Tainted therapy and mistaken memory: Avoiding malpractice and preserving evidence with possible adult victims of childhood sexual abuse

Recent malpractice cases reflect increased liability for psychotherapists working with possible adult victims of childhood sexual abuse. These cases have related to recovery of past memory of abuse and the fashion in which the therapist managed the recovery and treatment. Ways in which therapists may harm clients by omission and commission are explored. The emerging lack of clarity between investigative and therapeutic interviews is discussed. False memory is considered in relationship to malpractice liability, standards of care, and attempts to preserve potential evidence. The author proposes written informed consent and investigative interviewing procedures for working with potential memory recovery cases. Formats for general informed consent to psychotherapy for patient record keeping of newly emergent material are appended.     

Violence against women: Mental health effects. Part II. Conceptualizations of posttraumatic stress

A broad range of psychological aftereffects have been noted among women who have experienced male-perpetrated violence. These symptoms vary considerably among individuals, across social contexts, and across different types of violent encounters (Coley & Beckett, 1988; Goodman, Koss, & Russo, 1992; Koss, 1988; Straus, Gelles, & Steinmetz, 1980). Nevertheless, a remarkably consistent picture of the psychological sequelae of violence—particularly sexual and physical assault—emerges from the empirical and clinical literature (Koss, 1988). In this article, we use the posttraumatic stress disorder diagnosis—a frame that captures many of the disparate symptoms described by researchers—as a basis for exploring several conceptual models that have been developed to explain women's responses to violence.     

Coming Out, Visibility, and Creating Change: Empowering Lesbian, Gay, and Bisexual People in a Rural University Community

Personal and professional challenges faced in encouraging the development of a gay community in a rural university setting are described. Community psychologists who are lesbian, gay, or bisexual (LGB) must assess their willingness to be open and the roles they can play in developing helping resources. These issues concern how to encourage the empowerment of others while maintaining a collaborative role in a situation of major personal investment. Two specific challenges–developing informal helping resources for local LGB people and fostering institutional and policy changes to make the university a safer place for LGB faculty, staff, and students–are described. Community psychologists must consider personal risk when they become involved in empowerment efforts with this population.A white male community psychologist and a licensed clinical psychologist, I have been on the faculty of the Department of Human Development and Family Studies at Pennsylvania State University since 1972. I served as Faculty Adviser to the Lesbian, Gay, and Bisexual Student Alliance at the University for ten years, and worked extensively with lesbian, gay, and bisexual people in the local town, State College, PA, to develop community resources since the mid 1980’s. I had been granted tenure before the events described in this paper occurred.     

Body image and risky sexual behaviors: an investigation in a tri-ethnic sample

The impact of negative body image on risky sexual behaviors has not been extensively investigated. The present study examined the relationship between two aspects of body image, appearance shame and appearance investment, and potentially risky behaviors. The study employed a tri-ethnic sample of 1547 women seeking services at two family planning clinics. Logistic regression was utilized to examine the relationship between potential risk behaviors and shame and investment. Results supported that these aspects of body image were significant predictors of inconsistent condom use, having multiple sex partners in the past year, and having sex after drinking alcohol or using drugs, and that demographic variables (e.g., age, marital status, ethnicity) could not fully account for these relationships. The importance of future research investigating the relationships among body image, perceived relationship security, affect-management strategies, and risky sexual behaviors is emphasized.     

A Qualitative Study of the Supports Women Find Most Beneficial When Dealing with a Spouse’s Sexually Addictive or Compulsive Behaviors: Insights for Pastoral Counselors and Clergy

There is currently a void in the literature regarding the kinds of support women find most beneficial when dealing with a spouse’s sexually addictive or compulsive behaviors. Addressing this void is particularly relevant for clergy, seeing as they are increasingly sought out as an initial and/or primary support for dealing with this marital issue. Using grounded theory methodology, 22 women from Canada and the USA were interviewed to find out what they found most helpful as they sought support to cope with a spouse’s sexually addictive and compulsive behaviors. Insights for pastoral counselors and clergy were highlighted.     

Cognitive-behavioral Strategies for Parkinson’s Disease: A Report of Three Cases

Three patients diagnosed with idiopathic Parkinson’s disease (PD) were treated with cognitive-behavioral therapy (CBT): a 43-year-old woman suffering from depression and social anxiety, a 45-year-old man with sexual problems and maladaptive coping strategies, and a 78-year-old man with freezing of gait. On the basis of functional analyses, interventions were selected, including cognitive methods, social skills training, paradoxical instructions and strategies to improve management of freezing. The interventions were related to improved adaptation to motor impairments and better ability to cope with the disease. These case presentations suggest that CBT can improve quality of life in PD by modifying maladaptive cognitive, emotional and behavioral reactions to the disease and its symptoms.     

