Transcript Dr Ian Newey

Effects of Child Sexual Abuse &
The Assessment and Treatment
of Survivors
Dr. Ian Newey
Overview
1.
2.
3.
4.
5.
Prevalence
Problem?
Effects on a child
Treatment
Discussion
Prevalence of Child Sexual abuse
• Estimates vary – problematic measurement due to
differing definitions, and ethically accessing an
accurately reporting representative sample
• However, a Norwich based study carried out by Cathy
Kenney of the Unthank Centre in the early 1990s
suggested that one in three girls and one in five boys
report having some form of unwanted sexual experience
before the age of eighteen years old.
• It is estimated that children with disabilities are 4 to 10
times more vulnerable to sexual abuse than their nondisabled peers.
National Resource Center on Child Sexual Abuse, 1992.
Is this a problem?
Does it do them any harm?
Task
Gunborg Palme (2006) states that some people who have been
abused suffer from certain problems as a result of this abuse.
She divides these problems into the following categories:
Psychological
Social
Sexual
Physical
Effects
Divide into four groups (one category for each group) and write
down the ways in which a child might be affected by being
sexually abused
In children and adolescents who
experienced trauma, we may see…
Re-enactment of aspects of the trauma into their daily lives (e.g.
with children: in play, drawings, or speech).
Anger, hostility, impulsive and aggressive behaviours
Poor ability to regulate emotions
Fear
Anxiety, phobias
Depression
Sexually inappropriate behaviour
Self-destructive behaviour
Feelings of isolation and stigma
Poor self-esteem
Difficulty in trusting others
Relationship problems
Problems with school performance.
Substance misuse
Post-Traumatic Stress Disorder
Early trauma
1) Deficits in emotion regulation/ self-soothing.
2) Alterations in attention and consciousness e.g. dissociation
3) Impact on sense of self and self-worth e.g. chronic guilt,
responsibility and shame (egocentric world view).
4) If repetitive and premeditated abuse by caretakers we can
expect a complex perception of the perpetrators.
5) Difficulties in relationships e.g. can’t trust/ be intimate,
“others are dangerous”.
6) Somatisation and medical problems
7) Hopelessness
Exacerbating & ameliorating factors
Gunborg Palme (2006) states that the extent to which a
person suffers with a variety of post abuse sequelae
depends on several factors including:
• the level of invasiveness (e.g. penetrative acts rather
than exposure)
• However, it should be noted that children can be
extremely traumatised following exposure to
relatively low level acts on the hierarchy of abuse,
depending on other factors.
• Trauma focused cognitive therapists hypothesise
that it is the meaning of an abusive experience rather
than the experience itself.
Exacerbating & ameliorating factors
The duration (single trauma can often be more
easily processed than repeated acts of abuse)
The relationship with the abuser (prognosis is
worse if abused by mother as opposed to a
stranger)
Exacerbating & ameliorating factors
Intrapsychic factors (e.g. John Briere believes that
attachment is an important factor in the development of
“resilience”)
Early identification of sexual abuse victims appears to be
crucial to the reduction of suffering of abused youth and
to the establishment of support systems for assistance in
pursuing appropriate psychological development and
healthier adult functioning.
As long as disclosure continues to be a problem for
young victims, then fear, suffering, and psychological
distress will, like the secret, remain with the victim.
(Bagley, 1992; Bagley, 1991; Finkelhor et al. 1990;
Whitlock & Gillman, 1989)
Exacerbating & ameliorating factors
• External protective factors (a supportive third
person – such as a non-abusive parent,
another believing understanding relative or
professional involved long term).
• There is the clinical assumption that children
who feel compelled to keep sexual abuse a
secret suffer greater psychic distress than
victims who disclose the secret and receive
assistance and support (Finkelhor & Browne,
1986)
What is post-traumatic
symptomatology?
DSM-IV Definition:
Trauma & Fear
Re-experiencing
Avoidance
Arousal
Duration
Impairment
Also
Thoughts and beliefs about self, the world,
the future
feelings of guilt and shame
How do we talk to clients about
their traumas?
We know that clients are thinking about their trauma
anyway, asking will not make it worse.
It’s worse not to ask.
Consider client characteristics – emotional arousal,
willingness to talk, how have others responded in
the past.
Let them know how long you will spend talking
about this – allowing for time to talk about other
things/ do relaxation/ mindfulness etc at the end.
Make a plan for someone to meet them after the
session, fun/ distracting activities lined up.
Practical skills
Assessment:
• Details of the trauma
• Meaning of the trauma
• Prior traumas
• Ongoing threats
• Current stresses
• Coping/ resources
• Social supports
• Losses associated with
trauma
• Co-morbid issues
• Range of emotional
responses (anger, guilt)
• Context of trauma
• Dissociation vs.
capacity to engage
emotions
• Avoidance vs.
commitment to
treatment
Trauma Timeline
A zoomed out “Google earth” view
Each year (0-1, 1-2, 2-3…..) – systematic – time coded –
chronologically ordered – coherent
Not overwhelming – fits on one A3 sheet of paper – it is
manageable (but conversely – there is a significant amount of
“stuff” on the timeline – people have permission to feel bad
about it)
Distress ratings – taking control – calibrating and defining
tolerance
Celebrating as a survivor
Psychoeducation
Normal reaction to abnormal events
Normal memories and trauma memories
Avoidance
Trauma memories and normal
memories
Verbally Accessible Memory breakfast memory & memory of dinner
th
on 12 February 2009
Situationally Accessible Memory –
when we’re reminded by things in our
environment – trauma memory
Memory in PTSD
Trauma memories
Normal memories
Amygdala
High affect
Triggered by matching stimuli
Sensory
Fragmented
Original meanings (which might be
wrong, e.g. I died)
No time code
Not connected to other memories
Hippocampus
Voluntary recall
Semantic
Coherent with low affect
Time code
Connected to other memories
Piecing together a coherent
memory
Not a nice process
Overflowing linen cupboard metaphor
Splinter analogy
The memories will never be fluffy Disney Hannah
Montana type memories, but we can get rid of the
intrusions and the high levels of anxiety
Present moment focus
Train metaphor
Dissociation and grounding
5 senses: sight, sound, touch, taste, smell.
Coping cards/ objects that remind person of the
here and now.
Reducing avoidance
In line with the person’s life goals what are their
past experiences stopping them from doing now?
Graded exposure
Reclaiming Life
Compassionate mind
Values and goals
Safe Place exercise – a place where you feel ok
Practice Safe place exercise as a group and then in
pairs.
Reflections, thoughts & discussion