abuse in women and children

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.

4. 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

5. 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

6. 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.

7. 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.

9. 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

10. 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

11. Forms of Child abuse
Physical
sexual
emotional maltreatment
neglect

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.
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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

23. 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

24. 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.

25. 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.

27. PSYCHOLOGICAL REMEDIES
PREVENTION
MANAGEMENT

28. 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

29. 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)

31. REMEDIES IN ABUSED
CHILDREN
Physical Health Concerns
Developmental Issues
Interpersonal Issues
Intrapersonal Issues
Behavioral Issues

32. 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

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

34. 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

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

37. 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.

38. 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.

39. 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.

40. 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.

41. 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

42. 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.

43. 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

44. SALAMAT PO
THANK YOU FOR LISTENING