Treating the Sexual Concerns of Adult Incest Survivors and Their Partners

SUMMARY

Negative attitudes about sex and sexuality and many types of sexual dysfunction are common aftereffects of sexual child abuse and incest. The traumatic sexualization and the aversive sexual conditioning resulting from childhood abuse have long gone unrecognized, however. This article presents research findings regarding the impact of incest on sexual attitudes and functioning along with treatment recommendations.     

African American Women Survivors of Sexual Assault:

More attention has recently focused on the psychological experiences of women survivors of sexual assault. However, little work has examined the experiences of African American women survivors, particularly with regard to the impact of race and class on survivors' experiences. We address these limitations by presenting a socio-historical analysis of African American women's rape experiences. This analysis considers the relationship between sexual and economic oppression in African American women's lives. Second, we discuss the influences of these socio-historical factors on African American women's post-assault experiences. Finally, recommendations for therapy with African American women survivors are provided.     

Mediators of Posttraumatic Mental Health in Sexual Assault Survivors

The development of posttraumatic growth (PTG) and the relationship between PTG and distress outcomes in sexual assault is an important area of investigation. Recent research suggests that some forms of cognitive processing might be critical in the development, maintenance, and resolution of posttraumatic mental health among sexual assault survivors. The objective of this study was to examine factors associated with posttraumatic mental health among sexual assault survivors. Seventy-three participants who experienced sexual assault completed measures of trauma symptoms, PTG, changes in outlook, cognitive processing, and support and coping. Results revealed that significant levels of posttraumatic symptomatology and low levels of PTG were reported 3 years following sexual assault. A weak relationship was found between symptoms of distress and growth. Contrary to predictions, only ratings of hope and brooding rumination were mediators of the relationship between posttraumatic symptoms and PTG. Reflective rumination was not related to the development of PTG.     

The Phenomenon of Comparative Development Between Female Survivors and Their Partners: Implications for Couples Therapy

The aim of this phenomenological study was to better understand the influences of families of origin on couple relationships when the female was a childhood sexual abuse survivor. Six couples participated in semi-structured individual interviews and each individual completed two-week diaries. The findings revealed that female survivors and their partners had comparable developmental histories. Implications for practice include the importance of recognizing that (1) male partners who had developmental experiences that were similar to those of their partners may contribute to the difficulties in the current couple relationship; and (2) both partners’ developmental experiences should be taken into consideration equally to facilitate the female survivors’ recovery process.     

Correlates of Postassault Self-Defense/Assertiveness Training Participation for Sexual Assault Survivors

Past research has shown that self-defense/assertiveness training may have positive implications for sexual assault survivors. However, little is known about the correlates of self-defense/assertiveness training participation for sexually victimized women. In this study we examined the assault characteristics and experiences that relate to women's enrollment in postassault training using data from 1,623 female college sexual assault survivors. It appears that more violent attacks may lead survivors to enroll in postassault training, especially when their resistance was less effective. Postassault training participants were marginally more likely to have told someone about their assault, experienced less supportive reactions from others, exhibited marginally less current anxiety, and reported more postassault suicidal ideation than nonparticipants. These survivors may enroll in training to exercise control over future assaults occurring and as a way of healing from sexual assault. Suggestions for future research and the development of self-defense training programs for sexual assault survivors are presented.     

Couples Therapy with Childhood Sexual Abuse Survivors (CSA) and their Partners: Establishing a Context for Witnessing

This article proposes a clinical practice for therapy with couples in which one partner suffered sexual abuse in childhood. Such couples often encounter unique difficulties with physical contact, intimacy, sexuality, communication, and trust, and their relationship dynamic may be marked by reenactments of past traumatic relational patterns. This clinical practice is founded on the assumption that establishing the witnessing lacking during the traumatic event in childhood can break the traumatic reenactments in adulthood, and spur recovery. The suggested practice may facilitate twofold witnessing: the couple's therapist witnesses the reenactments of the trauma in the couple's relationship; and the survivor's partner witnesses the trauma's effect on the survivor's personal life and relationship. Twofold witnessing can help break the cycle of traumatic reenactment and help the survivor integrate the events of her life into a more coherent, continuous narrative. The partner's presence also facilitates acknowledgement of what happened to the survivor, and helps the survivor elaborate on her stories of resistance, survival, and strength. Finally, each of the partners is able to appear more wholly and fully, and together to tell the preferred stories of their life as a couple, replete with the multiple relational patterns they wish to live, which may contradict the characteristics of the original trauma.     

Cultural Considerations for Treating PTSD in Latinx Sexual Assault Survivors With Prolonged Exposure

There is growing interest in the implementation of culturally responsive mental health care that balances treatment fidelity and cultural fit (Castro et al., 2004). Prolonged exposure (PE) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD) and has been successfully implemented in low-income and ethnoracial minority samples (Feske, 2008) and with Latinx individuals specifically (Vera et al., 2011). However, cultural and systemic factors may contribute to Latinx individuals experiencing higher conditional risk for PTSD (Alcántara et al., 2013), disparities in mental health care utilization (Alves-Bradford et al., 2020), and challenges with PTSD treatment delivery (Valentine et al., 2017). Culturally responsive implementation of PE with Latinx clients involves making culturally informed but person-specific assessments of clients, with adaptations as needed. We propose several culturally responsive strategies for therapists to consider when conducting PE with Latinx sexual assault survivors, such as building trust and rapport early on, conducting culturally informed assessment, investing in psychoeducation, optimizing imaginal exposure and in vivo exposure, and problem-solving barriers to homework engagement. Therapists are encouraged to approach this work with cultural humility (Fisher-Borne et al., 2015; Tervalon & Murray-Garcia, 1998) through open listening, critical self-reflection, and consideration for the way in which Latinx identity intersects with other important identity characteristics that can impact treatment relevance and engagement.     

