Effects of Child Sexual Abuse & The Assessment and Treatment of Survivors Dr. Ian Newey

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. can’t 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. • It’s 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. 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 Practical skills • Assessment:

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 we’re 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

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 person’s 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