Aspects of Safe Attachment in the Recovery from Trauma

Abstract

The attachment capacities of trauma survivors were hypothesized to be positively related to their recovery from traumatic event(s). Recovery from psychological trauma is conceptualized as consisting of multiple criteria, and proceeding through a series of stages. The safe attachment dimension of the Multidimensional Trauma Recovery and Resiliency (MTRR) scale was examined through factor analyses, resulting in four factors or subscales. One hundred and twenty-six participants were rated according to recovery status and on the MTRR scale by clinicians from various clinical settings. Recovery status was positively correlated with the overall Safe Attachment dimension and with each of the four separate subscales. Implications for psychotherapeutic goals are discussed.     

Cognitive interference for trauma cues in sexually abused adolescent girls with posttraumatic stress disorder

Investigated cognitive processing of fear-relevant information in sexually abused adolescent girls with posttraumatic stress disorder (PTSD) using a modified Stroop procedure (MSP). Participants were 20 sexually abused girls with PTSD, 13 sexually abused girls without PTSD, and 20 nonvictimized girls who served as controls, 11 to 17 years old. Word conditions included abuse-related threat, developmentally relevant (related to the experience of sexual abuse, e.g., trust, secrecy, and intimacy), general threat, positive, and neutral. Girls with PTSD were expected to show cognitive interference for trauma-related words as well as for developmentally relevant words, relative to adolescents without PTSD. Overall color naming was significantly slower in the PTSD group than in the nonabused controls. Contrary to expectation, all participants demonstrated cognitive interference for trauma-related words. Relevant theoretical and methodological issues are highlighted.     

Multidimensional Self-Perception of Sexually Abused Girls: Factor Models and Differences Between Sexual Abuse and Comparison Groups

This study investigated the multiple dimensions of self-perception in a sample of sexually abused and nonabused comparison girls (n = 140), with particular attention to self-perception in the scholastic, social, athletic, physical (appearance), and behavioral conduct domains. First, this study examined whether the five dimensions of self-perception were psychologically discrete. Second, the relationships between the self-perception factors and childhood sexual abuse were investigated using structural equation modeling. The results supported the multidimensionality of self-perception and suggested the presence of two distinct second-order self-perception factors: academic- and social-self. While the sexually abused girls indicated less positive perception for the academic-self than the comparison group, the two groups did not differ regarding the social-self. The findings highlight the importance of a multidimensional approach to self-perception in assessing and treating sexually abused children.     

Sexual and Physical Abuse Among Adolescent Girls with Disruptive Behavior Problems

We examined the prevalence and age of onset of physical and sexual abuse in a clinic-referred sample of adolescent girls, as well as differences in diagnoses and symptoms among abused and non-abused girls. Forty-nine girls (aged 13–17 years) with disruptive behavior were interviewed along with their primary caretaker. Data were gathered through both a structured interview with the girl and her parent, as well as self and parent-report questionnaires. Findings indicated that the prevalence of Conduct Disorder (CD) and Major Depression were higher for abused girls. Somatoform Pain Disorder was significantly less likely for physically abused girls, compared to girls who were both physically and sexually abused. Of CD symptoms, truancy was twice as high for the physically and sexually abused group, compared to the prevalence for non-abused girls. Internalizing symptoms were also highest for the dual abuse group. Onset graphs show that the onset of sexual abuse usually occurred at an earlier age than the onset of physical abuse. Abused girls showed an earlier age of onset of CD symptoms. Results indicated that the experience of combined types of abuse is associated with a poorer psychiatric prognosis.     

Child molestations by homosexual foster parents: Illinois, 1997--2002

Do those who engage in homosexuality disproportionately sexually abuse foster or adoptive children as reported by child protective services? Illinois child services reported sexual abuse for 1997 through 2002. 270 parents committed "substantiated" sexual offenses against foster or subsidized adoptive children: 67 (69%) of 97 of these mother and 148 (86%) of 173 of these father perpetrators sexually abused girls; 30 (31%) of the mothers and 25 (14%) of the father perpetrators sexually abused boys, i.e., 92 (34%) of the perpetrators homosexually abused their charges. Of these parents 15 both physically and sexually abused charges: daughters by 8 of the mothers and 4 of the fathers, sons by 3 of the mothers, i.e., same-sex perpetrators were involved in 53%. Thus, homosexual practitioners were proportionately more apt to abuse foster or adoptive children sexually.     

