Group Therapy for Survivors of Childhood Sexual Abuse

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Group Therapy for Survivors of Childhood Sexual
Abuse

• Lisa Hayes, MSW, LSW
• Tammy Moore MSW, LISW-S
• Mount Carmel Crime and Trauma Assistance Program
• 777 W. State St. Suite 403
• Columbus, OH 43201
• 614-234-5900

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Our Program Crime and Trauma Assistance Program

• Individual and Group Counseling
• Recent Crime Victims
• Traumatic Loss
• Children, Adolescents, Adults

• Free of Charge
• Trauma focused
• EMDR trained therapists
• Advocacy and Community Education

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Warning

• Trauma providers often have trauma history
• This workshop may be triggering
• Take care of yourself

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What is Childhood Sexual Abuse (CSA)?

• You were abused if you were, as a child, teen
  and/or into your adulthood, if you were
• Fondled, kissed, or held for sexual gratification
  without consent
• Forced to perform oral sex on an adult, sibling,
  or other family member
• Raped or otherwise penetrated
• Made to watch sexual acts
• Forced to listen to excessive talk about sex
• Fondled or hurt genitally while bathed
• Subjected to unnecessary medical treatments to
  satisfy an adults sadistic or sexual needs
• Shown sexual movies or other pornography
• Made to pose for seductive or sexual photographs
• Involved in child prostitution or pornography
• Forced to take part in ritualized abuse in which
  you were physically, psychologically, or sexually
  tortured
• (Adapted From The Courage To Heal, Bass Davis,
  2008.)

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Why is this group so important?

• Breaks silence of CSA
• Provides language and education
• Reduces shame response
• Adds support network
• Breaks cycle of abuse
• Provides coping skills
• Lack of treatment
• Reduces future traumatic incidents

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Group Set-up

• 12-15 week closed group
• 8-10 participants
• Female adult survivors of CSA
• Assessment is required with CTAP staff
• Must be receiving individual therapy
• Focused on abuse
• Structured format
• Meets for 2 hours
• 2 Facilitators
• Begin and end with grounding exercise

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Choosing Facilitators

• Understanding of CSA
• Ability to do process group
• This is more than a support group
• Ability to confront challenging and distracting
  behavior
• Trust amongst facilitators
• Available to debrief after group
• Availability to members and their therapists

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Consider Group Make up

• Age
• Cultural background/ beliefs
• Sexual orientation

• SES
• Diagnoses
• Coping and History

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Things to Consider When Working with Childhood
Sexual Abuse Survivors

• Complex/ Chronic PTSD
• Other mental health disorders
• Dual Diagnosis
• Personality Disorders
• Medical History
• Life Stressors

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Group Hazards

• Attention seeking behaviors
• Confront immediately
• Avoidant behaviors
• Point out pattern
• Re-creating family of origin dynamics
• Bring awareness
• Attendance
• Have a policy in beginning

• Transference
• Dissociation
• Interrupt
• Must have plan with each member
• Triggers
• Grounding exercises
• Sensory intervention
• Contact outside of group
• Bring to group

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How to Assess Group Readiness

• Assessment can take multiple sessions
• Must be in individual therapy
• Stabilization before any trauma treatment
• Rule out
• AOD problems
• Eating disorders
• Safety Issues
• Dissociative Disorders

• No contact with offender
• Has a support system
• Not in a domestic violence relationship

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Screening Potential Members

• Assess ability to tolerate trauma narrative
• Can she cope with trauma memories?
• May need to do individual work before beginning
  group
• Is she participating in trauma focused care or
  willing to do so?
• Are there high-risk behaviors?
• Safety and stabilization every time
• Any current self harm?
• Is she willing to safety plan?

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Screening Potential Members contd

• Affect tolerance
• Can she display congruent affect throughout
  trauma narrative?
• Can she regulate affect?
• Dissociation
• Can she regulate dissociation throughout trauma
  narrative?
• Administer DES (Carlson Putman, 1993)
• Expect mild/moderate dissociation
• Diagnosis of DID not suitable for group

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Screening Potential Members contd

• AOD
• Is she currently abusing a substance?
• Has she abused a substance in the past?
• Is there a relapse prevention plan?
• Has she been able to stop substance use for at
  least 90 days? Or has been in treatment?
• Eating Disorders
• Is she currently engaging in behaviors associated
  with an eating disorder?
• Is she willing to engage in care to manage eating
  disorder?

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Overview of Group Topics

• Trust
• Week 1
• Triggers
• Week 2
• Neurological Aspects of Trauma
• Week 3
• Coping
• Week 4
• Group Trauma Disclosure
• Week 5

• Shame Guilt
• Week 6
• Anger
• Week 7
• Family/Boundaries
• Week 8
• Inner Child
• Week 9-10
• Intimacy
• Week 11
• Termination
• Week 12

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First Phase of Group (weeks 1-4)

• Establish Group Guidelines
• Identify Treatment Goals
• Group rapport and trust building
• Introduce group format and expectations
• Front loading with trauma education
• Affect tolerance
• Building Coping Skills
• Naming the trauma

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Specific Interventions

• Group Format and Expectations
• Check In Best Worst
• Model feedback format
• Naming the trauma
• Defining CSA
• Gradual desensitization
• Trauma Education
• Neurological effects of trauma (Ogden Minton,
  2000)
• Trigger Identification
• Coping
• Sensory Coping (Ogden Minton, 2000)
• Challenging patterns of coping

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Second Phase of Group (weeks 5-8)

• Sharing trauma narrative
• Processing shame and guilt
• Experiencing and releasing anger
• Family of origin
• Establishing and maintaining boundaries

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Specific Interventions

• Sharing Trauma Narrative Sharing your story
• Why Telling is Transformative (Bass Davis,
  2008)
• Structured
• No time limit
• Provide breaks
• Feedback and questions
• Shame and Guilt
• Identifying Hidden Shame (Davis, 1990)
• Group exercise Its not my fault

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Specific Interventions contd

• Anger
• Anger party
• Empty chair
• Physical release (play-doh activity)
• Family
• Families Of Origin (Davis, 1990)
• Genogram
• Limits and boundaries to set with family
• Boundaries
• Looking at Individual Relationships (Davis, 1990)
• Dealing With Your Family Now (Davis, 1990)

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Third Phase (weeks 9-11)

• Meeting your Inner Child
• Intimacy

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Specific Interventions

• Inner Child
• Meeting Your Inner Child (Capacchione, 1991)
• Childs Photo (Dayton, 1990)
• Intimacy
• Evaluate current relationship(s)
• Establishing ground rules for intimate
  relationships (Maltz, 2001)

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Termination (week 12)

• Expect disruption
• Start process at beginning of group
• Group involved in planning
• Review treatment goals
• Plan next step
• Tool boxes

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Specific Interventions

• Tool Box
• Coping strategies
• Affirmations
• Reminders that the abuse was not their fault
• Contact list
• Play-Doh
• Positive feedback

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Life After Group

• Members identify their own next step
• SIA (www.siawso.org or 410-893-3322)
• Internet support groups
• www.aftersilence.org
• www.rainn.org
• Members continue to meet
• Couples therapy
• Continued individual therapy
• EMDR

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Self Care

• Prevents secondary/ vicarious trauma
• Make time for your own life
• Have a routine for end of each group

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Questions
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Time to Relax

• Guided imagery exercise