See the Triumph Healing Arts Workshops for Survivors of Intimate Partner Violence and Sexual Assault

Existing research demonstrates the potential value of arts-based interventions for survivors of abuse and other forms of trauma. The See the Triumph Healing Arts Workshops were designed to provide survivors of intimate partner violence and sexual assault with an opportunity to express themselves and connect with others through arts-based interventions. When appropriate, using the art developed through the workshops to create an art exhibit can be useful for raising awareness and giving voice to survivors in the local community. The preliminary results of the pilot evaluation suggest that the workshops were well-received and allowed participants to experience emotional expression, connection with others, and greater self-awareness.     

Correlates of Serious Suicidal Ideation and Attempts in Female Adult Sexual Assault Survivors

Relations between (a) serious suicidal ideation and attempts and (b) demographics, trauma history, assault characteristics, post‐assault outcomes, and psy‐chosocial variables were examined among female adult sexual assault survivors. Younger, minority, and bisexual survivors reported greater ideation. More traumas, drug use, and assault disclosure related to greater attempts, whereas perceived control over recovery was related to fewer attempts. Child sexual abuse and some assault characteristics predicted suicidal behavior. Depression was related to suicidal behavior until psychosocial variables were accounted for. Specifically, using substances to cope and self‐blame predicted greater ideation, whereas receiving aid/information support was related to less ideation. Implications for research and treatment are discussed.     

Issues in Sex Therapy with Survivors of Intrafamily Sexual Abuse

No abstract available for this article.     

Sexual Assault Programming for College Students

The authors discuss workshops designed to promote awareness of sexual assault and to provide education about such assault on college campuses.     

Subjective Sleep Disturbances in Sexual Assault Survivors: Associations With Trauma and Posttraumatic Stress Disorder Symptom Severity

Prior work implicates sleep disturbance in the development and maintenance of posttraumatic stress disorder (PTSD). However, the majority of this literature has focused on combat veteran men, and limited work has examined links between sleep disturbance and PTSD symptoms in sexual assault survivors. This is a notable gap in the literature, as sexual trauma is disproportionately likely to result in PTSD and is more common in women. We sought to examine the relations between subjective sleep disturbance, sexual assault severity, and PTSD symptoms in a sample of sexual assault survivors with PTSD (PTSD+), without PTSD (PTSD-), and healthy controls. The sample (N = 60) completed the Insomnia Severity Index and prospectively monitored their sleep for 1 week using the Consensus Sleep Diary. The sexual assault survivors also completed the Sexual Experiences Survey and PTSD Checklist-5. Results of group comparisons found that the PTSD+ group reported significantly higher insomnia symptoms, longer sleep onset latency, more nocturnal awakenings, and lower sleep quality compared to the healthy control group and higher insomnia symptoms compared to the PTSD- group. Results of regression analyses in the sexual assault survivors found that insomnia symptoms and number of nocturnal awakenings were significantly associated with higher PTSD symptoms, and sexual assault severity was significantly associated with higher insomnia symptoms, longer sleep onset latency, and lower sleep quality. These findings highlight specific features of sleep disturbance that are linked to trauma and PTSD symptom severity among sexual assault survivors.     

Sexual Assault: The Female Victim,Her Male Partner,and Their Relationship

Using the Crisis model of Fox and Scherl, treatment issues for the female sexual assault victim and her male partner are proposed.     

Her Body Speaks: The Experience of Dance Therapy for Women Survivors of Child Sexual Abuse

This qualitative, phenomenological study explores the experiences of dance therapy for 5 women who had been sexually abused as children. Using in‐depth, largely unstructured interviews, the women reflect on their dance therapy experiences and on their perceptions of the role of these experiences in their psychological healing. Analysis of these data revealed 6 common themes related to the women's sense of spontaneity, permission to play, struggle, freedom, intimate connection, and bodily reconnection. The implications of the findings are discussed in terms of the therapeutic nature of dance therapy and how this therapeutic modality facilitates change and healing in clients' lives.     

Integrating Internal Family Systems and Solutions Focused Brief Therapy to Treat Survivors of Sexual Trauma

In a recent study 56% of women and 37% of men were survivors of childhood sexual abuse. These individuals who experience sexual trauma may experience depression, anxiety, post-traumatic stress disorder (PTSD) or substance use disorders (Devlin et al., in Fam J 27(4):359–365, 2019). While there are several treatment approaches specifically developed to target trauma and its effects, (e.g., trauma focused cognitive behavioral therapy, and eye movement desensitization and reprocessing) we propose that integrating internal family systems therapy (IFS) and solution focused brief therapy (SFBT) offers a brief, systemic way to improve family relationship patterns in families where one member has experienced sexual trauma. A case vignette is used to show the integration of these two approaches.

     

The Lesbian Victim of Sexual Assault:

No abstract available for this article.     

Politicizing Survivors of Incest and Sexual Abuse

Abstract

As both a feminist therapist and a survivor of incest, moving myself beyond therapeutic issues into an area of public education has been crucial to my own healing process. Receiving positive responses to my workshops and discussion groups, it became apparent that using a similar approach with clients who were survivors might be beneficial to their healing. As a member of The Counseling Center for Women, a feminist therapy collective in Israel, I suggested we sponsor a public exhibition and a series of programs of the topic of incest and abuse. The Municipality of Tel Aviv was approached to be its governmental sponsor. Entitled “Silent No More,” the program moved therapists and clients from working in the privacy of therapy to a public forum. What began as an uncomplicated educational program became an emotional process and a politicizing of individuals to help others as well as themselves. Moving from a feeling of shame to a sense of empowerment, the exhibition gave us a new sense of self-esteem and strength in our own abilities and our recovery process.