Counselor preference and anticipated comfort ratings for a clinic sample of sexually abused versus non-abused girls

We compared counselor preference and anticipated comfort ratings for sexually abused and non-abused girls. Twenty-five sexually abused and 22 non-sexually abused girls between ages 7 and 17 participated in an initial psychological evaluation at a university outpatient clinic. Results obtained using the Counselor Preference and Comfort Survey revealed no significant difference between sexually abused and non-abused girls' ratings of their preference for male or female counselors and their anticipated comfort with male counselors; non-abused girls expressed significantly higher anticipated comfort with female counselors than did their abused counterparts. It was illustrated that younger girls', abused and non-abused, were more likely to prefer a female counselor and to anticipate being more comfortable with a female counselor. In addition, older non-abused girls were more likely to prefer a male counselor and more likely to anticipate being comfortable with a male counselor. Participants in both groups expressed a higher preference for and anticipated comfort with female counselors as compared with male counselors.     

A Prospective Study of High-School Adolescent Sexting Behavior and Psychological Distress

Abstract

Relying on conceptualization of sexting as a deviant behavior, which appear to be related with mental health problems, we examined the relationship between sexting and psychological distress. A one-year longitudinal study was performed among 216 girls and 143 boys, aged from 15 to 17?years (M?=?16.32, SD = .64). Participants completed the Sexting Behavior Questionnaire and the Depression Anxiety and Stress Scale at both time points of the study. The results showed that the prevalence for receiving sexts between the two time points was around 30%, and for sending sexts around 60%. The prevalence rates of receiving and sending sexually explicit context were quite stable over time, though they varied significantly across gender. Participants usually had sexted with a current or (ex)partner or friends. The number of person with whom participants exchange sexts did not exceed five. Anxiety and stress symptoms were more prevalent among sexters who receive sexts at the baseline than follow-up study (p < .05). Stress has been found to be significant predictors of sending sext at the baseline study (p < .05), while depression of receiving and sending at the follow-up study (p < .001). This study confirms that sexting is common among youth, and appears to be associated with negative consequences.     

Transference and countertransference issues with sexually abused clients

Abstract

This paper explores some of the therapeutic issues which arise when working with sexually abused clients. It is suggested that both the client and the therapist may at moments take any of the three positions in the Oedipal triangle and that the mother, father and child status are interchangeable in the transference and counter-transference. It is also suggested that the Oedipus myth represents the failure of a family to contain sexual and murderous passions. I describe a Hindu myth which takes a similar triangle of passion but illustrates how containment is possible. It is proposed that this implies we need to re-evaluate the presence of the erotic in therapy in a more positive light. It is further suggested that the sexually abused client needs to experience the containment of passion if a healing process is to occur.     

Questioning Children Who May Have Been Sexually Abused

Summary

This article derives from an Open Forum on Leading Questions sponsored by the American Professional Society on the Abuse of Children. It represents the thoughts of participants in the Open Forum, and the article attempts to integrate analogue research that relates to questioning children about past events into questioning practice with children who may have been sexually abused. It proposes a continuum of questions that includes four categories: most preferred, preferred, less preferred, and least preferred.     

The Multidimensional Trauma Recovery and Resiliency Instrument

Abstract

This paper describes two studies leading to the construction of and psychometric support for the MTRR-99, a shortened version of the Multidimensional Trauma Recovery and Resiliency Scale (MTRR-135, formerly MTRR). In the first study, the original body of MTRR-135 data was reevaluated to remove psychometrically weak or theoretically unnecessary items. The remaining 99 items were then assessed for reliability, validity, and internal consistency. In the second study, the new MTRR-99 was applied to assess the recovery status of 164 incarcerated women prisoners with extensive abuse histories. Together, these two studies further document the utility of a multidimensional approach to assessing trauma impact, recovery, and resiliency; in addition, they provide preliminary evidence for the MTRR-99 as a viable measure for use with clinical and non-clinical populations.     

Strengthening Voices

SUMMARY

As a therapist I have chosen to work with adolescent girls whose voices are among the weakest in our society. They have been sexually, physically and/or emotionally abused as children. Many have seen their mothers beaten by their boyfriends or husbands. Many have body-perfection obsessions such as anorexia and bulimia. Almost all of them have run away from home, hung out downtown, stolen property, relied on drugs and alcohol, and purposefully hurt themselves to take away their feelings. Many have resorted to selling their bodies on the streets or within their peer groups. They all operate from a self-belief of worthlessness, a belief that has gender socialization and abuse at its core. It is at this core that the therapeutic relationship must begin. This article describes a therapy relationship with a 14-year-old girl. This work with adolescent girls is described as being guided by three main principles, that of relationship, justice and soul work.     

