA survivors in adulthood is urgent and a prerequisite for providing practical clinical evidence focusing on the postintervention period in the group of survivors. This article presents the resiliency journey of an adult female survivor of CSA that occurred from the age of eight as a typical case of trauma recovery involving religious and educational factors. The study's findings demonstrate women's ability to overcome adversity, as well as their emotional resilience, within a modern understanding of Confucian philosophical doctrine and of education as a preventive factor.
The long-term effects of sexual abuse and mental support Previous global studies all show that victims of CSA suffer long-term effects of psychiatric, psychological, and physical symptoms. CSA has been correlated with higher levels of depression, guilt, shame, self-blame, eating disorders, somatic concerns, anxiety, dissociative patterns, repression, denial, sexual problems, and relationship problems (Bentovim et al., 2018). In some cases, survivors experienced sexual dysfunction when they came into adolescence. A study done on the prevalence and predictors of sexual dysfunction in the US revealed that victims of CSA experience sexual problems more than the general population. They found that male victims of CSA were more likely to experience erectile dysfunction, premature ejaculation, and low sexual desire, and they found that women were more likely to have arousal disorders (Laumann, Piel, & Rosen, 1999). These mental health issues are explored by psychologists and clinicians through empirical evidence. Also drawing on these long-term effects of CSA, many intervention strategies have been implemented, corresponding to different problems and different individuals. Therefore, it is important to point out that each victim's responses and experiences in CSA will not be the same. Although it is often viewed as a traumatic experience, there is no single symptom among all survivors, and clinicians need to focus on the individual needs.
In addition to psychotherapy and medical interventions, religion and spirituality are commonly regarded as important coping strategies by victims of CSA. Religion may contribute to greater resilience, attribution of meaning, and guidance as well as providing a social support network (Durà-Vilà et al., 2013). Although the spiritual impact of abuse can be devastating, some studies also document that spirituality can be a source of resiliency for many children and that those who can cope spiritually, also do a better job of coping emotionally and physically (Crisp, 2007). Religious and spiritual activities that are often performed by victims/survivors to recover from the SAT are: increasing the spiritual knowledge (e.g., religious education, Bible study), practicing spiritually (e.g., ritual, virtuous actions), consolidating the spiritual relationships (e.g., church involvement, holy matrimony), and experiencing spirituality and religion (e.g., meditation, prayer; see Pargament, 2013). Each of these activities is designed to sustain and strengthen the individual's relationship with the Gods, Saints, Buddha or other supernatural forces. Therefore, religion and spirituality are confirmed as being supportive factor in recovering from sexual abuse. However, when reviewing studies on the application of religion and spirituality as a form of mental support to sexual abuse survivors, there were only studies on Catholicism (Durà-Vilà et al., The long-term effects of CSA analyzed above were confirmed to exist in Vietnamese adult survivors (Tran, 2020). Intervention strategies from psychologists, clinicians as well as support from social organizations have contributed to a positive effect in helping this group of survivors recover. At the same time, the application of spiritual and religious support strategies with the group of survivors was also carried out, focusing on Buddhism and Christianitythe two religions with the largest number of followers in Vietnam (Phan, 2010). However, a study on the psychological trauma of children and adolescents living in incomplete families by Nguyen (2019) reported that Confucianism and Confucian educational ideology in the family were the factors that aggravated the trauma of children being abused by their family members and were even a cause of suicide in children and adolescents. When studying the psychological trauma of sexually abused children, Nguyen et al. (2016) also found that Confucian philosophical ideas of gender and the prejudice that stems from within the family is the main reason female victims are not protected and have no voice in the family.
Confucianism has had a profound impact on the culture and spiritual life of Vietnamese people (Vuong et al., 2018). The doctrine of Confucianism is divided into two parts: Lower (studying the social relationships) and upper (studying the operation of the universe and human beings). This doctrine is preached through forms of education, family activities, and social relationships (Vuong et al., 2018). In particular, over the past 1000 years, Confucian philosophy has become an educational viewpoint, a cultural feature, and an educational tradition of many Vietnamese families (Smith, 2021). From these analyzes, combined with practical evidence on SAT in Vietnam, it can be seen that the Confucian perspective is associated with the long-term effects of CSA as well as the resilience of this group of victims. Research on the resiliency process in survivors living in Confucian families, as well as the relationship between Confucianism and CSA, is urgently needed to serve as practical evidence to contribute to the case study or to consider as a model case in clinical psychotherapy and counseling.

