Sexual Assault: Therapeutic Considerations when Body and Beliefs come under Attack

1. ACHA - 2010 Bill Buhrow, PsyD Director of Health and Counseling Services Asst. Prof. Graduate Department of Clinical Psychology George Fox University Sexual Assault: Therapeutic Considerations when Body and Beliefs come under Attack

2. Goal (in addition to stated objectives) • Increase our sensitivity and awareness to client spirituality resulting in a bio-psycho-social-spiritual model • Encourage increased attention to client spirituality where applicable in treatment • Facilitate improved competence in addressing mental health related spiritual issues

3. “Religion” in Therapy • APA sees religion as an important ethical issue of diversity and requires competency • The American Psychological Association • (APA) Council of Representatives (2007) recently adopted a resolution on religious prejudice. It reads, in part: “BE IT RESOLVED that the American Psychological Association condemns prejudice and discrimination against individuals or groups based on their religious or spiritual beliefs, practices, adherence, or background” (p. 3).

4. Theism vs. Naturalism. Psychologists debate their disciplines stance toward God. APA Monitor May 2010 • Article references a special issue of APA’s Journal of Theoretical and Philosophical Psychology (vol. 29, no.2) where papers both support and reject the notion that psychology discriminates against theism – “the philosophy that God not only exists but matters” • Psychology should be open-minded about a philosophy that is well-received in America’s mainstream, though not in psychology’s.” Teo – editor (a “non-religious person”) • “We’re talking about the possibility of a systematic bias against the majority of consumers of psychology.” - Slife (BYU and one of the proponents arguing psychology’s bias against theism)

5. Ethical Principles of Psychologists and Code of Conduct • General Principle E: Respect for People's Rights and DignityPsychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination . . . Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices.

6. Competence • 2.01 Boundaries of Competence(a) Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience. • (b) Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals . . .

7. you have a general idea of where you’re going but you never know what you might see or what side trips you might take along the way Therapy’s like a Road Trip

8. Integrating spirituality is like a game of . . . Chutes and Ladders

9. Phase 1 of Treatment:March - May (12 sessions) • Timing issues • Things will get worse before they get better • Ct worried depression may deepen • Ct asked to decide if now’s the right time to deal with the abuse issue • Ct decided to address abuse because of disturbing nightmares

10. Phase 1 • Thoughts and emotions giving different messages • Dissociative responses • Spiritual? – not a focus in phase 1 • Termination issues?

11. Treatment Goals for Phase 1 • Stabilize affect • Manage SI • Build basic self care and efficacy skills • Decrease nightmares • Primary treatment modalities: • CBT and skill building • No attempt to decrease dissociating

12. Therapeutic Conclusions: Phase 1 • Emotional Development • Unable to label emotions, overwhelmed by emotions, dissociates when she thinks about abuse – curls up in a fetal position for 3 days • Identity development • Fractured sense of self • No real person inside, only sense of self was in relation to a perfectionistic, abusive mother • Why’d the abuse happen? • “Worthless, not valuable, damaged, broken, something wrong with her”

13. Phase 2 of Treatment:Sept - May • PRESENTING PROBLEM • continue the work she initiated • became engaged - plans to be married in May • depression was not evident • focus of therapy: • abuse issues and other relationship issues • become an equal and whole partner for fiancé’ • fear around sex with fiancé once they are married

14. Themes • Shame and guilt • Fears giving up control of her body in having sex with future spouse • Challenged negative self-talk and core beliefs • Ct split off neg emotions regarding mom – progressed to “I hate mom” • Life events

15. Themes – cont • Physical intimacy issues with fiancé • Began feeling good and life going better but still dealing with shame issues • Ct angry with God

16. Therapy review • Decreased depression (off meds now) • Nightmares decreased in severity and frequency • Physical intimacy probs with fiancé decreased • Less conflict with parents • Less reported feelings of chaos in life • Most significant thing learned in tx: “Truth and freedom are worth fighting for”

17. Phase 3 of Treatment: 2 ½ years • Grief and Loss • Guilt and Despair • Good Mom Bad Mom • Vocabulary for Abuse and Perpetrators • Marital Problems & Husband’s Extracurricular Activities • Confronting the Deceased • Help from the Local Church

18. Phase 3 of Treatment: 2 ½ years • Support from Others • Becoming an Peer with her Spouse • Psalm of Susan: “God, I surrender. I give up” • “I’m pregnant” • Anger at God and perpetrator • Celebrate Recovery: No More Anonymity

19. Spiritual obstacles (chutes) and resources (ladders) • Chutes • Identity Issues: Guilt and shame, Worthless, Lonely, Despair, “Broken”, “I’m the cause” • Refusing healing – cling to pain • Assumption of other’s sin as her own • Splitting mom and God • Ladders • Relationships with others (therapist, God, group, etc.) • Child of God • Knowing the truth • Redemption

20. Spiritual “chutes” (obstacles) for the client become obstacles for the therapist and the treatment process.So, part of the therapeutic work involves assisting the client past the spiritual obstacles, as well.

21. Management of issues while doing the trauma work • Seizure Disorder • Other mental health issues • Major Depressive Symptoms (depression, SI, cutting, low motivation, low energy, etc.) • PTSD (nightmares, flashbacks, triggers, sleep problems, etc.) • Marital and pregnancy issues • Death of loved one