Recovering Process from Child Sexual Abuse During Adulthood from an Integrative Approach to Solution-Focused Therapy: A Case Study

ABSTRACT

In recent times, strengths-based recovery approaches that focus on the present and build strategies that look toward the future have become popular. However, some cases require the consideration of experiences from previous stages of the clients’ development. This single-case study explores the psychotherapeutic process of a middle-aged woman who presented with a history of child sexual abuse (incest) and a long-term adult diagnosis of depression that was treated in public health services. This psychotherapy involved an integrative approach to solution-focused therapy; specifically, the approach proposed by Yvonne Dolan to work with adult survivors of sexual abuse, in conjunction with techniques and strategies from the transtheoretical model. Measures incorporating therapeutic working alliance and outcomes were administered over sessions. Results showed positive outcomes from this therapeutic intervention, which remained at 3-month and 12-month follow-ups. Implications for practitioners’ specialist practice in health services are discussed, given the complexity of comorbid mental health conditions with a history of child sexual abuse.     

The intimacies of young people’s sexual health and pleasure

This paper considers the discourse of intimacy in young people’s accounts of sexual health. In interviews with people from Sydney aged 18–25 years, diverse understandings of sexual safeties are offered, reflecting a range of sex partner intimacies. This is seen in participants’ accounts of having a range of different partners, having different experiences with a particular partner, and having sex with friends. This discourse is considered against Australian sexual health websites for young people. In the websites, connections between safeties and intimacies are not explored, and discussion of safety is limited to condom use, as per the concept of ‘safe sex’. How condom use is supported and/or challenged by sexual and friendship intimacies is overlooked. In considering research claims about the missing discourse of pleasure in formal approaches to young people’s sexual health, I extend this to a missing discourse of intimacy. Connections between pleasure, intimacy, safety, and friendship are explored throughout this paper, and theorisations of intimacy as cultural, public, and intersubjective are considered, drawing upon the works of Lauren Berlant and Eva Illouz. It is argued that sexual health research and promotion that engages with young people’s conceptualisations of intimacy will better engage with young people’s sexual cultures, and hence be more relevant and useful to this population.     

Sexual agency,risk and vulnerability: a scoping review of young Indigenous Australians’ sexual health

This review of qualitative research examining young Indigenous Australians’ sexual health highlights the profoundly social nature of young people’s sexual lives. Nineteen peer reviewed published papers were identified for inclusion. Findings reveal efforts made by some young Indigenous Australians to control their sexual lives, mitigate risk and maintain their sexual health. The review identified factors which are conducive to sexual health risks and vulnerability, including incomplete knowledge about STIs and safer sexual practices; gossip and ridicule concerning sexual activity and its consequences; damaging expectations about male prerogatives with respect to sexual relationships; limited inter-generational communication about sexual health issues; inadequate school-based sexual health education; and tensions between Indigenous and biomedical explanations of sexual health issues. Future research priorities include a focus on young Indigenous people in cities and towns across Australia, and in regional and remote settings in New South Wales and Victoria; understanding how Indigenous cultural values support young people’s sexual health; young men’s sexual and service-based practices; and the experiences of same-sex attracted and gender diverse youth. This research would inform the design and delivery of culturally safe and acceptable sexual health services and programmes, underpinned by an understanding of factors in young Indigenous Australians’ everyday sexual lives.     

Lesbian,Gay, Bisexual,Sexual-Orientation Questioning Adolescents Seeking Mental Health Services

Summary

Lesbian, gay, bisexual, and sexual-orientation questioning (LGBQ) adolescents have many of the same health needs as straight adolescents. In addition, they must learn to manage a stigmatized identity that may create confusion, anxiety, and emotional turbulence for them. Beyond stigma, LGBQ youth are often found to be at higher risk for substance abuse, violence, depression, suicide, and sexual health problems. Based on responses given by urban adolescents seeking mental health services to a clinical self-assessment questionnaire (Adquest), this article examines the relationship between sexual identity and risk factors related to safety, health, sex, substance use, family and friends, worries, and their desire to talk about these in counseling. Findings indicate that LGBQ youth are at higher risk than straights, and express greater desire to talk about substance use, health, their personal lives, and their friends. Mental health practitioners working with these young persons must properly assess and address their risks by creating a sense of community and safe environment for open discussion.     