Study purpose
This study is part of a longitudinal research project on mental support and intervention measures for female sexual abuse victims since 2016 in Vietnam (Nguyen et al., 2016). The purpose of the present study is to understand the lived experiences of a Confucian woman who had been sexually abused as a child by her brother and to understand her resiliency process throughout her childhood, adolescence, and adulthood.
With this goal, the researchers posed two research questions to explore: 1. How did she survive in the family that caused her trauma? 2. How did she recover from the SAT?

Research team and reflexivity
The five researchers involved in this study with different tasks are presented in Table 1 (see Table 1).
The participant is currently a student studying at the research team's university. There was no prior relationship between the research team and the participants. When the recruitment information for research volunteers was announced to the classes through the lecturers, the participant actively contacted the research team with the desire to better understand her trauma and help disseminate the project's values to other survivors. Before participating, the participant was given full information about this project, including the objectives, vision and ethical issues in personal information security and scientific publication.

Study design
As Creswell and Poth (2016) noted, qualitative research strategies are particularly appropriate to address the experience and perspectives of the participant. The method of investigating those realities and experiences is referred to as narrative research, a qualitative research method designed to capture the detailed stories or life experiences of an individual. With narrative research, we can learn about the survival and resiliency process of CSA victims throughout their psychological development. Through time-lapse narrative interviews, the researchers documented the participant's key milestones, thereby identifying key events and drivers that create, or promote the resilience.
The wider longitudinal research study, of which this study is a part, was conducted through 25 in-depth interviews between two researchers and the participant, each lasting between 45 to 60 minutes. The interview location was a psychological counseling office belonging to a key university in the south of Vietnam, which guaranteed a comfortable space and the confidentiality of the interviewee information.
This study belongs to the research project 'Counseling for sexually abused children with artist playtherapy' (Nguyen et al., 2016), which is funded by the Ministry of Education and Training of Vietnam, project number B2020.SPS.19 and supervised by the Department of Science and Technology Ethics committee of the Ho Chi Minh City University of Education (under the Ministry of Education and Training of Vietnam). This project aims to design and test the psychological interventions and support for sexually abused children. The data extraction used to conduct this study was approved by the Department of Science and Technology Ethics committee of the Ho Chi Minh City University of Education (Permit number: 1815/QD-BGDDT) and conducted in accordance with the Declaration of Helsinki. The participant was fully informed about the study process of the project, as well as the study conducted in this article prior to the interview.

Consent
Consent for participation in the research project was given by the participant in the interview recording and signed consent form. The name and personal information of the participant in this study were anonymized. The data used for publication was approved by the participant. The written informed consent from the participant is confirmed by her signature and the research team, under the supervision and guarantee of the Department of Science and Technology Ethics committee of the Ho Chi Minh City University of Education. Written informed consent for publication of the participant's case details was obtained from the participant.

Participant
Once participants contacted the researchers to take part in the larger research project, a single participant from the group was purposively sampled for this case study based on the following criteria: 1. The participant must have experience of SAT. 2. Must be currently undergoing recovery. 3. Must follow the Confucian religion.
The criteria were assessed during the recruitment process through classroom discussions, where the participants voluntarily shared their experiences. CSA is a traumatic experience and not every survivor can overcome it and recover. Therefore, the researchers requested a private and confidential meeting with the selected participant to double-check that the participant was indeed willing to share the story. Screening criteria were discussed again privately with the participant, and further information on the research project was given. After the participant agreed to take part, the contact details were shared with the fifth researcher who contacted the participant officially. Confidentiality of the participant information was maintained through all stages of the recruitment and research phases.
