Training Mental Health Professionals in Child Sexual Abuse: Curricular Guidelines

This study explored whether counseling practices with women survivors of child sexual abuse reflect the belief that women do not sexually abuse children. Canadian therapists (n?=?164) who work with women survivors of child sexual abuse were surveyed about their beliefs about what constitutes child sexual abuse, who commits child sexual abuse, and their practices regarding inquiries about abusive behavior. A majority self-reported that they ask women and think it is important to ask but most believe that clients will not spontaneously self-disclose inappropriate sexual thoughts or behaviors. How broadly or narrowly therapists defined child sexual abuse was not related to self-reported therapeutic discussion. Therapists demonstrated differential gender beliefs about child sexual abuse perpetration, but this did not relate to self-reported counseling practices. Implications for therapist education are discussed.     

Implications of the Memory Controversy for Clinical PracticeAn Overview of Treatment Recommendations and Guidelines

The controversy surrounding delayed and recovered memories of incest/child sexual abuse has had a profound impact on clinical practice. This article first provides an overview of the positions taken by both sides in the dispute, the “false memory” proponents and the traumatic stress proponents. It then presents the major findings of several of the professional task forces charged with reviewing the controversy and arriving at recommendations for research, clinical practice, and forensic practice regarding delayed recall of memories for sexual abuse. The current status of scientific and clinical knowledge is discussed, especially in terms of its implications for therapists and clinical practice. Nineteen recommendations and practice guidelines are presented for therapists working with individuals who report or suspect childhood sexual abuse on the basis of continuous and/or recovered memory.     

Implications of the Memory Controversy for Clinical Practice: An Overview of Treatment Recommendations and Guidelines

SUMMARY

The controversy surrounding delayed and recovered memories of incest/child sexual abuse has had a profound impact on clinical practice. This article first provides an overview of the positions taken by both sides in the dispute, the “false memory proponents and the traumatic stress proponents”. It then presents the major findings of several of the professional task forces charged with reviewing the controversy and arriving at recommendations for research, clinical practice, and forensic practice regarding delayed recall of memories for sexual abuse. The current status of scientific and clinical knowledge is discussed, especially in terms of its implications for therapists and clinical practice. Nineteen recommendations and practice guidelines are presented for therapists working with individuals who report or suspect childhood sexual abuse on the basis of continuous and/or recovered memory.     

Countertransference reactions in therapeutic work with incestuous sexual abusers

The study was a qualitative investigation aimed at therapists' responses to working with a population of incestuous sexual abusers. Semi-structured interviews were conducted with nine therapists who were recruited from psychotherapy, psychology, and forensic psychology services in the National Health Service (NHS) in the UK. The predominant therapeutic model was psychodynamic; however, cognitive-behavioural and integrative approaches were practiced by some therapists. The data were analyzed using interpretative phenomenological analysis (Smith, 1996). Results suggested that the therapists experienced a considerable amount of negative and difficult feelings and that they tended to experience feeling controlled and deceived, which seemed to influence their ability to create and maintain the therapeutic relationship. It was suggested that the dynamics of incestuous sexual abuse played a part in these difficulties. The results are discussed with reference to the clinical therapeutic literature.     

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.     

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.     

INTIMATE JUSTICE: CONFRONTING ISSUES OF ACCOUNTABILITY, RESPECT, AND FREEDOM IN TREATMENT FOR ABUSE AND VIOLENCE

Intimate justice theory is a set of nine interrelated concepts that describe the ethical dimensions of equality, fairness, and care in ongoing partnerships. Understanding ethical dimensions involves examining internalized beliefs and behavior in terms of their motivation and impact on the partner, particularly as they empower, disempower, or abuse power. The concepts of intimate justice theory are applied to confront disempowerment and abuses of power, to challenge internalized beliefs about how one should treat one's partner, to explore how internalized beliefs were developed through experiences in the family of origin, and to develop an awareness of the linkages between intimate partner abuse and social injustice. This article demonstrates how therapists can utilize three of the concepts-accountability, respect, and freedom-to structure the opening phase of treatment for abuse and violence. The primary focus of the opening phase is on establishing accountability for change in the abusive man and protecting the safety of the injured partner. This involves challenging the abuser's sense of entitlement and working to rethink what respect is and restoring freedom to his partner. The discussion incorporates the findings of an exploratory, qualitative study that investigated the experiences of 30 abusive men and their partners who were clients in a university-based counseling clinic. The article elaborates six interventions that can be utilized in clinical settings to structure treatment with abusive men.     

