Supervising counsellors and psychotherapists who work with trauma: a Delphi study

In this study the Delphi technique was used to identify the main supervision issues that require attention and consideration when supervising counsellors and psychotherapists working with trauma. A panel of supervisors, who were additionally experienced in working with trauma in adulthood, completed a series of three questionnaires comprising two qualitative and one quantitative round. Themes and key concepts were identified from the data, and the respondents rated the importance of the themes using a visual analogue scale. This iterative process identified areas where there was consensus amongst the respondents and areas where contention was apparent. The results revealed significant issues pertinent to the supervision of trauma therapists, with a particularly strong emphasis around training, experience and organisational issues. Directions for further research emerging from the study are also discussed.     

Adult male survivors of childhood sexual abuse

This paper outlines the conclusions drawn from a qualitative research study which involved in-depth interviews with 2.5 adult males who had been sexually abused during childhood. The full findings have been described in Adult Male Survivors of Childhood Sexual Abuse published by Pitman (1995). The book includes many of the men's first person accounts of their experiences of abuse.     

Flashback phenomena in survivors of childhood sexual abuse: A four-stage treatment model

There has been a growing awareness of Post-Traumatic Stress Disorder (PTSD) as a consequence of childhood sexual trauma. Central to this diagnosis is the flashback experience. Flashbacks are essentially memories which have not been integrated into everyday consciousness and return as intrusive symptoms, usually accompanied by dread and panic. This article presents a treatment strategy based on a four-stage model. The model includes (1) education; (2) assisting clients in identifying their flashback patterns; (3) designing coping strategies; and (4) processing the flashback. The goal is to assist the client with the management and integration of traumatic memory.This article is based on a paper practical guidelines to treating incest survivors' flashbacks presented at the World Congress of Cognitive Therapy, Toronto, June 1992.     

Psychological assessment of adult survivors of childhood sexual abuse within a naturalistic clinical sample

This study investigates the long-term effects of childhood sexual abuse (CSA). Differences between abused and nonabused individuals in psychiatric symptomatology, interpersonal functioning, social and occupational functioning, personality dynamics, and therapeutic alliance were examined. The relationship between abuse severity and long-term effects was also analyzed. Data were gathered from 51 patients seeking individual psychotherapy at a community outpatient clinic. Findings suggested that CSA survivors tend to experience greater psychiatric distress and poorer interpersonal functioning than nonabused clinical controls. No significant differences were found in social and occupational functioning or in alliance developed by the end of the therapeutic assessment process. Abuse severity was significantly related to increased symptomatology and poorer interpersonal functioning. Findings support and extend existing literature and are especially useful for clinicians working with abuse survivors.     

A short-term group treatment model for gay male survivors of childhood sexual abuse living with HIV/AIDS

HIV-positive gay male survivors of childhood sexual abuse (CSA) face three layers of trauma: childhood abuse, homophobic oppression, and HIV/AIDS. Additionally, CSA has been shown to increase HIV risk behavior among gay men, and the trauma of HIV infection often parallels the experience of CSA. Effective coping strategies are particularly important for people living with HIV/AIDS in order to adapt to physical, psychological, and social implications of infection. However, coping strategies once adaptive in the context of CSA may become maladaptive in adulthood. Interventions are needed that enhance coping and address CSA for survivors living with HIV/AIDS to protect their own health and to prevent new transmissions. This article presents a group model found to be efficacious for treating gay male survivors of CSA living with HIV/AIDS.     

Context matters: the benefits and costs of expressing positive emotion among survivors of childhood sexual abuse

Positive emotions promote adjustment to aversive life events. However, evolutionary theory and empirical research on trauma disclosure suggest that in the context of stigmatized events, expressing positive emotions might incur social costs. To test this thesis, the authors coded genuine (Duchenne) smiling and laughter and also non-Duchenne smiling from videotapes of late-adolescent and young adult women, approximately half with documented histories of childhood sexual abuse (CSA), as they described the most distressing event of their lives. Consistent with previous studies, genuine positive emotional expression was generally associated with better social adjustment two years later. However, as anticipated, CSA survivors who expressed positive emotion in the context of describing a past CSA experience had poorer long-term social adjustment, whereas CSA survivors who expressed positive emotion while describing a nonabuse experience had improved social adjustment. These findings suggest that the benefits of positive emotional expression may often be context specific.     

