Traumatic bonding: clinical implications in incest.

The concept of traumatic bonding, taken from the literatures on trauma, victimization, and exploitation, holds promise for explaining some of the more confusing dynamics of incest. This article offers a definition of traumatic bonding, demonstrates how it can be applied in cases of incest, and discusses the implications of this concept for therapeutic intervention.     

Integrating three approaches to counter resistance in a noncompliant elderly client

1. The term "resistance' has been defined primarily in the psychoanalytic literature and is a significant issue in the treatment of mentally ill people. This issue needs to be addressed for the change process to begin. 2. An understanding of resistance from psychoanalytic, cognitive, and behavioral perspectives will enable the nurse to assist the client in achieving mental health. 3. Countertransferance can be used to understand the client's motives, hence becoming aware of therapeutic goals, or it can hinder the therapeutic process. 4. The psychiatric-geriatric population is complex. With the acceptance that an elderly client can benefit from psychotherapy and with an understanding of different approaches, the client may experience symptom relief.     

Sibling Incest Dynamics: Therapeutic Themes and Clinical Challenges

Increasing empirical evidence points to the prevalence and devastating effects of sibling incest. The dynamics of incestuous sibling relationships are complex and typically embedded in severely dysfunctional families. Often confused and/or distressed by their incestuous experiences, many victims fail to disclose the abuse. Left undisclosed and untreated, unresolved issues of mutuality and consequent shame and guilt can lead to life-long emotional problems and dysfunctional behavioral patterns that are difficult to repair. Two cases illustrate common therapeutic themes, the importance of timely disclosure and coordinated, multi-dimensional treatment approaches, as well as the therapeutic challenges of assisting sibling incest victims who present for treatment as adults.     

Young female incest victims in treatment: Stages of growth seen with a group art therapy model

This article describes a treatment model for female child incest victims combining art and group therapy. Five stages of growth are identified: gathering, self-disclosure, regression, reconstruction, and ending.This project is in part supported by a grant from the National Center on Child Abuse and Neglect, Department of Health and Human Service.     

Sister–Sister Incest: Data from an Anonymous Computerized Survey

Retrospective data were entered anonymously by 1,521 adult women using a computer-assisted self-interview. Thirty-one participants were victims of sister–sister incest, 40 were victims of brother–sister incest, 19 were victims of father–daughter incest, 8 were victims of sexual abuse by an adult female (including one mother), and 232 were victims of sexual abuse by an adult male other than their father before reaching 18 years of age. The rest (1,203) served as controls. The victims of sister–sister incest had significantly more problematic outcomes than controls on many measures as adults. Victims of sister–sister incest were more depressed and more likely than controls to be distant from the perpetrator-sister and to have traded sex for money, experienced an unplanned pregnancy, engaged in four different types of masturbation, and engaged in 13 different same-sex behaviors. Our findings were consistent with other reports of early eroticization and persistent hypereroticization of incest victims.     

The Three Fallacies: Evaluating Three Problematic Trends in Clinical Practice

In an era of condensed treatment and managed care, three trends are gaining prevalence in some graduate training programs and in some circles of the practicing community, limiting clinicians from utilizing the therapeutic techniques needed to help a client achieve long-standing intrapsychic change, a precondition for maintaining therapeutic gains post treatment. The first trend, the equation of empathy with sympathy, hinders the therapeutic dyad from truly understanding a client’s internal experience and implicitly conveys the message that anxiety-provoking material is less welcome in the consulting room. The second trend, prizing cognition over affect, results in a primary focus on secondary thought process, discounting the affective experience that unconsciously steers behavior and thought. This trend is, in large part, due to the widespread dissemination of cognitive-behavioral therapy efficacy research and the belief by some individuals that psychodynamic forms of treatment lack empirical support. The last and most problematic trend, the rigid utilization of treatment manuals, tends to result in a reductionistic approach to treatment, limiting psychotherapy to a set of techniques while also overlooking salient aspects of treatment that can predict positive outcomes. Treatment manuals oversimplify the process of therapy; as a result, the therapeutic dyad is less likely to uncover and discover the multiple origins of one’s suffering, contributory factors that are not always readily available to conscious awareness. This paper discusses each trend and the therapeutic implications that result.     