Reclaiming the Mother-daughter Relationship after Sexual Abuse

This paper seeks to provide direction to therapists working with mothers and daughters after a disclosure of father-daughter sexual abuse. The importance of the mother's belief in and support for the child's recovery is highlighted, as are some of the cultural assumptions about mothers and daughters which negatively impact on the relationship. Despite paying lip service to offender responsibility, there continues to be a culture of mother blaming in the child sexual abuse and family therapy literature on incest. Current research findings challenge some of the prevalent myths about mothers’ responses to their children's disclosures. Few clinical sources have addressed this issue, and therapists who reject the mother blaming literature are therefore left with little guidance as to how to work more effectively with mothers and daughters. Consequently they may unwittingly further undermine the relationship. Work with mothers and daughters as they recover from intrafamilial sexual abuse is discussed, and key therapeutic themes and guidelines for practice presented. We explore the significant theme of the rebuilding of trust between mothers and daughters and facilitate a process whereby the woman is able to bear witness to and acknowledge the trauma experienced by her daughter.     

Fear and expectations: differences among female victims of domestic violence who come to the attention of the police

This study investigated a broad range of female victims of domestic partner abuse who came to the attention of the police. Ninety-five consecutive victims were interviewed by officers in a police department's domestic violence unit. Twenty-two percent of the victims matched expectations of women who were both afraid of their abusers and expected future abuse. Surprisingly, 46% of the victims were unafraid of their offenders and believed that future abuse was unlikely. A consistent pattern of findings supports the conclusion that a much broader range of victims than expected comes to the attention of the police. These results suggest exploring alternative police responses for different types of victims.     

Politeness Strategies in Confrontations of Prejudice

This project draws on the self-regulation of prejudiced responses model and politeness theory to investigate the role of politeness strategies in interpersonal confrontations of prejudice. One hundred and three participants were exposed to experimental confrontations of prejudiced remarks made about Native Americans. The results generally indicate that direct confrontations, which included an explanation of why the response was perceived as prejudiced, were most effective in reducing prejudiced responses and reducing levels of reported prejudice. Furthermore, participants generally accepted confrontations of their prejudiced responses and did not negatively evaluate their confronters. Finally, the more positive politeness participants perceived in the confrontations, the more positively they evaluated their confronter. Implications for theory and the confrontation of prejudice in everyday life are discussed.     

“A Very Steep Climb”: Therapists’ Perspectives on Barriers to Disclosure of Child Sexual Abuse Experiences for Men

ABSTRACT

Recent studies indicate that men experience unique barriers to disclosure of child sexual abuse. Blind spots held by mental health providers and social service agencies may inadvertently help produce and sustain these barriers. However, therapists who specialize in treating this population may also hold important insights into the barriers clients face. Because delayed and nondisclosure of child sexual abuse have been associated with negative mental health outcomes for adult survivors, understanding these barriers is critical to improve clinical practice and facilitate help-seeking. Using conventional content analysis, this study examined the perceptions of nine therapists who specialize in the treatment of men who were sexually abused in childhood, many of whom are considered pioneers in the field. Analyses identified nine types of barriers, which were organized into three categories: intrapersonal experience (difficult feelings, lack of language, and self-engagement), social milieu (internalized social stigma, negative responses, social loss or judgment, and masculine identity dissonance), and health care environment (structural barriers, relational challenges with therapists, and unhelpful therapeutic strategies). Implications for future research, clinical training, and clinical practice are discussed.     

Exploring gender and elder abuse from the perspective of professionals

We conducted an online survey of professionals working in two Canadian provinces to learn about their knowledge of elder abuse from a gender-based perspective. A total of 169 professionals (90% women) completed a survey in either French or English. Five topic areas emerged from the analysis: the influence of gender on the risk of abuse; types of abuse detected; knowledge gaps; capacity to respond to gender-based abuse; and awareness of resources. To gain further insight into these results, we conducted three focus groups with a total of 24 professionals. Professionals held relatively little recognition of, or knowledge about, gender related to elder abuse. Our results indicate the need to develop educational and awareness raising opportunities for professionals who work with abused older adults in both French and English to identify and respond to the unique needs of older women and men.     

Association between physical partner violence, posttraumatic stress, childhood trauma, and suicide attempts in a community sample of women

Our objective was to estimate the prevalence of intimate partner violence (IPV) and to explore its association with childhood maltreatment, substance misuse, posttraumatic stress, and suicidal behavior in a representative community sample of women. IPV was operationalized as a "physical attack or beating by a spouse, boyfriend, or live-in partner." We surveyed 637 women in Memphis, Tennessee, by telephone survey. Sixteen percent reported ever experiencing IPV by a male partner, and 75% endorsed multiple assaultive acts. Of abused women, 5.9% met current PTSD diagnostic criteria, and an additional 11.8% were assessed with subthreshold symptoms. Abused women were more likely than other women to be divorced, to have less than 13 years education, to endorse high levels of childhood victimization, to have abused drugs and alcohol, and to have attempted suicide. Twenty-three percent of IPV+ (abused) women reported a suicide attempt at some time in their lives compared with 3% of IPV- (nonabused) women (p < .0001). Further, multiple logistic regression analysis showed that childhood sexual and emotional abuse and low educational attainment were the only significant predictors of IPV. These results suggest that in women who endorse IPV, careful inquiry of past abuse, trauma-related symptoms, suicidal behavior, and drug use may be important, so that interventions can be both timely and appropriate.     

