Working with Adult Survivors of Childhood Sexual Abuse

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1 University of Minnesota, Twin Cities School of Social Work Jane F. Gilgun, Ph.D., LICW Working with Adult of Childhood Sexual Abuse Adult survivors of childhood sexual abuse will come to you with a wide variety of issues, mediated by the assets in their various environments whether they've been able to mobilize their assets into processes that have helped them to cope with, overcome, and adapt to the effects of childhood sexual abuse the risks in their environment. Risks can pile up to such an extent that the persons is in a major life-long struggle to cope with, overcome, and adapt to the effects not only of the childhood sexual abuse but other risks as well. Therefore, within your caseload of adult survivors there will be a wide range of abilities to cope with the effects of sexual abuse. Long-Term Effects of Child Sexual Abuse, unless they've had therapy, often do not connect their present ways of coping and affective states with their experience of childhood sexual abuse. As we discussed in class, child sexual abuse also represents emotional abuse and leaves a spiritual wound that is similar to the effects of childhood emotional abuse and neglect that is not accompanied by sexual abuse. Therefore, though your clients may show a range of abilities to cope and a range therefore of life accomplishments and socio-economic statuses, it is very likely that they will share a deep sense of shame, a sense of being defective, bad, and unworthy long-term depression and anxiety questions about the meanings of sexual expression in their lives a range of ways of coping, such as dealing directly and effectively with the effects; medicating the effects through chemicals, gambling, sexual behaviors, overeating, work, hobbies, entertainment, physical exercise; using others to feel better through manipulation, trickery, intimidation, and verbal, psychological, physical, and sexual abuse and violence For many clients, shame, anxiety, depression, and concerns about sexual issues may be repressed most of the time, while for others, they may experience pain associated with these issues continually every day for their entire lives. Repression, however, to borrow a metaphor from Salter (1995) is like walking on the skin of hot larva. Without warning, the skin can break, and the person plunges into the larva,

2 2 burning and in such emotional pain that the person has a great deal of difficulty articulating it. Therapeutic Approaches to To improve coping with the effects of childhood sexual abuse, survivors can benefit from a variety of therapeutic approaches. To be an effective therapist with survivors, recognize that survivors benefit from a wide range of therapeutic approaches, such as group work, 12-step work, immersion in the arts such a poetry, dance, drama, and graphic art, and therapy of various types: individual, couple, group, and family; the centrality of agency; that is, of wanting to overcome the effects, being willing to let go of the secondary gains associated with ineffective coping, and willingness to examine barriers to coping with effects, such as feeling unworthy of having good things in one's life coping with the effects of childhood sexual abuse is life-long; the abuse will never go away, but as survivors develop coping skills and are able to let go of the emotional pain, they will suffer less and will cope better with their suffering when it occurs. The Person of the Therapist In working with survivors in individual, couple, family, and group therapy, the following are qualities that are likely to facilitate clients' recognition of the wide-spread nature of the childhood sexual abuse, the re-experiencing and transformation of the meanings of the sexual abuse, and the development of effective coping strategies. Focus therapeutic work with survivors on survivors own issues; keep selfdisclosure to a minimum and if you do use it, use it only to facilitate clients' processes; Be there affectively with clients; connect emotionally with clients, but maintain your own sense of self so that clients will know it is their pain and you are there with them as you; you will only be effective to the extent that you can connect with them at their levels of pain and senses of being profoundly defective; if you are identifying with clients' pain and lose your analytic stance, then you need some supervision to deal with this; can you, for example, handle a client who says she can only have an orgasm when she thinks about cutting her father's throat? Create a deep sense of safety for clients;

