Refusing to be Marginalized: Groupwork in Mental Health Services for Women Survivors of Childhood Sexual Abuse

Childhood sexual abuse is a major aetiological factor in the development of mental health difficulties experienced by women. Although this conclusion is supported by two decades of extensive research, it has had little impact on the provision of mainstream mental health services. It remains exceptional for there to be specialist therapy or counselling provision for women survivors of childhood sexual abuse within statutory mental health services. This represents a serious gap in service provision and, it is argued, results in extended and inappropriate treatment for women survivors using mental health services. In this article, the development of a multi-agency approach to the provision of groupwork for women survivors of childhood sexual abuse within mental health service is described. A women-centred model of groupwork is outlined. Evaluation and funding are discussed. It is argued that, as a time-limited and effective treatment option, groupwork for women survivors of childhood sexual abuse should form a central part of service provision within statutory adult mental health services.     

Unresolved Childhood Sexual Abuse: Are Older Adults Affected?

This article presents case studies and discussions regarding three observed characteristics of unresolved childhood sexual abuse in adult survivors over 65 years of age. Specifically, chronic depression, elder abuse, and the misdiagnoses of residual abuse trauma as dementia or mental illness are compared to parallel issues identified by researchers in younger adult survivors. A brief overview of the childhood abuse literature and recommendations regarding professional training, the development of new services, and additional research are included.     

Testing Posttraumatic Stress as a Mediator of Childhood Trauma and Adult Intimate Partner Violence Victimization

This study examined whether potential posttraumatic stress disorder (PTSD) mediated the relationships between different forms of childhood trauma (sexual abuse, physical abuse, violence between caregivers) and intimate partner violence (IPV) victimization (psychological, physical, sexual). Participants were 1,150 female nurses and nursing personnel. Path analytic findings revealed potential PTSD partially mediated the relationships between childhood sexual abuse and psychological IPV and childhood sexual abuse and sexual IPV. Potential PTSD did not mediate the relationship between other types of childhood trauma and IPV. This study adds to the literature indicating PTSD as a risk factor for revictimization in the form of adult IPV among women. Screening for and treatment of PTSD among female child sexual abuse survivors could prevent future IPV victimization.     

Further Labeling Within the Category of Disability Due to Chemical Dependency Disorder

This paper raises issues of validity and consequences of appending the label Borderline Personality Disorder to chemically dependent women who are adult survivors of child sexual abuse. Parallels between documented sequelae of childhood sexual abuse and DSM-III-R delineated characteristics of Borderline Personality Disorder are noted as is the DSM-III-R insertion of "No information" with respect to Predisposing factors. This clinician suggests that the label Borderline Personality Disorder and its accompanying assumptions function to generate negative expectations regarding both the course and direction of the therapy process. By failing to consider the impact of childhood abuse this label provides neither appropriate diagnosis nor therapeutic directionfor women with a diagnosis of chemical dependency who are adult survivors of childhood sexual abuse.     

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.     

The Role of Sexual Trauma in the Treatment of Chemically Dependent Women: Addressing the Relapse Issue

A review of the literature indicates a high incidence of sexual trauma among women who seek treatment for substance abuse. Additionally, clients who have experienced sexual trauma appear to be more susceptible to relapse, the return to substance abuse. This article explores issues surrounding sexual trauma and chemical dependency. It aims to provide direction for relapse prevention with a relapse-prone population. Application of traditional milieu substance abuse treatment for sexual trauma survivors is explored. Recommendations for working with sexual trauma survivors who are also substance abusers are presented, as are suggestions for research.     

