<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2 20190208//EN" "http://jats.nlm.nih.gov/publishing/1.2/JATS-journalpublishing1.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="case-report" dtd-version="1.2" xml:lang="en">
    <front>
        <journal-meta>
            <journal-id journal-id-type="pmc">F1000Research</journal-id>
            <journal-title-group>
                <journal-title>F1000Research</journal-title>
            </journal-title-group>
            <issn pub-type="epub">2046-1402</issn>
            <publisher>
                <publisher-name>F1000 Research Limited</publisher-name>
                <publisher-loc>London, UK</publisher-loc>
            </publisher>
        </journal-meta>
        <article-meta>
            <article-id pub-id-type="doi">10.12688/f1000research.55227.1</article-id>
            <article-categories>
                <subj-group subj-group-type="heading">
                    <subject>Case Report</subject>
                </subj-group>
                <subj-group>
                    <subject>Articles</subject>
                </subj-group>
            </article-categories>
            <title-group>
                <article-title>Case Report: The&#x00a0;resiliency&#x00a0;journey&#x00a0;of a&#x00a0;Vietnamese&#x00a0;female&#x00a0;sexual&#x00a0;abuse&#x00a0;survivor:&#x00a0;an&#x00a0;exploration in&#x00a0;life&#x00a0;history</article-title>
                <fn-group content-type="pub-status">
                    <fn>
                        <p>[version 1; peer review: 1 approved with reservations]</p>
                    </fn>
                </fn-group>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author" corresp="yes">
                    <name>
                        <surname>Giang</surname>
                        <given-names>Thien-Vu</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Formal Analysis</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <uri content-type="orcid">https://orcid.org/0000-0002-6536-0707</uri>
                    <xref ref-type="corresp" rid="c1">a</xref>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Le</surname>
                        <given-names>Duy-Hung</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Funding Acquisition</role>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <role content-type="http://credit.niso.org/">Supervision</role>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Nguyen</surname>
                        <given-names>Thanh-Huan</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Investigation</role>
                    <role content-type="http://credit.niso.org/">Resources</role>
                    <role content-type="http://credit.niso.org/">Software</role>
                    <role content-type="http://credit.niso.org/">Visualization</role>
                    <uri content-type="orcid">https://orcid.org/0000-0001-8183-4629</uri>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Huynh</surname>
                        <given-names>Van-Son</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Conceptualization</role>
                    <role content-type="http://credit.niso.org/">Funding Acquisition</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Project Administration</role>
                    <role content-type="http://credit.niso.org/">Supervision</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Review &amp; Editing</role>
                    <xref ref-type="aff" rid="a2">2</xref>
                </contrib>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Nguyen-Thi</surname>
                        <given-names>Diem-My</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Data Curation</role>
                    <role content-type="http://credit.niso.org/">Investigation</role>
                    <role content-type="http://credit.niso.org/">Methodology</role>
                    <role content-type="http://credit.niso.org/">Resources</role>
                    <role content-type="http://credit.niso.org/">Validation</role>
                    <role content-type="http://credit.niso.org/">Visualization</role>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <aff id="a1">
                    <label>1</label>Psychology Department, Ho Chi Minh City University of Education, Ho Chi Minh City, 700000, Vietnam</aff>
                <aff id="a2">
                    <label>2</label>Rector, Ho Chi Minh City University of Education, Ho Chi Minh City, 700000, Vietnam</aff>
            </contrib-group>
            <author-notes>
                <corresp id="c1">
                    <label>a</label>
                    <email xlink:href="mailto:thienvust0708@gmail.com">thienvust0708@gmail.com</email>
                </corresp>
                <fn fn-type="conflict">
                    <p>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>22</day>
                <month>10</month>
                <year>2021</year>
            </pub-date>
            <pub-date pub-type="collection">
                <year>2021</year>
            </pub-date>
            <volume>10</volume>
            <elocation-id>1071</elocation-id>
            <history>
                <date date-type="accepted">
                    <day>15</day>
                    <month>10</month>
                    <year>2021</year>
                </date>
            </history>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2021 Giang TV et al.</copyright-statement>
                <copyright-year>2021</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <self-uri content-type="pdf" xlink:href="https://f1000research.com/articles/10-1071/pdf"/>
            <abstract>
                <p>Currently, the studies on sexual abuse trauma,&#x00a0;and&#x00a0;resilience&#x00a0;in&#x00a0;Confucian survivors are still limited.&#x00a0;The&#x00a0;purpose of this&#x00a0;study is to explore the resilience of Confucian women after sexual abuse trauma to&#x00a0;provide&#x00a0;evidence to support in&#x00a0;counseling&#x00a0;and psychotherapy&#x00a0;practices.&#x00a0;The article&#x00a0;describes&#x00a0;the&#x00a0;resiliency story&#x00a0;of&#x00a0;a Vietnamese Confucian female survivor who was abused by her brother from the age of 8 to 16.&#x00a0;The&#x00a0;life history approach&#x00a0;used&#x00a0;in qualitative narrative research&#x00a0;was applied in this study.&#x00a0;The researcher&#x00a0;identified&#x00a0;two factors that&#x00a0;strongly influence&#x00a0;the survivor&#x2019;s resilience: (1) the effectiveness of passive education in the general education curriculum is oriented to both competence and quality development; and (2)&#x00a0;an authentic&#x00a0;understanding of the core Confucian philosophical&#x00a0;doctrine:&#x00a0;the&#x00a0;neutrality&#x00a0;and the&#x00a0;self-nurture.&#x00a0;Based on the&#x00a0;findings, we propose a 7-stage flow diagram of a Confucian women's resilience&#x00a0;following&#x00a0;sexual abuse.&#x00a0;These&#x00a0;findings&#x00a0;provide&#x00a0;important evidence-based practice for&#x00a0;counselors&#x00a0;and clinicians in supporting and&#x00a0;intervening&#x00a0;for sexually abused Confucian women&#x00a0;and&#x00a0;contribute&#x00a0;to the impact of&#x00a0;studies on&#x00a0;religious and spiritual&#x00a0;factors&#x00a0;affecting&#x00a0;the resilience of sexual abuse survivors.</p>
            </abstract>
            <kwd-group kwd-group-type="author">
                <kwd>Child sexual abuse</kwd>
                <kwd>sexual abuse trauma</kwd>
                <kwd>resilience</kwd>
                <kwd>Confucian female survivor</kwd>
                <kwd>life history</kwd>
                <kwd>narrative research.</kwd>
            </kwd-group>
            <funding-group>
                <award-group id="fund-1">
                    <funding-source>Vietnamese Ministry of Education and Training</funding-source>
                    <award-id>B2020-SPS-19</award-id>
                </award-group>
                <funding-statement>This study belongs to the research project &#x2018;Counseling for sexually abused children with artist playtherapy&#x2019; funded by the Vietnamese Ministry of Education and Training, code B2020-SPS-19. </funding-statement>
                <funding-statement>
                    <italic>The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</italic>
                </funding-statement>
            </funding-group>
        </article-meta>
    </front>
    <body>
        <sec id="sec1" sec-type="intro">
            <title>Introduction</title>
            <sec id="sec2">
                <title>An overview of childhood sexual abuse</title>
                <p>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 (
                    <xref ref-type="bibr" rid="ref7">Bolen &amp; Gergely, 2014</xref>). 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) studies on the current situation surrounding CSA (
                    <xref ref-type="bibr" rid="ref6">Blakemore 
                        <italic toggle="yes">et al</italic>., 2017</xref>; 
                    <xref ref-type="bibr" rid="ref21">Murray 
                        <italic toggle="yes">et al</italic>., 2014</xref>; 
