The influence of intersectionality on the counseling experiences of women survivors of child sexual abuse from minoritized racial and ethnic groups.

The incidence of survivors of childhood sexual abuse (CSA) diagnosed with cancer is unknown. It is estimated that one in three women and one in six men in the United States are survivors of CSA. Survivors of CSA diagnosed with cancer are presented with multiple and potentially accumulating traumas. The re-traumatizing nature of a cancer diagnosis and treatment affects all elements of the CSA survivor's care and may impede her/his treatment. To date, the impact of CSA on the medical treatment of people with cancer has been unexplored with the existing studies on female survivors of CSA with cancer focusing on the post-treatment experience and their higher incidence of sexual dysfunction. This article describes the impact of CSA on the cancer treatment of 18 survivors of CSA and the clinical interventions used to address the unique psychosocial needs of this population. Anecdotal information suggests that the survivors of CSA may find aspects of the cancer experience reminiscent of their history of abuse. All 18 survivors of CSA experienced distressing memories of their abuse during their cancer treatment. Fifteen CSA survivors presented traumatic memories that were inaccessible to conscious thought processes prior to their cancer diagnosis. Psychodynamic interventions address issues of disruption in the cancer treatment, non-adherence, and difficulties in relationships with the health care team. Containment of intense affect and distressing thoughts rather than exploration improved CSA survivors' adherence with cancer treatments. The acquisition of self-comforting skills helped CSA survivors feel less re-victimized by their cancer experience. The establishment of an environment of internal and external safety improved communication with the health care team. Health care/psycho-social clinicians' awareness and use of appropriate interventions can minimize the affects of re-traumatization and enhance the CSA survivor's treatment experience.

<i>The Child Sex Scandal and Modern Irish Literature: Writing the Unspeakable</i>, by Joseph Valente and Margot Gayle Backus

This study aimed to explore the sexual relationships experienced by a non-clinical group of lesbian women survivors of male perpetrated child sexual abuse (CSA), where the abuse occurred between the ages of eight and 15 years. By adopting a phenomenological approach it was intended that these experiences would be explored through the eyes of the women participating in the study. It was further intended that the study would illuminate an underresearched area, thus offering some guidance to therapists and other professionals working therapeutically with lesbian survivors of CSA. Eight lesbian survivors participated in individual focused interviews, each lasting about one hour. The interviews were audiotaped, transcribed and subjected to stringent content analysis, with referral back to participants for clarification and verification in keeping with the phenomenological tradition. The study identified several issues which appear to be unique to lesbian survivors, namely woman-to-woman sexual assault, ‘negotiated sex’ and lack of sexual spontaneity in relationships where both women are survivors of CSA, and the concept of a double secret: CSA and lesbianism. Overall, however, the study demonstrated a sense of commonality of experience with those of heterosexual women. This in itself was found to be reassuring because it would appear that the therapeutic signposts and approaches commonly looked for and adopted, when working with heterosexual women survivors, are appropriate. Ultimately it is hoped that the study will help therapists and helpers to provide a quality service to lesbian survivors of CSA, based on evidence rather than supposition and stereotype.

Childhood sexual abuse is a complex trauma with unique trauma-causing factors that could have devastating long-term, negative effects on survivors. To date, little attention has been given to loss and specifically stigmatized or hidden loss as a unique trauma-causing factor. Method: This article reports the findings of a scoping review designed to identify research exploring the losses associated with childhood sexual abuse in women survivors. A systematic search of databases for articles published between 1983 and 2019 were conducted using keywords related to loss and women survivors of childhood sexual abuse. Findings: Twenty studies were selected for review using predefined inclusion criteria: studies that include adult women survivors of childhood sexual abuse, studies that include child/childhood sexual abuse, studies that include stigmatized loss, studies that indicate stigmatized loss in adult women survivors of childhood sexual abuse. Sources were subject to quality appraisal and data were extracted in line with the review question. Discussion and Contribution: Findings acknowledged and extended on Bloom’s model of stigmatized loss and suggested that female survivors of childhood sexual abuse may experience an overall loss of self-efficacy, presenting as a loss of personal agency, interpersonal agency, and sexual agency. The results of this research suggest that loss be considered in support interventions with women self-reporting childhood sexual abuse. It is recommended that further research be conducted to confirm these findings so that they may advocate for inclusion in childhood sexual abuse treatment interventions.