Top Ten Questions Male Sexual Abuse Survivors Want to Know from Health Care Research

Sexual abuse is an often overlooked public health issue for boys and men. Given its prevalence and well-documented connection to mental and physical health disorders, the relevance of male survivor input and engagement in health care research is profound. Using a community-based participatory research design, an in-person focus group with male survivors of sexual abuse and researchers was conducted. This paper describes the top ten research questions male sexual abuse survivors would like to have answered. Survivors were most interested in knowing how sexual abuse and assault impact men’s emotional and sexual functioning, what factors are involved in preventing and treating sexual assault-related emotional distress, and what can be done to prevent sexual abuse of boys and men. The fact that some of the questions survivors expressed an interest in knowing about have actually previously been investigated by researchers suggests a disconnect in translating evidence-based findings. Clinical and research implications include designing outreach interventions and gender-specific psychoeducation to increase engagement and access to care for men.     

Recovery from sexual assault: an innovative two-stage group therapy model

This article describes an innovative two-stage model of sexual assault therapy groups for women in a university setting. This model is recommended for use in various settings and includes a supportive therapy group and two specialized therapy groups, one for childhood sexual abuse survivors and the other for sexual assault (acquaintance rape and stranger rape) survivors. Theoretical underpinnings of the model are discussed in addition to practical aspects of group development such as elements of an effective group, screening of potential members, and marketing and recruitment techniques.     

Memory for autobiographical facts and events: a comparison of women reporting childhood sexual abuse and non‐abused controls

Although there is evidence that many adult survivors of childhood sexual abuse (CSA) have a period when they forget their abuse, existing research is equivocal about whether such individuals show other autobiographical memory impairments. The present study addressed some of the sampling and measurement problems apparent in previous studies and compared 74 women reporting a history of CSA with 60 non‐abused controls on their ability to recall facts and events from childhood. The results showed that the CSA group did not differ from the controls in the quality of their memories for autobiographical incidents. However, they were significantly less able than controls to recall specific facts about their personal history, such as significant addresses and names of significant individuals, after controlling for educational level, depression and childhood address changes. CSA group participants reporting a period of abuse forgetting appeared more impaired than those with continuous abuse memories in their recall of personal semantic facts, but were similar in their recall of autobiographical incidents. The findings suggest that experiencing a period of abuse forgetting is a more influential factor in predicting the ability to recall personal semantic facts than abuse status alone. Copyright © 2002 John Wiley & Sons, Ltd.     

Childhood physical and sexual abuse in depressed patients with single and multiple suicide attempts

Research has shown both childhood physical and sexual abuse to be associated with later suicide attempts, although some studies have not supported these findings. However, few studies have investigated differences in physical and sexual abuse histories among single and multiple suicide attempters. The goals of the current study were two-fold: (a) to replicate previous findings of associations between childhood sexual and physical abuse and suicide attempts, and (b) to explore differences in reports of childhood physical and sexual abuse among single and multiple suicide attempters. While our results supported the findings that individuals with a history of suicide attempts are more likely to report histories of childhood physical and sexual abuse, we did not find a difference in reported abuse between single and multiple suicide attempters. Implications of these findings, as well as implications for future research, are discussed.     

Effects of Incest in Aging Survivors: Psychopathology and Treatment Issues

Most older people who have been sexually abused in childhood have probably never been treated for the consequences of their destructive experiences. The character pathology and long-term effects of child sexual abuse are described. Parallels were drawn between delayed Posttraumatic Stress Disorder seen in older veterans and World War II victims and later-life onset of posttraumatic psychopathology in aging incest survivors. Special geropsychological treatment issues, such as the appropriateness of explicit inquiry regarding a history of abuse and the role of power, gender, and shame in the psychotherapeutic relationship, are presented. The dilemma of uncovering repressed malignant childhood trauma in aging individuals is discussed. With proper medical and psychological preparation, demanding curative interventions with older survivors may be considered.     

Sexual trauma and personality: developmental vulnerability and additive effects.