                    <xref ref-type="bibr" rid="ref35">Stoltenborgh 
                        <italic toggle="yes">et al</italic>., 2011</xref>); (2) studies on CSA prevention (
                    <xref ref-type="bibr" rid="ref3">Barron &amp; Topping, 2013</xref>; 
                    <xref ref-type="bibr" rid="ref30">Rudolph &amp; Zimmer-Gembeck, 2018</xref>; 
                    <xref ref-type="bibr" rid="ref31">Rudolph 
                        <italic toggle="yes">et al</italic>., 2018</xref>); and (3) studies on support, intervention and healing the SAT (
                    <xref ref-type="bibr" rid="ref1">Adams 
                        <italic toggle="yes">et al</italic>., 2018</xref>; 
                    <xref ref-type="bibr" rid="ref32">Sanjeevi 
                        <italic toggle="yes">et al</italic>., 2018</xref>). This research is the result of the efforts of various countries, communities, and societies working together to protect children's rights.</p>
                <p>When studying the survivors' life experiences, it is essential to learn about the development of their social relationships after the abuse. Some of the negative long-term effects that CSA has on a child is the consequences and precariousness of the victim's communication abilities, interaction, and social connections when they become adults (
                    <xref ref-type="bibr" rid="ref27">O'Leary 
                        <italic toggle="yes">et al</italic>., 2010</xref>), go to work (
                    <xref ref-type="bibr" rid="ref8">Colarusso, 2010</xref>), get married (
                    <xref ref-type="bibr" rid="ref14">Fergusson 
                        <italic toggle="yes">et al</italic>., 2013</xref>) and even after having children (Mrazek &amp; Kempe, 2014). It is also important when studying the essence of relationships to consider the cultural, religious, and social factors that influence the survivor&#x2019;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.</p>
                <p>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 (
                    <xref ref-type="bibr" rid="ref11">Dietz 
                        <italic toggle="yes">et al</italic>., 2012</xref>; 
                    <xref ref-type="bibr" rid="ref15">Furniss, 2013</xref>). The issue of self-resilience, as well as the discovery of the link between the victim&#x2019;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.</p>
                <p>In Vietnam, research on CSA has been limited to presenting the situation (
                    <xref ref-type="bibr" rid="ref20">Linh, 2021</xref>; 
                    <xref ref-type="bibr" rid="ref37">Tran, 2020</xref>), proposing solutions (
                    <xref ref-type="bibr" rid="ref25">Nguyen, 2018</xref>), practicing some manipulations of counseling, psychotherapy (
                    <xref ref-type="bibr" rid="ref23">Nguyen 
                        <italic toggle="yes">et al</italic>., 2016</xref>), and providing social support for victims (
                    <xref ref-type="bibr" rid="ref12">Dinh Vinh, 2020</xref>), 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 post-intervention period in the group of survivors.</p>
                <p>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&#x2019;s findings demonstrate women&#x2019;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.</p>
            </sec>
            <sec id="sec3">
                <title>The long-term effects of sexual abuse and mental support</title>
                <p>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 (
                    <xref ref-type="bibr" rid="ref4">Bentovim 
                        <italic toggle="yes">et al</italic>., 2018</xref>). 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 (
                    <xref ref-type="bibr" rid="ref19">Laumann, Piel, &amp; Rosen, 1999</xref>). 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&#x2019;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.</p>
                <p>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 (
                    <xref ref-type="bibr" rid="ref13">Dur&#x00e0;-Vil&#x00e0; 
                        <italic toggle="yes">et al</italic>., 2013</xref>). 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 (
                    <xref ref-type="bibr" rid="ref10">Crisp, 2007</xref>). 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 
                    <xref ref-type="bibr" rid="ref28">Pargament, 2013</xref>). Each of these activities is designed to sustain and strengthen the individual&#x2019;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 (
                    <xref ref-type="bibr" rid="ref13">Dur&#x00e0;-Vil&#x00e0; 
                        <italic toggle="yes">et al</italic>., 2013</xref>), Christianity (
                    <xref ref-type="bibr" rid="ref41">Yan, 2001</xref>), Islam (
                    <xref ref-type="bibr" rid="ref5">Bhutto &amp; Rind, 2019</xref>), and Buddhism (
                    <xref ref-type="bibr" rid="ref33">Sasson, 2014</xref>). The impact of other religions and belief systems has rarely been studied and deployed only at the level of common sense and indigenous knowledge.</p>
                <p>The long-term effects of CSA analyzed above were confirmed to exist in Vietnamese adult survivors (
                    <xref ref-type="bibr" rid="ref37">Tran, 2020</xref>). 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 Christianity &#x2013; the 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 
                    <xref ref-type="bibr" rid="ref24">Nguyen (2019)</xref> 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, 
                    <xref ref-type="bibr" rid="ref23">Nguyen 
                        <italic toggle="yes">et al</italic>. (2016)</xref> 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. </p>
                <p>Confucianism has had a profound impact on the culture and spiritual life of Vietnamese people (
                    <xref ref-type="bibr" rid="ref39">Vuong 
                        <italic toggle="yes">et al</italic>., 2018</xref>). 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 (
                    <xref ref-type="bibr" rid="ref39">Vuong 
                        <italic toggle="yes">et al</italic>., 2018</xref>). 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 (
                    <xref ref-type="bibr" rid="ref34">Smith, 2021</xref>). 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.</p>
            </sec>
        </sec>
        <sec id="sec4">
            <title>Methodology</title>
            <sec id="sec5">
                <title>Study purpose</title>
                <p>This study is part of a longitudinal research project on mental support and intervention measures for female sexual abuse victims since 2016 in Vietnam (
                    <xref ref-type="bibr" rid="ref23">Nguyen 
                        <italic toggle="yes">et al.</italic>, 2016</xref>). 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.</p>
                <p>With this goal, the researchers posed two research questions to explore:
                    <list list-type="order">
                        <list-item>
                            <label>1.</label>
                            <p>How did she survive in the family that caused her trauma?</p>
                        </list-item>
                        <list-item>
                            <label>2.</label>
                            <p>How did she recover from the SAT?</p>
                        </list-item>
                    </list>
                </p>
            </sec>
            <sec id="sec6">
                <title>Research team and reflexivity</title>
                <p>The five researchers involved in this study with different tasks are presented in 
                    <xref ref-type="table" rid="T1">Table 1</xref> (see 
                    <xref ref-type="table" rid="T1">Table 1</xref>).</p>
                <table-wrap id="T1" orientation="portrait" position="float">
                    <label>Table 1. </label>
                    <caption>
                        <title>Research team&#x2019;s information.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">Research team</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Role</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Credential</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Occupation</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Gender</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">Experience and training</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">The 1
                                    <sup>st</sup> author</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Interviewer, data coding and analysis</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">PhD Student in Psychology</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Counselor, researcher</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Male</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Participated in training courses on mental health counseling, depression intervention, counseling for children with SAT, and school counseling.