3 3 Only when clients feel safe with you can they tell their stories; telling their stories means they pull the skin off the hot lava and let the lava flow; Be prepared to have clients talk about some of their issues many times; they may have to revisit many times in order to understand and assimilate how the abuse has affected them; Facilitate meaning-making; making sense of the sexual abuse and of the effects of sexual abuse are central to improved coping and release of painful affect. Though the meanings of sexual abuse are complex, in their most straightforward, some of the meanings are the following: someone took advantage of them; they were abused and used; the abuse tells them about perpetrators and only says about them that they did not have the resources to protect themselves; there was no one else there to protect them; feeling like a bad person, like the "scum of the earth," like someone who deserves to be treated badly, all are usually deep-rooted and often repressed beliefs that deeply affect survivors' quality of life; the actions of perpetrators are malevolent, though in some cases malevolence is an unintended consequence of the profound self-centeredness of perpetrators; malevolence is malevolence, no matter what the intention of perpetrators; you have the right to be happy; many of the ways of coping that they have developed [such as imagining cutting perpetrators' throats] are ways of reclaiming a sense of power, control, and personal integrity; many persons have the will to be good, and the will to be a good person requires learning and practicing being good to yourself and to others. Be alert to contradictions and make decisions about the appropriateness of pointing them out; for example, a client may at one point talk about loving times with persons who perpetrated against them and at other times talk about hating the persons who perpetrated; or, clients may discuss a memory or recurrent image, state that it never happened, and put themselves down for having such an image; at some point, survivors benefit a great deal from being able to assimilate the many fragmented and often contradictory perspectives that they may have. meanings. As therapists, understand that survivors may take years to assimilate such Communicate to survivors that you value them, respect their struggles, and will help them see when their behaviors are hurting others. Helping survivors to see when their behaviors are hurting others might even be part of your contract with them. Only connect; if survivors are not able to be present to you, this is a therapeutic issue; if you are not able to be present to clients, then you must get extended supervision so that you can be present; otherwise you may have to refer such clients to others. References Gilgun, Jane F. Unpublished notes related to research on the effects of childhood sexual abuse. Salter, Anna C. (1995). Transforming trauma: A guide to understanding and treating adult survivors of child sexual abuse. Thousand Oaks, CA: Sage.

4 School of Social Work University of Minnesota, Twin Cities Jane F. Gilgun, Ph.D., LICSW 4 Post-Traumatic Stress From DSM-IV An event that overwhelms everyday coping capacities Persistent Reexperiencing of the event recollections for children--repetitive re-enactment dreams feeling as if the event is happening again psychological distress to events that symbolize own event(s) Persistent avoidance of situation associated with trauma and/or numbing of general responsiveness avoidance of thoughts and feelings related to the event(s) avoidance of situations that recall the events inability to recall aspects of the event(s) feelings of detachment/estrangement from others restricted range of affect sense of a shortened future disinterest in previous activities for children--regressions Physiological arousal hypervigilance irritability/outbursts of anger startle responses difficulty staying asleep/falling asleep

5 School of Social Work University of Minnesota, Twin Cities Jane F. Gilgun 5 Unintentional Self-Destructive Responses to Child Sexual Abuse: Coping that Becomes Part of the Problem Acting out against the self self-hatred self-disgust shame guilt I'm fundamentally defective Acting out against others that results not only from trauma but from belief systems and other risk factors controlling others emotional abuse physical abuse sexual abuse highway madness neglect of children Believing the blame the victim sentiment that is wide-spread in our culture what were you doing there why didn't you tell someone? there's something about me that invites this I should've been able to stop this Self-medication chemicals over-eating gambling masturbation, sexualizing others

6 School of Social Work University of Minnesota, Twin Cities Jane F. Gilgun 6 Adults ' Responses to Their Own Childhood Sexual Abuse and Other Traumas Accepting Dismissive Pre-Occupied Disorganized Questions: What might be the balance between risks and protective factors over time? What intensity and duration might the abuse have been? What might the sexual abuse have meant to survivors? What might have been the attachment styles of these survivors prior to the abuse? After the abuse? Are survivors consistent over time in their responses to childhood trauma?

