ABUSE AMONG WOMEN AND CHILDREN

1. Psychological Remedies
Available to Abused
Women and Children
MANILA, PHILIPPINES
April 22, 2015
MILEN SANTIAGO RAMOS MA. MSc PhD
Clinical Psychology – Neuroscience– Criminology
April 22, 2016
UPWILOCI2589 SantaClaraStreet, 888 SantaAna, Manila, 1009 Metro Manila

2. NEW FACES OF ABUSE

3. CHILD ON LEASE

4. CYBER SEX DEN IN BRGY COGON, CORDOVA
TOWN CEBU PHILIPPINES

5. DATE RAPE -RECENT DRUG

6. Liquid ecstacy

7. CHILD MARRIAGES - YEMEN

8. Child Bride - YEMEN

9. Classification by motive and degree rather than by type of injury.
Four categories are proposed:
A, abuse: premeditated ill treatment undertaken for gain by disturbed,
dangerous, and manipulative individuals;
B, active ill treatment: impulsively undertaken because of
socioeconomic pressures, lack of education, resources, and support, or
mental illnesses;
C, universal mild ill treatment: behaviour undertaken by all normal
caring parents in all societies; and
D, neglect: defined here as anunintentional failure to supply the child’s
needs.

10. Classification by type of injury.
Physical abuse
Physical abuse means that child’s physical body suffers harm.
It includes beating, spanking, slapping, kicking, dragging, burning, yanking on any
body part, unwanted tickling, and so on. Basically, any kind of touch the child doesn’t
want and that is harmful to them. It also includes physical neglect through denial of
food or medication, and inappropriate personal or medical care.
Mental abuse
Mental abuse (i.e., psychological or emotional abuse) means that child’s mind suffers
harm.
Mental abuse includes yelling, manipulating, fear mongering, shaming, creating false
guilt,forbidding to feel certain feelings (like anger), convincing that you have to feel
certain feelings and act accordingly, name calling, isolation, threatening, imposing
false and irrational beliefs, etc. Furthermore, all forms of abuse (e.g., physical or
sexual) are mentally harmful, too.
Sexual abuse
Sexual abuse is the physical and/or mental harm that is related to sex and sexuality.
Sexual abuse includes physical and/or mental components related to child’s
sexuality: rape, inappropriate touching, forced nudity, spanking on the buttocks,
caregiver’s language and behavior that’s age inappropriate for the child,
sexualization of the child, seduction by the caregivers, imposing shame and guilt in
relation to sex, any kind of physical, emotional, psychological, or verbal
incest/molestation.

11. Based on how it is enacted, child abuse can be classified into active,
passive, and vicariousabuse.
Active abuse means that child’s personal boundaries are actively
violated (i.e., the caregiver is too involved and over-controlling).
Some examples of that can be spanking, yelling, name calling,
molestation, shaming, etc.
Passive abuse means that the caregiver-child bond is not stable or
broken (i.e., the caregiver is physically or emotionally too distant or
completely unavailable). It includes neglect and abandonment. Some
examples are emotional unavailability, not being there for the child,
withdrawal of affection, lack of mirroring and validation, and so on.
Vicarious abuse means that the caregiver fails to protect the child
or puts them in an environment where the child suffers some form of
abuse from others.

12. FORMS OF ABUSE IN ADULTS
Abuse can take many forms. It can include:
Physical abuse such as hitting, pushing, pinching, shaking,
misusing medication, ; withholding food or drink; force-feeding
,scalding, restraint and hair pulling, ; failing to provide physical care
and aids to living.
Sexual abuse such as rape, sexual assault, or sexual acts to which
the person has not or could not have consented, or pressurising
someone into sexual acts they don’t understand or feel powerless to
refuse.
Psychological or emotional abuse such as threats of harm or
abandonment, being deprived of social or any other form of contact,
humiliation, blaming, controlling, intimidation, coercion, harassment,
verbal abuse and being prevented from receiving services or
support.

