Treatment Techniques for Adult Female Survivors of Childhood Sexual Abuse

The author reviews recent empirical, case study, and conceptual literature that examines or discusses treatment techniques for adult female survivors in individual therapy. These techniques are divided into the following 11 categories: relationship-building techniques; questioning: family-of-origin techniques; writing techniques; gestalt work, role playing, and psychodrama; transactional analysis and inner-child work: hypnotherapy and guided imagery; cognitive techniques; behavioral techniques; life-skills training; and other techniques. The author concludes with implications for researchers and practitioners.     

The Satir Model with Female Adult Survivors of Childhood Sexual Abuse

Child sexual abuse is a recognized problem in the United States and Canada. There are several approaches to therapy with adult survivors of childhood sexual abuse. This article discusses Virginia Satir's model of therapy as it applies to sexual abuse. The emphasis of the Satir model is on transforming the impact of the abuse, no matter how the client chooses to process her relationship with the abuse, and is illustrated through a case study.     

Spirituality and the Current Adjustment of Adult Survivors of Childhood Sexual Abuse

We explore the role of spirituality in the current adjustment of adult survivors of childhood sexual abuse (CSA). A sample of 101 men and women survivors of CSA completed questionnaires on spirituality (relationship with God or higher power), person factors (blame attributions, self-acceptance, hope), and current adjustment (mood, personal growth, resolution of the abuse). Results indicated that relationship with a benevolent God or higher power is related to the experience of less negative mood and a greater sense of personal growth and resolution of the abuse. Also, relationship with a higher power is related to other person factors such as self-acceptance and hope. Relationship with a benevolent God appears to have an indirect link to depressive mood and resolution of abuse through the mediating pathways of hope and self-acceptance. In contrast, relationship with God appears to have a more direct association to the outcome of personal growth for these survivors .     

Clinically Significant Change After Cognitive Restructuring for Adult Survivors of Childhood Sexual Abuse

This study investigated the outcome of cognitive restructuring for adult survivors of childhood sexual abuse in terms of clinically significant change. Twenty-six participants were assessed for depression, State anxiety, State anger, State guilt and self-esteem before and after 10 weekly sessions of group Rational-emotive behavior therapy, and at follow-up after 8 weeks. In contrast to a previous analysis of the data in terms of statistical significance, indicating significant improvements on all variables from pre- to posttreatment, an analysis based on clinically significant change showed a differentiated treatment effect. Cognitive restructuring was found to be highly effective in facilitating recovery on anxiety, depression and anger, but less effective for guilt and low self-esteem. Only 3 patients (11, 54%) recovered on all 5 variables, while 10 patients (38, 46%) showed recovery on at least 4 variables. Relationship to the perpetrator and pre-treatment irrational evaluative beliefs (measured by means of the Survey of Personal Beliefs) were found to be the best predictors of treatment outcome. A poor response to treatment was associated with the perpetrator being a close family member and with more Other-directed Shoulds, while recovery was associated with the perpetrator being a friend or stranger and with more Awfulizing, Self-directed Shoulds and negative Self-worth beliefs.     

Adult Re-collections of Childhood Sexual Abuse

A controversy exists regarding adults who come to bear memories of childhood sexual abuse. This debate in both the scientific literature and popular press has evolved into a dichotomous categorization which demands an identification of these memories as either "true" or "false." This paper will lend a theoretical foundation to the discussion, considering the phenomenon from a variety of perspectives, including: psychoanalytic, developmental and cognitive theories of psychology, folkloristic studies, and the sociology of knowledge. The goal of this consideration is to determine what can be said about "truth" in light of these memories. Implications for social work practice and research are provided.     

Childhood Sexual Abuse and Female Spiritual Development

Religiously involved lay women (N = 266), 31% of whom had been sexually abused in childhood, filled out the revised Spiritual Experience Index (SEI-R). Results showed higher SEI-R scores for the sexually abused group, with a more accepting attitude compared with those with a striving attitude. A subscale of the SEI-R revealed that the sexually abused may turn to their faith and spirituality for support. Those with the highest educational achievements, Catholics, and those who experienced emotional abuse scored high on the Spiritual Openness subscale. Implications for spiritual development and counseling are discussed.     

