Counselling Psychology Assignment

Topic: Sexual Abuse

MATA SUNDRI COLLEGE FOR WOMEN

By: Sukhpreet kaur (psy/21/82)

Gurmeyhar kaur (Psy/21/82)

Crisis intervention: Counselling for sexual abuse

Abuse is the misuse or maltreatment of people, places, or things. It can be active as in physically
or mentally punishing someone or passive as in neglect. However, the result is damaging.
The abuse continues until some interventions or insights result in behavioral changes between
the buildup of tension and the abuse that follows. Such changes can come through counseling if
counselors recognize what is happening and use appropriate methods to break the cycle.

The two primary areas of abuse most prevalently seen in counselling are interpersonal abuse
and intrapersonal abuse.

INTERPERSONAL ABUSE
Interpersonal abuse involves violent or neglectful actions against others, especially those within
one’s family (i.e., siblings, spouses/partners, children, older adults) or those with whom one
works or with whom one has daily contact.
Interpersonal abuse can take several forms, but the two most prevalent are emotional abuse and
physical abuse.

Sexual Abuse
Sexual abuse is sexual contact that involves physical or psychological coercion or at least one
individual who cannot reasonably consent to the contact (e.g., a child). Such abuse includes
paedophilia, incest, and rape, and it concerns society much more than any other sexual problem.

According to the American Psychological Association (2018) Sexual abuse, also referred to as
molestation, is abusive sexual behavior by one person upon another. It is often perpetrated using
force or by taking advantage of another. Sexual abuse is unwanted sexual activity, with
perpetrators using force, making threats or taking advantage of victims not able to give consent.
Most victims and perpetrators know each other.

Immediate reactions to sexual abuse include shock, fear or disbelief. Long-term symptoms
include anxiety, fear or post-traumatic stress disorder (APA, 2021, adapted from
Encyclopaedia of Psychology).

When force is immediate, of short duration, or infrequent, it is called sexual assault.

The term also covers any behaviour by an adult or older adolescent towards a child to stimulate
any of the involved sexually. The use of a child, or other individuals younger than the age of
consent, for sexual stimulation is referred to as child sexual abuse or statutory rape.
Four victims of sexual abuse—child, sibling, spouse/partner, and older adult.

VICTIMS

Child Sexual Abuse

One of the most insidious forms of child abuse is childhood sexual abuse (CSA). This type of
abuse includes unwanted touching, sexual remarks, voyeurism, intercourse, oral sex, and
pornography (Cobia, Sobansky, & Ingram, 2004; Deblinger, Mannarino, & Cohen, 2015).
youngster sexual abuse refers to the act of an adult or older adolescent abusing a youngster for
sexual pleasure. It includes instances of an adult or older individual engaging in direct sexual
contact with a kid, as well as intentionally exposing their genitals to a child to seek pleasure.
Individuals may exploit their sexual inclinations to frighten or manipulate a child, coercing or
pushing them to participate in sexual acts, exposing them to explicit material, or involving them
in the production of child pornography.

When sexual abuse occurs in childhood, it often leads to distress, acute trauma, and even post-
traumatic stress disorder (PTSD) (Putman, 2009). In sexual abuse situations, “most abuse of boys
is done by perpetrators outside the family; girls’ abuse is predominantly intrafamilial” (Hutchins,
1995, p. 21). Almost 1 in 5 girls is sexually abused by age 18 (Crespi & Howe, 2000; Deblinger
et al., 2015), and 12% to 18% of boys are sexually abused during childhood or adolescence
(Cobia et al., 2004; Tomes, 1996).

People with Developmental Disabilities

People with developmental disabilities are often victims of sexual abuse. According to research,
people with disabilities are at a greater risk for victimization of sexual assault or sexual abuse
because of lack of understanding (Sobsey & Varnhagen, 1989).
Spouses

Spousal sexual abuse is a form of domestic violence. When the abuse involves threats of
unwanted sexual contact or forced sex by a woman's husband or ex-husband, it may constitute
rape.