You are what you read. The use of bibliotherapy to facilitate psychotherapy

1. In the course of therapy with individuals or couples, it is sometimes helpful to suggest reading specific material to assist in the therapeutic process. 2. It is important that the therapist be totally familiar with the recommended material and have a specific purpose for the recommendation. 3. The therapeutic interaction, rather than the reading of material, is the focus of the treatment. 4. Such reading may prove helpful because it becomes an educational experience and comprehension of a concept is increased; the material can be "validating" when written by someone unknown to the client who has had a shared experience; and it can remove a struggle for control from the therapeutic relationship by giving information or opinions directly to the client.     

Groups for Incest Survivors; A New Context

This article outlines a new context for group work with young women who have experienced incest. It describes how ideas from the work of White, Epston, Kamsler and de Shazer on the evolution, maintenance and resolution of problems can be applied to enhance the therapeutic effectiveness of group work with teenage survivors of incest. Externalisation, exploration of beliefs and restorying are found to assist the young women greatly to reconnect with their own resourcefulness.     

A clinical practice model for treatment of college-aged incest survivors

Adult incest survivors frequently exhibit signs and symptoms of posttraumatic stress disorder. Many clinicians have geared their group treatment of incest survivors to address these manifestations. Given the nature of the sexual abuse, the early developmental periods in which some trauma occurs, the past and current relationship between the victim and the perpetrator, and the dynamics inherent in this violation and betrayal of trust, love, and power within the family unit, additional clinical concerns and safeguards must be considered. In addition, the struggles of college-aged incest survivors to come to terms with their history of sexual abuse often mirror the developmental tasks faced by their peers--autonomy, intimacy, sexuality, and formation of personal values and ethics. To focus solely on the incest without also considering these developmental issues may solidify a gridlock between inadequate resolution of the developmental issues and the continued victimization of the student incest survivor. The author discusses a time-limited group treatment for college-aged incest survivors that uses a modified posttraumatic stress disorder model as a conceptual framework and addresses both sets of concerns.     

The Psychodynamics of a Clinician's Hope: A Delicate Balance

A clinician's sense of hope is not easily maintained in the therapeutic situation. Exploring the psychodynamics of hope in two interviews—one focusing on a community mental health psychotherapist and the other on a school social worker—this paper proposes that maintaining hope requires an intense affect state, an active blend of emotional and intellectual reflections in the mind of the clinician. Ongoing hope is the product of a delicate balance between a clinician's tolerance for the tragic in life and the expectations of positive treatment outcome. These reflections occur in an intrapsychic space, a point of juncture between the clinician's primary process longings/fears and secondary process thoughts. Hope is constructed in this space. It gains its language, form, and substance from the integration of personal experience, client observation and clinical theory. Reflective activity helps a clinician avoid disabling transference to a client and promotes identifications that lead to realistic treatment goals.     

Psychotherapeutic Considerations for Working with Betrayed Spouses: A Four‐task Recovery Model

The treatment of infidelity is one of the most challenging and misunderstood aspects of marital therapy, with therapists frequently making treatment decisions based on faulty assumptions. By too quickly trying to ‘fix’ the marriage or by assuming that the betrayed spouse contributed to the unfaithful partner's infidelity, the therapeutic process can inadvertently re‐traumatise an already emotionally fragile client, while not addressing his or her emotional needs. This paper addresses therapeutic considerations for working with the betrayed partner, and provides practical guidelines for addressing the psychological and emotional needs of a betrayed client. A grounded theory model of the recovery path for betrayed partners is presented, as well as suggestions for further research.     

An Integrated Human Behavior Theory

Abstract

In this article, the behavioral exchange model as derived from the work of Emerson, is presented to help the practitioner more adequately conceptualize the interaction between the clinician and the client. This model can help the clinician develop and further his/her understanding of how power differentials between the clinician and the client affect the therapeutic relationship. This model describes how clients use a cost-benefit framework to determine if treatment is worthwhile-meaning that if the client perceives the rewards of an interaction as not outweighing the costs, then the client may terminate treatment. Finally, this model can assist the clinician in constructing an integrative framework for the diverse variables reviewed in the text, and with this framework will be better equipped to influence them.     

THERAPIST-CONDUCTED CONSULTATION: USING CLIENTS AS CONSULTANTS TO THEIR OWN THERAPY

Using qualitative research methodology, the authors developed an in-session therapeutic procedure called the therapist-conducted consultation (TCC) which is designed to enhance the therapist-client collaborative relationship. In the TCC, the therapist and client(s) relinquish their traditional roles and discuss the client's treatment. During this process, clients are invited to (a) share their perspective of treatment, (b) assess whether treatment is meeting their goals, and (c) suggest how treatment could change to improve their experience. The three-stage model of the TCC that resulted from the research is presented with a case example.     