A Group Design for Adult Female Survivors of Childhood Incest

This paper will describe short term groups for women sexually molested as children. The goals of such a group were to provide an atmosphere in which women could discuss the experience of sexual abuse, explore the consequences of incest, be exposed to the probably phases of recovery and discuss practical coping skills. The design of the group is detailed, as are recommendations and relevant issues for therapists. Women's responses to the group, such as increase in self-esteem, trust level, assertiveness and confrontation with the abuser, are also discussed.     

Timing Disclosure Sessions: Adding a Narrative Perspective to Clinical Work with Adult Survivors of Childhood Sexual Abuse

Though the literature on the diagnosis and treatment of survivors of childhood sexual abuse has burgeoned in the last 20 years, relatively little guidance is available in the popular or professional literature to assist clients or therapists about issues of disclosure of this abuse to family members. When authors explicitly focus on disclosure, the timing of such disclosure is usually framed within a psychological and/or interpersonal perspective. In this article, we suggest that attention to characteristics of the sexual abuse narrative itself offers an important additional resource to guide decision making with respect to disclosure. We also describe ways that a narrative approach to disclosure can produce empowering conversational practices. A detailed case example provides the clinical material to illustrate this narrative approach to disclosure.     

Childhood Sexual Abuse

Abstract

Childhood sexual abuse is a problem that leads to serious psychological disturbances evidenced through the symptoms of post-traumatic stress disorder (PTSD). This article discusses the treatment of sexual abuse survivors within a psychoanalytic framework. Different theoretical perspectives including classical Freudian, ego-psychological, object-relational and self-psychological are presented. Several relational treatment models, including feminist psychodynamic approaches, are offered. Themes include the importance of developing a strong therapeutic alliance and analyzing transference responses.     

Using Narrative Therapy in the Treatment of Adult Survivors of Childhood Sexual Abuse in the Context of Couple Therapy

Abstract

Childhood Sexual Abuse (CSA) is a prevalent social issue. Many theoretical approaches have been applied to the treatment of CSA, these approaches predominately focus on the treatment of children and adolescents, failing to address adulthood and couples’ relations. This limited focus fails to address long-lasting relational implications CSA survivors face. This paper proposes the application of a systemic therapeutic modality, Narrative therapy when treating adult survivors of CSA in couple therapy. The treatment of CSA in the context of couple therapy will be discussed. Clinical vignettes will be used. Implications for clinical practice and future research will be discussed.     

Current Treatment Strategies for Dissociative Identity Disorders in Adult Sexual Abuse Survivors

SUMMARY

During the past decade, increasing numbers of clinicians and researchers have suggested that the dissociative disorders, including dissociative identity disorder (DID), may be more prevalent than previously hypothesized. The “rediscovery” of DID is due, in part, to the recognition that early childhood trauma in conjunction with the propensity to dissociate, are etiologic factors for the development of DID. The purpose of this article is to raise clinical consciousness regarding DID, discuss the definition and etiology of the dissociative disorders, their assessment, and an approach to treatment of the sexual abuse survivor who has DID. This treatment program, while integrating some of the techniques recommended by others, is unique in its step-by-step flexible organization as well as its multifaceted format. The author's experience to date suggests that the sooner that a dissociative disorder can be identified in the adult sexual abuse survivor client, the more rapid the therapeutic progress.     

Hierarchical Relationships in Dependency Grids: Explorations in Survivors of Childhood Sexual Abuse

A methodology for representing the patterns of dependency in a dependency grid using partial order scalogram analysis by coordinates (POSAC) is presented. The technique, devised by Shye (1985) Shye, S. 1985. Multiple scaling: The theory and application of partial order scalogram analysis, Amsterdam: North Holland.  [Google Scholar], shows these patterns as hierarchical relationships that indicate superordinate and subordinate resources. An index of depth of resource support is calculated in addition to an index of breadth of resource (which is shown to correspond to an index of dispersion of dependency). The procedure was applied to data from 54 survivors of child sexual abuse and a similar number of control subjects who all completed both an adult and child dependency grid. There was significantly less breadth of resource in the abuse group, more so for the child version than the adult, but there was significantly more depth of resource in the dependency grids from the child sexual abuse survivors.     

