Survivors of Abuse

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Survivors of Abuse
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Issues of Abuse

• The Prominent feature in all forms of abuse is
  power.
• Most abusers are fearful of losing control.
• Abuse escalates during pregnancy.
• There is a CYCLE OF VIOLENCE.
• Cycle does not apply to sexual abuse.

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Helpful responses to Abuse

• Ask if abuse is occurring
• Identifies described behavior as abuse
• Acknowledges the seriousness of abuse
• Being directive in exploring resources
• informing about shelters, other resources
• support groups
• Active listening

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Unhelpful responses to Abuse

• Displays of anger toward abused
• Blaming victim
• Giving advise
• Ignoring abuse
• Aligning with the abuser
• Refusing to help the person until they leave the
  abuser

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Other Issues

• Family violence is accompanied by brainwashing
• Hostage Syndrome
• Victims always blame themselves
• Feel unworthy of help
• fear they will not be believed
• Most common form of abuse is sibling abuse

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Family violence

• Elder Abuse
• Parent abuse by violent adolescents
• LOW COST TO PERPETRATORS
• Two Types of Violence in Couples
• Expressive Violence and Instrumental Violence

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Instrumental and Expressive violence

• Expressive violence is mutual combat
• Goal is to express emotions/and hurt
• Role of victim and perpetrator are not fixed
• Partners share responsibility for violence

• Instrumental violence is unequal conflict
• Goal is CONTROL another
• Role of victim and perpetrator is fixed
• Victim is ALWAYS trying to please and placate

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Treatment issues

• Couple counseling is inappropriate for
  Instrumental violence
• Victim must be safe/ Arrest policies very
  important/Danger is real
• Groups very important modality
• Progress is made when victim starts defining her
  strengths
• Assess for alcohol and drug use
• LONG term goal Change self concept from victim
  to survivor status

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Child Abuse

• DEFINITION
• CHARACTERISTICS OF PARENTS
• 1. May have been abused as a child
• 2. Lack of knowledge of normal development
• 3. Lack of parenting skills no role models
• 4. Socially isolated, stress, low self esteem
• 5. Lack of trust in the system
• 6. Abuse of alcohol and drugs

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Characteristics of the Child

• Position of child, sex of child
• Product of difficult labor and delivery
• Physically ill, hyperactive, sleeplessness
• Temperament of child performing tasks

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Environment

• Chronic stress, divorce, financial stress
• Instability absence of support system
• Socioeconomic level may influence
• Paternalistic culture Rule of thumb
• Spare the rod, spoil the child

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Assessment nursing care

• Physical evidence of abuse
• Conflicting stories about the accident
• Child with concussion fell out of bed.
• 6 month old turned on hot water
• Concern about a cold when burns are present
• excessive delay in seeking treatment
• parent absent when you try to question

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Assessment Cont

• Inappropriate response of the child
• Little or no response to pain
• Excessive fear of being touched
• Excessive or lack of separation anxiety
• Indiscriminate friendliness to strangers
• Previous reports of abuse
• Repeated visits to the ER for injuries

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Legal Aspects

• When must we report abuse
• Who must report. Professionals are held to a
  higher standard
• It is not enough to just report abuse to the
  Health Care Provider (MD or FNP) and hope for the
  best
• School nurses observe abuse and must report

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When to Report

• A Child or Elder Abuse Neglect or Exploitation
• Adults it is up to the individual to report
• Toll Free Hotline [phone]
• (1-877-STOP ANE)
• Local telephone [phone]
• Facsimile [phone]
• Email abuseneglect_at_tjpc.state.tx.us
• Address 4900 North Lamar, 5th floor
• Austin Texas 78751
• http//www.rockwallcountytexas.com/DocumentView.as
  p?DID541

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Characteristics of the family
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Maslow's hierarchy of needs

• Security
• Self Value
• Strokes (Recognition)
• Stimulation
• Structure
• Self actualization

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The Healthy Family

• Each member works on basic tension of
• How can I maintain a sense of self and remain in
  this family.
• Problems, but the family owns them
• Like an orchestra
• everyone is playing their own instrument but are
• playing the same tune
• Open System

• Each person can get their needs met.
• Each spouse can function without the other
• Open and flexible members have other
  relationships in the community
• An open system vs. a closed system

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The Unhealthy Family

• The basic unit is
• immature and needy
• low self-esteem
• not in the relationship by choice
• enmeshment
• A closed system
• Dependent on each other to get needs met
• Communication is triangulated

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Triangles in Communication

• Mother talks to child about problems with Father
• Child tries to support mother and meet her needs
• Child also tries to support father and meet his
  needs
• Mother needs to talk to Father and not the child

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The Dysfunctional FamilyCO-DEPENDENT

• Appears insecure hides strength
• Submissive, humble
• Hates decisions
• Individual blames self
• Other centered
• I understand this is just a front
• I will just try harder
• Insecure, angry and shamed

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Dysfunctional Family COUNTER DEPENDENT

• Self-centered
• Insensitive and proud of it
• Intrusive and intimidating
• Insecure, angry and shamed
• Appears secure, hides fear
• Grandiose, power dominance
• Who do I trust me
• Who is at fault them
• Deny weakness

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Boundaries

• Emotional and physical space between you and
  another person
• Where you stop and the next person begins
• A Limit that others are not allowed to cross
  because of the negative impact
• Allows for appropriate closeness in the
  relationship
• Boundary within a family
• If a bathroom or bedroom door is shut
• Knock and wait
• http//www.homespunhealers.com/setting-healthy-bou
  ndaries