Cognitive-behavioral therapy for women with lifelong vaginismus: process and prognostic factors

Cognitive-behavioral therapy (CBT) seems an effective treatment of lifelong vaginismus, but mechanisms of action have not yet been established. The present study explored whether the effect of CBT for lifelong vaginismus is mediated by changes in fear of penetration and avoidance behavior, which CBT explicitly aims to alter. A second aim of this study was to predict treatment outcome on the basis of pre-treatment variables. Participants with lifelong vaginismus were allocated at random to a 3-months CBT (n=81) or a waiting-list control condition (n=36). Full vaginal penetration with the penis of the partner constituted the primary outcome measure. Change scores in successful 'non-coital penetrative-behavior' and 'fear of coitus' were used to measure the mediating variables. Treatment resulted in an increase of intercourse (outcome), a decrease in fear of coitus, and an enhancement of successful non-coital penetration behavior, compared with no treatment. Outcome (intercourse) was partly mediated by changes in fear of coitus and changes in avoidance behavior. No treatment predictors could be detected in this study sample. It is concluded that techniques such as gradual exposure, aimed at decreasing avoidance behavior and penetration fear, constitute an important avenue of change in the treatment of lifelong vaginismus.     

Childhood physical and sexual abuse and lifetime number of suicide attempts: a persistent and theoretically important relationship

BACKGROUND: Research to date has indicated that childhood abuse is associated with suicide, though little research has examined the unique contribution of specific types of abuse to suicidal behavior. We predict that childhood physical and violent sexual abuse will have a greater effect on suicide attempts than molestation and verbal abuse. METHODS: The National Comorbidity Survey data were used to test these predictions while controlling for a number of psychiatric and psychosocial variables. RESULTS: As expected, childhood physical and violent sexual abuse showed similar effects on lifetime suicide attempts, which were stronger than the effects of molestation and verbal abuse. LIMITATIONS: This was a cross-sectional, retrospective study, so true causality cannot be shown. Some measurement limitations exist. Additionally, effect sizes were small but still significant. CONCLUSIONS: While all forms of childhood abuse are troubling and create risk for future psychopathology and suicidality, the present study indicates that childhood physical and violent sexual abuse should be seen as greater risk factors for future suicide attempts than molestation and verbal abuse.     

Women’s Close Friendships across Sexual Orientation: A Comparative Analysis of Lesbian-Heterosexual and Bisexual-Heterosexual Women’s Friendships

Interviews were conducted in close friendship pairs with women who ranged in age from 18 to 52 years at the time of interview. Results suggest that women of different sexual orientation identities had different friendship profiles. Comparisons across friendship type suggest that bisexual-heterosexual friends consistently experienced a shift in friendship dynamic based on the sex of partner for the bisexual friend and were more likely than lesbian-heterosexual friends to integrate their friendship into their social lives. Lesbian-heterosexual friendships were significantly more likely to include an explicit acknowledgment of non-heterosexual identity. Although cross-orientation friendships did not consistently include a feminist/political dimension, when friends also differed in racial identity a feminist/political dimension in the friendship became apparent. In cross-race friendships racial minority identities were explicitly acknowledged even when non-heterosexual identities were not.     

Conceived Through Rape/Incest? Adoptive Parents’ Experiences Managing Uncertainty and Disclosure Surrounding their Children's Origins

Adoptive parents may be placed with children conceived under difficult circumstances, such as via rape or incest. At the same time, adoptive parents are generally encouraged to communicate openly with their children about their adoption stories and birth families. No research has examined the experiences of parents who adopt children who were conceived through rape or incest. This exploratory study examines how parents discuss their decision-making when adopting children conceived via rape or incest, how they manage varying levels of uncertainty about their children's origins, and whether and how they plan to disclose this information to children. The researchers used thematic analysis to examine the experiences of 11 couples (22 parents) interviewed at four time points after adopting children who were reportedly conceived via rape or incest. Findings revealed that even soon after adopting, parents discussed the need to eventually talk to their children about their conception circumstances. Parents generally struggled to determine how and when to disclose this information, particularly when they felt uncertain about the veracity of the conception stories they had been told. Some hoped to rely on professionals or birth mothers to guide them in these communications. Findings have implications for supporting adoptive families as they navigate the complexity of managing sensitive information and uncertainty when adopting children conceived through rape or incest. Practitioners should provide ongoing guidance to adoptive parents about how and when to disclose developmentally appropriate information to children about difficult conception circumstances.