Memory retrieval in treating adult survivors of sexual abuse

Abstract

Therapists working with adult survivors of sexual abuse must be sensitive to the powerful ambivalence such clients have toward addressing their victimization. They fear experiencing the significant emotional turmoil which occurs in therapy and the powerful loyalty conflicts they encounter in their families-of-origin. Establishing rapport and allowing clients to set the pace for disclosing and addressing their abuse are critical components of the therapy process. The authors describe effective Ericksonian approaches for establishing these critical treatment elements. Ericksonian techniques for utilizing the client's internal resources and retrieving repressed memories are also discussed, followed by case examples illustrating specific hypnotic methods.     

Psychodynamic group therapy for male survivors of sexual abuse

The group therapy literature on male sexual abuse is very preliminary and concerned solely with short-term support models. This paper describes a long-term psychodynamic therapy group for male survivors that has been running successfully in a clinic setting for almost three years. This combined group and individual treatment approach presupposes the selection of men who are capable of using group process to explore basic personality and relationship problems. With sexually abused men, certain treatment issues are paramount. These concern the safety of group boundaries, power and control, facilitating intimacy, handling shame and guilt, and the effects of trauma. Special attention is given to the gender-related dynamics and conflicts that occur in a group of male survivors with a male leader.     

Resolving the trauma organized system of sexual abuse by confronting the abuser: A focal family therapy approach with a woman who was a childhood victim of sexual abuse

The longer-term emotional and interpersonal effects of sexual abuse in childhood are reviewed and approaches to treatment discussed. The notion of a 'trauma organized system' to account for the long-standing effects of abuse is described. A major potential issue in creating therapeutic change is confronting the abuser, and a case is described where a woman brought her family for therapy when it was feared that the father, who had abused her in childhood, might abuse his grandchildren. A focal family therapy approach was used: this takes into account the traumatic nature of abusive events and their long-term organizing effects on individual and family functioning. The process of therapeutic work is described, including the resolution of traumatic effects by confronting the abusive act.     

Secondary traumatic stress and adjustment in therapists who work with sexual violence survivors: the moderating role of posttraumatic growth

ABSTRACT

Due to their secondary exposure to the traumatic events disclosed by clients, therapists who work with sexual violence survivors are at risk of experiencing secondary traumatic stress. We examined whether the negative effects of secondary traumatic stress on therapist adjustment would be buffered by posttraumatic growth. Sixty-one therapists who work with sexual violence survivors completed measures of secondary traumatic stress, posttraumatic growth and a range of adjustment indicators. Hierarchical multiple regression analyses demonstrated that posttraumatic growth moderated the negative impact of secondary traumatic stress on therapist depression, anxiety, personal meaning and satisfaction with life. Posttraumatic growth sustained positive affect through a direct effects model only. This study provides support for the protective role of posttraumatic growth in adjustment to secondary traumatic stress.     

The impact of Christian counselling on survivors of sexual abuse

The absence of research and growing involvement of Christians in all areas of counselling gave rise to this study which explores the impact of Christian counselling on adult survivors of sexual abuse. The sample of 44 women and 5 men from an inter-denominational, self-help network, completed a self-report questionnaire of perceived Christian and professional counselling experiences involving issues of trust, power, directive approach, use of prayer and Scripture, responsibility and outcome. Results show that Christian counselling is experienced as qualitatively different from professional counselling: Christian counsellors are perceived as significantly more directive and more powerful than professional counsellors and the overall outcome was perceived more negatively. A number of key factors were identified which influenced the negative experience of some Christian counselling. These included having experience of professional counselling, an emphasis on the use of prayer and Scripture, perceiving the counsellor to have different goals from the client, feeling blamed for continued distress and having prior experience of prayer ministry. Implications for counselling practice and training are discussed.     