                                    <break/>5 years of research experience in counseling psychology, school psychology, trauma and mental health in children and adolescents.</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">The 2
                                    <sup>nd</sup> author</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Data coding and analysis</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">PhD in Psychology</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Counselor, lecturer, researcher</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Male</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Participated in training courses on counseling psychology, school counseling and currently in charge of training modules on counseling at the university.
                                    <break/>10 years of research experience in counseling psychology, school psychology and educational psychology.</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">The 3
                                    <sup>rd</sup> author</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Data coding and analysis</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Master in Psychology</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Lecturer, researcher</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Male</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Participated in training courses on school counseling and qualitative research.
                                    <break/>5 years of research experience in school psychology and educational psychology.</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">The 4
                                    <sup>th</sup> author</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Supervisor</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Professor in Psychology</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Researcher, Principal</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Male</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Participated in training courses on counseling psychology, school counseling, qualitative and quantitative research design, and currently is the head of the university&#x2019;s research ethics committee.
                                    <break/>Over 25 years of research experience in counseling psychology, educational psychology, development psychology, mental health in children and adolescents.</td>
                            </tr>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="middle">The 5
                                    <sup>th</sup> author</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Interviewer,Facilitator</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">PhD Student in Psychology</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Lecturer, researcher</td>
                                <td align="left" colspan="1" rowspan="1" valign="middle">Female</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Participated in training courses on counseling psychology.
                                    <break/>8 years of research experience in school counseling and educational psychology.</td>
                            </tr>
                        </tbody>
                    </table>
                </table-wrap>
                <p>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&#x2019;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.</p>
            </sec>
            <sec id="sec7">
                <title>Study design</title>
                <p>As 
                    <xref ref-type="bibr" rid="ref9">Creswell and Poth (2016)</xref> 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&#x2019;s key milestones, thereby identifying key events and drivers that create, or promote the resilience.</p>
                <p>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.</p>
                <p>This study belongs to the research project &#x2018;Counseling for sexually abused children with artist playtherapy&#x2019; (
                    <xref ref-type="bibr" rid="ref23">Nguyen 
                        <italic toggle="yes">et al.</italic>, 2016</xref>), 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.</p>
            </sec>
            <sec id="sec8">
                <title>Consent</title>
                <p>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&#x2019;s case details was obtained from the participant.</p>
            </sec>
            <sec id="sec9">
                <title>Participant</title>
                <p>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.</p>
                <p>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.</p>
                <p>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 &#x201c;dirty&#x201d;. 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.</p>
            </sec>
            <sec id="sec10">
                <title>Data collection and analysis</title>
                <p>Given the scope of the current article, data collection was based on L&#x2019;s SAT-related events since the age of 8. This life-history method, according to 
                    <xref ref-type="bibr" rid="ref17">Goodson (2001)</xref>, 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 &#x2018;socially read biography&#x2019;, 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.</p>
                <p>Further, in line with the life-history method, data were collected by in-depth, unstructured interviews (
                    <xref ref-type="bibr" rid="ref17">Goodson, 2001</xref>). 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&#x2019;s resiliency ability. Specifically:
                    <list list-type="order">
                        <list-item>
                            <label>(1)</label>
                            <p>How do you understand your resiliency ability after these bad things happen to you?</p>
                        </list-item>
                        <list-item>
                            <label>(2)</label>
                            <p>For you, how did Confucianism and your belief in Confucianism affect your resilience? (see all questions in 
                                <xref ref-type="bibr" rid="ref16">Giang, 2021</xref>)</p>
                        </list-item>
                    </list>
                </p>
                <p>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&#x2019;s narratives (
                    <xref ref-type="bibr" rid="ref17">Goodson, 2001</xref>). In other words, the stories told by L during the interview were interpreted to highlight the foci of the study.</p>
                <p>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
                    <sup>st</sup>, 2
                    <sup>nd</sup> and 3
                    <sup>rd</sup> authors). After that, the three results are discussed in a group and supervised by the 4
                    <sup>th</sup> 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.</p>
            </sec>
        </sec>
        <sec id="sec11">
            <title>Findings</title>
            <p>The main findings are presented in this section and they are illustrated with quotations extracted from the transcripts (
                <xref ref-type="bibr" rid="ref16">Giang, 2021</xref>). After briefly describing L&#x2019;s experiences, we propose a resiliency journey that involves learning Confucian philosophies and preventive education programs at school.</p>
            <sec id="sec12">
                <title>L&#x2019;s sexual abuse traumatic experiences</title>
                <p>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&#x2019;s interview were summarized in 
                    <xref ref-type="table" rid="T2">Table 2</xref> by the research team (see 
                    <xref ref-type="table" rid="T2">Table 2</xref>).</p>
                <table-wrap id="T2" orientation="portrait" position="float">
                    <label>Table 2. </label>
                    <caption>
                        <title>L&#x2019;s summary of SAT timeline.</title>
                    </caption>
                    <table content-type="article-table" frame="hsides">
                        <thead>
                            <tr>
                                <th align="left" colspan="1" rowspan="1" valign="top">6&#x2013;11 years old</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">12&#x2013;13 years old</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">14 years old</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">15 years old</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">16 years old</th>
                                <th align="left" colspan="1" rowspan="1" valign="top">16&#x2013;to date</th>
                            </tr>
                        </thead>
                        <tbody>
                            <tr>
                                <td align="left" colspan="1" rowspan="1" valign="top">Curious, interested in learning about her body and its development</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Trusting and taken advantage of due to lack of understanding about the abusive behavior</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Begins to feel uncomfortable with abuse; Actions are taken to protest or denounce but these are not recognized; Loss of faith in family relationships</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Feels guilty knowing the truth about CSA;