A Preliminary Report Comparing Trauma-Focused and Present-Focused Group Therapy Against a Wait-Listed Condition Among Childhood Sexual Abuse Survivors with PTSD

Summary

The movement among states to promulgate, publish, and implement treatment standards for programs and providers of treatment for men who batter has gained increasing momentum in recent years. This movement, in turn, has created controversy. On the one hand, there are those who view the process of standards development, as well as the products, as essentially good and evolving. On the other hand, there are those who have argued that the process has been flawed, exclusionary, and the products based more on philosophy than sound science. The present paper describes the thoughts of a researcher who also served as chair of a state standards committee. The role of research in standards development and evolution is discussed. The role and contribution of researchers to a collaborative process of standards development and implementation is discussed. Suggestions for enhancing the collaborative process are provided.     

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.     

Levels of Social Support and Coping Strategies in Adult Survivors of Child Sexual Abuse

The study examined the effects of levels of social support and types of coping strategies on the psychological adjustment of adult survivors of childhood sexual abuse. Five hundred students from two universities in the Limpopo Province of South Africa participated in this study (males =115, females = 383). Mixed methods were used for the collection and data analysis. Higher the level of social support received correlated with superior psychological adjustment. The specific types of coping styles adopted did not affect psychological adjustment in the survivors.     

An Analysis of the Impact of Prison on Women Survivors of Childhood Sexual Abuse

Summary

The prevalence of child abuse histories among incarcerated women has fundamental implications for understanding women's well-being during incarceration. This review of the literature on child sexual abuse and women in prison suggests that incarcerated survivors are likely to be frequently reexposed to the powerful traumatizing processes associated with their early abuse, including traumatic sexualization, powerlessness, stigmatization, and betrayal (Finkelhor & Browne, 1985). Reexposure to these traumagenic dynamics has the potential to trigger traumatic reJivings of imprisoned survivors' pasts, to which survivors respond with a variety of coping strategies often seen in prison, including substance abuse, violence, self-injury, and suicide. The implications of these dynamics and women's responses to them for those who work with incarcerated women, for prison policy, and for research are discussed.     

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.     

Intrafamilial Sexual Abuse: Family-of-Origin and Family-of-Procreation Characteristics of Female Adult Victims

We examined connections between incest victims' family-of-origin and family-of-procreation characteristics in a sample of 40 American women who were in treatment for childhood or adolescent experiences of victimization. Retrospective data on their families-of-origin were collected along with their perceptions of current relationships with family members in the three-generational system. Results showed a close association between family-of-origin and family-of-procreation characteristics, especially in the areas of intergenerational intimacy, intergenerational fusion/individuation, and personal authority. A number of significant correlations were also found between subjects' past and present relationships with family-of-origin members and the dimensions of moral and religious orientation, achievement, and intellectual and cultural orientation, conflict, and control in their family-of-procreation. Some aspects of individual adjustment, including alienation, emotional discomfort, and defensiveness, were strongly related to various family-of-origin and family-of-procreation characteristics.     

Autobiographical Memory Disturbances in Childhood Abuse Survivors

Summary

Clinicians have noted that childhood abuse survivors frequently report that they have forgotten large parts of their childhood. While memory for abusive experiences has attracted a great deal of attention from researchers, other types of memory disturbances may also accompany a history of childhood trauma. Many clinicians report that certain types of sexual abuse, and abuse at certain developmental stages, is more likely to result in reports of gaps in memory for the abuse. However, because information has been mainly collected in clinical populations, the possibility of confounding between abusive experiences and psychological disturbances cannot be ruled out. This article reports on data gathered from a large, epidemiologic study conducted within a health maintenance organization. A history of childhood physical or sexual abuse doubled the prevalence of general autobiographical memory loss for women, while for men, the rate increased 1.5 times over those with no abuse history. Higher rates of autobiographical memory loss were noted where both types of abuse were reported. Further, multiple incidents of sexual abuse, sexual abuse by a relative, and more severe sexual abuse increased reports of autobiographical memory loss. Theoretical perspectives on changes in the memory system that may affect trauma survivors are discussed.     

Remembering and Forgetting Childhood Sexual Abuse

Out of a large number of university students who responded to a questionnaire about childhood sexual abuse (CSA), approximately a quarter reported that they had an experience in childhood that qualified. The majority of students who reported a CSA experience refused, elsewhere in the questionnaire, to classify themselves as ‘sexually abused’. Moreover, those who claimed lack of understanding of the event at the time it occurred also reported that they thought about the event less often in the intervening years and that they conceivably would have not remembered the event even if asked directly about it. Lack of understanding at the time of encoding leads to less reported memory. These observations are discussed in terms of possible mechanisms for how genuine sexual abuse experiences might be temporarily forgotten-even for extended periods-and subsequently remembered.