Week 4

Question 1

What are the most important questions to ask to a patient who has experienced sexual abuse? (9)

Answer 1

Have you ever talked about it with everyone?
How old were you?
Who was the perpetrator?
How many times did it happen?
Were you able to tell anyone at the time?
What kind of contact was it?
When did your sexual problems start?
Does the abuse play a role in your sexual problems?
Do you experience flashbacks during sex now? (PTSD)

Question 2

What are consequences of child sexual abuse? (10)

Answer 2

Drug abuse
PTSD
Depression, anxiety, personality disorder
Physical problems
Re-victimization
Risky sexual behavior
Low self-esteem
Low life satisfaction
Educational underachievement
Suicidal / self-harm

Question 3

What is an important protective factor in developping (sexual) problems after sexual abuse?

Answer 3

Family characteristics / social support

Question 4

What is the prevalence of abusers being male?

Answer 4

> 90%

Question 5

What is the prevalence of abusers being someone you know?

Answer 5

> 80%

Question 6

What are three core elements in treating sexual problems?

Answer 6

1. Extinction of fear
2. Feelings of guilt and shame
3. Reconstructing cognitions about situation and own role

Question 7

What kind of treatment is needed when someone developped a personality disorder (like Borderline) after sexual abuse?

Answer 7

More intensive treatment like schema therapy

Question 8

What kind of treatment is needed when someone developped PTSD after sexual abuse?

Answer 8

• CBT
• EMDR
• Pharmacological therapy (SSRI’s)
  Sexual problems will not be resolved with only PTSD treatment

Question 9

What are four conditions for effective punishment?

Answer 9

1. Consistency
2. Swift (right after offending behavior)
3. Punishment ‘hurts’ the offender
4. Punishment is related to offending behavior

Question 10

What is always more effective than punishment?

Answer 10

Rewarding good behavior

Question 11

Why can get offending behavior get worse when low risk offenders get treatment for it? (two reasons)

Answer 11

1. The low risk get in contact with the high risk
2. They’ll get disconnected from their protective behaviors (friends, sports)

Question 12

Where is it best to interfere in the sexual motivation cycle in treatment?

Answer 12

(dis)inhibition

Question 13

What three things are important to keep in mind while working on (dis)inhibition?

Answer 13

1. State disinhibition: intoxication (drunk)
2. Trait disinhibition: impulsivity
3. Choice disinhibition: antisocial traits

Question 14

Why is interfering at the sexual stimulus level (like conditioning something into not being sexual anymore) not a good idea?

Answer 14

Because then the person might not be sexually attracted to anything anymore (which is not something that many people want). It doesn’t just shift from children to adult women (example).

Question 15

What is important when focussing on how to treat an offender?

Answer 15

• The needs of the offender
• Motivation of the offender
• Disorders (that need to be treated first) like psychosis, depression or ADHD
• Intelligence

Question 16

What is specifically important to take into account while treating someone with narcissism?

Answer 16

Finding a way to communicate while keeping their self-image up