A comparative study of therapy duration for survivors of childhood sexual abuse

The goal of this study was to determine whether duration of group therapy affected outcomes for women with a history of childhood sexual abuse (CSA). The sample included women from 6-month therapy groups (n = 42) and the comparison group who completed 12 months of therapy (n = 114). When outcomes attained by the 6-month group were compared with those of the 12-month group, those in the 6-month group showed significantly greater gains in self-esteem, symptom change, and posttraumatic stress disorder symptoms. In addition, although participants in the 6-month group improved more in depression scores than those in the 12-month group, the difference was not statistically significant. The results of this study indicate that intensive 6-month group therapy for female survivors of CSA may be even more beneficial than less intensive 12-month groups.     

Partner awareness regarding the adult sequelae of childhood sexual abuse for primary and secondary survivors

This qualitative study investigates factors that may facilitate or impede awareness within couples regarding the sequelae of childhood sexual abuse for adult females and their partner. Six couples were interviewed about perceived effects of the abuse for self and partner and their perceptions regarding their awareness of these effects. Transcribed data were analyzed using grounded-theory methodology. Emergent themes regarding potential barriers to and facilitators of agreement are outlined in the context of the expressive and receptive abilities and motivations of each partner in communicating about the abuse. Preliminary implications for marriage and family therapy and further research are provided.     

Emotionally Focused Therapy for couples and childhood sexual abuse survivors

This study explored Emotionally Focused Therapy (EFT) for couples with childhood sexual abuse survivors (CSA) and their partners. Half of the couples in this study reported clinically significant increases in mean relationship satisfaction and clinically significant decreases in trauma symptoms, and thematic analyses identified numerous areas where trauma survivors were challenged in fully engaging in the therapy process. In particular, trauma symptoms such as affect dysregulation and hypervigilance were identified to play a role in the challenges that survivors experienced in fully engaging in the EFT process. Results of these thematic analyses yielded clinical recommendations for working with CSA survivors and their partners in EFT for traumatized couples. Recommendations for future study were articulated.     

The process of coping with domestic violence in adult survivors of childhood sexual abuse

Research suggests that the use of disengaged or avoidant strategies to cope with interpersonal violence contributes to the development of depressive symptoms and other psychological difficulties. Survivors of childhood sexual abuse (CSA) who are exposed to subsequent episodes of abuse may be more likely to rely on disengaged coping strategies, placing them at elevated risk of psychological symptomatology. In this study, we explored the interrelationships between coping, depression, and self-esteem in an ethnically diverse sample of domestic violence survivors (N = 219) with and without a history of CSA. As predicted, CSA survivors (n = 86) reported significantly greater use of disengaged coping strategies (wishful thinking, self-criticism, and social withdrawal) than non-CSA survivors (n = 133). As hypothesized, both a CSA history and the use of disengaged coping significantly predicted higher levels of depression and lower self- esteem. Clinical implications of the findings are discussed.     

Evaluation of adult protective services: perspectives of community professionals

Due to challenges associated with client characteristics, funding, and the expectation of poor outcomes, few studies have evaluated the services provided by Adult Protective Services (APS). The article reports community-based professionals' satisfaction with APS when investigating cases of suspected elder abuse. Results from a 12-item quantitative survey indicate respondents were most satisfied with the intake process, followed by assessment, and case management. Satisfaction was higher than expected, though areas for improvement are identified. This survey and its results should serve as a starting point for more extensive evaluation methodologies needed to enhance the delivery of services provided by APS.     

Efficacy of a group intervention for adult women survivors of sexual abuse

This study evaluates the effects of a group intervention for women sexually abused in childhood or adulthood. The sample consisted of 41 women involved in a group intervention based on a feminist approach offered by help centers for sexual assault victims in Quebec and 11 women in a wait-list comparison group. Results reveal that the group intervention reduced psychological distress and consequences associated with sexual abuse and that gains were maintained at three-month follow- up. Analyses of potential factors related to differential gains indicated that abuse-related variables and concurrent individual interventions were not linked to outcomes. Exploratory analyses suggested that women experiencing severe physical partner violence showed greater gains with respect to self-blame/stigmatization, sexual anxiety, and anxiety related to assertiveness.     