13. Financial or material abuse such as theft, fraud or exploitation,
pressure in connection with wills, property, or inheritance, misuse of
property, possessions or benefits.
Neglect such as ignoring medical or physical care needs and
preventing access to health, social care or educational services or
withholding the necessities of life such as food, drink and heating , or
failing to ensure adequate supervision or exposing a person to
unacceptable risk.
Discriminatory abuse such as that based on race or sexuality or ,
harassment, /slurs / maltreatment because of someone’s race,
gender, disability, age, faith, culture, or sexual orientation
Institutional abuse can sometimes happen in residential homes,
nursing homes or hospitals when people are mistreated because of
poor or inadequate care, neglect and poor practice that affects the
whole of that service

14. rape trauma syndrome
domestic stockholm syndrome
post traumatic stress syndrome
false memory syndrome
child sexual abuse accomodation
syndrome
FORMAL DIAGNOSTIC FORMULATION

15. (RTS or rape trauma syndrome)
is the psychological trauma experienced by a rape
victim that includes disruptions to normal
physical, emotional, cognitive, and interpersonal
behavior. The theory was first described by
psychiatrist Ann Wolbert Burgess and sociologist
Lynda Lytle Holmstrom in 1974
is a cluster of psychological and physical signs,
symptoms and reactions common to most rape
victims immediately following and for months or
years after a rape

16. DOMESTIC STOCKHOLM SYNDROME
This phenomenon appears in the bizarre attachment of some
hostages to their captors known as the "Stockholm Syndrome. " It
explains why some victims love their abusers.
In a bank vault in Stockholm, Sweden twenty-seven years ago,
Kristin, the hostage was held by Olafson, the armed assailant. She
could not speak, she could not eat, she could not use a toilet without
his permission. She was not only terrified, she was infantilized
Kristin denied that Olafson, her captor, was the source of her pain.
Many hostages deny or repress or forget that fact. They do realize,
consciously and deep inside, that someone with the power to take
their life is not killing them. On the contrary, this powerful person
gives them food and blankets and permission to speak and the right
to use a toilet. The hostage feels grateful and attached

17. Patty Hearst felt it toward Cujo, one of her Symbionese
Liberation Army captors
a battered wife might love her spouse because she was
trained from infancy to love an abusive parent --that is, to
equate love with the intimate enduring dependence on
one who provides life's necessities and who also hits and
hurts.
the battered wife might love her spouse because relief
from punishment is so rewarding that she has learned to
savor this feeling while denying the pain of physical
abuse.
Or, she might love qualities that are lovable and suppress
any outrage in response to behaviors that are cruel. Love
is notoriously irrational, complex and paradoxical.

18. Posttraumatic stress disorder (PTSD) may
develop after a person is exposed to one or
more traumatic events, such as major stress
, sexual assault, terrorism, or other threats
on a person's life.
The diagnosis may be given when a group of
symptoms, such as disturbing recurring
flashbacks, avoidance or numbing of
memories of the event, and hyperarousal,
continue for more than a month after the
occurrence of a traumatic event.

19. Child sexual abuse
accommodation
syndrome (CSAAS) is a syndrome
developed by Roland C. Summit in 1983 to describe how he
believed sexually abused children responded to ongoing
sexual abuse.
Roland Summit described how children try to resolve the
experience of sexual abuse in relation to the effects of
disclosure in real life. Summit posited five stages:[
Secrecy
Helplessness
Entrapment and accommodation
Delayed disclosure
Retraction

20. The False Memory Syndrome
came about in 1992 . A foundation was formed by Pamela
and Peter Freyd, after their adult daughter Jennifer
Freyd accused Peter Freyd of sexual abuse when she was a
child.
The FMSF describes its purpose as the examination of the
concept of false memory syndrome and recovered memory
therapy and advocacy on behalf of individuals believed to
befalsely accused of child sexual abuse[3]
with a focus on
preventing future incidents, helping individuals and
reconciling families affected by FMS, publicizing information
about FMS, sponsoring research on it and attempting to
discover methods to distinguish a true or false allegation of
abuse

21. INTIMATE PARTNER RELATIONSHIP
DISTRESS –DSM V
DSM- 5 code: V61.1 0 (ICD-10 code, Z63.0)
[Problematic] quality of the intimate (spouse or partner) relationship or
[Problematic] relationship quality is affecting the course, prognosis, or treatment of a
mental or other medical disorder
● Impaired functioning in behavioral, cognitive, or affective domains. Examples:
•Behavioral problems
●Conflict resolution difficulty
●Withdrawal
●Overinvolvement
•Cognitive problems
●Chronic negative attributions of the partner’s intentions
●Chronic dismissals of the partner’s positive behaviors
•Affective problems
●Chronic sadness, apathy, and/or anger about the partner.