In this section, the participant's information is presented in the form of biographical summaries, as well as key events in her life history. The participant was a Confucian woman (anonymous name L), who was 20 years old at the time the study took place, studying at university. L has a history of being sexually abused by her biological brother (older than L 12 years old) between the ages of 8 and 16 years old. The types of abuse changed over time. For the first three years L was completely unaware that she was being abused. The brother would occasionally use erotic statements when talking with L and show L pictures of adult women wearing underwear or nude. L thought this was just normal communication and was amused when her brother introduced her to the development of the female body as an adult. From 12 to 15 years old, when L entered puberty with many drastic changes in the body, the brother approached L more, often sending messages via social media such as Facebook to confide in L. He often told L about his broken relationships to gain her trust and understanding. At first, her brother sometimes used some sensitive words when referring to the private area, but he gradually increased his erotic language, as well as sending L pictures and clips of sex as a way to educate her. From the age of 14, L started to feel uncomfortable when her brother kept texting her and sending her explicit pictures. L once told her parents, but they responded with silence and distrust. L was disappointed and lived a closed life. By the time L was 15, CSA cases were exposed and widely published in Vietnam, creating opportunities for many victims to speak up and ask for help from society. At this point, with the support of her homeroom teacher, L realized that she had been abused for a long time. L decided to speak up and protest to her brother. L asked her brother to stop the abuse, or else she would report it to the police. This only deterred her brother for the first three months, however. After that, he became even more aggressive in stroking L, touching her sexually, making her feel very uncomfortable and "dirty". When L was 16 years old, the abuse reached its climax. She was lured by her brother to drink alcohol and perform sexual acts, and was eventually raped by her brother. L fell into despair and depression and shared that she once attempted suicide but was discovered by her father, so it was not successful. By this time, the parents believed that what L shared was true and took action to intervene with her brother. Although they did not report to the police, L's parents took L to live with her aunt in another city and she continued to attend high school. L had managed to cut off the source of her abuse from here. However, the period that followed was the most challenging as she tried her best to balance her emotions, resilience, and reintegration into daily life. Details of her resilience and how she coped with the SAT are presented in the findings and key events sections which follow.

Data collection and analysis
Given the scope of the current article, data collection was based on L's SAT-related events since the age of 8. This lifehistory method, according to Goodson (2001), generates not only deeper knowledge about the individual but also about the social reality and family relationship that she has to act out and operate within. Data collected from the accounts reported by L are collectively known as 'socially read biography', which provides insight into her resilience process, and the socio-cultural context, and offers a significant source of information and knowledge about Confucian female CSA survivors. From the perspective of social transformation, the employment of the life history method in this study is in line with the social approach to narrative research which enables the survivor to express her voice and attitudes towards the CSA.
Further, in line with the life-history method, data were collected by in-depth, unstructured interviews (Goodson, 2001). Because CSA is a sensitive topic to discuss as well as to research, the interviews were face-to-face with just two people present in addition to the interviewee. During the first two sessions, the researchers established a relationship with L through open and friendly exchanges to create a safe, positive and comfortable atmosphere for L. When L felt ready to share her story, the researcher conducted 25 interviews. Parallel to each interview, the researcher observed in detail L's views, feelings, and behaviors, especially unconscious behaviors and body language expressions when retelling her story. L was interviewed with open-ended questions and was encouraged to answer and share her experiences as a victim and survivor of CSA. Interview questions focused on exploring life experiences, the resiliency process following SAT, and the impact of religion and education on the participant's resiliency ability. Specifically: (1) How do you understand your resiliency ability after these bad things happen to you?
(2) For you, how did Confucianism and your belief in Confucianism affect your resilience? (see all questions in Giang, 2021) The 25 interviews were conducted in Vietnamese for convenience and so that the participant felt most comfortable when sharing her experience. All the details in L's story quoted in this article were translated from Vietnamese into English by the author, who is fluent in both languages. Interview data was recorded (under the restricted conditions with the consent of the participant) and the research team confirmed not to use these for any personal interest. These recordings, after being processed, were stored in a secure data system set up by the Computer Science Center of the university where the participants are studying. During the interview process, the researcher systematized the events that occurred in the participant's story in chronological order, noting important events as well as keywords and sentences serving the data analysis. As data collection was underpinned by the method of life history, deliberate strategies were employed for data analysis of the participant's narratives (Goodson, 2001). In other words, the stories told by L during the interview were interpreted to highlight the foci of the study.
The data analysis was based on transcriptions of in-depth life history interviews with detailed observations of the participant's behaviors, emotions, and perspectives. The story told by L was considered and analyzed in the broader context of mental health and social life in Vietnam rather than examined in isolation. The analysis process was interpreted independently by three researchers (the 1 st , 2 nd and 3 rd authors). After that, the three results are discussed in a group and supervised by the 4 th researcher to ensure reliability and semantic consistency. After the group discussion, the result was returned to a participant for comment and approved to be used in the findings section.

Findings
The main findings are presented in this section and they are illustrated with quotations extracted from the transcripts (Giang, 2021). After briefly describing L's experiences, we propose a resiliency journey that involves learning Confucian philosophies and preventive education programs at school.
L's sexual abuse traumatic experiences L described various types of sexual abuse trauma (SAT), involving violence, harassment (in person and online), coercion, intimidation, and mental/physical stress. The acts of sexual abuse mainly took place at L's family home, during periods of parental absence, or when L used online social networks. During the period of abuse before developing more resilience, L experienced a range of emotions and thoughts. The emotions and thoughts verbalized during L's interview were summarized in Table 2 by the research team (see Table 2).
