Sexual abuse trauma and treatment of survivors Flashcards
What is sexual abuse prevelance
1 in 4 females
1 in 7 males
What can sexua abuse consist of
inappropriate nudity genital exposure observation of the child kissing, fondling, masturbation fellatio, cullilingus digital/penile penitration dry intercourse rape
What are most frequent diagnoses with sexual abuse
PTSD BPD eating disorders depression anxiety
Individuals abused as children are more likely to do what with alcohol
use to self-soothe
begin drinking at earlier ages
What is symptom severity affected by
Type of abuse who abuser is and relationship to victim age of onset and duration of abuse other significant relationships additional life traumas Pre-morbid personality (some people recover from things easier than others) Subsequent life events support from others following abuse
Issues in sexual abuse
age difference position of power over victim perception of force secrecy shame and guilt threat of harm to victim or family sexual arousal in victim
What is the function of symptoms
symptoms are attempts at adaptation
Common symptoms
low self-esteem
depression
hypervigilance, exaggerated startle response
self destructive behavior (eating disorder, cutting, etc)
suicidal ideation
dissociation
damage to brain, learning ability, memory
nightmares, sleep disturbances
isolation, w/drawl
addiction
What happens with traumatic memories
They are encoded differently from normal events
Where are traumatic memories imprinted
sensory and emotional modes in less organized and dissociated ways
What are the 3 parts of memory
Encoding (memory creation)
Consolidation (storage)
Retrieval
When may memories return
reminders such as flashbacks, nightmares
What is sexual abuse
Traumatic
violation of the body, boundaries and trust
What is the betrayal trauma theory
predicts that the degree to which a negative event represents a betrayal by a trusted needed other will influence the way in which that event is processed and remembered
What is not the goal of treatment
Not have the patient remember
What is explicit memory
consciously able to retrieve past experience (readily available)
What is implicit memory
info that is not consciously available to the individual
What are the long term effects of childhood sexual abuse
cognitive emotional behavioral interpersonal physical
What are principles of sensitive practice
respect rapport sharing control sharing info respecting boundaries fostering a mutual learning process consideration of ebbs and flows demo of awareness of the prevalence of violence and CSA
What are feelings that may interfere with treatment
fear and distrust physical pain need to feel in control discomfort w/ men triggers dissociation self harm ambivalence about the body conditioning to be passive
What are possible treatment issues
Trust-pt. question trust w/ therapist, therapist goes long distances to prove trust
distance- distrust may lead to distance when pt. needs opposite
Boundaries- abusive family roles are distorted, leads pt to ask personal info about therapist
Limits
Flexibility
Anger
Control-major goal in tx is balancing both letting go of control and being in control
Role modeling
Responsibility
Idealization
Red flags during treatment
dissociation
flashbacks
silence
safety concerns w/ regard to leaving places
Acting out (suicide attempts, cutting , drinking, etc.)
What is grounding
methods for stopping the re-experiencing of trauma, or related symptoms, and getting back to the here and now
Grounding techniques
Maintain visual contact w/ environmental cues
keep client in well lit area
don’t allow hiding in dark confined areas
have client keep eyes open
instruct client to focus on objects around them
discuss previous flashbacks
use clients name
remind client to look at your face
Assist client to write or draw something
plan ways to cope with stress
develop crisis response plan
Items to use for Grounding
Sight Sound Smell taste touch
What is helpful to do with clients who dissociate or have flashbacks
brainstorm a list of techniques (e.g take deep breaths, stretch upper body, shake out legs, etc.)
Strategies to use with cutting
Mark the body (with marker)
Feel pain (snap rubber band)
feel pressure (rub skin with brush)
Need to feel (eat, touch, shower, jumping jacks, massage)
Express rage (punch punching bad, hit pillow, throw things)
Punish self (write down reasons, remind self you re punishing yourself with feelings)
Feel calm or in control (deep breathing, journal writing, bath)
Communicate indirectly (write letter and don’t mail it, paint/draw)
Treatment interventions for self harm
psycho-education communication skills music art techniques sensory based treatment journaling guided imagery cognitive behavioral DBT
What are the 4 core areas of DBT
Emotional regulation
crisis survival
interpersonal effectiveness
mindfulness