22. ISSUES
PHYSICAL HEALTH CONCERNS
Sexually Transmitted Diseases and Fear of Acquired
Immunodeficiency Syndrome (AIDS)
Sexual and Physical Adequacy
Pregnancy
Scarring and Permanent Damage
Encopresis and Enuresis
Psychosomatic Complaints

23. Interpersonal Issues
Identification With the
Aggressor
Victimizing Behaviors
Intimacy
Betrayal

24. Intrapersonal Issues
Fear
Trauma
Anxiety
Depression
Lack of Expression of Feelings
Guilt, Blame, and Responsibility
Loss and Grief
Self-Worth, Self-Esteem, Self-Efficacy
Stigmatization/Damaged Goods
Learned Helplessness

25. Behavioral Issues
Avoidant Behavior
Dependent Behavior
Aggressive Behavior
Hypersexual Behavior
Suggestive Sexual Behavior
Masturbation

26. PSYCHOLOGICAL REMEDIES
Prevention
Management

27. Prevention
HOW TO PREVENT POTENTIAL RAPE
http://www.wikihow.com/Prevent-a-
Potential-Rape
HOW TO AVOID BECOMING A RAPE VICTIM
http://www.wikihow.com/Avoid-
Becoming-a-Rape-Victim

28. MANAGEMENT
How to Deal with After Effects of Rape
http://www.wikihow.com/Deal-With-the-After-Effects-of-Rape
How to Cope with Rape Related Post traumatic
Stress Disorder
http://www.wikihow.com/Cope-With-Rape-Related-Post-Traumatic-
Stress-Disorder
How to Heal from Rape and Sexual Assault
(Rape Trauma Syndrome)
http://www.wikihow.com/Heal-From-Rape-and-Sexual-Assault-
Rape- Trauma-Syndrome)

29. What Qualifies as Rape
Rape is sex while someone is unconscious
Rape is sex while someone is impaired
Rape is women having sex with men against their will
Rape is forced oral sex
Rape is forced sex with no weapon present
Rape is unwanted sex without physical resistanc
Rape is unwanted sex between a husband and wife
Rape is unwanted or forced sex from someone you used to
or are currently dating
Rape is a teacher sleeping with a student
Rape is any sex that you don't want

30. TREATMENT modalities
cognitive vs behavioral
individual vs family
group vs. family
play therapy

31. Treatment phases and structuring the healing process
The early phase of therapy with adult survivors of childhood sexual abuse
focuses on building up trust between the counsellor and the survivor and
preparing the survivor for the healing process. During this phase of
therapy the survivor is encouraged to tell their story which allows the
counsellor to assess which therapeutic techniques may be the most
beneficial.
Telling their story is difficult for some survivors. Their memories are
fragmented and all jumbled up making it hard for them to relate what
happened when. There is often a feeling of being overwhelmed by the
abuse and just not knowing how to start. Many survivors just can't
differentiate between episodes of abuse and their whole sense of
childhood was taken over by it. At this stage there are tools which can be
used to help the survivor put their childhood back together into a
recognisable whole by focusing on specific incidents or episodes of their
lives to structure their stories.

32. The middle phase of therapy is where the brunt of the work is
done which includes re-processing the trauma. Simply stated,
processing the trauma of childhood sexual assault involves:
Acknowledging the fact of the abuse and its impacts.
Experiencing and releasing some of the feelings associated with
the trauma that typically has remained unexpressed.
Exploring a range of feelings towards the abuser/s and non-
protective parents, siblings or caretakers; and
Making cognitive reassessments of the abuse (i.e. why it
happened, who was responsible etc).
If these avenues are explored, the traumatic events are faced and
processed by necessity. The abuse can no longer remain frozen in
time and continue to maintain the survivors status quo: The status
quo that includes beliefs about vulnerability, helplessness,
mistrust, stigmatisation, with a negative view of self and others.