A relational understanding of the needs of siblings of children who have been sexually abused

This participatory research project highlighted the views and experiences of young people who are the brothers and sisters of children and young people who have experienced child sexual abuse. By working with young people who had experienced sexual abuse and their siblings, this practitioner research sought to give these young people a voice. The research involved a group process with young people who have experienced sexual abuse and have siblings, and one-to-one online consultations with the brothers and sisters of young people who have experienced abuse. All the young people spoke of their sibling and family relationships as unique and requiring unique responses to these relationships by services and health-care professionals. Siblings’ needs in the aftermath of a child sexual abuse discovery are often overlooked. This research describes how just as children who have experienced sexual abuse may feel anger, fear, guilt, shame, anxiety, and confusion, so do their siblings. Brothers and sisters of young people who have experienced sexual abuse describe significant relational trauma with intense emotional experiences of isolation, confusion, sadness, and anger. There is a real need to support young people and families to find words and develop capacities to talk about child sexual abuse -- a need to find supportive ways to speak about what has occurred and understand its impact on all. The study clearly demonstrated the significant level of need and impact on brothers and sisters of young people who have experienced sexual abuse.     

Belonging to the library: humanising the space for social work education

Abstract

This article describes the running of four Living Libraries on a UK postgraduate social work course. A Living Library is a metaphoric remodelling of a conventional library where people, as authors of their experiences, provide specialist knowledge based on authorial areas of expertise. In the Living Libraries discussed here, ‘Living Books’ carried stories of social work—their narratives were of lived experiences as people using social care services; as carers in personal relationships with others who use social care services; or, as social work practitioners. The focus of this article is on those Living Libraries involving the participation of the first two of these groups. Drawing on social psychology, phenomenology and human geography, we propose that a Living Library can act as a connective space within social work education by engendering a discursive forum where all participants—people with experiences of services, students, practitioners and social work educators—are given both the freedom and obligation to talk openly about their differential experiences, fears and hopes for social work. Through this process, opportunities are created to consider how improvements that meet all stakeholders’ interests may be achieved.     

Obstacles to Help-Seeking for Sexual Offenders: Implications for Prevention of Sexual Abuse

ABSTRACT

Persons with potentially harmful sexual interests such as attraction to minors are unlikely to seek or receive treatment before a sexual offense has been committed. The current study explored barriers to help-seeking in a sample of 372 individuals in treatment for sexual offending. Results revealed that the shame and secrecy resulting from stigma associated with pedophilic interests often prevented our respondents from seeking professional counseling, and only about 20% tried to talk to anyone about their sexual interests prior to their arrest. Barriers to seeking and receiving psychological services included concerns about confidentiality, fears of social and legal consequences, personal shame or confusion about the problem, affordability, and challenges finding competent therapists who were adequately equipped to help them. Understanding and ultimately reducing obstacles to help-seeking can improve the quality of life for people with harmful sexual interests and potentially prevent sexual abuse of children or other vulnerable individuals.     

College women’s sexual and reproductive health screening behaviors and the role of mother–daughter communication

Abstract

Objective: The study investigated the role of mother–daughter communication and race in college women’s decisions to pursue sexual health screening services. Participants: Participants were 301 college women who primarily identified as White and Asian American (M_age = 19?years). Methods: Participants completed an online survey that assessed mother–daughter communication about sex and responded to items pertaining to pursuing sexual health screening services. Results: Maternal communication predicted daughters’ screening behaviors and sexual anxiety mediated the negative association between conservative communication from mothers and screening behaviors. Asian American college women were less likely than White college women to report that they received frequent and open communication about sex from their mothers and reported higher levels of sexual anxiety. Conclusions: Mothers should be aware of the implications their communication patterns may have on their daughters’ sexual and reproductive health, and college women’s sexual anxiety should be addressed in order to increase utilization of screening services.     

Resilience and risk factors associated with experiencing childhood sexual abuse

The effects of child sexual abuse are wide‐ranging and impact on children, families and health/social care systems. The authors review this literature, examining the shortcomings of the ‘victim–offender’ model, and consider the complex, multifactorial nature of this question. Factors associated with a progression from victim to perpetrator are explored and the prevalence of abuse in the general population is also discussed. Protective as well as risk factors are considered and the pivotal role of ‘personal reliance’ is considered as it relates to empowering damaged young people to become healthy adults. The authors also discuss implications for the treatment of young people who become abusers. Two case examples are brie?y reported upon and the article concludes with a consideration of ways to helpfully address the needs of children who become sexual perpetrators. Copyright © 2004 John Wiley & Sons, Ltd.     

Visibility,Immobility and Stigma: Young People's Use of Sexual Health Services in Rural Areas†

Teenage pregnancy has become a major policy issue, for which young people are often publicly held solely responsible. However, a combination of factors substantially increases the risks of conception faced by young people engaging in early sexual activity. This article reports the main findings of a study of teenage pregnancy in linked seaside and rural areas, focusing on the experiences and perceptions of young people living in rural localities. They identify the issues of immobility, visibility and attitudes of stigma as affecting their ability to access sexual health services. The young people highlighted issues for service and policy development and the behaviour of professionals, both within schools and from sexual health services. Education, social and health services and the voluntary sector have important roles to play in responding to their needs.     