It can be seen that the feelings, thoughts, and responses (behavior), as well as the psychological trauma and forms of abuse, experienced by L during the period of abuse, are similar to those found in other victims of SAT. However, when considering the long-term effects, there is a significant difference between L and other published cases. The next findings section presents L's recovery process of struggle and resilience from the age of 16, when completely separated from the perpetrator and she is no longer being abused.

L's struggle and resilience journey
Since moving to her aunt's house, L has not seen her brother. She also blocked him on Facebook and other social networking sites in order to completely cut contact. She only keeps in touch with her parents. However, the days following this transition were a challenging time for her. During one interview L recounted the first day of entering a new school: In my religion, if a woman is not a virgin before marriage, it is a sin to my family and my future husband. I'm embarrassed. (Session 3, March 14 th , 2020) In the first three months following the move, it was difficult for L to adjust to the new learning environment and make new friends. Her trust in society seemed to be falling apart. L withdraws and limits communication with friends: My 16-year-old [self] was in a crisis! I couldn't trust anyone and myself! I do not want anyone to know this ugly thing! (Session 3, March 14 th , 2020) Not only that, but L's trust in her parents also broke down: Why did not they denounce him? Why are they defending him before the law? Instead, they moved me to live somewhere else. Is the role and face of the eldest son in the family so important? Parents are willing to let their daughters suffer because they do not want to hurt their sons! It is not fair! (Session 6, April 25 th , 2020) It can be seen that L suffered fierce internal struggle and torment related to her role in the family, her outlook on life, and the way she interacts and integrates socially. L commented: L recalled the day she was most desperate, the day she attempted suicide, her father was able to intervene and tell L: When he dissuaded me from committing suicide, my father told me a philosophy of life. What makes me reflect and overcome the trauma later: [a] good person needs to learn all the time to know and correct himself. If you want to correct yourself, you must first keep your heart and mind for success, and then bring happiness to yourself and society. For the time being, please temporarily live away from family to observe and study the root of the problem, including your wishes. From there, train your own will, purify your soul from the pollution of CSA. Finally, correct your mistakes to be happy. (Session 7, May 9 th , 2020) L's father's words were from the Confucian philosophies. The training of will and knowledge is the way to help people overcome suffering. Her father's teachings act as a resource to help L continue to live and explore this life. Her parents do not hate L but show their love skilfully. The parent separate L from the place that causes her suffering. Even so, they still protect L's brother to a certain extent. As for her brother, L cut off contact. Since then, L has always showed resistance and kept her distance from her brother, so he could not do anything to her: When describing how she overcame the fear, humiliation, torment, and pain caused by the SAT, L reports that she never forgets her father' statement [a] and considers it as her life philosophy, helping herself to be motivated to learn and overcome her dark past. L said: Everything that happens in the world has a cause. The influence of educational factors, mostly passive education (integrated across subjects, taught throughout lessons and different blocks in the educational program) had created a solid psychological foundation for L. Thanks to her father's advice, combined with her reflection on life, L realized her resources and understood how to recover from the SAT.