The treatment needs of victims/survivors of child sexual abuse (CSA) from ethnic minority communities: A literature review and suggestions for practice

One significant finding from an exhaustive literature review on child sexual abuse (CSA) and ethnic minority communities is that victims appear to be at higher risk for suicidality. This may be due to the many barriers to professional help-seeking in this group, most commonly associated with protecting the family's name. This makes their treatment needs particularly critical, after the barriers have finally been crossed. Of all their treatment needs, cultural competency is identified as essential. It asks for non-racist attitudes and practice, self-reflection and awareness, a ‘multicultural framework’ which recognises differences in power between mainstream and minority groups and respects the right to cultural differences, the provision of an interpreter trained in matters to do with sexual assault, choice about having an ethnically matched or non-matched service provider (and thus employment of workers from diverse backgrounds), the routine provision of training in cultural competency by management in service organisations, and mandatory data collection on variables related to ethnicity. A ‘multicultural framework’ is seen to be the most important of these elements, else it could lead to the vilification of collectivist and patriarchal cultures (which ethnic minority communities tend to be), threatening cultural safety. This adds trauma to the victim who has already suffered an abuse of power, and further alienates clients in critical need of clinical intervention.     

The "Wall of Fear": the bridge between the traumatic event and trauma resolution therapy for childhood sexual abuse survivors

A multitude of published books and papers on child sexual abuse (CSA) describe symptoms, long-term effects, and therapy for survivors of abuse. However, the parallels between the nature of the sexual trauma event(s) as originally experienced by the victim and the therapeutic process into which the survivor later becomes engaged have not been reported. This paper attempts to fill that gap and proposes that the concept of a Wall of Fear is the bridge connecting the two. In the first part of the paper, a model of the CSA experience based upon Furniss (1991) will be explained in order to point out the basis for the dissociation and other symptomatology demonstrated by the CSA victim. Following that, the stages of therapy will be mapped out, with special attention to the concept of the Wall of Fear (Oz, 1999) and traumatic memory resolution (abreactions) and with reference to the experience of the original traumatic events. Therapist fear of decompensation will be addressed.     

Increasing the usability of cognitive processing therapy for survivors of child sexual abuse

There is an ongoing need for empirically based treatments for child sexual abuse (CSA) that are time-efficient and cost-effective. This article describes a modification of cognitive processing therapy for child sexual abuse (CPT-SA) that increases the therapy's usability by reducing the number of individual therapy sessions required. The modifications are based on the developing literature on stage-based approaches to the treatment of CSA and incorporate dialectical behavior therapy skills training into the treatment protocol. Initial pilot data (N = 6) on modified CPT-SA suggests the therapy may be effective for the treatment of posttraumatic stress disorder (PTSD) and depression.     

Preventing child sexual abuse (CSA) in ethnic minority communities: A literature review and suggestions for practice in Australia

A systematic literature review was conducted to address the immense national gap in knowledge on child sexual abuse (CSA) and ethnic minority communities in Australia, which necessarily borrowed from overseas. One theme explored within the review was that of prevention, and it was found that school-based programs are the most common type of prevention effort. The literature also calls for ‘culturally tailored’ programs to avoid homogenising victims' needs, however in Western multicultural countries like Australia there is a risk that such school-based programs heighten racism for ethnic minority children. Thus, program elements that are culturally sensitive could be incorporated into universal programs instead. Universal programs are also beneficial because they help reach many children regardless of their cultural background, help send the message that all children are equally valued and protected, help create unity and support among diverse victims, and can be further justified by three relatively stable cross-cultural findings: (i) that the prevalence of CSA is high worldwide, (ii) all children require protection irrespective of gender, and (iii) perpetrators are usually known to the victim. To help mobilise their role, service providers could co-deliver school-based programs especially to address institutional CSA within schools. They could also provide training to other health professionals to improve their identification of CSA and confidence to probe; a form of early intervention and therefore ‘secondary prevention’. Overall, this review argues that the importance of family reputation in collectivist cultures needs to be taken into account when designing and evaluating prevention programs so that delays in disclosure and help-seeking due to cultural pressure are not mistaken as evidence for their ineffectiveness. The findings are significant because they help progress the ‘prevention’ field in Australia where literature is essentially absent, particularly in the school and service system arenas.     

