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

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Sexual Assault Therapeutic Considerations when
Body and Beliefs come under Attack

• ACHA - 2010
• Bill Buhrow, PsyD
• Director of Health and Counseling Services
• Asst. Prof. Graduate Department of Clinical
  Psychology
• George Fox University

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Goal (in addition to stated objectives)

• Increase our sensitivity and awareness to client
  spirituality resulting in a bio-psycho-social-spir
  itual model
• Encourage increased attention to client
  spirituality where applicable in treatment
• Facilitate improved competence in addressing
  mental health related spiritual issues

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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).

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Theism vs. Naturalism. Psychologists debate
their disciplines stance toward God. APA Monitor
May 2010

• Article references a special issue of APAs
  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 Americas
  mainstream, though not in psychologys. Teo
  editor (a non-religious person)
• Were talking about the possibility of a
  systematic bias against the majority of consumers
  of psychology. - Slife (BYU and one of the
  proponents arguing psychologys bias against
  theism)

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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.

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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 . . .

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Therapys like a Road Trip

• you have a general idea of where youre going but
  you never know what you might see or what side
  trips you might take along the way

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Integrating spirituality is like a game of . . .

• Chutes and Ladders

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Phase 1 of TreatmentMarch - May (12 sessions)

• Timing issues
• Things will get worse before they get better
• Ct worried depression may deepen
• Ct asked to decide if nows the right time to
  deal with the abuse issue
• Ct decided to address abuse because of disturbing
  nightmares

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Phase 1

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

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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

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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
• Whyd the abuse happen?
• Worthless, not valuable, damaged, broken,
  something wrong with her

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Phase 2 of TreatmentSept - 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

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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

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Themes cont

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

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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

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Phase 3 of Treatment 2 ½ years

• Grief and Loss
• Guilt and Despair
• Good Mom Bad Mom
• Vocabulary for Abuse and Perpetrators
• Marital Problems Husbands Extracurricular
  Activities
• Confronting the Deceased
• Help from the Local Church

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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
• Im pregnant
• Anger at God and perpetrator
• Celebrate Recovery No More Anonymity

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Spiritual obstacles (chutes) and resources
(ladders)

• Chutes
• Identity Issues Guilt and shame, Worthless,
  Lonely, Despair, Broken, Im the cause
• Refusing healing cling to pain
• Assumption of others sin as her own
• Splitting mom and God
• Ladders
• Relationships with others (therapist, God, group,
  etc.)
• Child of God
• Knowing the truth
• Redemption

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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.
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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

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