Counselling Survivors of Childhood Sexual Abuse (Therapy in Practice)

Series: Therapy in Practice In this Third Edition of Counselling Survivors of Childhood Sexual Abuse, Claire Burke Draucker and Donna S Martsolf identify the.
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Alternatively, in an inconsistent parenting environment where there is a lack of responsiveness to a child, this will influence the child's sense of self and make him or her feel unworthy of love. In this situation, children tend to develop extreme dependency and clinginess, characteristic of a preoccupied attachment pattern. Some survivors of CSA develop a fixation on safety in their adult relationships. Fearfulness, jealousy, feelings of emptiness, abandonment fears, problems with identity, emotional outbursts, and lack of boundaries are all features of Borderline Personality Disorder BPD; American Psychiatric Association, In a sample of incest survivors, Alexander found that attachment predicted avoidance of memories of the abuse along with various personality disorders, including BPD.

Rose is 61 years old. She had been adopted after her biological family died in a car crash. She reported that her biological parents were Jewish Danish immigrants. When she was adopted, she was 6 years old. Her stepfather was the minister of a church who molested her in the basement where he worked.

Rose reported having flashbacks of violence toward her. She said that her stepfather was an authoritarian who controlled everything. Rose had many difficulties later in life as a result of her CSA and the lack of a secure base and loving caregivers. The blatant betrayal of her adoptive parents made it very difficult for her to form interpersonal relationships as an adult, and this fear of intimacy probably contributed to her status as the only support group member without a spouse.

She suffered from multiple health problems and did not have the social support that would have allowed her to cope adequately with all her economic, medical, and social struggles.

Best Clinical Practices for Male Adult Survivors of Childhood Sexual Abuse: “Do No Harm”

Externalizing factors of betrayal include anger and hostility. Survivors often express anger towards the abuser, other family members, society, and themselves Finkelhor, Gender differences emerge regarding the direction of anger. Alternatively, girls show more aggressive behaviors toward themselves.

Female survivors of CSA are more likely to have attempted suicide Dube et. Steele found that girls who had experienced CSA had higher levels of suicidal thoughts and activities. Adolescents with histories of suicidal behavior and suicidal ideation are more likely to experience attachment-related trauma e. Another dynamic of CSA that has a harmful influence on survivors is the feeling of powerlessness. A small child who is being sexually abused does not have the power to defend himself or herself from the predator in the home.

Unlike other traumatic events that are rare or isolated, living with an abuser is unremitting stress for a dependent child. A chronic state of hyperarousal and vigilance can cause dysregulation of a child's developing brain and body, as the home, a supposed safe haven, is a place of danger and degradation where the abused child is powerless to escape.

Continuous feelings of being trapped add to a sense of powerlessness. According to the Learned Helplessness Hypothesis developed by Abramson, Seligman, and Teasdale , when a person considers outcomes in life to be uncontrollable—or if their attributions for failure are stable, global, and internal—he or she is more likely to develop depression. Much evidence has accumulated that overall, when a person lacks an internal sense of control over his or her life, that person is more prone to depression e.

Another major effect of powerlessness is anxiety, which is expressed through increases in fearfulness, somatic complaints, changes in sleep, and nightmares American Psychiatric Association, These symptoms are frequently associated with post-traumatic effects of CSA, often resulting in the development of anxiety disorders, including PTSD e.

For example, Ashley reported her feelings of helplessness and powerlessness since her father was in charge of everything, and she could not disclose her abuse to anyone. For Ashley, her feelings of powerlessness as a child led her to become preoccupied with remaining in control of situations as an adult. In order to command more power over her life, she was very committed to therapy and spent many years on developing a strong sense of self.

Complex PTSD is more difficult to diagnosis and treat, leaving survivors with more severe health issues and somatic complaints, personality and identity changes, and with an increased vulnerability to future harm. However, secure attachment can lead to a willingness to confront memories of trauma Alexander, A predisposition toward anxiety disorders and PTSD can be tied to the attachment perspective. It is the responsibility of an attentive, caring parent not only to protect a child, but also to teach the child self-protection strategies.