Practical ways psychotherapy can support physical healthcare experiences for male survivors of childhood sexual abuse

Many survivors of child sexual abuse who engage in psychotherapy also experience physical health problems. This article summarizes the findings of a multiphased qualitative study about survivors' experiences in healthcare settings. The study informed the development of the Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse (Schachter, Stalker, Teram, Lasiuk, & Danilkewich, 2009), which is intended to help healthcare providers from all disciplines understand the effect of child sexual abuse on some survivors' abilities to access and benefit from health care. This paper discusses what psychotherapists can learn from the healthcare experiences of the male survivors who participated in this project. It also offers practical suggestions for supporting male clients who experience difficulty seeking treatment for physical health concerns.     

Childhood sexual experiences and adult health sequelae among gay and bisexual men: defining childhood sexual abuse

Gay and bisexual men carry the burden of HIV infections in the United States and have high rates of childhood sexual abuse that predict HIV and other health outcomes. This study examined differential effects of forced, consensual, and no childhood sexual experiences (CSE) on health outcomes among a probability sample of adult men who have sex with men (MSM). The forced sex group had the highest levels of psychological distress, substance use, and HIV risk. There were no differences in rates of depression and suicidal ideation between the consensual- and no-sex groups. The consensual- and forced-sex groups had higher rates of substance use and transmission risk than the no-sex group. The forced-sex group, however, had significantly higher rates of frequent drug use and high-risk sex than the consensual group. Findings suggest that forced CSEs result in a higher-risk profile than consensual or no childhood sexual experiences, the kind of risk pattern differs between forced and consensual childhood sexual experiences, and the underlying mechanisms that maintain risk patterns may vary. It is important to clarify risk patterns and mechanisms that maintain them differentially for forced and consensual sex groups so that interventions may be tailored to the specific trajectories related to each experience.     

Profiles of adult survivors of severe sexual,physical and emotional institutional abuse in Ireland

Adult survivors of institutional abuse were interviewed with a comprehensive assessment protocol which included the Childhood Trauma Questionnaire, the Institutional Child Abuse Processes and Coping Inventory, the Structured Clinical Interviews for Disorders of the Diagnostic and Statistical Manual of Mental Disorders IV axis I disorders and personality disorders, the Trauma Symptoms Inventory, a Life Problems Checklist, the Experiences in Close Relationships Inventory and the Kansas Marital Satisfaction Scale. Profiles were identified for subgroups that described severe sexual (N = 60), physical (N = 102), or emotional (N = 85) abuse as their worst forms of maltreatment. Survivors of severe sexual abuse had the most abnormal profile, which was characterised by higher rates of all forms of child maltreatment and higher rates of post‐traumatic stress disorder, alcohol and substance abuse, antisocial personality disorder, trauma symptoms and life problems. Survivors of severe emotional abuse were better adjusted than the other two groups. The profile of survivors of severe physical abuse occupied an intermediate position between the other two groups. A thorough assessment of abuse history and current functioning should be conducted when providing services to adult survivors of institutional abuse, since this may have important implications for the intensity of services required. Survivors of severe sexual abuse may require more intensive services. Copyright © 2009 John Wiley & Sons, Ltd.     

Treatment issues for survivors of physical and sexual abuse*

Many clients who participate in family therapy have experienced trauma such as physical and sexual abuse in their families of origin. Extensive literature suggests that abusive experiences can result in post-traumatic stress disorders, depression, anxiety, personality disorders, and other long-term effects. Without recognition of the effects that abuse can have on individuals, it is possible to misdiagnose clients or fail to provide them with adequate assistance. This study is an attempt to compare the symptomology of nonabused clients with physically and sexually abused clients using an empirically sound measure. The results demonstrate that the majority of clients who experienced physical and/or sexual abuse in their backgrounds scored in the clinical range on scales from the Millon Clinical Multiaxial Instrument (MCMI) (Millon, 1984). In contrast, clients who did not report abuse had significantly lower scores than the abused clients, and the majority of the nonabused clients scored in the nonclinical range on the scales of the MCMI. Treatment and theoretical implications surrounding the issues of abuse are discussed, and recommendations for marriage and family therapists are provided.     