Two types of sexual trauma, sexual abuse in childhood and rape in adulthood, were investigated in terms of possible effects on personality. Four groups of participants were studied: women who had experienced sexual abuse in childhood, women who had experienced rape as adults, women who had experienced both of these sexual traumas, and a control group of women who had experienced no sexual trauma. Personality functioning was assessed using the Dimensional Assessment of Personality Pathology. Groups who had experienced childhood sexual abuse displayed the highest degree of personality disturbance; however, the additive effects of repeated sexual trauma were limited. These findings may reflect the outcome of specific adversity in childhood on the psychobiological constructs underlying personality.     

Social and emotional outcomes of childhood sexual abuse: A review of recent research

A total of 41 articles examined the social and emotional outcomes of childhood sexual abuse. The outcomes examined included suicide and substance use, gang involvement, pregnancy, running away, post-traumatic stress disorder (PTSD), risky sexual behavior, and behavioral problems. Results for each of these outcomes tended to vary by developmental period. However, problems of internalizing and externalizing behavior appeared to be specific to sexually abused children of all age groups. Some studies found differences in outcome according to gender, race, and age. Although findings related to abuse characteristics were found to vary from study to study, severity of the abuse, use of force, and victim's relationship to the perpetrator were found to be especially important. Other factors, such as family support and parental monitoring, were found to mitigate a negative outcome. Limitations are discussed along with suggestions for future research.     

The Importance of a Comprehensive Clinical Diagnosis for Group Psychotherapy of Borderline and Narcissistic Patients

This article presents a psychoanalytically oriented model of group treatment for female adult survivors of childhood sexual abuse. Two key treatment, issues—the survivor's struggle to trust her own mind and her tenacious allegiance to an omnipotent, all-bad self-representation—are used to illustrate ways in which the transference/countertransference matrix of the group permits members to enact, identify, and work through central internalized relational configurations. The group therapist's role is to maintain transitionality, a focus on process, and the capacity for play.     

The counsellor as researcher: Boundary issues and critical dilemmas

Some of the ethical issues that emerged during a study of adult male survivors of childhood sexual abuse are reviewed Some cases where boundary issues became problematical, and the dilemmas faced in working within a person-centred, qualitative approach, are discussed. Considerations for counselling researchers and their trainers when undertaking research are examined     

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.     

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.     

THE NEED FOR POWER IN WOMEN WHO WERE SEXUALLY ABUSED AS CHILDREN An Exploratory Study

Ten women who had been sexually abused as children and a matched group of women who had not been sexually abused participated in a preliminary study to explore the hypothesis that feelings of powerlessness and a compensatory need for power continue into adulthood for survivors of childhood sexual abuse. The Picture-Story Exercise (PSE) was used as an indirect assessment technique to determine the level of the need for power (McClelland, 1985; Winter, 1973, 1988). Results indicated that the stories of women with sexual abuse histories revealed a higher need for power and greater fear of power than those of nonabused women. Further content analysis of the PSE revealed that sexual abuse survivors' stories also contained more references to Finkelhor and Browne's (1986) dynamics of powerlessness, traumatic sexualization, betrayal, and stigmatization. These findings suggest important directions for future research as well as areas for therapeutic exploration.     

Childhood trauma and marital outcomes in adulthood

Although existing research suggests that certain childhood traumas such as childhood sexual abuse are associated with interpersonal (e.g., marital) difficulties in adulthood, there has been limited research on interpersonal sequelae of other types of traumas. In addition, the association between childhood traumas and interpersonal outcomes has often been limited to a particular outcome such as divorce, and existing studies have rarely controlled for the co‐occurrence of other traumas when evaluating interpersonal outcomes. The current study sought to evaluate the associations between 7 childhood traumas and 2 marital outcomes—marital disruption (i.e., divorce and separation) and marital satisfaction—in a large, national probability sample. Results from univariate and multivariate analyses indicated that (a) probability of marital disruption was higher among people who during childhood had experienced physical abuse, rape, or serious physical attack or assault; and (b) current marital satisfaction was lower among people who during childhood had experienced rape or sexual molestation. Results support the importance of childhood traumas in predicting 2 important marital outcomes.