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Healthy Boundaries

• The right and need for the individual to
• To explore
• Interests
• Hobbies
• Outlets
• Make their own mistakes
• Bring back to the family
• My unique personality to enrich our lives

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Healthy BoundariesPrevent

• Enmeshment
• Dissociation
• Excessive Detachment

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Incest Family Dynamics

• Multigenerational and Multifaceted
• Mother
• Parentified in family of origin
• Low self-esteem
• Father
• Immature and dependent
• Needs mothering
• Self-centered
• Relationship
• She mothers him
• Children place stress on the relationship
• Less time to take care of the father
• Needs are left unmet

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Incest Family Dynamics

• Mother becomes overwhelmed
• Increases if family
• Has increased stress
• Several children
• Financial problems
• Chronic illness
• A child becomes parentified
• helps mother in caretaker role
• helps to meet fathers needs
• Father feels neglected by mother
• Looks to child for affection
• Incest occurs gradually as child begins to take
  on the mothers roles
• Family places the childs needs last

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Incest

• Confusion created by the perpetrator
• Child believes it is their fault
• Father coerces child to keep secret
• Father perceives child as sexual peer
• Closed system
• Isolated family
• Must keep the secret
• Mother and child relationship
• Mother denies sexual abuse is happening
• Ambivalence
• Love for the mother
• Anger about the lack of protection from abuse

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Survivors of Childhood Sexual Abuse

• Adult perpetrator is most often known and trusted
• Fathers, brothers, camp councilors, coaches,
  religious leaders
• Most often male perpetrator
• 92 of females male perpetrator
• 38 of males female perpetrator
• Average length of time of when an adult begins to
  perpetrate children and they get caught is 9
  years
• Abuse most often begins before the age of 7
• Childhood sexual abuse
• 15 to 30 of girls
• 4 to 16 of boys
• More difficulty reporting
• Fear of being labeled gay or weak (male
  perpetrator)
• They are supposed to like it (female perpetrator)

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Incest

• Incest (p.488)
• Sexual victimization of a child or adolescent
• Perpetrator does not seek occupations for access
  to victims
• Relationships by
• Blood or Marriage
• Perpetrator looks to the child for
• Gratification
• Fulfillment
• Power and control
• Child may feel special
• Distorted thinking
• Teaching the child about sexuality
• Giving the child pleasure

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Pedophilia

• Pedophilia (p.487)
• Primary sexual attraction is to children
• The victim is younger than 13
• Pedophile
• 16 years or older
• 5 years older than victim
• Expressed towards either same-sex or opposite-sex
  children
• Pedophile
• May need to feel power over the victim
• Provides more control than relationships with
  adults
• Attracted to children
• Less than 13 years old
• Lack of secondary sex characteristics

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Sexual Abuse

• All Survivors are not the same
• Effect of sexual abuse varies with factors
• Differs from physical abuse
• not cyclical
• Neglect can play a powerful role

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Effects of Abuse

• Can contribute to
• Depression
• Personality problems
• Achievement
• Grades and achievement drop
• Super-achiever often care takers
• May marry abusive spouses
• Use alcohol and drugs
• Develop mental illness
• Problems with trust

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DSM IV DX

• Anxiety Disorders
• Major Depression
• Post Traumatic Stress Disorder and Acute Stress
  Disorder
• (reviewed in the crisis module)
• Dissociative Identity Disorder

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Dissociative Identity Disorder

• Presence of 2 or more distinct personalities
• At least 2 of these personalities take control of
  the persons behavior
• Very difficult to diagnose
• Response to severe abuse in CHILDHOOD
• In order to be multiple, must be able to
  dissociate.
• The greater the severity of dissociative
  symptoms, the smaller the left hippocampus is.

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Dissociative Phenomena

• All of us dissociate
• Dissociation is the defensive device by which
  people split off from conscious awareness
  different aspects of experience
• Aspects are cognitive, affective, behavioral and
  somatic
• Ever been bored and left class

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S.A.N.E.Sexual Assault Nurse Examiner

• This Registered Nurse is educated to be able to
• Provide comprehensive care to sexual assault
  survivors
• Demonstrate competency in conducting a forensic
  exam to include evaluation for evidence
  collection
• Have the expertise to provide effective courtroom
  testimony
• Show Compassion and sensitivity to survivors of
  sexual assault
• http//www.oag.state.tx.us/victims/sapcs.shtml

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Unhelpful Responses

• Displays of anger toward abused
• Giving advise
• Ignoring abuse
• Aligning with the abuser

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The Therapeutic Relationship Helpful Responses

• Ask if abuse is occurring
• Identifies described behavior as abuse
• Acknowledges the seriousness of abuse
• Acknowledge feelings
• Seeing you hurt upsets me
• Being directive in exploring resources
• informing about shelters, other resources
• support groups
• Active listening

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The Milieu

• Provide a safe environment
• Clients can be comforted by the locked
  environment
• Inpatient Psychiatric Units
• Consistency
• Response to the clients behavior is always the
  same
• Communicate the staff are here to keep you safe
• Be careful with the use of touch
• Misunderstood
• Abreaction
• Recall of a repressed traumatic experience
• Client re-experiences the abuse
• Client will test to see if the Nurse will remain
  therapeutic or become abusive
• Remain nonjudgmental
• Objective
• Non-threatening

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Therapy for the Survivor

• Group therapy
• Rape Support Groups
• Incest Survivor Support Groups
• Survivors of Childhood Sexual Abuse

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Sexual Abuse and Children

• Memories change over time
• I should have stopped it
• Bad Girl
• Fix the memory
• Talk about it
• Allow the Survivor to talk