                                    <break/>Decides to strongly protest and denounce the perpetrator;
                                    <break/>Feels dirty and helpless when abused again after a hiatus.</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Feels hopeless; Experiences depression; Attempted suicide; Termination of acts of aggression; Does not live with family.</td>
                                <td align="left" colspan="1" rowspan="1" valign="top">Initiation of resilience; Recalls the effectiveness of skills learned; Exchange and study Confucian philosophy; Return to the family with an official voice; Recovery and development.</td>
                            </tr>
                        </tbody>
                    </table>
                </table-wrap>
                <p>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&#x2019;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.</p>
            </sec>
            <sec id="sec13">
                <title>L&#x2019;s struggle and resilience journey </title>
                <p>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:</p>
                <disp-quote>
                    <p>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
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>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:</p>
                <disp-quote>
                    <p>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
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>Not only that, but L&#x2019;s trust in her parents also broke down:</p>
                <disp-quote>
                    <p>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
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>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:</p>
                <disp-quote>
                    <p>I know I have been abused. That is a crime. I am a victim of this incident and I must move on &#x2026; That is what I learned and [was] advised from my 9th grade homeroom teacher. However, I cannot forgive my family (including father, mother, and brother). I want to be recognized in my family! (Session 4, March 28
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>In addition, L suffered a period of depression as a result of feeling trapped and unsupported:</p>
                <disp-quote>
                    <p>Every night, feelings of emptiness and despair rise within me. Even in my dreams, I see myself being rejected by my parents. If my father had not stopped me that day, I would be dead by now. Death might be better in this case. It took me a long time to get over that emptiness and despair. (Session 5, April 11
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>L recalled the day she was most desperate, the day she attempted suicide, her father was able to intervene and tell L:</p>
                <disp-quote>
                    <p>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
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>L&#x2019;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&#x2019;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:</p>
                <p>When describing how she overcame the fear, humiliation, torment, and pain caused by the SAT, L reports that she never forgets her father&#x2019; statement [a] and considers it as her life philosophy, helping herself to be motivated to learn and overcome her dark past. L said:</p>
                <disp-quote>
                    <p>Everything that happens in the world has a cause. The fact that I was taken advantage of by my brother, as well as the way my parents treated me, was for a reason. Recalling at the age of 17, a year after that terrible day, I&#x2019;m a different person! I was able to make friends and continue my education. (Session 8. May 23
                        <sup>rd</sup>, 2020)</p>
                </disp-quote>
                <p>It is not easy for a survivor to make it through the SAT and related past experiences on their own. The case of L is different. L recovered significantly in just one year. So, what happened during that period? L recalled and recounted that:</p>
                <disp-quote>
                    <p>I met my old homeroom teacher again. I told her about moving to another place. She was glad that I was no longer abused. She asked me what I plan to do and how to live in the future. This made me think a lot. I recall a lesson in secondary school. It was a famous short story from Vietnam in 1986, about the awakening of a son just because he was so focused on searching for faraway things that he forgot about the small and simple happy things next to him. I realized I was missing out on my friends in class. They always ask and encourage me. Why did I leave them and live a closed life? Am I being too selfish and indulging my feelings? I have to change! (Session 9, June 8
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>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&#x2019;s advice, combined with her reflection on life, L realized her resources and understood how to recover from the SAT.</p>
                <p>L did not deny that CSA was a traumatic event, and faced it step by step:</p>
                <disp-quote>
                    <p>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
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>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&#x2019;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:</p>
                <disp-quote>
                    <p>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
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>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:</p>
                <disp-quote>
                    <p>The noble moral values of the Vietnamese people, as well as the practical value of life skills, give me the courage to overcome these bad things. (Session 12, July 21
                        <sup>st</sup>, 2020)</p>
                    <p>My father's statement and my family's Confucian upbringing are the things that have influenced me to this day &#x2026; Whoever you are, you will have these relationships and you have the things you need to do to achieve balance, or so-called neutrality. By the time my parents found out I was raped, my father taught me about the cycle of life. It is a lesson about self-nurture (lessons of being and relationships) in the lower part of Confucian philosophy. It took me three years to think, reflect, and learn about this lesson. (Session 12, July 21
                        <sup>st</sup>, 2020)</p>
                    <p>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
                        <sup>st</sup>, 2020)</p>
                </disp-quote>
                <p>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:</p>
                <disp-quote>
                    <p>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 my goal of regaining equality for women in Confucian families with antiquated, outdated views. I want parents to properly understand the spirit of Confucianism and give equal love to both sons and daughters. At the same time, I want female survivors like me to be brave, to fight against prejudice to gain happiness. (Session 20, October 5
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>At this stage, when reiterating the issue of CSA as well as her SAT, L was able to share very comfortably. With L, those experiences are valuable life experiences and a driving force for her development. L never forgot, nor let it affect her negatively. L commented:</p>
                <disp-quote>
                    <p>It is part of my life. I cannot deny it. The Confucian philosophy, especially the neutrality and unconditioned lifestyle, has guided me to the right, to the fight for the equal rights and safety of women and girls.</p>
                    <p>Initially, I joined a non-governmental organization for the protection of children&#x2019;s rights. During my studies, I will participate more in projects to protect children, as well as provide psychological support to victims of sexual abuse. I will help them overcome the SAT themselves. (Session 15, August 30
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
                <p>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 areas &#x2013; an area that is still heavily prejudiced in Vietnam. The researcher met L again in the next interview session, where L shared that:</p>
                <disp-quote>
                    <p>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 &#x2026; (Session 23, October 26
                        <sup>th</sup>, 2020)</p>
                    <p>Now my brother has been held accountable for his behavior. He contracted STDs and lost the ability to have children. This is retribution, a proper punishment of Heaven for him. Truly to the Confucian philosophy of &#x2018;What you sow, you reap what you reap!&#x2019;... I am not happy, not sad, and not despise him &#x2026; (Session 24, November 3
                        <sup>rd</sup>, 2020)</p>