Chinese Parents’ Perspectives on Adolescent Sexuality Education

ABSTRACT

There is growing interest in China to understand how young people learn about sexuality, but there are few existing studies about the role of parents as sex educators of their children. This study surveyed 694 Chinese parents of adolescents in three cities about their knowledge, attitudes, and practices regarding sexuality education for their children. The majority supported sexuality education, yet few parents had provided it. High-income parents had more favorable sexual attitudes and, in turn, were more likely to educate children about sexuality. The findings provide insight into parents’ role in adolescents’ sexual behavior and can be useful to sexuality education professionals.     

The alcohol contexts of consent,wanted sex,sexual pleasure,and sexual assault: Results from a probability survey of undergraduate students

Objective: To examine, in a probability sample of undergraduate students, characteristics of students’ most recent sexual experiences (including alcohol use) as well as their experiences with nonconsensual sex. Participants: In January and February 2015, 22,046 students were invited to participate in an anonymous, cross-sectional, Internet-based survey; 7,032 surveys were completed (31.9%). Methods: Measures included background characteristics (age, gender, sexual orientation), most recent sexual event items (sexual pleasure, wantedness, alcohol use), and experiences with nonconsensual sex (since college and lifetime). Results: Respondents reporting sober consensual sex were more likely to report higher levels of sexual pleasure and wantedness. Nonconsensual oral, vaginal, or anal penetration occurring during college were reported by 15.8% of women and 7.7% of men. Students more often told friends, partners, or family members and rarely disclosed to university faculty or police. Conclusions: Implications for campus policy and health education are addressed.     

Sexual Pleasure and Wellbeing

ABSTRACT

Pleasure may be the key to the successful working of the reproductive systems of humans. However, for all the enjoyment sexual relationships can provide, there are countervailing forces of guilt and disappointment at work on the individual psyche. Religious and social norms enforce limits on sexual expressiveness. These controls are defended as means to protect individuals and their partners from unhappiness due to infidelity. The contrasting balance of potential pleasure on the one hand and deeply felt self-controls on the other gives rise to many problems of sexual health. Couples with discordant expectations about sexual pleasures can find their relationships crumbling. Deeply planted understandings about inappropriate behavior can cause individuals to feel shame or fear when faced with choices about their sexuality and particularly their desires. People unable to achieve desired pleasures due to physical handicaps experience a loss of wellbeing that can be extremely distressing. Simultaneously society struggles to control the individual expression of harmful sexual behavior such as child molestation while protecting the rights of individuals to enjoy personal satisfaction. The recognition and promotion of sexual pleasure as an integral part of wellbeing is one of the most challenging elements on the sexual health agenda. Progress in this area will require extraordinary efforts by professional groups and political leaders to forge a forthright understanding of the meaning of pleasure in people's lives, and the priority of promoting healthy sexuality as a part of a global health agenda.     

A Case Study Approach to Reducing the Risks of Child Sexual Exploitation (CSE)

ABSTRACT

The risk of child sexual exploitation is a growing concern, both within community and child care settings. Within community services working with vulnerable young people, the risks of exploitation are pervasive and present a constant management problem for professionals. This makes the need for focused educational interventions within such settings all the more vital. This case study aims to describe the assessment, formulation, intervention, and outcomes of a young female considered to be at risk of sexual exploitation. It was hypothesised that, after completion of a psychoeducational group designed to enhance knowledge and skills around child sexual exploitation, positive outcomes would be seen in psychometric assessment, risk-taking behavior, and risk awareness. Results demonstrated no clinically significant change for measures of impulsivity, resourcefulness, or self-reported difficulties. A significant increase was seen for self-reported self-esteem, and all outcomes revealed a positive direction of change. Observational accounts of behavioral and attitudinal change produced more positive results, revealing an increase in prosocial behaviors and a reduction in risk-taking behaviors. Outcomes are discussed in relation to the individual’s history and the residential care environment. Implications for future research and practice are outlined, and the study limitations are considered.     

Young People who have Sexually Abused: What do they (and their parents) want from Professionals?

This article presents the findings of a small scale qualitative study of user perspectives in the adolescent sexual aggression field. Twenty four service users who had received intervention from nine different specialist providers completed a structured questionnaire about their experiences of professional involvement. Both young people who had sexually abused and parents identified the kinds of professional intervention which they found useful, as well as practices that they experienced as unhelpful. Young people and their families alike were found to value supportive interventions which gave them an opportunity to gain insight into the nature of sexual abuse as well to address their own feelings about their problems.     