7 University of Minnesota, Twin Cities School of Social Work Jane F. Gilgun, Ph.D. 7 Developmental Psychopathology Definitions of Key Concepts in the Risk/Resilience Framework focuses on patterns of human development leading both to adaptive and maladaptive outcomes by studying high risk groups, usually longitudinally. This research has shown that not all persons with risk factors have adverse outcomes. Risk Factors and Vulnerability a statistical, probabilistic concept that predicts that a proportion of an at-risk group will experience adverse outcomes cannot predict that any one person in an at-risk group will experience that outcome do identify individuals who are vulnerable to associated outcomes reside within individuals, families, other social groups, and communities Cumulative Risks a series of risks that may interact and overwhelm whatever resources an individual can marshall, while in other cases persons appear to have the resources to cope Risk factors do not operate in isolation from other influences on development Resources can offset the influences of even multiple, cumulative risks Assets positive counterparts of risk are statistical concepts not all persons with assets turn out well nor do all persons from backgrounds with few assets turn out poorly on the level of individuals, assets may not function as assets at all individuals with a few assets may use them extremely well Protective Factors assets individuals actively use to cope with, adapt to, or overcome vulnerability-inducing conditions, or risks associated with positive outcomes when individuals have been exposed to risks reside within individuals, families, other social groups, and communities

8 Resilience 8 represents positive outcomes when individuals are exposed to risk; assumes the presence of assets that the individual actively use to overcome, adapt to, or cope with risk associated with interactions of risks and protective factors defined as a set of behaviors and internalized capacities o behaviorally, resilience means coping with, recovering from, or overcoming adversities o as internalized processes, resilience is ability to maintain a sense of personal competence and integration in the face of adversity persons who are resilient cope through flexible, problem-solving, and help-seeking behaviors rather than rigid and brittle responses to stress and other adversities Ebbs and Flows of Resilience there is no such thing as a completely invulnerable person when vulnerabilities are severely stressed, there is likely to be a diminishment in optimal functioning resilience is not necessarily stable across all situations and adversities some persons could be resilient because they have not encountered adversities that could overwhelm their resources Conversely, persons who are not adapting well at one point can become adaptive at other points

9 School of Social Work University of Minnesota Jane F. Gilgun, Ph.D., Instructor 9 Risks and Protective Factors in the Development of Violent Behaviors Many persons have risk factors for violent behaviors. Many persons also have assets to counter risk factors. When assets serve to counter risk factors, they are called protective factors. When risk factors overwhelm protective factors, or when assets cannot be mobilized to serve as protective factors, violent behaviors take place if persons have risks for violence. When persons are able to mobilize their assets so that they become protective factors and the protective factors are sufficient so that they are not overwhelmed by risks, then violent behaviors do not take place and persons are considered resilient. Prevention involves decreasing risk factors and increasing assets in the expectation that they will become part of protective processes. Using these principles as guidelines, persons can be classified according to their levels of risks and assets. The classification may be organized as a typology describing patterns in the distribution of risks and assets. These categories can then be used to predict whether or not persons will commit violent acts. 1. Persons who are high in assets and low in risks are unlikely to commit violent acts 2. Persons who are high in assets and high in risks are vulnerable to committing violent acts; most, however, will seek help in order to cope with their tendency toward violence. However, some people with many assets don't use them to counter risks. Therefore, a few seemingly innocuous risks can become lethal risks because of an absence of protective factors. 3. Persons who are low in assets and low in risks are likely to commit violent acts when others support, encourage, and model violent behaviors. 4. Persons who are low in assets and high in risks are likely to commit violent acts.

10 10 University of Minnesota, Twin Cities School of Social Work Jane F. Gilgun October 2000 Qualities Associated with Resilience At least one long-term relationship with an adult inside or outside the family where the adult models pro-social behaviors and values the young person admires and emulates the adult's positive qualities the adult praises and appreciates the young persons pro-social values and behaviors the young person confides personal and sensitive material to the adult the young person seeks out the adult in times of stress and hurt the young persons shares happy news and events with the adult the young person shares with the adult events that occur in peer group At least one long-term friend pro-social friend during childhood and adolescence (longer than five years) who serves a similar role as the pro-social adult described above Has a will to be law-abiding Has a will to engage in pro-social behaviors Is persistent in the face of obstacles Enjoys accomplishing tasks Discusses a sense of inadequacy with others and feels better afterward Views others as deserving of respect Deals directly with persons who are the occasions of anger Makes amends when actions/words hurt others Believes and acts out the idea that negotiating for what you want is respectful Believes and acts out the idea that taking what you want is selfish and wrong Believes that living well is the best revenge Redresses wrongs through negotiation and not through getting back at others Equates masculinity with respect for women Equates masculinity with emotional expressiveness Equates being a girl or woman with assertiveness Engages in consensual sexual behaviors with others Goes for a run, a swim, or other physical activity when stressed Uses a wide range of pro-social ways to maintain emotional equilibrium Listens to and learns from criticism Enjoys dating in high school Masturbation related is related to sexual desire Has a wide range of sexual fantasies, primarily of age peers Imagines a positive future