PSYCHOLOGICAL CHANGES AFTER ABUSE

Experiencing sexual violence can lead to several different emotions. There is no right or wrong
way to feel. The victim may experience some (or all) of the following:
• Numb - The shock and trauma of sexual abuse can make one feel numb to it. one may find
oneself feeling strangely calm, or simply unable to process what has happened.
• Guilty - Individual may be telling herself that it was her fault, even though it wasn’t.
• Angry - Feeling anger is common, one may feel anger at the person who did this to him/her, or
even at self.
• Ashamed - one may feel embarrassed and ashamed about what happened, even though it was
not one’s fault and totally out of one’s control.
• Depressed - One may lose his/her enjoyment of life, feeling like there’s nothing to look
forward to anymore.
• Anxious - Activities one used to do without a second thought may now make one feel anxious,
like going out alone. Additionally, sexual abuse or violence can have a profound effect on a
survivor’s attitude towards sex. A person may find that she has become very conflicted after the
event. It is normal for their attitude towards sexual encounters to turn one of two ways:
• becoming hyper-sexual or
• suffering from sexual anorexia (avoidance) It’s important to recognise that one’s attitude
towards sex following abuse is not bad or immoral. One may have a lot of inner hurt that is
implicating your thoughts and behaviors towards sex. But recovery and healing are possible, and
one won’t feel this way forever.

PREVENTING AND TREATING INTERPERSONAL ABUSE.

Prevention programs in the interpersonal abuse arena are mainly educational and behavioral.
They focus on teaching listening skills and appropriate behavioral interactions. A number of
them have an Adlerian base. Although they may take multiple forms, prevention programs
usually stress cooperation, collaboration, and self-esteem.
when child sexual abuse occurs early in a person’s life, the child may blame herself or himself
for the abuse just as children of divorce often first find themselves at fault before they come to
realize they have been victimized. In addition, child sexual abuse may not be treated until
adulthood when other complications, such as couple intimacy, overlie the original problems.

Therefore, counsellors must deal with a plethora of current and historical issues in working with
child abuse. Anger and feelings of betrayal on the part of the abuser must be dealt with before
working with the family as a whole to correct the problem and prevent it from happening again.
Overall, those who have been abused physically or sexually, regardless of age, status, or gender,
do not have one treatment modality that works best in helping them resolve the traumas of their
experiences and make adequate and necessary adjustments (Hyde, Bentovim, & Monck, 1995;
Oates & Bross, 1995; A. R. Roberts, 2007). Rather, a variety of treatments have been used with
members of varied populations.

Crisis Intervention Programs

Counselors should be familiar with the rape crisis intervention services in their communities so
that they make appropriate referrals when necessary. Many communities have established rape
crisis centers to serve as first responders to sexual violence in their communities. Most of these
agencies provide crisis intervention through medical and legal advocacy. They provide volunteer
advocates to accompany survivors to hospitals and police departments and to guide them through
the process of medical forensic evidence collection and legal prosecution. The advocate not only
facilitates the delivery of these services but also helps to protect the survivor from secondary
victimization by promoting positive interactions with other professionals (Campbell, 2006). To
assist in the medical aspects of rape crisis intervention, many communities have developed
Sexual Assault Nurse Examiner (SANE) programs that hire nurses who are specifically trained
to provide crisis/medical intervention, collect forensic evidence, provide appropriate postrape
medical care, and coordinate services among multiple service providers (Campbell, Patterson, &
Lichty, 2005). Rape crisis centres also provide survivors with information about available
services and resources, promote social support, provide psychoeducation regarding common
reactions to sexual assault and offer options to facilitate a survivor’s ability to make informed
decisions during this difficult time in his or her life (Ullman & Townsend, 2008). Most rape
crisis centers also offer supportive counseling and 24-hour hotlines for survivors and their
support systems.

Counselling Treatment Model

When counsellors work with sexual trauma survivors, they first should work to develop a
trusting therapeutic alliance, as survivors may have great reluctance to discuss their memories
of the trauma and may have had negative experiences with other service providers.

Counsellors should demonstrate empathy and positive regard for clients as they carefully assess
client concerns through the multisystemic lens. This type of assessment is imperative in
developing a treatment approach that is tailored to the client’s specific needs.

To provide trauma-informed counselling services, counsellors can integrate information

regarding the client’s context while following research-supported treatment guidelines. The
treatment approaches outlined in the following text are drawn from expert consensus guidelines
for the treatment of PTSD (Foa, Davidson, & Frances, 1999; Foa, Keane, & Friedman, 2000) and
are adapted specifically for rape-related trauma.