33. During this phase the abused child is integrated with the adult
self so that they work together as a unified whole rather than
being split and working against each other. Emphasis is also
placed on cognitive restructuring, educating the survivor and the
formulation of new coping strategies.
Through this sort of trauma processing a clear line is drawn
between the past and the present leaving the individual feeling
more in control and determined to deal with the impacts the
abuse has had on their lives.
It is at this stage that a stronger sense of self and changes in
world view evolve and new coping skills can be incorporated
into their behavioural repertoire. At this stage the survivor
actively engages in healing making decisions about the options
open to them. This is also a stage of exploration of possibilities
which can lead the survivor further along the path to integration.
This is a good time for group work, self-esteem and assertiveness
training, stress management and/or self-defence classes.

34. The last phase of the healing process is
the termination phase. This involves empowering
the survivor to make their own choices and
decisions without relying on the counsellor. It
includes the survivor's separation from the
counselling process while establishing support
networks. These might include self-help support
groups as well as supportive friends, partners, or
family member

35. Treatment approaches
Treatment of adult survivors of childhood sexual assault
incorporates a number of therapeutic approaches which reflect
major the theoretical schools of therapy, emotional, cognitive
and behavioural.
Experiential or exploratory techniques focus on accessing
emotions, re-experiencing the trauma and integrating these
with the adult self.
Cognitive therapy aims to identify the survivor's distorted
cognitions of themselves, others and the world and attempts
to replace these with more accurate and realistic cognitions.
Behavioural therapies focus on enhancing the survivor's
behavioural repertoire through the acquisition of more
adaptive behavioural responses, coping strategies and learning
new skills.

36. TREATMENT MODALITIES (metaanalysis)
Play therapy seemed to be the most effective treatment
for social functioning
Cognitive-behavioral, abuse-specific, and supportive
therapy in either group or individual formats was most
effective for behavior problems
Cognitive-behavioral, family, and individual therapy
seemed to be the most effective for psychological
distress
Abuse-specific, cognitive-behavioral, and group therapy
appeared to be the most effective for low self-concept.

37. Cognitive therapy (CT) is a type
of psychotherapy developed by
American psychiatrist Aaron T. Beck. CT is one of the
therapeutic approaches within the larger group
of cognitive behavioral therapies (CBT) and was first
expounded by Beck in the 1960s. Cognitive therapy is
based on the cognitive model, which states that
thoughts, feelings and behavior are all connected, and
that individuals can move toward overcoming difficulties
and meeting their goals by identifying and changing
unhelpful or inaccurate thinking, problematic behavior,
and distressing emotional responses. This involves the
individual working collaboratively with the therapist to
develop skills for testing and modifying beliefs,
identifying distorted thinking, relating to others in
different ways, and changing behaviors

38. Behavioral therapy is
a treatment that helps change
potentially self-destructing behaviors.
It is also
called behavioral modification or
cognitive behavioral therapy. Medical
professionals use this type
oftherapy to replace bad habits with
good ones

39. Individual vs. Group psychotherapy
The therapeutic alliance in group psychotherapy is with the group itself
(comprised of the group psychotherapist and the group members) and
not just with the psychotherapist.
Different therapeutic factors are at work in group psychotherapy. In
group psychotherapy, interpersonal feedback from peers is considered
the most powerful therapeutic factor.
The attachment process is different in group psychotherapy. The
attachment is to the group itself and attachment issues are analyzed and
worked through within this context.
In group psychotherapy, a client participates in a plethora of roles and
relationships and learns about the many complex roles and relationships
that make up the fabric of life

40. Individual vs Family Therapy
individual therapy is one-to-one work between client and therapist.
Some people simply want the supportive environment of an
unbiased third party, some people want help in pursuing meaningful
life direction. Within the framework of individual therapy,
psychotherapist can use techniques from one or a variety of
theoretical orientations.
Family therapy involves two or more members of a family (couples
therapy is technically a subset of family therapy). Family therapy is
best used when there is a need to address problems or issues that
affect family functioning when one or more family members are
affected. While family therapists employ a variety of treatment
approaches, family therapy is consistent in emphasizing the entire
family as a unit. This approach to therapy focuses more on inter-
relational issues than on an individual's internal concerns.

41. SALAMAT PO