L did not deny that CSA was a traumatic event, and faced it step by step: It was very painful. There are times when I want to give up. Those memories still appear, in waves, not as many and fast as before. Gradually, I realized that I had lived with the SAT for almost 10 years and that I was still alive. I acknowledge the existence of this pain in my life. I never forget, and I do not allow myself to forget. The perpetrator will have to pay the penalty. I learned this in Civic Education. I know more about the legal and social support of CSA. I will fight to free myself! (Session 17, September 14 th , 2020) Thus, one year after the end of the abuse, although the pain and trauma still affect her, L has learned to adapt and change herself to overcome that pain. L continued to reflect on her father's words, her former homeroom teacher's questions, and what she learned in the educational program she went through. This was her coping strategy: The last year of high school, when the pressure of studying and exams hit, was also the time when L was enlightened with many philosophies to overcome the painful past and work towards a good future. L stated: I did not expect the pressure of college entrance exams to be the driving force pushing myself to overcome my SAT. (Session 11, July 7 th , 2020) L has determined her academic goals and future, thereby overcoming the darkness of her past. For L, the memory of being abused becomes a driving force that makes her constantly learn and strive to improve herself, protect herself, and help those around her to change their perception of the CSA. The following quotes from L clearly describes how she overcame darkness and became enlightened: The When we properly understand Confucianism and behave correctly with the core views on human life, social relationships, and neutrality, it will help us to have a better and broader understanding of the problems, thereby creating internal strength to overcome the SAT. (Session 12, July 21 st , 2020) By studying Confucian philosophy, L strengthened her beliefs in herself. This philosophical contemplation created a tremendous change in her resilience. With this, L has accepted her past and overcome the darkness of her life. She was enlightened and had gained valuable religious experiences. Besides, there is also the participation of education as passive, long-term support. All form a solid and enlightening spiritual resource, leading L to find her rights and her ego. Following high school, L's life was able to develop as she entered university. This was also the time when L realized her dreams and sublimated negative emotions into positive, meaningful experiences. L recounted how she felt on the first day she entered the university lecturing hall: It was a great day at 18 when I was no longer a schoolgirl, but a student. This is the first step for me to achieve L's academic and life goals went quite smoothly, she achieved what she set out to do and became an advocate and volunteer to provide mental support for sexually abused children in remote areasan area that is still heavily prejudiced in Vietnam. The researcher met L again in the next interview session, where L shared that: Step into the university, I shine and spread positive existential values! I hope my story will be an inspiration or a living testimony to other survivors … (Session 23, October 26 th , 2020) In the last conversation between the researcher and L, L shared a message that she wants to send to female survivors who are stuck, repressed, and resigned in Confucian prejudiced families: If I use a symbol to describe my life, I will be a lotus. The lotus is the Vietnamese national flower, symbolizing purity, being close to the mud without the foul smell of mud. I used to live in the mud, in the painful darkness of the SAT. I was miserable, ugly, and despised myself. But I was enlightened, I shined and showed my beautya beautiful lotus rose in the dirty mud! I want to send a message to the other survivors: 'Live like a lotus, beautiful and radiant in your way!' (Session 25, November 10 th , 2020)

Discussion
L's story provides insight into the journey of resilience of a Vietnamese Confucian female CSA survivor. L experienced the long-term effects of CSA that previous studies have reported: depression, suicide, low self-image, low self-esteem, social isolation, etc. (Hailes et al., 2019). She overcame the SAT to find spiritual balance, reintegrate into daily life and grow. Based on the findings, we propose a 7-stage diagram of the psychological progression of a Confucian woman's resilience after sexual abuse. In this section, we focus our analysis and discussion on the findings from L's story to explore the stages of SAT resiliency.
L's mental and spiritual resources: The passive effect of the education curriculum and the most authentic perception of Confucian philosophy In L's story, we discovered two factors influencing her resilience: the passive effect of the educational program, and Confucianism. These two factors create mental and spiritual resources that helped L to cope and gradually overcome the SAT.
Previous studies have confirmed that religion can be a support or impediment to the resilience of sexual abuse victims We argue, however, that L's story demonstrates how when the neutrality in Confucian philosophical doctrine is properly understood, it can form a great spiritual resource to help overcome the SAT. The idea of neutrality was particularly significant for L: 'Whoever you are, you will have these relationships and you have the things you need to achieve balance' (Session 12, July 21 st , 2020). When survivors maintain a neutral attitude toward the perpetrator and CSA-related issues by being non-judgmental, nonretaliatory, and accepting that the trauma that has happened in their life; they will be strengthened in will and inner strength. When a survivor's will and inner strength is strong enough that they can live independently they can transform the SAT into value. This is also a philosophy within the lower part of Confucianism. In Confucianism, there is no need for formalities, religious rituals, prayers, or participation in religious activities to balance emotions, or talk and repent with God. It is paramount that you read, understand, and reflect on the teachings of Confucianism. To properly understand the authentic perception and successfully apply Confucian philosophy to life, one must learn the lower part first, then the upper part (O'Harrow, 2021). In the lower part, you have to learn from self-nurture (get to know yourself, isolate things to observe, find out the roots, train your will, get rid of sins, correct your mistakes, and find happiness), behave in accordance with the norms of the family and the country (appropriate social behavior) and with the world (contribute to society, find happiness in yourself and those around you). L had studied the Confucian doctrine from the beginning to enlighten and better understand the philosophy, as a foundation to overcoming SAT.
