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Effects of Child Sexual Abuse

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The Assessment and Treatment of Survivors Dr. Ian Newey * Ian Overview Prevalence Problem? Effects on a child Treatment Discussion Prevalence of Child Sexual abuse ... – PowerPoint PPT presentation

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Title: Effects of Child Sexual Abuse


1
Effects of Child Sexual Abuse The Assessment
and Treatment of SurvivorsDr. Ian
Newey
2
Overview
  • Prevalence
  • Problem?
  • Effects on a child
  • Treatment
  • Discussion

3
Prevalence of Child Sexual abuse
  • Estimates vary problematic measurement due to
    differing definitions, and ethically accessing an
    accurately reporting representative sample
  • However, a Norwich based study carried out by
    Cathy Kenney of the Unthank Centre in the early
    1990s suggested that one in three girls and one
    in five boys report having some form of unwanted
    sexual experience before the age of eighteen
    years old.
  • It is estimated that children with disabilities
    are 4 to 10 times more vulnerable to sexual abuse
    than their non-disabled peers.National Resource
    Center on Child Sexual Abuse, 1992.

4
Is this a problem? Does it do them any harm?
5
Task
  • Gunborg Palme (2006) states that some people who
    have been abused suffer from certain problems as
    a result of this abuse.
  • She divides these problems into the following
    categories
  • Psychological
  • Social
  • Sexual
  • Physical
  • Effects
  • Divide into four groups (one category for each
    group) and write down the ways in which a child
    might be affected by being sexually abused

6
In children and adolescents who experienced
trauma, we may see
  • Re-enactment of aspects of the trauma into their
    daily lives (e.g. with children in play,
    drawings, or speech).
  • Anger, hostility, impulsive and aggressive
    behaviours
  • Poor ability to regulate emotions
  • Fear
  • Anxiety, phobias
  • Depression
  • Sexually inappropriate behaviour
  • Self-destructive behaviour
  • Feelings of isolation and stigma
  • Poor self-esteem
  • Difficulty in trusting others
  • Relationship problems
  • Problems with school performance.
  • Substance misuse
  • Post-Traumatic Stress Disorder

7
Early trauma
  • Deficits in emotion regulation/ self-soothing.
  • Alterations in attention and consciousness e.g.
    dissociation
  • Impact on sense of self and self-worth e.g.
    chronic guilt, responsibility and shame
    (egocentric world view).
  • If repetitive and premeditated abuse by
    caretakers we can expect a complex perception of
    the perpetrators.
  • Difficulties in relationships e.g. cant trust/
    be intimate, others are dangerous.
  • Somatisation and medical problems
  • Hopelessness

8
Exacerbating ameliorating factors
  • Gunborg Palme (2006) states that the extent to
    which a person suffers with a variety of post
    abuse sequelae depends on several factors
    including
  • the level of invasiveness (e.g. penetrative acts
    rather than exposure)
  • However, it should be noted that children can be
    extremely traumatised following exposure to
    relatively low level acts on the hierarchy of
    abuse, depending on other factors.
  • Trauma focused cognitive therapists hypothesise
    that it is the meaning of an abusive experience
    rather than the experience itself.

9
Exacerbating ameliorating factors
  • The duration (single trauma can often be more
    easily processed than repeated acts of abuse)
  • The relationship with the abuser (prognosis is
    worse if abused by mother as opposed to a
    stranger)

10
Exacerbating ameliorating factors
  • Intrapsychic factors (e.g. John Briere believes
    that attachment is an important factor in the
    development of resilience)
  • Early identification of sexual abuse victims
    appears to be crucial to the reduction of
    suffering of abused youth and to the
    establishment of support systems for assistance
    in pursuing appropriate psychological development
    and healthier adult functioning.
  • As long as disclosure continues to be a problem
    for young victims, then fear, suffering, and
    psychological distress will, like the secret,
    remain with the victim.(Bagley, 1992 Bagley,
    1991 Finkelhor et al. 1990 Whitlock Gillman,
    1989)

11
Exacerbating ameliorating factors
  • External protective factors (a supportive third
    person such as a non-abusive parent, another
    believing understanding relative or professional
    involved long term).
  • There is the clinical assumption that children
    who feel compelled to keep sexual abuse a secret
    suffer greater psychic distress than victims who
    disclose the secret and receive assistance and
    support (Finkelhor Browne, 1986)

12
What is post-traumatic symptomatology?
  • DSM-IV Definition
  • Trauma Fear
  • Re-experiencing
  • Avoidance
  • Arousal
  • Duration
  • Impairment
  • Also
  • Thoughts and beliefs about self, the world,
  • the future
  • feelings of guilt and shame

13
How do we talk to clients about their traumas?
  • We know that clients are thinking about their
    trauma anyway, asking will not make it worse.
  • Its worse not to ask.
  • Consider client characteristics emotional
    arousal, willingness to talk, how have others
    responded in the past.
  • Let them know how long you will spend talking
    about this allowing for time to talk about
    other things/ do relaxation/ mindfulness etc at
    the end.
  • Make a plan for someone to meet them after the
    session, fun/ distracting activities lined up.

14
Practical skills
  • Assessment
  • Details of the trauma
  • Meaning of the trauma
  • Prior traumas
  • Ongoing threats
  • Current stresses
  • Coping/ resources
  • Social supports
  • Losses associated with trauma
  • Co-morbid issues
  • Range of emotional responses (anger, guilt)
  • Context of trauma
  • Dissociation vs. capacity to engage emotions
  • Avoidance vs. commitment to treatment

15
Trauma Timeline
  • A zoomed out Google earth view
  • Each year (0-1, 1-2, 2-3..) systematic time
    coded chronologically ordered coherent
  • Not overwhelming fits on one A3 sheet of paper
    it is manageable (but conversely there is a
    significant amount of stuff on the timeline
    people have permission to feel bad about it)
  • Distress ratings taking control calibrating
    and defining tolerance
  • Celebrating as a survivor

16
Psychoeducation
  • Normal reaction to abnormal events
  • Normal memories and trauma memories
  • Avoidance

17
Trauma memories and normal memories
  • Verbally Accessible Memory - breakfast memory
    memory of dinner on 12th February 2009
  • Situationally Accessible Memory when were
    reminded by things in our environment trauma
    memory

18
Memory in PTSD
  • Trauma memories
  • Amygdala
  • High affect
  • Triggered by matching stimuli
  • Sensory
  • Fragmented
  • Original meanings (which might be wrong, e.g. I
    died)
  • No time code
  • Not connected to other memories
  • Normal memories
  • Hippocampus
  • Voluntary recall
  • Semantic
  • Coherent with low affect
  • Time code
  • Connected to other memories

19
Piecing together a coherent memory
  • Not a nice process
  • Overflowing linen cupboard metaphor
  • Splinter analogy
  • The memories will never be fluffy Disney Hannah
    Montana type memories, but we can get rid of the
    intrusions and the high levels of anxiety

20
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21
Present moment focus
  • Train metaphor

22
Dissociation and grounding
  • 5 senses sight, sound, touch, taste, smell.
  • Coping cards/ objects that remind person of the
    here and now.

23
Reducing avoidance
  • In line with the persons life goals what are
    their past experiences stopping them from doing
    now?
  • Graded exposure

24
Reclaiming Life
  • Compassionate mind
  • Values and goals
  • Safe Place exercise a place where you feel ok
  • Practice Safe place exercise as a group and then
    in pairs.

25
Reflections, thoughts discussion
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