The recommended treatment components address specific PTSD symptoms that occur following
sexual trauma:

(a) psychoeducation about commonly experienced PTSD symptoms,

(b) exposure therapy (ET) to facilitate the client’s ability to process memories related to the
event,
(c) cognitive restructuring (CR) to challenge the client’s maladaptive beliefs about his or her role
in the event, and
(d) anxiety management techniques to enhance positive coping skills.

Psychoeducation

Survivors of sexual trauma benefit from receiving information regarding commonly experienced
reactions to sexual assault (e.g., guilt, anger, shame, powerlessness, helplessness, fear) and the
symptoms of PTSD as described previously (Marotta, 2000). Many survivors express that they
feel relief when they realize they are not “crazy” but are rather experiencing an expected
reaction to a highly traumatic event (Rauch, Hembree, & Foa, 2001). The counselor should be
prepared to provide information and resources about medical and legal decisions and assist the
survivor in accessing the services of the local rape crisis center, as appropriate.

Exposure Therapy

The two treatment modalities for sexual trauma with the most research support are ET and
cognitive behavioral therapy (CBT) with CR (Russell & Davis, 2007). The goal of ET is to assist
a survivor in working through painful memories, situations, thoughts, and emotions associated
with the traumatic event and which currently evoke anxiety and fear. As noted previously, many
survivors of sexual trauma engage in avoidant coping strategies in order to avoid this intense
anxiety and fear (Fortier et al., 2009), and it is understandable that they will be resistant to this
strategy when it is presented to them in counseling. To encourage clients to undertake this
difficult work, counselors should express empathy and acknowledge a survivor’s fear, spend
time educating the client about the rationale for this treatment strategy, and convey positive
expectations for recovery (Draucker, 1999). As suggested by Foa, Rothbaum, and Steketee
(1993) and as adapted by Choate (2008, p. 177), counselors can explain the use of ET to clients
in the following way:
1. Memories, people, places, and activities now associated with the rape make you highly
anxious, so you avoid them.
2. Each time you avoid them, you do not finish the process of digesting the painful experience,
and so it returns in the form of nightmares, flashbacks, and intrusive thoughts.
3. You can begin to digest the experience by gradually exposing yourself to the rape in your
imagination and by holding the memory without pushing it away.
4. You will also practice facing those activities, places, and situations that currently evoke fear.
5. Eventually, you will be able to think about the rape and resume your normal activities without
experiencing intense fear. When the client is ready to begin the process, the counselor can use
imaginal exposure to assist the client in repeatedly recounting memories associated with the
sexual trauma until the memories no longer cause intense anxiety and fear (Foa et al., 1999).

Clients are asked to close their eyes, to imagine the traumatic event in vivid detail, and to
describe it as if it were happening in the present. Writing about the event in a journal also may be
helpful for clients as they practice describing their memories outside of sessions (Harris, 1998).

This is an extremely difficult phase of treatment for clients as they face the thoughts, feelings,
and images associated with the event that they have been attempting to avoid out of fear.
Counselors should acknowledge this difficulty and encourage clients in their willingness to
process the event gradually in order to cope with their fears.

ET also involves in vivo exposure, a process through which clients are asked to focus on
activities and situations associated with the event that they currently avoid because it evokes
intense fear and disrupts daily functioning. The client hierarchically lists all avoided situations
and activities, ranking them from least to most distressing. It should be noted that the counsellor
should review this list to ensure that these situations or activities are actually safe and that it
includes only those things that are interfering with the client’s ability to engage in his or her
daily routines. Starting with the activity or situation that is least distressing, the client remains in
this particular environment for a minimum of 30 minutes. This time is recommended because it
is long enough for the client to experience fear, to evaluate the actual level of danger present in
the situation, and to allow the fear and anxiety to decrease. Anxiety management techniques can
be used during this time. Over the course of counselling, the client can progress through the
hierarchy until he or she is able to resume daily routines and functioning.

Cognitive Restructuring

CR is effective in reducing symptoms associated with sexual trauma (Foa et al., 1993; Resick &
Schnicke, 1993; Russell & Davis, 2007). In this phase, clients learn to identify the automatic
thoughts or beliefs that they experience during negative emotional states related to the sexual
trauma. The counsellor’s ability to understand the client’s broader context can assist the client in
fully identifying and exploring thoughts and beliefs related to the traumatic event. As clients
identify these thoughts and beliefs, they learn about typical cognitive distortions related to sexual
trauma, learn to evaluate distortions, challenge them, and eventually replace them with more
rational or beneficial thoughts (McDonagh et al., 2005; Meadows & Foa, 1998). One specific
form of CBT with CR that is designed specifically for rape-related trauma is cognitive
processing therapy (CPT; Resick & Schnicke, 1993). In CPT, survivors learn to identify and
challenge “stuck points” in five specific areas: self-blame and guilt, power and control, self-
esteem, trust, and intimacy. These are described briefly in the following text.