In terms of the impact of education, Tho (2016) states that Vietnamese education is heavily influenced by Confucianism. Confucianism attaches great importance to learning and considers it to be the foundation of human development in society. According to Yao and Yao (2000), in Confucianism, the five minimum moral qualities of a person are Benevolence (loving others), Propriety (showing respect and order in words and deeds), Righteousness (behaving morally), Wisdom (showing understanding and good judgement), and Trustworthiness (being reliable and honest). These are still the leading educational maxims in Vietnam, especially in moral education (self-nurture) and students' comprehensive personality development. The five basic qualities of Confucianism, and other valuable aspects derived from Vietnamese traditions are considered indispensable content in moral education and are integrated into all school subjects. Thus, with foundations in Confucian doctrine, the Vietnamese curriculum equips students with solid spiritual roots and moral values as resources for them to cope effectively with adversity. In L's story, it is impossible not to consider her participation in the preventive educational program on life skills, especially the CSA prevention skills that have been promoted in Vietnam since the 2015-2016 academic year (Nguyen, 2018). CSA prevention skills that have been deployed in educational activities for Vietnamese students include: safe and unsafe touches, privacy protection, supportive relationships, safe social media usage, safe dating, and refusal skills (Nguyen, 2018; Linh, 2021; Tran, 2020). These are also the skills that L had learned since the 9th grade. Along with the skills education, the subject of Civic Education and Literature equipped L with core beliefs and values. In Civic Education, L was taught the five moral values (of Confucianism), but also equipped with legal knowledge on women's and children's rights. This knowledge system has similarities with Confucian doctrine when it comes to moral cultivation, law enforcement and social stabilization. Because of her interest in Confucianism, L instilled these values. In Literature, L was taught to love herself in the past, present and future. The life values that this subject brings to L are love, tolerance and forgiveness. L forgives her past, her brother's crime, and resolves to live a fulfilling life. The comprehensive prevention skills, and education on moral values underpinning human potential, particularly the five basic qualities of Confucianism, have supported the formation of positive mental resources and supported abused victims to overcome SAT through the concept of neutrality.
L' resiliency journey: The process of spiritual nurture towards the neutrality The findings show that L's resiliency journey had stages, with the learning and improvement of life values learned in school and an authentic understanding of Confucian philosophy through different timelines. Her story started with curiosity around sex; to guilt and self-loathing; then acceptance and seeking out resources; finally, contemplation, enlightenment, and overcoming pain. In terms of long-term effects, L experienced torment, loss of faith in herself and her family, social isolation, depression, and even attempted suicide. This SAT experience, as well as expressions of long-term effects, is quite similar to that of survivors in other cultures (Hailes et al., 2019). According to Durà-Vilà et al. (2013), the psychological process that abused victims, specifically Catholic nuns go through to achieve recovery includes 8 stages: (1) Shock and distress; (2) Self-doubt; (3) Anger and mistrust; (4) Withdrawal and mediation; (5) Secrecy or disclosure; (6) Community acceptance; (7) Spiritual integration; (8) Posttraumatic growth. The nuns' understanding of their abuse in the light of their religious beliefs enabled the trauma to be transformed into a potential catalyst for growth. Therefore, considering religious and spiritual aspects when supporting religious people with SAT may allow religious narratives that incorporate the trauma to unfold. It is important for the believers to have an authentic perception of the religious philosophy and how to apply these philosophies in daily life.
Throughout her story, L discusses self-nurture and neutrality -two core principles of Confucian philosophy that any believer must understand and live by. These are also two factors that motivated L to learn about her trauma and overcome it. Initially, she could not accept the fact, but her interest in the authentic perception in Confucian philosophy prompted her to search for explanations. L learned how to analyse problems neutrally and applied this to her SAT. She was successful in transforming her crisis into a motivation for learning and was able to practice self-nurture with the core philosophical values of Confucianism. Some contents of the current Vietnamese educational program still maintain the Confucian philosophy, taking the cultivation of qualities as the main focus in the development of student's personality.  This is an inheritance of Confucian philosophy in education and has created a powerful inner resource to help L overcome her SAT. L was able to turn SAT into a resource for her self-development, so that she could serve the community and help prevent future cases like hers.

Stage 1 -Suffering and Depression
From L's story, we have proposed a model of SAT resiliency detailed in seven stages (see Figure 1).

Conclusion
L's narrative highlights the importance of early prevention of CSA through educational programs, as well as using religious-spiritual factors as a resource rather than a perpetuation of the problem. The passive effect of the educational curriculum and the authentic perception of Confucian doctrine are the two factors helped L overcame the SAT. It is the core values of Confucianism -nurture and the neutrality -that have changed L's perception of CSA and SAT in a positive light. L's resiliency journey went through seven stages with different psychological developments, starting with suffering and depression, through the process of contemplation and understanding of the Confucian philosophy of life to move on to dedication and happiness. This resiliency journey reflects the Confucian point of view of education and human development: Self-nurture. Clinicians or mental health counselors working with religious trauma victims, especially Confucian victims, should be mindful of the importance of considering their spiritual beliefs and their acknowledgment of the Confucian philosophy. It is necessary and highly feasible to help this group of clients understand the authentic perception of Confucianism, as well as elicit hidden values passively created from the educational program.