Experimental avoidance and high-risk sexual behavior in survivors of child sexual abuse

While many long-term correlates of child sexual abuse (CSA) have been identified, theories to explain the development of these correlates have received little empirical validation. The process of experiential avoidance is one theory that has been proposed to account for many of the correlates of CSA. The purpose of the current study was twofold: (1) To attempt to develop a more complex measure of experiential avoidance in women with and without a CSA history, and (2) to explore variables related to two of the long-term correlates of CSA, general psychological distress and high risk sexual behavior. Levels of current distress, high-risk sex, and experiential avoidance were examined in 257 undergraduate females (mean age 20.0) using self-report questionnaires. The results of the current study indicate that CSA survivors report higher levels of experiential avoidance and high-risk sexual behavior with persons other than their primary partners. Implications of these findings for theory development, therapy with CSA survivors, and HIV prevention programs are discussed.     

Effects of group therapy on female adolescent survivors of sexual abuse: a pilot study

Treatment interventions for female sexual abuse survivors was explored through a pilot study examining the relationship between group treatment and adolescent self-image. Self-image was defined as body image, self-reliance, self-control, and impulse-control. An experimental pre-post design was utilized. Participants were 13 female adolescent high school drop-outs with a history of sexual abuse who participated in the National Guard Youth Challenge Program at Camp Shelby in Mississippi. Participants completed the Offer Self- Image Questionnaire for Adolescents. The hypothesis that group therapy was an effective intervention for sexual abuse survivors was not supported; however, this is likely due to the small sample size. Because this was a pilot study, mean trends were observed to see directional changes that may assist future researchers. Observation of mean trends revealed that participants who received group therapy increased in levels of impulse control while the group that did not receive group therapy remained the same. Mean trends also revealed that the experimental group had a decrease in self-reliance whereas the control group maintained their levels of self-reliance.     

The sexual abuse questionnaire: a preliminary examination of a time and cost efficient method in evaluating the presence of childhood sexual abuse in adult patients

This paper provides the results of two studies designed to evaluate a newly constructed self-report instrument, the Sexual Abuse Questionnaire (SAQ). The SAQ was designed as a brief screening device to aid in the identification of a childhood sexual abuse history. A "unique" feature of the SAQ is the inclusion of a number of non-face valid questions derived from clinical experience. Both studies used an undergraduate population of self-reported abused and non-abused participants. Based upon the combined results of the two studies, the final version of the SAQ was developed, which is comprised of 45 items that manifest good test-retest reliability, internal consistency, and convergent and discriminative validity. The SAQ can discriminate between abused and non-abused male and female participants.     

Medical examinations for child sexual abuse in Scotland: good enough practice?

This questionnaire survey of a representative sample of practitioners in Scotland sought to establish speci?cally how widely guidance on child protection issued by the Scottish Executive Health Department was being followed by practitioners, NHS Trusts and health boards. It aimed to identify the medical practitioners involved and the range of current practice in child sexual abuse examinations throughout Scotland. The results suggest that the medical assessment of children who disclose sexual abuse is a low‐volume, highly specialized activity, practised by about one in ?ve paediatricians and forensic medical examiners in Scotland. Most (79%) are aged between 41 and 60 years; 59.8% have less than 10 years' experience in the ?eld; and the majority (86.3%) perform fewer than two examinations per week. Available guidance is comprehensive and uniform, highlighting the importance of joint specialist working, use of the colposcope for photodocumentation, training and continuing professional development in this specialized area of work. Despite this, the results of our survey of practitioners show that throughout Scotland, the care offered to children and the service provided to the courts are suboptimal. Copyright © 2004 John Wiley & Sons, Ltd.     

Group issues and activities for female teen survivors of sexual abuse

The impact of sexual abuse can be devastating, especially for young girls at the crucial stage of adolescent development. Ramifications for these survivors of incest and extrafamilial abuse are addressed. Group therapy as an effective means of intervention is described. Group considerations discussed include group name; member and leadership selection; confidentiality; contracting and closed nature; parent meetings; self-disclosure; and objectives.Twelve weeks of group topics, activities, and homework are detailed. These topics are applicable to most female teen survivors of sexual abuse, independent of the age or gender of their perpetrators.