Hidden in the Margins: A Qualitative Examination of What Professionals in the Domestic Violence Field Know About Transgender Domestic Violence

This qualitative study endeavored to examine the views and experiences of individuals who work with, and those who consider issues related to, transgender domestic violence in an effort to determine what (if anything) is known about this construct. Using a phenomenological approach, ten interviews were conducted with individuals who professionally confront transgender intimate partner violence. Overall, the study found that many individuals from different disciplines were in agreement concerning the paucity of resources for this population, and future research would benefit from quantitative research to understand more about transgender domestic abuse. Furthermore, criminal justice organizations should take active steps within their own agencies to appropriately address this problem for transgender victims of abuse. Finally, all of the participants stated their beliefs that transgender domestic abuse is a very serious problem and believed that more research should be done to better understand it before it can be addressed.     

Intervention with abused older males: conceptual and clinical perspectives

Men and women experience abuse in different ways and older men have particular treatment needs that must be addressed by clinicians. The current design and configuration of clinical services may create barriers to abused older men receiving treatment fully suited to their needs. In this article, the unique experiential dynamics and help seeking behaviors of older men who experience abuse are delineated and recommendations are given for structuring services to better meet their needs. Gender-sensitive clinical techniques and modalities are described and suggestions for interventions that could prove particularly efficacious in the treatment of older men are offered.     

SUBSTANCE ABUSE TRAINING AND PERCEIVED KNOWLEDGE: PREDICTORS OF PERCEIVED PREPAREDNESS TO WORK IN SUBSTANCE ABUSE

As frontline mental health care providers, social workers need to be prepared to confront and properly manage substance abuse issues in practice. This study examined predictors of recent master of social work (MSW) graduates' perceptions of preparedness to practice in the area of substance abuse. A cross-sectional design was used, and 232 recent MSW graduates completed a mail-in survey (65.7% response rate). Respondents were more likely to perceive themselves as prepared to work with substance abuse issues if they received more formal academic training in substance abuse and had higher knowledge of substance abuse concepts and models. The findings support the need to include substance abuse education in social work curricula.     

Prevalence estimates and correlates of elder abuse in the United States: The National Intimate Partner and Sexual Violence Survey

This study examines the prevalence and correlates of psychological abuse and physical abuse against women and men aged 70 or older. Self-report data from 2,185 respondents in the 2010 National Intimate Partner and Sexual Violence Survey (NISVS) were used to create weighted estimates for past-year experiences of abuse. Correlates were then examined using survey logistic regression models. More than 1 in 10 adults who are 70 years of age or older (14.0%) have experienced some form of abuse in the past year, with 12.1% experiencing psychological abuse and 1.7% experiencing physical abuse. One in five victims (20.8%) were abused by both intimate and nonintimate partners. Health care insecurity was the strongest correlate of past-year abuse. The odds of experiencing abuse were 4.53 times greater for those who experienced health care insecurity than for those who did not. This presents a significant challenge for identifying and helping victims of abuse.     

Differences in childhood sexual abuse experience between adult Hispanic and Anglo women in a primary care setting

The literature on racial and ethnic factors in childhood sexual abuse is limited. The purpose of this exploratory study was to document Hispanic-Anglo differences in childhood sexual abuse experiences and assess whether these differences may be explained by socio-demographic and family environmental differences. Adult Hispanic (n = 69) and Anglo (n = 19) women from a family medicine clinic waiting room reporting a history of childhood sexual abuse completed an in-depth survey concerning the sexual abuse experience and their childhood environment. In this study, Hispanics were more likely to report a family member as the perpetrator and to experience more self-blame as a result of the abuse. Hispanics were also more likely to take action in response to the abuse, especially those who were more acculturated to U.S. culture. However, most of the observed differences in this study could be explained by socio-demographic or family environment variables, not by ethnic background. Qualitative research on the family environments of Hispanic victims of child sexual abuse may further explicate the dynamics and risk factors for abuse by family members.     

Best Practices in the Treatment of Substance-Abusing Women in the Child Welfare System

ABSTRACT

This paper reviews the literature on women's chemical dependency and its effects on their children. Many risk factors (e.g., a history of traumatic exposure) and consequences (interference with parenting) of substance abuse are unique for women, giving rise to special treatment needs of substance-abusing women with children. Substance-abusing mothers also experience unique barriers to receiving the services they need to recover, such as absence of child care and lack of gender-specific treatment in their communities. Model programs are described and recommendations are offered for best treatment practices for women with chemical dependency who present in the child welfare system.