However, this study has some limitations. Although in the case presented here, L's religious beliefs seems to have had a positive impact on her well-being, it would be naıve to think that this is always the case. Confucian beliefs can be a source of meaning and resilience but also have the potential to be damaging and present barriers to women's equality. Clinicians and mental health counselors need to be alert to maladaptive cognitions and coping reactions in traumatized religious patients. With these findings, we have only approached it from the perspective of a typical case in Vietnam, and more descriptive studies as well as large-scale interviews are needed to fully understand Confucian CSA. In addition, as part of our long-term study on CSA, these results are of great significance in preparing an experimental model according to the stages of SAT resilience in a Confucian woman. This is the basis for us to continue studying this research question using an ethnographic approach on CSA and SAT in Confucian survivors. Accordingly, the study supports the notion that greater attention needs to be paid to religiosity in the lives of adults who have been sexually abused as children.

Anthony F. Santoro
HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA This case report presents data from a series of interviews with a Vietnamese Confucian woman with a history of child sexual abuse (CSA). This manuscript has several strengths, including its emphasis on the importance of socio-cultural and religious factors in the context of the long-term effects of CSA, as well as its appreciation of religion/spirituality as a potential source of support and coping resource for individuals who experienced CSA. Considering that much of the related research has focused on Judeo-Christian samples, research is warranted exploring associations between religious/spiritual beliefs and CSA among people from other faith systems (e.g., Confucian faiths). The presented participant's understanding of her process of healing from CSA through her identity as a Vietnamese Confucian woman makes for an interesting read. That said, although this case's story is inspiring, it is unclear how the findings are relevant to the field's understanding of disease processes, diagnosis, or treatment. Of note, the case presented is not of a patient and does not focus on the case's treatment. The case report does not include information regarding any physical examinations, diagnostic tests, treatment, or related outcomes, and additional details related to family and personal background are needed for the reader to contextualize findings. The manuscript would benefit from more clearly stating: (1) the rationale for presenting this participant's story as a case report; (2) how this case report is relevant to the field's understanding of disease processes, diagnoses, or treatment; and (3) the importance of findings and how other practitioners might find this case useful. The manuscript also makes a few statements that seem beyond what can be supported by the data and level of evidence, making this reviewer have reservations about recommending this manuscript for approval in its present form. Detailed comments and suggestions are listed below: This reviewer recommends greater care in referring to evidence-based practice. For instance, the manuscript writes, "findings provide important evidence-based practice for counselors and clinicians" (Giang et al., 2021, p. 3). This statement is beyond the scope of a case report and not supported by the data presented. Please see Bolton (2001) 1  Additional details regarding the case's background would be beneficial, specifically, details related to the family structure and dynamics, social and school functioning, any significant medical history, personality attributes, etc. Further information about the level of adult supervision and the frequency in which she was left alone with her brother would be helpful. Additional details about how she disclosed the abuse to her parents and how her parents reacted to this disclosure seem appropriate. Further information describing the progression and frequency of the abuse are needed. Additional details about the circumstances that prompted disclosing the abuse to her teacher, how she disclosed the abuse to her teacher, and how her teacher reacted to this disclosure seem important. How soon after the sexual assault was her suicide attempt? ○ Additional methodological details are needed. How often did interviews occur? How long did interviews last? How were the data analyzed? What were the steps taken to process and analyze the data? Was a set of thematic codes developed and applied to interviews? How were disputes between the three researchers who analyzed the interview data resolved? ○ The participant's father's words to her seem like he is blaming her for the abuse. In tandem with being sent to live with her aunt, it reads like she was punished for the abuse. Did the participant report such feelings? If so, how were they resolved? ○ From the presented quotes, it seems like the participant's source of support came from her interpersonal relationships (e.g., her teacher, making new friends) and academic engagement (e.g., focusing on entrance exams). More clarity is needed regarding how her religious beliefs and personal spirituality supported her coping.