                    <p>After a long time, I have continuously struggled and provided knowledge about CSA, corrected Confucian ideology and gender equality, my parents have changed their minds. They acknowledged the truth about my brother and expressed their regret for treating me unequally in the past. Everything happens for a reason! My father used to say so! (Session 24, November 3
                        <sup>rd</sup>, 2020)</p>
                </disp-quote>
                <p>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:</p>
                <disp-quote>
                    <p>If I use a symbol to describe my life, I will be a 
                        <italic toggle="yes">lotus.</italic> 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 beauty &#x2013; a beautiful lotus rose in the dirty mud! I want to send a message to the other survivors: &#x2018;Live like a lotus, beautiful and radiant in your way!&#x2019; (Session 25, November 10
                        <sup>th</sup>, 2020)</p>
                </disp-quote>
            </sec>
        </sec>
        <sec id="sec14" sec-type="discussion">
            <title>Discussion</title>
            <p>L&#x2019;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. (
                <xref ref-type="bibr" rid="ref18">Hailes 
                    <italic toggle="yes">et al</italic>., 2019</xref>). 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.</p>
            <sec id="sec15">
                <title>L&#x2019;s mental and spiritual resources: The passive effect of the education curriculum and the most authentic perception of Confucian philosophy</title>
                <p>In L&#x2019;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.</p>
                <p>Previous studies have confirmed that religion can be a support or impediment to the resilience of sexual abuse victims (
                    <xref ref-type="bibr" rid="ref13">Dur&#x00e0;-Vil&#x00e0; 
                        <italic toggle="yes">et al</italic>., 2013</xref>; 
                    <xref ref-type="bibr" rid="ref22">Murray-Swank &amp; Pargament, 2005</xref>). Our findings correspond with this view. Confucianism was both a barrier and spiritual support to the survivors. In L's case, during the period of abuse, Confucian philosophy was a constraint on her equal rights. She did not have a voice and couldn&#x2019;t denounce her abuser. Previous studies on mental trauma and the mental health of Vietnamese children and adolescents also provides good evidence for this outdated prejudice (
                    <xref ref-type="bibr" rid="ref23">Nguyen 
                        <italic toggle="yes">et al</italic>., 2016</xref>; 
                    <xref ref-type="bibr" rid="ref25">Nguyen, 2018</xref>). Vu argues that only once the outdated stereotypes of Confucianism have been phased out of Vietnamese families and society, can women truly have freedom (
                    <xref ref-type="bibr" rid="ref38">Vu, 2009</xref>). 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
                    <sup>st</sup>, 2020). When survivors maintain a neutral attitude toward the perpetrator and CSA-related issues by being non-judgmental, non-retaliatory, and accepting that the trauma that has happened in their life; they will be strengthened in will and inner strength. When a survivor&#x2019;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 (
                    <xref ref-type="bibr" rid="ref26">O'Harrow, 2021</xref>). 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.</p>
                <p>In terms of the impact of education, 
                    <xref ref-type="bibr" rid="ref36">Tho (2016)</xref> 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 
                    <xref ref-type="bibr" rid="ref40">Yao and Yao (2000)</xref>, 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&#x2019; 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&#x2019;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 (
                    <xref ref-type="bibr" rid="ref25">Nguyen, 2018</xref>). 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 (
                    <xref ref-type="bibr" rid="ref25">Nguyen, 2018</xref>; 
                    <xref ref-type="bibr" rid="ref20">Linh, 2021</xref>; 
                    <xref ref-type="bibr" rid="ref37">Tran, 2020</xref>). 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&#x2019;s and children&#x2019;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&#x2019;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.</p>
            </sec>
            <sec id="sec16">
                <title>L&#x2019; resiliency journey: The process of spiritual nurture towards the neutrality</title>
                <p>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 (
                    <xref ref-type="bibr" rid="ref18">Hailes 
                        <italic toggle="yes">et al</italic>., 2019</xref>). According to 
                    <xref ref-type="bibr" rid="ref13">Dur&#x00e0;-Vil&#x00e0; 
                        <italic toggle="yes">et al</italic>. (2013)</xref>, 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&#x2019; 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.</p>
                <p>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.</p>
                <p>From L&#x2019;s story, we have proposed a model of SAT resiliency detailed in seven stages (see 
                    <xref ref-type="fig" rid="f1">Figure 1</xref>).</p>
                <fig fig-type="figure" id="f1" orientation="portrait" position="float">
                    <label>Figure 1. </label>
                    <caption>
                        <title>Flow diagram showing the stages of SAT resilience in a Confucian woman.</title>
                    </caption>
                    <graphic id="gr1" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/58786/0e7dd12d-e088-4e53-ae8b-16e05ac128c5_figure1.gif"/>
                </fig>
            </sec>
        </sec>
        <sec id="sec17" sec-type="conclusion">
            <title>Conclusion</title>
            <p>L&#x2019;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.</p>
            <p>However, this study has some limitations. Although in the case presented here, L&#x2019;s religious beliefs seems to have had a positive impact on her well-being, it would be na&#x0131;ve 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&#x2019;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.</p>
        </sec>
        <sec id="sec18">
            <title>Data availability</title>
            <sec id="sec19">
                <title>Underlying data</title>
                <p>Figshare: The resiliency journey of a Vietnamese female sexual abuse survivor: An exploration in life history. 
                    <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.6084/m9.figshare.15390255.v3">https://doi.org/10.6084/m9.figshare.15390255.v3</ext-link> (
                    <xref ref-type="bibr" rid="ref16">Giang, 2021</xref>).</p>
                <p>This project contains the following underlying data:
                    <list list-type="bullet">
                        <list-item>
                            <label>&#x2010;</label>
                            <p>Anonymised transcripts (in English)</p>
                        </list-item>
                    </list>
                </p>
            </sec>
            <sec id="sec20">
                <title>Extended data</title>
                <p>This project contains the following extended data:
                    <list list-type="bullet">
                        <list-item>
                            <label>&#x2010;</label>
                            <p>Interview guide (in English)</p>
                        </list-item>
                    </list>
                </p>
                <p>Data are available under the terms of the 
                    <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/publicdomain/zero/1.0/">Creative Commons Zero &#x201c;No rights reserved&#x201d; data waiver</ext-link> (CC0 1.0 Public domain dedication).</p>
            </sec>
        </sec>
    </body>
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    <sub-article article-type="reviewer-report" id="report97618">
        <front-stub>
            <article-id pub-id-type="doi">10.5256/f1000research.58786.r97618</article-id>
            <title-group>
                <article-title>Reviewer response for version 1</article-title>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author">
                    <name>
                        <surname>Santoro</surname>
                        <given-names>Anthony F.</given-names>
                    </name>
                    <xref ref-type="aff" rid="r97618a1">1</xref>
                    <role>Referee</role>
                    <uri content-type="orcid">https://orcid.org/0000-0001-5738-0735</uri>
                </contrib>
                <aff id="r97618a1">
                    <label>1</label>HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA</aff>
            </contrib-group>
            <author-notes>
                <fn fn-type="conflict">
                    <p>
                        <bold>Competing interests: </bold>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>28</day>
                <month>10</month>
                <year>2021</year>
            </pub-date>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2021 Santoro AF</copyright-statement>
