Child sexual abuse Flashcards
Intergenerational sexual abuse
PEER Brothers/siblings (most common) cousins INTERGENERATIONAL Uncles/Aunts Grandfathers/Grandmothers Mothers Fathers Stepfathers
Family sexual abuse involves:
Relational betrayal and trauma
Caregiver betrayal and trauma
Conflict of loyalties at disclosure
Confusion around understanding situation
(particularly if sibling sa)
Dilemmas around maintaining family integrity
Loss and grief of the family ideal
Diagnosis of trauma
DSM doesn’t help us. Currently, can add on DESNOS
to a PTSD diagnosis. Complex PTSD not
in DSM5
PTSD COMPLEX PTSD (Disorder of Extreme Stress not otherwise specified – DESNOS) BORDERLINE PERSONALITY DISORDER (Controversy in diagnosing BPD versus Complex Trauma) DISSOCIATIVE IDENTITY DISORDER DEVELOPMENTAL TRAUMA DISORDER (not in DSM-V)
Developmental trauma disorder
The diagnosis of PTSD does not take into
account how the developmental stages of
children may affect their symptoms and how
trauma can affect a child’s development.
Hasn’t been officially recognised in the DSMV
as a diagnosis but was lobbied
unsuccessfully by leading Psychiatrists to be
included.
7 domains of Developmental trauma disorder
- Attachment
- Biology
- Affect or emotional regulation
- Dissociation (coping mechanism)
- Behavioural control
- Cognition (Planning issues common)
- Self-concept (Young person grows up feeling like
its their fault, self concept of shame)
Biological component of dev trauma
(i)sensory-motor developmental dysfunction (often confused with autism) = a condition where sensory stimuli aren’t interpreted properly by the brain and nervous system. Children with this condition tend to be either hypersensitive (oversensitive) or hyposensitive (under-responsive) to stimuli.
(ii) sensory-integration difficulties -
People with Sensory issues/difficulties misinterpret everyday sensory information, such as touch, sound and movement,
(iii) somatization, and
(iv) increased medical problems
what helps recovery Paul Mullen
The Developmental Stage of the child when the abuse occurred
Resiliency of the Child
Quality of the Relationship with the Mother
Level of Success at school, sport and with peers
A secure and supportive family background
Strong relationship with father (non offending)
A stable and supportive partner relationship
Bouverie Centre model (founded by anne welfare)
Developed a model of working incorporating the lenses of individual work, systemic work and feminism
Treatment integrates individual and family work
Individual work to address the traumatic
symptoms and offender issues. Family Work – to overcome the impact of the sexual abuse on relationships and to create optimal family environment to allow good recovery.
Weave between the two
Early on do family work between victimised children and non offending parent. Mine info from the offender to help with victim work, and mine info from the victim to help with the offender work
Why do family work
Victim needs unambiguous validation and belief from all the family.
Victim has suffered relational trauma and attachment disruptions due to the abuse …..work between the victim and the non offending parent provides possibilities for this repair and future relationships.
The abuse in the family has set up unhealthy patterns of interaction in the family that need to be addressed as well as stopping the abuse.
Intrapsychic trauma treatment
Establish a sense of safety.
Stabilisation
Assist clients to find a language to understand and communicate their experiences ie “process” their experiences. EMDR very useful (after 3 months best)
Assist clients to integrate the fragmentary nature of their memories.
Medication? SSRI anti depressants/atypical antipsychotic medications/cortisol. Restore their sense of power and being in control.
Discover what are the normal coping mechanisms of the client – are these helpful or creating more problems (eg
self harming, some kids masturbate chronically until they
harm themselves - need better ways to self soothe)
Provide healthy strategies for self soothing.
Social and interpersonal linkages vital (include the family in the work). Restore the connection between the survivor and the community.
Explain the possible irritability, emotional difficulties and other PTSD symptoms to family and client. What family thought were personality traits often actually PTSD symptoms
Reframe the experience for the client to cut out shame, guilt, self blame, etc.
Take each client as a unique individual rather than apply a formula for treatment.
Goals of Family work
- Unambiguous acknowledgement of sexual abuse.From the Non offending parents and the other family members. Possibly from the offender (if an intrafamilial offender and particularly if a major caregiver of the child)
Validation and Support
Sense of Justice - Psychoeducation on PTSD. Critical for conceptual understanding by the family. Helpful for non-blaming by family members - blame will mean they never come forward.
- Opportunity for nurturance and care, relational repair.
- Restoring narrative of trauma in the family context. Parents get to know and understand the extent of the what their child has been through. Parents, in their witnessing, are able to convey to their child that the child was not to blame and was not responsible for the abuse.
Often the parent sees offending parent and child as having an affair - important they realise it is not the case.
- Development of normal intimacy and attachment between parent, child and siblings
- Victims feel safe and trust in the family (over the long term)
Method of family work (with an offending parent)
- Holistic framework for interconnecting work. Family Work Involves juggling a series of different therapeutic relationships that all interconnect in order to achieve the goals.
Information from one part of the system is sometimes
used to help change another part of the system.
Same counsellor or careful co-ordination between treating team members. - Individual or dyadic work first. Victim and Perpetrator must not be put into the room together (maybe much later it might be possible as a confrontation). Often need to do the individual work first to engage and educate the parent, victim and siblings. Victim often does not feel safe with even non-offending family members. Pay attention to sibling subsystem – can be very influential.
- Engagement and the non-offending parent crucial first step. Need to be clear and direct and provide strong information from all the treating system (difficulties if splitting here). Convey a non-blaming position.
- Work with familial offender. Most organisations say to use a different counsellor for victim and perpetrator, but it can be really useful to have that perspective of both. Offender work is specialised and requires knowledge of the level of their minimisation or denial of crimes and their cognitive distortions. Need to get them to own up and feel remorse, rare cases talk to the victim (at least 2 years into therapy)
- Rectify relationships between non-offending parent, siblings and victim. Consider what might get in the way of the relationship now. Uncover all the misunderstandings and concerns that still exist about the history.
- Couple work. Sometimes, when working with an adult
survivor, it is more appropriate to work with the couple relationship. Or when there isn’t any hope of changing anything in the family, can focus on the couple. Focus on sexual problems, fear of intimacy, trust, triggering of PTSD with touch, anger, difficulties in parenting and mothering. Lot of support and education needed for partner. - ?Family reunification - rare. More often a restructured family evolves with new ways of relating and correcting emotional problems. This has only happened 3 times in Anne’s career, always led by what victims want not parents.
Sibling sexual abuse
Similar but different! to parent offender work.
Sex offending behaviour is a different treatment requirement.
Issues around family break-up or togetherness are more complex.
Prevalence most common form of SA.
More likely to involve coercion, force, and penetration than father or stepfather abuse.
Need to take particular care with both kids. With a partner, you get rid of the partner, but cannot do that with your kids.
Misconception that sibling abuse more benign, but it’s also bad. They don’t have the frontal lobes to groom like an adult, so more violent
Disclosure in Sibling sexual abuse
Carlson university study, 19% disclosed compared
to more than 50% of father or intergenerational abuse
Usually close to parents, and reason they don’t disclose
is because they thought it would ruin parent’s life.
Trying to protect parents. This pattern came out of
Annes PhD as well. When they finally do tell parents, they don’t understand, minimise, don’t validate, often therapists dont validate either, cultural thing.
SSA victims were initially more likely to have a good relationship with their carers/parents than intergenerational CSA victims…however, SSA victims were more likely to lose their parents in the aftermath of disclosure.