Self-Blame and Guilt.

As described throughout this chapter, self-blame is perpetuated by cultural beliefs and by

negative reactions from others in the survivor’s life. Individuals who incorporate negative social
reactions into their overall view of themselves tend to have the highest levels of PTSD symptoms
(Regehr, Marziali, & Jansen, 1999; Ullman, Filipas, Townsend, & Starzynski, 2006). It is
therefore important for counsellors to help their clients distinguish between attributions of blame
assigned to their character (e.g., “I am a bad person and deserved to be raped”) versus assigning
blame to some aspect of their behaviour (e.g., “I made a decision that day that I might not make
now”). Guilt often is related to self-blame, in that the survivor may perceive that he or she is
responsible for the violence or did not do enough to fight back or prevent the crime. The
counselor can assist the client in examining self-blaming and guilt-related beliefs and can help
the client begin to replace these thoughts with more logical and growth-enhancing self-
statements (e.g., “I did not do everything right in this situation, but the rapist is fully responsible
for this crime. I will now do everything I can to reclaim the power taken away from me by this
crime”; Choate, 2008).

Power and Control.

During an act of sexual violence, an individual is stripped of his or her power, and often
survivors continue to feel powerless and out of control long after the trauma has ended.
Counselors can assist the client in focusing on restoring his or her sense of personal power,
particularly regarding decisions made in the present. As part of regaining power and control,
counselors should encourage clients to take an active role in the counseling process, providing
them with as many choices as possible and allowing for flexibility in the timing and pacing of
sessions.

Self-Esteem.

In their CPT treatment manual, Resick and Schnicke (1993) recommend helping clients to focus
on the effect that the sexual trauma has had on their views of themselves. Clients’ answers to
these questions can help to uncover automatic negative thoughts such as “I am unlovable” or “I
am damaged goods.” Through CR, clients can learn to separate the events and their reactions
from their views of themselves as individuals (e.g., “Being a survivor of sexual trauma is a part
of who I am, but it does not define me. I have strengths and a sense of self that this trauma did
not disrupt”). As a part of this process, the survivor can gradually learn to view the sexual
violence as a traumatic but growth-enhancing event. It is helpful for clients to know that most
individuals report some type of growth after a traumatic event, including greater self-awareness,
strength, maturity, a more flexible worldview, increased empathy, greater sensitivity to the
suffering of others, and changes in relationships, spirituality, life philosophy, or life priorities
(Frazier & Burnett, 1994; Frazier et al., 2001; Koss & Kilpatrick, 2001; Williams & Sommer,
1994).

Trust and Intimacy.

Because sexual violence often is committed by someone the survivor knows and trusts, a client’s
capacity for intimacy and ability to trust may be disrupted. If a survivor questions his or her
judgment in selecting safe relationships, engages in self-blame, and receives victim-blaming
reactions, he or she can develop particular problems in trusting both self and others. To change
these stuck points, clients can explore beliefs they have developed related to relationships and
about the world in general (e.g., “People are bad and can’t be trusted”; “The world is unsafe and
unfair”; Frazier et al., 2001). They can then change those beliefs that are impediments to their
recovery, evaluate current relationships and their interactions with others who can provide
support, and fully explore the need for positive connections with others as part of the recovery
process.
Anxiety Management

Because one of the primary symptoms following a rape trauma is anxiety, anxiety management
techniques are suggested both to prevent and to reduce these symptoms. Meadows and Foa
(1998) suggest teaching clients coping skills to reduce anxiety-related symptoms such as
hypervigilance, hyperarousal, sleep disturbances/nightmares, and difficulty in concentration.
These coping strategies include progressive muscle relaxation training, controlled breathing
exercises, role-playing, covert modelling, positive thinking and self-talk, assertiveness
training skills, guided self-imagery, and thought-stopping. Clients can become empowered as
they learn to employ these and other anxiety management strategies that promote recovery from
sexual trauma.