11 Takes specific steps toward an imagined positive future 11

12 Search Institute's 40 Developmental Assets 12 The Search Institute of Minneapolis has identified 40 developmental assets that are associated with positive youth development, which they define as youth who are healthy, competent, and caring. The 40 assets listed below are based on a two-parent family of origin, or at least on a family of origin. They have not been adapted to youth in care. Thus, applying them to youth in care requires adaptation. The four instruments that HSA has developed not only incorporate the ideas of the Search Institute, but they go beyond Search to include ideas about how youth cope with, adapt to, and overcome risk. Resilience research and theory are fundamental to the HSA instruments. EXTERNAL ASSETS Support Family support: Family life provides high levels of love and support. Positive family communication: Young person and her or his parent(s) communicate positively, and young person is willing to seek advice and counsel from parent(s). Other adult relationships: Young person receives support from three or more non-parent adults. Caring neighborhood: Young person experiences caring neighbors. Caring school climate: School provides a caring, encouraging environment. Parent involvement in schooling: Parent(s) are actively involved in helping young person succeed in school. Empowerment Community values youth: Young person perceives that adults in the community value youth. Youth as resources: Young people are given useful roles in the community. Service to others: Young person serves in the community one hour or more per week. Safety: Young person feels safe at home, at school, and in the neighborhood. Boundaries and Expectations Family boundaries: Family has clear rules and consequences, and monitors the young person's whereabouts. School boundaries: School provides clear rules and consequences. Neighborhood boundaries: Neighbors take responsibility for monitoring young people's behavior. Adult role models: Parent(s) and other adults model positive, responsible behavior. Positive peer influence: Young person's best friends model responsible behavior. High expectations: Both parent(s) and teachers encourage the young person to do well. Constructive Use of Time

13 13 Creative activities: Young person spends three or more hours per week in lessons or practice in music, theater, or other arts. Youth programs: Young person spends three or more hours per week in sports, clubs, or organizations at school and/or in community organizations. Religious community: Young person spends one hour or more per week in activities in a religious institution. Time at home: Young person is out with friends "with nothing special to do" two or fewer nights per week. INTERNAL ASSETS Commitment to Learning Achievement motivation: Young person is motivated to do well in school. School engagement: Young person is actively engaged in learning. Homework: Young person reports doing at least one hour of homework every school day. Bonding to school: Young person cares about her or his school. Reading for pleasure: Young person reads for pleasure three or more hours per week. Positive Values Caring: Young person places high value on helping other people. Equality and social justice: Young person places high value on promoting equality and reducing hunger and poverty. Integrity: Young person acts on convictions and stands up for her or his beliefs. Honesty: Young person "tells the truth even when it is not easy." Responsibility: Young person accepts and takes personal responsibility. Restraint: Young person believes it is important not to be sexually active or to use alcohol or other drugs. Social Competencies Planning and decision-making: Young person knows how to plan ahead and make choices. Interpersonal competence: Young person has empathy, sensitivity, and friendship skills. Cultural competence: Young person has knowledge of and comfort with people of different cultural/racial/ethnic backgrounds. Resistance skills: Young person can resist negative peer pressure and dangerous situations. Peaceful conflict resolution: Young person seeks to resolve conflict nonviolently. Positive Identity Personal power: Young person feels he or she has control over "things that happen to me." Self-esteem: Young person reports having a high self-esteem. Sense of purpose: Young person reports that "my life has a purpose." Positive view of personal future: Young person is optimistic about her or his personal future. Copyright 1997 by Search Institute. All rights reserved. This chart may be reproduced for educational, noncommercial use only (with this copyright line). No other use is permitted without prior permission from Search Institute, 700 S. Third Street, Suite 210, Minneapolis, MN 55415; This list is an educational tool. It is not intended to be nor is it appropriate as a scientific measure of the developmental assets of individuals.

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