A parent who is abusive or neglectful does not serve as a secure base and may not teach a child the necessary coping strategies. A child who grows up in such a way will not have a functional working model of how to remain secure and sufficient, and this child may be predisposed to further victimization. Moreover, the lack of a supportive family system would make any victimization more likely to result in psychological damage. Ashley, Rose, Roberta, and Sue, who were participating in the group therapy, all reported having continuous nightmares, intrusive thoughts, and flashbacks--traumatic reenactments--of their sexual abuse.

Ashley reported that until her 40s, she had constant nightmares about the incidents of the abuse and rape.

Healing from Sexual Abuse & Incest - Mental Health help with Kati Morton

She reported that she started to change the events in her nightmares through talking to herself in her dreams and showing herself a way out of the abuse. Rose, on the other hand, reported that she had lots of nightmares until her stepfather died. Roberta's intrusive thoughts and flashbacks of her abuse consistently undermined her relationships with her children and ability to be present and engaged with them; she is still using anxiolytic medications, along with antidepressants, to feel like she is in control of her life.

The last dynamic related to sexual abuse is stigmatization. Stigmatization can be described as abuse-specific shame and self-blame. Such negative connotations about abusive experiences are communicated to children Finkelhor, These negative meanings are transmitted to children in many ways. For example, the abuser may directly blame, insult, or humiliate the child for the abuse, or the abuser may command the child to keep this activity secret. Stigmatization also occurs when attitudes from others carry negative connotations, both in and out of the family Finkelhor, When a child experiences stigmatization following sexual victimization by an adult, it is an example of misdirected blame and the failure of the family system to put responsibility on the perpetrator.

Roberta is 37 years old. She is married with two sons. When she was growing up, starting at age 6, Roberta was sexually abused by her older brother. She reported that he was doing sexual things to her and threatened her not to tell their parents. At age 11, Roberta told her brother to stop, and he did. She reported that it was almost as difficult as the abuse to go through that disclosure process, and she still suffers from anxiety and depression.

She reports that she feels responsible for the abuse due to this.

What can I do to prevent this in the future?

Additionally, through the exchange of affection, attention, privileges, and gifts for sexual behavior, a child might learn sexual behavior as a strategy to manipulate others to satisfy personal needs. Sue is a 49 year-old sexual abuse survivor who has never been married but has partner for 11 years. She reported that when she was growing up, her father was her perpetrator. She reported that her parents spent little time together and had little communication. Sue reported that when she was growing up, she spent most of her time with her father, and he was trying to satisfy his sexual needs through her.

He would buy expensive gifts for her while her mother became jealous. Sue reported that she has a hard time understanding why her mother was not monitoring them while they were spending enormous amounts of time alone with each other. Attachment history exerts a powerful and direct influence on relationships later in life. Some maladaptive attachment patterns that may emerge from the loss of an attachment figure are compulsive self-reliance or compulsive care-giving; adults with anxious attachments are more likely to demand love and care or to be compulsively caring yet simultaneously resentful that the caring is not reciprocated Bowlby, Such interpersonal difficulties often make therapy or counseling with mental health professionals indispensable for the person with a history of CSA who is looking to improve his or her mental health.

The recommendations for physicians in these studies indicate the need to slow down the examination process to enable more communication with the patient as well as asking the patient for permission to proceed with the examination. Yet, no recommendations exist to address the issue of childhood sexual abuse and its potential impact on adult male patients.

Male survivors of all forms of severe childhood psychological, emotional, or physical abuse resist disclosure of physical and psychological symptoms. Adherence to the guidelines we propose when interacting with male patients with histories of trauma can be a powerful tool for helping deliver more beneficial health care to all men.

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Research has shown that although only a small fraction of physicians routinely inquire about historical traumatic incidents, most patients report that they would actually favor such inquiries. Volunteers from two peer support organizations MaleSurvivor and Males for Trauma Recovery provided vignettes of their distressing experiences receiving health care services.