Women's disclosure of sexual abuse

Abstract

In this qualitative study of women who have experienced nonconsensual sexual activity, participants were asked to write accounts of their experiences focusing on what motivated them to confide in someone, to whom they confided, what the outcome was, and how it effected them. Participants had to be female and 18 years of age or older, and they had to have been sexually abused at some point in their lives. A total of 10 women participated. Nine of the women wrote about an abusive experience that happened to them as a child, and one wrote about an experience that occurred in adulthood. The participants wrote that they were able to disclose their past sexually abusive experience because they felt safe with the person to whom they confided, they felt they needed help, and the opportunity presented itself. They were more likely to disclose to non-family members than family members, and the majority of the people they disclosed to had a positive reaction. Consequently, most of the women in this study were positively affected by their disclosure. Findings of this study are similar to those of other studies on disclosure and sexual abuse.     

Rorschach assessment of malevolence in sexually abused girls.

Clinical samples of sexually abused and nonabused girls were compared on COP/AG, a proposed Rorschach index of malevolence. Defined as the co-occurrence of COP and AG in a single response, this variable is introduced as a Rorschach analog of a measure of malevolence devised for use with narrative material. Sexually abused girls scored significantly higher on COP/AG than did nonabused girls (p < .01), with no group differences emerging for either COP or AG alone. These findings provide empirical support for the salience of malevolence in the interpersonal perceptions and expectancies of victims of childhood sexual abuse. Clinical implications and directions for future research are discussed.     

Multigenerational Sexual Abuse: A Cognitive Developmental Approach to Understanding Mothers in Treatment

This paper takes a cognitive developmental perspective in the qualitative analysis of 9 interviews of women who were sexually abused as children and whose children were also sexually abused. It discusses ways in which the development of cognitive self-understanding can by stymied by childhood sexual abuse and how this, in turn, can affect a woman's ability to parent her children and take full advantage of psychotherapy. It studies the recovery process that participants describe at various stages of a social cognitive developmental model of self-understanding. Finally, it promotes the use of a cognitive developmental perspective in clinical work and offers suggestions for counselors addressing issues of childhood sexual victimization.     

Presenting problems of sexually abused girls receiving psychiatric services

Twenty-three behaviors among those suggested in the literature to be associated with sexual abuse were studied in 195 girls, ages 2-18 years, who were consecutive admissions to three Midwestern mental health agencies. Results indicated that sexually inappropriate behaviors, sleep disturbance, depressed mood, and delinquent behavior occurred more frequently in young abuse victims than in clinic comparisons. Sexually inappropriate behaviors and running away appeared more often in older sexually abused girls, than they appeared in older clinic comparisons. These comparisons of the presenting problems of sexually abused and nonabused girls suggested there are few behavioral "markers" of sexual abuse in clinical samples and that sexual abuse may not be a unique contributing factor in the ontogeny of childhood psychopathology.     

Current Treatment Strategies for Sexually Abused Children

SUMMARY

Given the disturbingly high prevalence of child sexual abuse, the expertise of medical and mental health professionals in treating child sexual abuse victims is essential. Relevant issues in treating these children include the mindfulness of developmental considerations, incorporation of a multi-modal therapeutic evaluation approach, clarification of treatment goals, appropriate use of and integration of various treatment modalities, and effective treatment termination. This article provides an introduction aid overview of treatment of sexually abused children of all ages, from preschoolers to adolescents, with special emphasis on the importance of developmentally linked evaluation and treatment strategies. Treatment is discussed in terms of goals, stages from evaluation to termination, and formats and modalities including individual psychotherapy, family psychotherapy, group psychotherapy and hypnotherapy, to provide a comprehensive overview of current treatment strategies for sexually abused children.     

A Latent Class Analysis of Childhood Maltreatment: Identifying Abuse Typologies

Multiple forms of abuse may co-occur, resulting in specific abuse typologies. A stratified random probability survey was conducted in Denmark with 4,718 participants, aged 24, from the 1984 birth cohort. A total of 2,980 interviews were successfully conducted. Latent class analysis was implemented using 20 categorical abuse experience items across four domains of childhood maltreatment. Logistic regression was conducted to ascertain whether abuse typologies could be differentiated by child protection status and gender. Four distinct abuse typologies were revealed: a non-abused group, a psychologically maltreated group, a sexually abused group, and a group experiencing multiple abuse types. Child protection status and female gender were predictive of group membership in certain abused groups compared to a non-abused group.     

Assessing Trauma Impact,Recovery, and Resiliency in Refugees of War

Abstract

This paper describes the psychometric properties and process of using the Multidimensional Trauma Recovery and Resiliency Scale (MTRR) with 83 untreated war-affected adolescent and adult refugees of diverse cultures, family of origin, age, gender, and time since the war. The MTRR met reliability, validity, and utility criteria with this convenience sample. This paper discusses modifications made to the MTRR-I format, questions, and prompts to enable work with the wide range of ages and cultures represented in the sample. The results support the MTRR as a tool that may have the ability to capture the complexity of culture as well as measure a variety of trauma responses and work with other measurements. Limitations of the study and avenues of future research are discussed.