                <copyright-year>2021</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <related-article ext-link-type="doi" id="relatedArticleReport97618" related-article-type="peer-reviewed-article" xlink:href="10.12688/f1000research.55227.1"/>
            <custom-meta-group>
                <custom-meta>
                    <meta-name>recommendation</meta-name>
                    <meta-value>approve-with-reservations</meta-value>
                </custom-meta>
            </custom-meta-group>
        </front-stub>
        <body>
            <p>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&#x2019;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&#x2019;s story is inspiring, it is unclear how the findings are relevant to the field&#x2019;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&#x2019;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&#x2019;s story as a case report; (2) how this case report is relevant to the field&#x2019;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: 
                <list list-type="bullet">
                    <list-item>
                        <p>This reviewer recommends greater care in referring to evidence-based practice. For instance, the manuscript writes, &#x201c;findings provide important evidence-based practice for counselors and clinicians&#x201d; (Giang 
                            <italic>et al.</italic>, 2021, p. 3). This statement is beyond the scope of a case report and not supported by the data presented. Please see Bolton (2001)
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-97618-1">1</xref>
                            </sup> and Reid 
                            <italic>et al.</italic> (2017)
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-97618-2">2</xref>
                            </sup> for related definitions.&#x00a0;</p>
                    </list-item>
                    <list-item>
                        <p>The manuscript&#x2019;s emphasis on the pervasiveness of CSA across nationalities and cultures seems to contrast with specifying CSA as a &#x201c;crime&#x201d; (Giang 
                            <italic>et al.,</italic> 2021, p. 2), considering laws and legal considerations vary regionally and across jurisdictions. Considering the manuscript&#x2019;s focus on CSA as a traumatic experience, and not the criminality of CSA, the provided definition should reflect this focus.</p>
                    </list-item>
                    <list-item>
                        <p>The introduction would benefit from additional details, with supporting citations, on the long-term mental health consequences of CSA.</p>
                    </list-item>
                    <list-item>
                        <p>The manuscript would benefit from providing a definition of sexual abuse trauma (SAT) and explaining how this differs from CSA. These terms are used interchangeably throughout the manuscript, and this can be confusing to the reader. This reviewer recommends using one term consistently throughout the manuscript to benefit the reader. Considering the manuscript&#x2019;s focus&#x2019; on CSA, it might be clearer to the reader if the manuscript focused solely on CSA.</p>
                    </list-item>
                    <list-item>
                        <p>The manuscript would benefit from clarifying what is meant by &#x201c;the current situation surrounding CSA&#x201d; (Giang 
                            <italic>et al.</italic>, 2021, p. 3).&#x00a0;Does this refer to the experiences of CSA? The contexts in which CSA occurs? The immediate, as opposed to long-term, consequences of CSA?</p>
                    </list-item>
                    <list-item>
                        <p>The manuscript&#x2019;s consideration of socio-cultural and religious contexts regarding the effects of CSA is much appreciated and a strength of the manuscript. The introduction may benefit from briefly discussing and referencing previous studies that have found differences across specific socio-cultural or religious groups regarding the impact of CSA and other early life trauma. Please see:&#x00a0;Arredondo and Caparr&#x00f3;s (2019)
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-97618-3">3</xref>
                            </sup>; McCormick 
                            <italic>et al.</italic> (2017)
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-97618-4">4</xref>
                            </sup>; Santoro 
                            <italic>et al. </italic>(2016)
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-97618-5">5</xref>
                            </sup>.</p>
                    </list-item>
                    <list-item>
                        <p>The manuscript would benefit from describing what is meant by &#x201c;self-resilience&#x201d; (Giang 
                            <italic>et al.</italic>, 2021, p. 3) and explaining how this differs from general resilience.</p>
                    </list-item>
                    <list-item>
                        <p>The manuscript would benefit from clarifying what is meant by, &#x201c;Clinical studies on resilience in people who have been sexually abused are still highly subjective&#x201d; (Giang et al., 2021, p. 3). This statement appears to overlook the empirical studies that have examined resilience among persons who experience sexual abuse (e.g., Wilcox, Richards, &amp; O&#x2019;Keeffe, 2004
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-97618-6">6</xref>
                            </sup>; Williams &amp; Nelson-Gardell, 2012
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-97618-7">7</xref>
                            </sup>).</p>
                    </list-item>
                    <list-item>
                        <p>The phrase &#x201c;manipulations of counseling&#x201d; (Giang 
                            <italic>et al.</italic>, 2021, p. 3) is unclear and comes across as strong language. Using &#x201c;manipulations&#x201d; suggests negative connotations. Perhaps this sentence can be re-written to improve clarity and use more tempered language.</p>
                    </list-item>
                    <list-item>
                        <p>The manuscript states, &#x201c;there has been no longitudinal study addressing the long-term effects of CSA&#x201d; (Giang 
                            <italic>et al.</italic>, 2021, p. 3). This statement is not factual; please see Wilson and Widom (2008)
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-97618-8">8</xref>
                            </sup>; Fergusson, McLeod, and Horwood (2013)
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-97618-9">9</xref>
                            </sup>.</p>
                    </list-item>
                    <list-item>
                        <p>The introduction emphasizes the importance of longitudinal studies examining the long-term effects of CSA. Although this assertion seems appropriate, it is unclear how this strengthens the rationale for the current case study.</p>
                    </list-item>
                    <list-item>
                        <p>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.</p>
                    </list-item>
                    <list-item>
                        <p>The first paragraph in the section named &#x201c;The long-term effects of sexual abuse and mental support&#x201d; (Giang 
                            <italic>et al</italic>., 2021, p. 4) would benefit from including additional supporting citations.</p>
                    </list-item>
                    <list-item>
                        <p>The manuscript&#x2019;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&#x2019;s religiosity/spirituality and may result in religious/spiritual struggles. Please see Burg, Mayers, and Miller (2011)
                            <sup>
                                <xref ref-type="bibr" rid="rep-ref-97618-10">10</xref>
                            </sup>.</p>
                    </list-item>
                    <list-item>
                        <p>It is unclear what the term &#x201c;incomplete families&#x201d; (Giang 
                            <italic>et al.</italic>, 2021, p. 4) means. Clarification is needed. Likewise, this reviewer recommends considering using more sensitive language.</p>
                    </list-item>
                    <list-item>
                        <p>The following sentence in the introduction requires supporting citations: &#x201c;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&#x201d; (Giang 
                            <italic>et al.</italic>, 2021, p. 4).</p>
                    </list-item>
                    <list-item>
                        <p>This reviewer appreciates the manuscript&#x2019;s inclusion of the reflexivity section.</p>
                    </list-item>
                    <list-item>
                        <p>To remain respectful of the participant&#x2019;s confidentiality and better protect anonymity, the details identifying the participant&#x2019;s attended university should be removed. Simply stating that the participant is a university student is sufficient.</p>
                    </list-item>
                    <list-item>
                        <p>Please clarify the term &#x201c;time-lapse narrative interviews&#x201d; (Giang 