A qualitative study of childhood sexual abuse survivors in Taiwan: toward a transactional and ecological model of coping

In this study, we aimed to explore the experiences of 10 female Taiwanese childhood sexual abuse (CSA) survivors (age range = 20-39 years) to broaden our understanding of the post-abuse coping process in a Chinese sociocultural context. This investigation was grounded on a feminist paradigm, and the consensual qualitative research method (Hill et al., 2005; Hill, Thompson, & Williams, 1997) was utilized as the strategy of inquiry. The transactional and ecological model of coping that emerged from the data describes the dynamic interplay among (a) intrapersonal, interpersonal, and sociocultural factors and (b) the coping process and outcomes of CSA survivors. Implications for research on CSA recovery and culturally appropriate interventions in a collectivistic sociocultural context are discussed.     

Research into the organisation,training and effectiveness of counsellors who work for free

The activities of voluntary or ‘paraprofessional’ counsellors, who work for free, represent a highly significant component of the delivery of psychological therapy in Britain and other countries. However, in recent years there has been relatively little published research into issues associated with the provision of service by counsellors who work on a voluntary part‐time basis, and who typically receive limited training and supervision. This paper introduces a special theme section on counselling in the voluntary sector, which highlights some recent examples of research into the context, organisation, training and effectiveness of such counsellors. Some suggestions are made concerning the research agenda for counselling in the voluntary sector.     

The relationship between childhood sexual abuse and sexual health practices of homeless adolescents

This study explored the gender differences in sexual self-concept, personal resources for sexual health, safe sex behaviors, and risky sexual behaviors among homeless adolescents with and without histories of sexual abuse. Data for this secondary analysis were collected in 2003 to 2004 in the first phase of a larger repeated-measures sexual health intervention study; 371 homeless youth between 16 and 23 years of age (M = 19.26, SD = 1.83) were recruited from a street outreach center. The majority (64.6%) of participants were males. Self-report instruments were completed at the outreach center via audio computer-assisted self-interview (A-CASI) format. It was found that female participants were better off than males on numerous measures of sexual health behaviors and attitudes. Sexually abused participants had significantly less future time perspective (p = .05), fewer sexual self-care behaviors (p = .04), and less social support than nonabused participants (p = .01) and almost significantly more sexual risk-taking (p = .08). However, no significant differences were found between abused and nonabused participants on sexual self-concept, self-efficacy or intention to use condoms, safe sex behaviors, AIDS knowledge, assertive communication, or self-efficacy to perform testicular/ breast self-exams. Overall, participants who did not report a history of sexual abuse had significantly more sexual health resources and engaged in fewer sex-risk behaviors than those who reported having been abused. These differences have notable implications for screening adolescents for a history of sexual abuse. Adolescents who report sexual abuse should receive risk counseling and be screened regularly for the development of sexual risk behaviors.     

Sex differences in childhood sexual abuse and suicide-related behaviors

Child sexual abuse and suicide-related behaviors are associated, but it remains unclear if the strength of this association differs in boys and girls. In a systematic review of this association in children and youth, we identified 16 relevant studies, all cross-sectional surveys of students. The association is stronger in boys specific to suicide attempt(s). Adjustments for potential confounding variables explained some, but not all of this sex difference. While additional research would strengthen causal inferences, this sex difference may be influenced by the nature and timing of child sexual abuse as well as the sex of the perpetrator, which in turn shapes the disclosure of these events.     

Emotions and suicidal ideation among depressed women with childhood sexual abuse histories

Depressed women with sexual abuse histories have a heightened risk of suicidal ideation (SI), which may be only in part attributable to psychiatric symptoms of depression and posttraumatic stress disorder (PTSD). Emotions and SI were studied among 106 women with histories of childhood sexual abuse enrolled in treatment trials for major depression. Assessments were conducted at baseline, 10, 24, and 36 weeks. Sadness, guilt, and shame-proneness were associated with self-reported and observer-rated SI across time after adjusting for depressive and PTSD symptoms, suicide attempt history, and sociodemographic characteristics associated with SI. These findings highlight the need for clinical attention to self-directed negative emotions to potentially reduce suicide-related risk.