Communication privacy management theory developed a way of understanding how people evaluate the amount and type of privacy they need or want in interpersonal relationships and the ramifications of decision making about disclosure. I had told my cardiologist of my problem. When I was on the table in the operating room with IV Valium [diazepam] and morphine, I still, somewhere deep in my brain, realized that there was a needle stuck in my groin [for heart catheterization and implanting a stent].

I started flailing about in a full-blown panic attack. The doctor called for a crash team and had people hold me down while they administered restraints and got an anesthetist to put me completely under. I had conscious sedation for the procedure. I told the doctor that I am a survivor of incest. During the procedure, I woke up feeling the scope inside my body and someone holding the cheeks of my behind open. I called out to the doctor that I was awake.

I heard him tell the anesthesiologist to give me more sedation. Once I was in recovery, I knew what had happened, but the doctor did not mention it and acted as if nothing happened. Just like my dad after he would rape me, it was not mentioned, as if it never happened. The abuse frequently happened at night once my parents had fallen asleep. The thought of someone watching me sleep brought up a little apprehension, yet the thought of possibly dying in my sleep [because of obstructive sleep apnea] overrode my anxiety, at least in the beginning of this medical procedure.

I was lying on the bed, when the nurse put the instrument that measures the breath through the nostrils, my understanding of the procedure and all the coping techniques I had went out the window. The instrument placed in my nostrils triggered my rape response. It was as if the perpetrator was there placing his hands over my mouth and nose all over again.

I felt like vomiting, but nothing came out. I went home and just blanked out for a while, then fell asleep. The office never called my primary doctor to explain what happened.

Attachment Theory

I was not able to find a woman urologist that would see adult male patients. I told the urologist about the sexual abuse when I was a kid, but he seemed not to get it. When he did the digital rectal examination, I winced due to the discomfort, and he joked: I woke up in the emergency room, and I was very scared. The thorough examination included a rectal exam. I began to shiver; I guess I was nervous, and I refused the examination.


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The ER [emergency room] doctor explained that he needed to see if I was bleeding and if that was why I passed out. Crying, I told him that my brother forced me to have anal intercourse when I was a kid. He was really cool. He said it was my choice to be examined. He told me if I agreed I would feel some pressure but he would be very brief. After, he asked me if I was okay and if I wanted to talk to a social worker. The new doctor told me what the scope was all about, and I freaked. I told him no way is anything going in my mouth and down my throat. He asked me if I had this test before or some other similar examination that upset me.

I thought a moment and I said what the hell. I told [him] when I was nine, my hockey coach would get me drunk on beer and then I had to [perform oral sex on him]. The doctor looked shocked and sad. He told me I really needed this scope and he understood why I was upset about it. I knew he was right so I agreed to do it. The day of the scope, the doctor was very kind to me.

He talked to me a lot about the scope and what he would be doing while I was sedated. Communication privacy management theory indicates that disclosure of private information, such as a history of sexual abuse or other ACEs, relies on privacy rules. The men in these vignettes decided to disclose, which then altered the relationship with the physician.

The resulting physician-patient relationship was unsuccessful in that the patients reported a negative experience. The physicians in Vignettes 5 and 6 responded empathically. You will be able to learn to distinguish between these. Additionally, when you come to therapy and start to deal with some of these memories you may gradually begin to remember more detail. This can feel quite disconcerting to experience but it is perfectly normal. Our unconscious mind stores memories away in different ways in order to try to protect us from the trauma we experienced. Unlocking memory is a gradual process that can be dealt with in therapy, sometimes over a number of years.

The issues of trust and of memory raise the question of being believed. This is the third aspect of counselling for survivors of sexual abuse that we want to talk about this week. Child abusers often plant ideas in the minds of their victims about what might happen if they ever tell.

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These might be threats against you or your family. Or it might be that they have suggested to you that the abuse was somehow your fault or that you colluded in it. It takes an enormous leap of faith to tell about your abuse for the first time. You will be watching very carefully for any reaction or doubt on the part of your therapist. We understand the difficulty this creates especially in the light of what we have said about the effects of trauma on memory. We will listen to what you have to say with openness and without making any judgement of you.