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Psychological treatment for abused women and children

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Psychological treatment for abused women and children

  1. 1. Psychological Treatment For Abused Women and Children (SEMINAR FOR UP WOMEN LAWYER S CIRCLE, INC. (WILOCI) AND ZONTA CLUB OF MANILA . APRIL, 2014, MANILA) MILEN SANTIAGO RAMOS MA, MSc, PhD CLINICAL PSYCHOLOGY - NEUROSCIENCE - CRIMINOLOGY.
  2. 2. RA 9262 is “ANTI-VIOLENCE AGAINST WOMEN AND THEIR CHILDREN ACT OF 2004 which was adopted / signed on March 8, 2004 and took effect last March 27, 2004 RA 9262 is a law that protects the rights of women & their children & also eliminates violence as it’s usually children and women are likely the victims due to unequal power relations
  3. 3. Violence Against Women and their Children (VAWC) is defined as: - Any act or a series of acts committed by any person against a woman who is his wife, former wife. - Against a woman with whom the person has or had a sexual or dating relationship, or with whom he has common child, - Against her child whether legitimate or illegitimate, - within or without the family abode, - which result in or is likely to result in physical, sexual, psychological harm or suffering, or economic abuseincluding threats of such acts battering, assault, coercion, harassment or arbitrary deprivation of liberty
  4. 4. Who are considered CHILDREN? Anyone below 18 years of age, or older but incapable of taking care themselves, including the biological children of the victim and other children under her care.
  5. 5. FOUR (4) ACTS that constitute VAWC ? A.) Physical violence – bodily harm or physical harm. B.) Sexual violence is an act, which is sexual in nature such as rape, sexual harassment. C.) Psychological violence is an act that causes mental or emotional suffering to the victim such as intimidation stalking, marital infidelity. D.) Economic violence is acts that make the woman financially dependent, such as withdrawal on financial support, destroying household property.
  6. 6. FOR PRACTITIONERS IN MENTAL HEALTH THE CONCEPT OF VIOLENCE IS VERY MUCH ASSOCIATED WITH UNDUE ACTUALIZATION OF BASIC INSTINCTS WHICH ARE SEX AND AGGRESSION of the perpetuator
  7. 7. DOMESTIC VIOLENCE INTIMATE PARTNER VIOLENCE BATTERED WIFE SYNDROME/ DOMESTIC STOCKHOLM SYNDROME PSYCHOPATHOLOGY (i.e.PERSONALITY DISORDERS) FACTORS OTHER THAN PSYCHOPATHOLOGY (i.e. advent of OFW – children are left on their own/our women in their place of work are prone to many forms of abuses; advent of technology leads to cyber or digital forms of abuse TYPICAL ABUSE PHENOMENA
  8. 8. Forms of Child abuse Physical sexual emotional maltreatment neglect
  9. 9. 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. 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
  10. 10. What is adult abuse? Abuse is a violation of a person's human and civil rights by any other person. Abuse can take many forms: Physical abuse Psychological abuse Financial or material abuse Sexual abuse Neglect or acts of omission Discriminatory abuse Institutional abuse
  11. 11. Physical abuse: hitting slapping pushing kicking burning giving medication that may harm disciplining in an inappropriate way Possible signs: fractures bruising burns pain marks not wanting to be touched
  12. 12. Psychological abuse: emotional abuse verbal abuse humiliation bullying the use of threats Possible signs: being withdrawn too eager to do everything they are asked showing compulsive behaviour not being able to do things they used to not being able to concentrate or focus
  13. 13. Financial or material abuse: stealing from the person cheating them using them for financial gain putting pressure on them about wills, property, inheritance or financial transactions misusing or stealing their property, possessions or benefits Possible signs: having unusual difficulty with finances not having enough money being too protective of money and things they own not paying bills not having normal home comforts
  14. 14. Sexual abuse: direct or indirect sexual activity where the vulnerable adult cannot or does not agree to it Possible signs: genital itching, soreness or having a sexually transmitted disease using bad language not wanting to be touched behaving in a sexually inappropriate way changes in appearance
  15. 15. Neglect or acts of omission including: withdrawing or not giving the help that a vulnerable adult needs, so causing them to suffer Possible signs: having pain or discomfort being very hungry, thirsty or untidy failing health
  16. 16. Neglect or acts of omission including: withdrawing or not giving the help that a vulnerable adult needs, so causing them to suffer Possible signs: having pain or discomfort being very hungry, thirsty or untidy failing health
  17. 17. Discriminatory abuse including: abusing a person because of their ethnic origin, religion, language, age, sexuality, gender or disability Possible signs: the person is not receiving the care they require their carer is over critical or makes insulting remarks about the person the person is made to dress differently from how they wish
  18. 18. Institutional abuse: abuse or mistreatment by an organisation or by any individual within a building where the the person is living or receiving care Possible signs: the person has no personal clothing or possessions there is no care plan for them he or she is often admitted to hospital there are instances of professionals having treated them badly or unsatisfactorily or acting in a way that cause harm to the person
  19. 19. Sexual Abuse in Children Symptoms of sexual abuse in chlildren are similar to those of depression or severe anxiety and nervousness. They can include: Bowel disorders, such as soiling oneself (encopresis) Eating disorders, such as anorexia nervosa Genital or rectal symptoms, such as pain during a bowel movement or urination, or vaginal itch or discharge Repeated headaches Sleep problems Stomach aches (vague complaints) Children who are abused may: Display disruptive behaviors such as using alcohol and street drugs or engaging in high-risk sexual behaviors Do poorly in school Have excessive fears Withdraw from normal activities