The Clinical Uses of Video Therapy in the Treatment of Childhood Sexual Trauma Survivors

The power of visual images, combined with the increased availability of video taping equipment, has dramatically expanded the use of recorded images in psychotherapy over the past three decades. However, it appears that earlier video feedback techniques may not have fully capitalized on this modality's potential for catalyzing therapeutic change. Further, we have found scant literature on the use of video therapy in the treatment of adult survivors of sexual trauma. Drawing conceptually from a trauma model, as well as from cognitive behavioral and systemic/cybernetic frameworks, this article describes the therapeutic use of video therapy in the treatment of childhood sexual abuse. In video therapy, the patient is directed to independently view video recordings of therapy sessions to help correct cognitive and affective distortions resulting from trauma. How these distortions develop within the context of an incest "family trance" and how they are connected with processes of conditioning and programming are discussed. Further, the use of video therapy for marital therapy, perpetrator confrontations, and addressing suicidal impulses is described. The need for further empirical research is highlighted.     

Unsexed and Ungendered Bodies The Violated Self

I propose that rape/incest potentiates a dual rendering of its history. There is a narrative cast in gendered and sexual states and enactments. And there is a thing narrative told by an unsexed and ungendered self (or “thing-self”). This splitting of trauma narratives ensues because the perpetrator is engaged simply not in humanized malignance, but also in an it-it encounter devoid of all desire. In the wake of sexual violation, there are traumatized sexed and gendered human selves. And there are traumatized unsexed, ungendered thing selves. The former seek an audience with a human recipient. But the latter are in search of a form of disembodied witnessing located in the thing dimension of the analyst's consciousness. My speculation about the thing-self originated with a female patient who had endured childhood incest. I begin with an extensive clinical presentation of that treatment, with an emphasis on a persecuted disembodied thing-self. That self was revealed through a peculiar form of analytic theater and an attendant hallucinatory process in the countertransference.     

The impact of therapist pregnancy on the treatment process

Therapist pregnancy is a powerful emotional stimulus and a real-life event that affects clients and the treatment process. In the present paper, previous literature is reviewed and clinical experiences of the author in a university counseling center are reported to address how therapist pregnancy influences clinical treatment. Although therapists often hesitate in emphasizing their pregnancy, evidence suggests that it is easy to underestimate the importance of the pregnancy for clients. Case examples are presented which demonstrate client responses and the significance of the pregnancy for four female clients. Gender differences in client reactions are not fully understood, and it may be particularly difficult to facilitate male clients in dealing with issues stimulated by the pregnancy. These clinical findings suggest that in a variety of settings, understanding and working with clients' reactions to the therapist's pregnancy can enhance treatment.     

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 Effectiveness of Group Treatment for Female Adult Incest Survivors

Very few clinicians receive training in the treatment of sexual abuse, yet during their careers many will encounter victims of sexual abuse. This article discusses the incidence of child sexual abuse, defines incest, and discusses treatment options. A review of group treatment is explored, with results being documented providing support for the effectiveness of the group treatment process.     

The Utility of Social Class,Race, and Gender in Clinical Practice: A Case Study Involving Intraracial Dyads

This article focuses on clinical work involving a male Black practitioner and a male Black client in which issues of social class, race, and gender were prominent in the treatment process. Three questions raised by the client early in the therapeutic encounter informed assessment, treatment, and the clinician's countertransference. Tenets from self-psychology, relational theory, intersubjectivity, and sociocultural factors relative to Black men are used to ground the discussion. Finally, the article illustrates why intraracial therapy should be understood in the context of the delivery of culturally competent services, highlighting how the intersection of a client's psychological issues, social class, race, and gender can emerge as functional features in psychotherapeutic work.     

Six Step Therapeutic Process to Facilitate Forgiveness of Self and Others

This theoretical article postulates a six step therapeutic process to facilitate forgiveness of self and others. The purpose of this article is to provide therapists with the therapeutic process that can be used to assist clients who are working through forgiveness and self-forgiveness. The combination of several therapeutic methods in a specific order might be effective in assisting clients to work through the forgiveness process in a systematic way. A case example that chronicles a client’s experience while working through forgiveness is provided. Lastly, a discussion of implications for practice and further research questions are presented.