                            <italic>et al.</italic>, 2021, p. 5).</p>
                    </list-item>
                    <list-item>
                        <p>How was the second inclusion criterion, &#x201c;2. Must be currently undergoing recovery&#x201d; (Giang 
                            <italic>et al.</italic>, 2021, p. 5), determined?</p>
                    </list-item>
                    <list-item>
                        <p>Additional details regarding the case&#x2019;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?</p>
                    </list-item>
                    <list-item>
                        <p>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?</p>
                    </list-item>
                    <list-item>
                        <p>The participant&#x2019;s father&#x2019;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?</p>
                    </list-item>
                    <list-item>
                        <p>From the presented quotes, it seems like the participant&#x2019;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.</p>
                    </list-item>
                    <list-item>
                        <p>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?</p>
                    </list-item>
                    <list-item>
                        <p>The manuscript notes, &#x201c;all form a solid and enlightening spiritual resource, leading L to find her rights and her ego&#x201d; (Giang 
                            <italic>et al</italic>., 2021, p. 10). The term &#x201c;ego&#x201d; has theoretical connotations linked to psychodynamic theory and should be avoided here. Replacing the term &#x201c;ego&#x201d; with another word (e.g., confidence, self-esteem, self-worth) is recommended.</p>
                    </list-item>
                    <list-item>
                        <p>Addition clarification is needed regarding how her understanding of Confucian philosophies evolved through processing her trauma.</p>
                    </list-item>
                    <list-item>
                        <p>It seems like the participant&#x2019;s beliefs were reinforced by external events, such as her brother contracting a sexually transmitted infection and losing his ability to have children &#x2013; essentially being punished. How did her healing journey reinforce her religious beliefs?</p>
                    </list-item>
                    <list-item>
                        <p>The description of the core tenets of Confucian philosophies in the discussion is informative, and this should be presented earlier in the manuscript.</p>
                    </list-item>
                </list>
            </p>
            <p>Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?</p>
            <p>No</p>
            <p>Is the case presented with sufficient detail to be useful for other practitioners?</p>
            <p>No</p>
            <p>Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?</p>
            <p>No</p>
            <p>Is the background of the case&#x2019;s history and progression described in sufficient detail?</p>
            <p>Partly</p>
            <p>Reviewer Expertise:</p>
            <p>Early life adversity; clinical psychology; neurocognitive functioning; HIV</p>
            <p>I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.</p>
        </body>
        <back>
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        <sub-article article-type="response" id="comment7400-97618">
            <front-stub>
                <contrib-group>
                    <contrib contrib-type="author">
                        <name>
                            <surname>GIANG</surname>
                            <given-names>V&#x0168;</given-names>
                        </name>
                        <aff/>
                    </contrib>
                </contrib-group>
                <author-notes>
                    <fn fn-type="conflict">
                        <p>
                            <bold>Competing interests: </bold>The authors confirm that we do not have any competing interests with the peer review report.</p>
                    </fn>
                </author-notes>
                <pub-date pub-type="epub">
                    <day>6</day>
                    <month>11</month>
                    <year>2021</year>
                </pub-date>
            </front-stub>
            <body>
                <p>
                    <bold>On behalf of the authors, I would like to thank you for your precious review. Based on your suggestions, we have adjusted the article to better fit a reported case, as well as further clarify the view of the findings of this article in support of Clinicians have a new approach to intervene for CSA victims. Specifically:</bold>
                </p>
                <p> </p>
                <p> 1. This reviewer recommends greater care in referring to evidence-based practice. For instance, the manuscript writes, &#x201c;findings provide important evidence-based practice for counselors and clinicians&#x201d; (Giang&#x00a0;
                    <italic>et al</italic>., 2021, p. 3). This statement is beyond the scope of a case report and not supported by the data presented.</p>
                <p> 
                    <bold>Response: I have corrected the statement into the scope of a case report. The findings can be referenced as a new approach in counseling for CSA survivors with different religion.</bold>
                </p>
                <p> </p>
                <p> 2. The manuscript&#x2019;s emphasis on the pervasiveness of CSA across nationalities and cultures seems to contrast with specifying CSA as a &#x201c;crime&#x201d; (Giang&#x00a0;
                    <italic>et al</italic>.,&#x00a0;2021, p. 2), considering laws and legal considerations vary regionally and across jurisdictions. Considering the manuscript&#x2019;s focus on CSA as a traumatic experience, and not the criminality of CSA, the provided definition should reflect this focus.</p>
                <p> 
                    <bold>Response: I have corrected the manuscript to focus on the CSA as a traumatic experience.</bold>
                </p>
                <p> </p>
                <p> &#x00a0;3. The introduction would benefit from additional details, with supporting citations, on the long-term mental health consequences of CSA.</p>
                <p> 
                    <bold>Response: I have supported more citations on the term mental health consequences of CSA.</bold>
                </p>
                <p> </p>
                <p> 4. The manuscript would benefit from providing a definition of sexual abuse trauma (SAT) and explaining how this differs from CSA. These terms are used interchangeably throughout the manuscript, and this can be confusing to the reader. This reviewer recommends using one term consistently throughout the manuscript to benefit the reader. Considering the manuscript&#x2019;s focus&#x2019; on CSA, it might be clearer to the reader if the manuscript focused solely on CSA.</p>
                <p> 
                    <bold>Response: I have edited the manuscript to focus only on the CSA.</bold>
                </p>
                <p> </p>
                <p> 5. The manuscript would benefit from clarifying what is meant by &#x201c;the current situation surrounding CSA&#x201d; (Giang&#x00a0;
                    <italic>et al</italic>., 2021, p. 3).&#x00a0;Does this refer to the experiences of CSA? The contexts in which CSA occurs? The immediate, as opposed to long-term, consequences of CSA?</p>
                <p> 
                    <bold>Response: I have edited this meaning into &#x2018;studies on the CSA&#x2019;s traumatic experience and causes&#x2019;.</bold>
                </p>
                <p> </p>
                <p> 6. The manuscript&#x2019;s consideration of socio-cultural and religious contexts regarding the effects of CSA is much appreciated and a strength of the manuscript. The introduction may benefit from briefly discussing and referencing previous studies that have found differences across specific socio-cultural or religious groups regarding the impact of CSA and other early life trauma.</p>
                <p> 
                    <bold>Response: I have added and reviewed more studies in the impact of socio-culture or religion to CSA.</bold>
                </p>
                <p> </p>
                <p> 7. The manuscript would benefit from describing what is meant by &#x201c;self-resilience&#x201d; (Giang&#x00a0;
                    <italic>et al</italic>., 2021, p. 3) and explaining how this differs from general resilience.</p>
                <p> 
                    <bold>Response: I have corrected the mistaken word &#x2018;self-resilience&#x2019; into &#x2018;resilience&#x2019; with the clear definition.</bold>
                </p>
                <p> </p>
                <p> 8. The manuscript would benefit from clarifying what is meant by, &#x201c;Clinical studies on resilience in people who have been sexually abused are still highly subjective&#x201d; (Giang 
                    <italic>et al.</italic>, 2021, p. 3). This statement appears to overlook the empirical studies that have examined resilience among persons who experience sexual abuse.</p>
                <p> 