  20. 20. Adult Manifestations of Childhood Sexual Abuse Symptoms or behavioral sequelae are common and varied. More extreme symptoms can be associated with abuse onset at an early age, extended or frequent abuse, incest by a parent, or use of force. Common life events, like death, birth, marriage, or divorce may trigger the return of symptoms for a childhood sexual abuse survivor. The primary aftereffects of childhood sexual abuse include the following: Emotional reactions Emotions such as fear, shame, humiliation, guilt, and self-blame are common and lead to depression and anxiety. Symptoms of posttraumatic stress Survivors may experience intrusive or recurring thoughts of the abuse as well as nightmares or flashbacks. Distorted self-perception Survivors often develop a belief that they caused the sexual abuse and that they deserved it. These beliefs may result in self-destructive relationships.
  21. 21. Physical Effects Chronic and diffuse pain, especially abdominal or pelvic pain (1), lower pain threshold anxiety and depression, self-neglect, and eating disorders have been attributed to childhood sexual abuse. Adults abused as children are four to five times more likely to have abused alcohol and illicit drugs They are also twice as likely to smoke, be physically inactive, and be severely obese Sexual Effects Disturbances of desire, arousal, and orgasm may result from the association between sexual activity, violation, and pain. Survivors are more likely to have had 50 or more intercourse partners, have had a sexually transmitted infection, and engage in risk-taking behaviors that place them at risk of contracting human immunodeficiency virus (HIV) Early adolescent or unintended pregnancy and prostitution are associated with sexual abuse Gynecologic problems, including chronic pelvic pain, dyspareunia, vaginismus, and nonspecific vaginitis, are common diagnoses among survivors (12-14). Survivors may be less likely to have regular Pap tests and may seek little or no prenatal care Interpersonal Effects Adult survivors of sexual abuse may be less skilled at self-protection. They are more apt to accept being victimized by others (15, 16). This tendency to be victimized repeatedly may be the result of general vulnerability in dangerous situations and exploitation by untrustworthy people.
  22. 22. PSYCHOLOGICAL REMEDIES PREVENTION MANAGEMENT
  23. 23. PSYCHOLOGICAL REMEDIES PREVENTION Home School Community 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
  24. 24. PSYCHOLOGICAL REMEDIES 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)
  25. 25. REMEDIES IN ABUSED CHILDREN Physical Health Concerns Developmental Issues Interpersonal Issues Intrapersonal Issues Behavioral Issues
  26. 26. 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
  27. 27. Interpersonal Issues Identification With the Aggressor Victimizing Behaviors Intimacy Betrayal
  28. 28. 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
  29. 29. Behavioral Issues Avoidant Behavior Dependent Behavior Aggressive Behavior Hypersexual Behavior Suggestive Sexual Behavior Masturbation
  30. 30. 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.
  31. 31. Working with adult survivors of child sexual assault Like adult victims, children experience significant psychological and emotional distress. Unlike adults, however, they are traumatized during the most critical period of their lives: When assumptions about self, others and the world are being formed; When their relations to their own internal states are being established; and When coping and relationship skills are first acquired. Therefore, the Post Traumatic Stress reactions impact upon the child's subsequent psychological and social maturation leading to atypical and potentially dysfunctional development. In other words, if untreated, the effects of sexual abuse in childhood are usually more dynamic and interactive, in contrast to trauma effects in adults who have a stable base development and maturation to draw on and for whom, with support, the trauma effects will wane over time.
  32. 32. Impacts of childhood sexual abuse are likely to occur in three stages. Initial reactions to victimisation: involving Post Traumatic Stress reactions; alteration in normal childhood development; painful affect; and cognitive distortions. Accommodation to ongoing abuse: involving coping behaviours intended to increase safety and/or decrease pain during victimisation (i.e. memory suppression, denial, dissociation, accommodation syndrome; Stockholm syndrome). Long term elaboration & secondary accommodation reflecting: the impacts of initial reactions and abuse-related accommodations on the individual's later psycho social development; and the survivor's ongoing coping responses to abuse related dysphoria. (Cognitive distortions, denial, memory suppression, dissociation, altered emotionality, impaired self-reference, avoidance, disturbed relatedness). For adults abused in childhood, who received no counselling or support at the time, some of the initial reactions of victim's to the abuse may abate over time but more typically such disturbances along with abuse-specific coping behaviours, generalise and elaborate over time. The typology by Finkelhor and Browne taken together with PTSD adequately describes these core impacts and their psycho-social and behavioural sequelae. These are the impacts which need to be addressed in working with adult survivors of childhood sexual abuse.
  33. 33. 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. 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. 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. 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. 36. MY CLINICAL CASES RELATED TO SEXUAL ABUSE First, is the case of intergenerational rape wherein the grandmother was raped, the daughter of the grandmother was also sexually abused and the granddaughter who came to our hands was also raped. These women was raped in each of their lifetime. Psychotherapy prevented potential rape on the fourth generation Second, is the disruption case wherein this adolescent was able to find an adoptive parent abroad but was send back home because of sexual acting out. This could have been prevented with good social case history Third, was the adolescent who was placed in a foster home but who eventually became a victim for the nth time…. This time by her foster father. Efficient screening of foster parents is a grave necessity
  37. 37. SALAMAT PO THANK YOU FOR LISTENING

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