Theory, sequencing, and strategy in treating adult survivors

Abstract

Effective therapy for adults molested as children should address post‐traumatic stress, self‐development, social factors, and loss. The therapist must individualize treatment for each sexual abuse survivor and pay close attention to the sequence and timing of therapeutic interventions.

Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder

“…A productive therapeutic approach may be an integration of the trauma models for abuse survivors in general (Briere, 2002;Courtois 1991;Herman 1992), with treatments that are effective with psychotic symptoms (Birchwood & Tarrier, 1992;Martindale, Bateman, Crowe, & Morgison, 2000;Read et al, in press), including: cognitive therapy (Chadwick et al, 1996;Garety, Fowler, & Kuipers, 2000;Morrison, 2002), psychosocial-residential treatment (Mosher, Valone, & Henn, 1995), psychodynamic approaches (Goltdiener & Haslam, in press;Karon & VandenBos, 1981), and early intervention (McGorry, 2000;Johannessen, Larsen, McGlashan, & Vaglum, 2000).…”

Psychotherapy and memories of childhood sexual abuse: A cognitive perspective

“…For example, memory recovery writers often emphasize the need to search for and find the appropriate 'triggers' or retrieval cues that will enable clients to recover accurate memories that 'otherwise seem completely out of their reach' (Claridge, 1992: p. 243). Suggested 'triggers' include childhood pictures and memorabilia, bibliotherapy, films and videos (sometimes depicting sexual abuse; Dolan,199 l), guided imagery, hypnosis, age regression, dreamwork, bodywork, and group work with other survivors (Blume, 1990;Courtois, 1991;Maltz, 1990;Olio, 1989). Although Olio expressly discussed the reconstructive nature of remembering, the underlying assumption made by most of these writers appears to be that, given the proper triggers, accurate records of the past will be located and replayed.…”

“…There are reasons for practitioners' attention to childhood sexual abuse in their treatment approaches. Real sexual abuse of children occurs at a much higher rate than was previously thought (Briere, 1992;Finkelhor, Hotaling, Lewis, and Smith, 1990) and there is clear evidence that childhood sexual abuse is associated with a variety of psychological problems in adulthood (Beitchman, Zucker, Hood, daCosta, and Cassavia, 1992;Briere and Runtz, 1990;Browne and Finkelhor, 1986;Claridge, 1992;Cole and Putnam, 1992;Courtois, 1992;KendallTackett, Williams, and Finkelhor, 1993;Sgroi, 1989;Trickett and Putnam, 1993).…”

“…We are concerned that, from the client's perspective, the therapist may be understood as saying 'You were abused and it is time for you to recognize it'. Although Courtois (1992) later argued that it is unethical to tell clients that they were abused unless there is conclusive evidence of the abuse, other therapists (e.g. Ellenson, 1985Ellenson, , 1986) have gone on record as having done so, as early as the first session (other examples are described by Loftus, 1993).…”

“…People who have always remembered being sexually abused as children, or who spontaneously come to remember previously-forgotten abuse, are on those bases different from clients who require months of guidance and memory recovery techniques prior to their first recollection of abuse (Braver, Bumberry, Green, and Rawson, 1992). For clients presenting with a variety of symptoms who do not initially remember being abused, guidance for the recovery of memories of childhood sexual abuse is explicitly recommended by many practitioners (Bass and Davis, 1988;Blume, 1990;Claridge, 1992;Courtois, 1988Courtois, , 1991Courtois, , 1992Dolan, 1991;Ellenson, 1985Ellenson, , 1986Engel, 1989;Gelinas, 1983;Herman and Schatzow, 1987;Maltz, 1990;Olio, 1989). Most of these writers accept the validity of Gelinas's (1983) notion of 'disguised presentation', in which an individual shows many of the hypothesized sequelae of childhood sexual abuse (e.g.…”