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The participant alludes to experiencing intrusive thoughts (e.g., memories entering her mind). Did she experience other symptoms of post-traumatic stress? Did these symptoms impact her social or academic functioning? ○ The manuscript notes, "all form a solid and enlightening spiritual resource, leading L to find her rights and her ego" (Giang et al., 2021, p. 10). The term "ego" has theoretical connotations linked to psychodynamic theory and should be avoided here. Replacing the term "ego" with another word (e.g., confidence, self-esteem, self-worth) is recommended. 11. The introduction emphasizes the importance of longitudinal studies examining the longterm effects of CSA. Although this assertion seems appropriate, it is unclear how this strengthens the rationale for the current case study. Response: We have limited the scope of study into conducting a case study to understand the psychological transformation of Vietnamese CSA survivors for providing practical clinical evidence focusing on the post-intervention.
12. The manuscript would benefit from avoiding generalizing presented findings to all women. This case is unlikely to represent the larger population of Vietnamese Confucian women; the manuscript would benefit from removing statements about the larger population. Response: I have removed the statements about the larger population, especially 'women' into 'woman'.
13. The first paragraph in the section named "The long-term effects of sexual abuse and mental support" (Giang et al., 2021, p. 4) would benefit from including additional supporting citations. Response: I have included more citations from previous studies in long-term effects of CSA.
14. The manuscript's mention of both the potential positive and negative influence of religion/spirituality in the context of CSA is important. However, the introduction focuses on the positive aspects of religion/spirituality, with limited attention to potential negative influences. The manuscript would benefit from also briefly mentioning how CSA may negatively impact a person's religiosity/spirituality and may result in religious/spiritual struggles. Response: I have briefly mentioned the negative impact of religiosity/spirituality to the CSA trauma of survivors.

15.
It is unclear what the term "incomplete families" (Giang et al., 2021, p. 4) means. Clarification is needed. Likewise, this reviewer recommends considering using more sensitive language. Response: I have adjusted the term 'incomplete families' into 'broken families'.
16. The following sentence in the introduction requires supporting citations: "it can be seen that the Confucian perspective is associated with the long-term effects of CSA as well as the is a view in Confucian philosophy of neutrality.
23. From the presented quotes, it seems like the participant's source of support came from her interpersonal relationships (e.g., her teacher, making new friends) and academic engagement (e.g., focusing on entrance exams). More clarity is needed regarding how her religious beliefs and personal spirituality supported her coping. Response: I have adjusted the sentence to be more clear. The influence of Confucian philosophical educational factors, mostly passive education (integrated across subjects, taught throughout lessons and different blocks in the educational program) had created a solid psychological foundation for the participant to explore clearer the Confucian philosophy. Thanks to her father's advice, her interpersonal relationships (her teacher and new friends), combined with her reflection on life, she realized her resources and understood how to recover from the CSA: Self-nurture, the lessons of being and relationship.
24. The participant alludes to experiencing intrusive thoughts (e.g., memories entering her mind). Did she experience other symptoms of post-traumatic stress? Did these symptoms impact her social or academic functioning? Response: I have adjusted the sentence to be more clear, 'The appearance of intrusive memories and panic attacks sometimes recurred during the first year. L took care of herself by learning to adapt and change herself to overcome that pain. This was a great effort in her self-nurture journey because at this time, psychotherapy services in Vietnam were not popular.' 25. The manuscript notes, "all form a solid and enlightening spiritual resource, leading L to find her rights and her ego" (Giang et al., 2021, p. 10). The term "ego" has theoretical connotations linked to psychodynamic theory and should be avoided here. Replacing the term "ego" with another word (e.g., confidence, self-esteem, self-worth) is recommended. Response: Thank you for your recommendation. I have replaced the term 'ego' with 'self-esteem'.
26. Addition clarification is needed regarding how her understanding of Confucian philosophies evolved through processing her trauma. Response: I have adjusted the sentences in the Findings section to clarify the impact of Confucian philosophy evolved through the CSA trauma's resilience. You can read it again in the manuscript.
27. It seems like the participant's beliefs were reinforced by external events, such as her brother contracting a sexually transmitted infection and losing his ability to have childrenessentially being punished. How did her healing journey reinforce her religious beliefs? Response: I have added a paragraph to clarify this issue in the end of the Findings section. It concerns the nature of Confucian philosophy and the processes of human development and self-learning after attaining the self-nurture.
28. The description of the core tenets of Confucian philosophies in the discussion is informative, and this should be presented earlier in the manuscript. Response: Thanks for your comment. I have adapted and used important information on Confucian philosophy in the section 'The long-term effects of sexual abuse and mental support'.