                    <bold>Response: I have corrected the idea with the new citation from the studies of resilience in CSA survivors.</bold>
                </p>
                <p> </p>
                <p> 9. The phrase &#x201c;manipulations of counseling&#x201d; (Giang&#x00a0;
                    <italic>et al</italic>., 2021, p. 3) is unclear and comes across as strong language. Using &#x201c;manipulations&#x201d; suggests negative connotations. Perhaps this sentence can be re-written to improve clarity and use more tempered language.&#x00a0;</p>
                <p> 
                    <bold>Response: I have corrected the idea into &#x2018;practicing counseling, psychotherapy&#x2019;.</bold>
                </p>
                <p> </p>
                <p> 10. The manuscript states, &#x201c;there has been no longitudinal study addressing the long-term effects of CSA&#x201d; (Giang&#x00a0;
                    <italic>et al.</italic>, 2021, p. 3). This statement is not factual.</p>
                <p> 
                    <bold>Response: I meant the Vietnamese studies. I have corrected the statement according to the Vietnamese context.</bold>
                </p>
                <p> </p>
                <p> 11. The introduction emphasizes the importance of longitudinal studies examining the long-term effects of CSA. Although this assertion seems appropriate, it is unclear how this strengthens the rationale for the current case study.</p>
                <p> 
                    <bold>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.</bold>
                </p>
                <p> </p>
                <p> 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.</p>
                <p> 
                    <bold>Response: I have removed the statements about the larger population, especially &#x2018;women&#x2019; into &#x2018;woman&#x2019;.</bold>
                </p>
                <p> </p>
                <p> 13. The first paragraph in the section named &#x201c;The long-term effects of sexual abuse and mental support&#x201d; (Giang&#x00a0;
                    <italic>et al.</italic>, 2021, p. 4) would benefit from including additional supporting citations.</p>
                <p> 
                    <bold>Response: I have included more citations from previous studies in long-term effects of CSA.</bold>
                </p>
                <p> </p>
                <p> 14. The manuscript&#x2019;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&#x2019;s religiosity/spirituality and may result in religious/spiritual struggles.</p>
                <p> 
                    <bold>Response: I have briefly mentioned the negative impact of religiosity/spirituality to the CSA trauma of survivors.</bold>
                </p>
                <p> </p>
                <p> 15. It is unclear what the term &#x201c;incomplete families&#x201d; (Giang&#x00a0;
                    <italic>et al</italic>., 2021, p. 4) means. Clarification is needed. Likewise, this reviewer recommends considering using more sensitive language.</p>
                <p> 
                    <bold>Response: I have adjusted the term &#x2018;incomplete families&#x2019; into &#x2018;broken families&#x2019;.</bold>
                </p>
                <p> </p>
                <p> 16. The following sentence in the introduction requires supporting citations: &#x201c;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&#x201d; (Giang&#x00a0;
                    <italic>et al.</italic>, 2021, p. 4).</p>
                <p> 
                    <bold>Response: I have added the supporting citation to this sentence in the manuscript.</bold>
                </p>
                <p> </p>
                <p> 17. To remain respectful of the participant&#x2019;s confidentiality and better protect anonymity, the details identifying the participant&#x2019;s attended university should be removed. Simply stating that the participant is a university student is sufficient.</p>
                <p> 
                    <bold>Response: I have re-stated that the participant is a university student.</bold>
                </p>
                <p> </p>
                <p> 18. Please clarify the term &#x201c;time-lapse narrative interviews&#x201d; (Giang&#x00a0;
                    <italic>et al</italic>., 2021, p. 5).</p>
                <p> 
                    <bold>Response: I have clarified the three key elements of narrative theorizing when processing the time-lapse narrative interviews.</bold>
                </p>
                <p> </p>
                <p> 19. How was the second inclusion criterion, &#x201c;2. Must be currently undergoing recovery&#x201d; (Giang&#x00a0;
                    <italic>et al</italic>., 2021, p. 5), determined?</p>
                <p> 
                    <bold>Response: I have added the information, &#x2018;2. Must be currently undergoing recovery (Self-assessed and double-checked by the researchers)&#x2019;.</bold>
                </p>
                <p> </p>
                <p> 20. Additional details regarding the case&#x2019;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?</p>
                <p> 
                    <bold>Response: I have corrected and adjusted the additional information of the participant which included: the participant&#x2019;s background (family structure and dynamics, social and school functioning, any significant medical history, personality attributes) and further information (the level of adult supervision and the frequency, her parents&#x2019; disclosure, the progression and frequency of the abuse, the circumstances that prompted disclosing the abuse to her teacher, the time she attempt to suicide after the sexual assault).</bold>
                </p>
                <p> </p>
                <p> 21. 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?</p>
                <p> 
                    <bold>Response: I have added more additional methodological details based on your suggestions in the manuscript in the Data collection and analysis section.</bold>
                </p>
                <p> </p>
                <p> 22. The participant&#x2019;s father&#x2019;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?</p>
                <p> 
                    <bold>Response: I have adjusted the sentence to be more clear. Her father had no intention of blaming her. He wanted her to think hard about suicide, is it the best solution? This is a view in Confucian philosophy of neutrality.</bold>
                </p>
                <p> </p>
                <p> 23. From the presented quotes, it seems like the participant&#x2019;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.</p>
                <p> 
                    <bold>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&#x2019;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.</bold>
                </p>
                <p> </p>
                <p> 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?</p>
                <p> 
                    <bold>Response: I have adjusted the sentence to be more clear, &#x2018;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.&#x2019;</bold>
                </p>
                <p> </p>
                <p> 25. The manuscript notes, &#x201c;all form a solid and enlightening spiritual resource, leading L to find her rights and her ego&#x201d; (Giang&#x00a0;
                    <italic>et al.</italic>, 2021, p. 10). The term &#x201c;ego&#x201d; has theoretical connotations linked to psychodynamic theory and should be avoided here. Replacing the term &#x201c;ego&#x201d; with another word (e.g., confidence, self-esteem, self-worth) is recommended.</p>
                <p> 
                    <bold>Response: Thank you for your recommendation. I have replaced the term &#x2018;ego&#x2019; with &#x2018;self-esteem&#x2019;.</bold>
                </p>
                <p> </p>
                <p> 26. Addition clarification is needed regarding how her understanding of Confucian philosophies evolved through processing her trauma.</p>
                <p> 
                    <bold>Response: I have adjusted the sentences in the Findings section to clarify the impact of Confucian philosophy evolved through the CSA trauma&#x2019;s resilience. You can read it again in the manuscript.</bold>
                </p>
                <p> </p>
                <p> 27. It seems like the participant&#x2019;s beliefs were reinforced by external events, such as her brother contracting a sexually transmitted infection and losing his ability to have children &#x2013; essentially being punished. How did her healing journey reinforce her religious beliefs?</p>
                <p> 
                    <bold>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.</bold>
                </p>
                <p> </p>
                <p> 28. The description of the core tenets of Confucian philosophies in the discussion is informative, and this should be presented earlier in the manuscript.</p>
                <p> 
                    <bold>Response: Thanks for your comment. I have adapted and used important information on Confucian philosophy in the section &#x2018;The long-term effects of sexual abuse and mental support&#x2019;.</bold>
                </p>
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        </sub-article>
    </sub-article>
</article>