A Survey of the First Five Years' Work of a Child Sexual Abuse Team

This paper describes a survey of the first 5 years' work of a specialist NHS child sexual abuse team (CSAT), which provides a post-disclosure treatment service to young people aged between 13 and 19. Information was obtained on the demographic characteristics of young people referred, the nature of their abuse and its perpetrators, and the type, length and outcome of the treatment provided. The survey was also used to ask four questions. Was the team providing a service to its target population, young people whose sexual abuse had been severe? Did the severity of abuse predict the intensity or length of therapy provided? Were there differences in the service provided to boys as opposed to girls? Finally, did experienced therapists achieve different results when compared with non-experienced therapists? It was found that the service was being used by its target group and that severity of abuse was associated with longer or more intensive therapy. The service did not appear to be adequately meeting the needs of boys. There was some indication that experienced therapists achieved the same treatment outcome as inexperienced therapists in a shorter period of time.     

Inter‐professional working in child protection with families with long‐term and complex needs

Within the United Kingdom there is growing awareness of the need to identify and support the small number of children who are living in families experiencing multiple problems. Research indicates that adverse experiences in childhood can result in poor outcomes in adulthood in terms of lack of employment, poorer physical and mental health and increases in social problems experienced. It is acknowledged that most of these children are known to child welfare professionals and that some are referred to social services, subsequently entering the child protection system. This paper reports research conducted with 28 experienced child welfare professionals. It explores their views about families known to the child protection system with long‐term and complex needs in relation to the characteristics of children and their families; the process of intervention with families; and the effects of organisational arrangements on practice. The research indicates that these families are characterised by the range and depth of the problems experienced by the adults, such as domestic violence, mental health difficulties and substance misuse problems, and the need for professionals to have good inter‐personal skills and access to specialist therapeutic services if families are to be supported to address their problems. Copyright © 2008 John Wiley & Sons, Ltd.     

Sexual Behavior,Mental Health,Substance Use,and HIV Risk Among Agency-Based Male Escorts in a Small U.S. City

Abstract

Relatively little research has examined the personal sex lives of indoor male sex workers (MSWs) or possible connections in this group between sexual behavior and factors related to HIV risk. As part of a larger project, this study collected data from 30 agency-based indoor MSWs (mean = 22.4 years) about their sexual behavior, mental health, and substance use. Few HIV risk behaviors with clients occurred. Drug use and mental health problems were relatively frequent, but not related to increased risk behavior. Instead, MSWs appeared to employ rational decision-making and harm-reduction strategies. Conceptualization of MSW sexual behavior may be required where HIV risk is not attributed to sex work per se, but to other influences such as economic and relational factors.     

Adverse Childhood Experiences and Healthcare Costs in Adult Life

ABSTRACT

The current study aims to present the prevalence of adverse childhood experiences and examine the healthcare costs associated with primary, allied, and specialist healthcare services. The Australian Longitudinal Study on Women’s Health is a general health survey of four nationally representative age cohorts. The current study uses 20 years of survey and administrative data (1996–2015) from the cohort born 1973–1978. Overall, 41% of women indicated at least one category of childhood adversity. The most commonly reported type of childhood adversity was having a household member with a mental illness (16%), with the most commonly reported ACES category being psychological abuse (17%). Women who had experienced adversity in childhood had higher healthcare costs than women who had not experienced adversity. The healthcare costs associated with experiences of adversity in childhood fully justify a comprehensive policy and practice review.     

Sexual Health in the Netherlands: Main Results of a Population Survey Among Dutch Adults

ABSTRACT

In 2006, the Rutgers Nisso Groep conducted an extensive population survey to assess the epidemiology of sexual health in the Netherlands. The sample consists of a random selection of the adult population living in the Netherlands (N= 4147) who were approached through internet panels. The study assesses the prevalence of a broad range of sexual health issues, including sexual and relational satisfaction, experience of sexuality, sexual identity, paraphilia, excessive desire, sexual dysfunctions, contraception, abortion, infertility, testing for sexually transmitted infections and HIV, condom use, and sexual violence. The data show, among other findings, that a small half of the adult Dutch population was basically without sexual health-related problems or stress during the year preceding the study. The other half experienced problems to a varying extent in one or more areas. Overall, 24% of the women and 19% of the men have experienced a need for professional sexual health care during the previous year. For women and men alike, relational problems are the most common complaint. About half of those in need of one or another form of sexual health care actually received it. Young people and people with an ethnic minority background show an elevated need for sexual health care.