BackgroundPrevious studies have frequently reported a high prevalence of co-occurring anxiety and depression among people who experienced stressful events in childhood. However, few have noted the symptomatic relationship of this comorbidity among childhood sexual abuse (CSA) survivors. Therefore, this study’s objectives were as follows: (1) to examine the relationship across symptoms between anxiety and depression among CSA survivors; (2) to compare differences between male and female network structures among CSA survivors.MethodsA total of 63 Universities and Colleges in Jilin Province, China, covered 96,218 participants in this study, a sub-set data of which met the criteria of CSA was analyzed with the network analysis. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), measured CSA. Anxiety was measured by the seven-item Generalized Anxiety Disorder Scale (GAD-7), and depression was measured by the Patient Health Questionnaire (PHQ-9). The sex difference between anxiety and depression among CSA survivors was compared.Results3,479 college students reported the experience of CSA (CTQ-SF total scores ≥ 8), with a prevalence of 3.62% (95% CI: 3.50–3.73%). Among CSA survivors, control worry, sad mood, and energy were central and bridge symptoms of the anxiety and depression network. Meanwhile, male CSA survivors appeared to have a stronger correlation between guilt and suicide, but female CSA survivors seemed to have a stronger correlation between control worry and suicide. Moreover, the edge of control worry-relax-afraid was stronger in the male network, while the edge of restless-relax was stronger in the female network.ConclusionControl worry, sad mood, and energy are crucial to offer targeted treatment and to relieve anxiety and depression symptoms for CSA survivors. Guilt needs more attention for male CSA survivors, while control worry remains more important for female CSA survivors to reduce suicidal ideation and suicide attempts.

In this article, the authors review 33 empirical studies investigating Posttraumatic Stress Disorder (PTSD) in survivors of childhood sexual abuse (CSA). In many of these studies, researchers also examined the impact of the co-occurring trauma of childhood physical abuse (CPA) in regard to PTSD symptoms. Methodological issues addressed in the review include definition and measurement of both CSA and CPA, assessment of PTSD, and additional aspects of experimental design. In this review, the authors explore the importance of the empirical investigation of the relationship between the level of trauma exposure (e.g., seventy and duration of trauma), and the level of PTSD symptoms. Suggestions for future research are proposed. Since a given survivor may often experience additional types of traumatic events across his or her lifetime, the utility of adopting a multiple-trauma perspective in understanding the impact of stressful life events across the lifespan is explored.

The adverse effects of childhood sexual abuse (CSA) are often significant and enduring. It is therefore important to identify therapeutic interventions that can effectively minimise these effects. Compassion focused therapy (CFT) is an integrative approach, rooted in evolutionary theory, affective neuroscience, mindfulness, and social and developmental psychology, that focuses on the cultivation and application of compassion for self and others, and may be an effective intervention for survivors of CSA. Originally developed for people with high levels of self-criticism and shame, CFT is being effectively applied to a wide range of therapeutic concerns. In particular, CFT targets many of the common issues and impacts relevant to survivors of CSA, who often experience shame as a result of their trauma and have great difficulties with self-compassion. While CFT holds significant promise as an intervention for this group, to date it has not been empirically tested.This study explored both the effectiveness and acceptability of a CFT group intervention for adult female survivors of CSA utilising a mixed quantitative and qualitative design. The study investigated three primary research questions, 1) What can be learnt from adult female survivors of CSA and the counsellors who work with them, about their perceptions and experience of self-compassion, to inform development of a CFT intervention with this client group? 2) How effective is a CFT intervention for increasing self-compassion and reducing post-traumatic stress symptoms, shame, fears of compassion, and other trauma-related symptom distress in adult female survivors of CSA? and 3) What are the therapeutic considerations in relation to a CFT intervention for adult female survivors of CSA based on participant experience and evaluation?Four separate studies were conducted to explore these questions. Study one consisted of two focus group discussions with adult female survivors of childhood sexual abuse (n = 7) and sexual assault counsellors (n = 7). A consensual qualitative research design was used to identify two core domains for the survivor focus group: Barriers to Compassion and Factors Supporting Compassion. The counsellor focus group revealed three domains: Therapeutic Factors to Support Compassion, Factors Affecting Client Readiness and Capacity, and Anticipated Outcomes. Outcomes from the focus group discussions informed study two, involving the development and pilot (n = 8) of an eight-week CFT group program for adult survivors of childhood sexual abuse (CFT-SA). Results showed significant reductions in hated self, fears of self-compassion, self-coldness, and general psychological distress with large effect sizes across all variables (d=.98 to 1.19). No significant change was observed for self-compassion, fears of receiving compassion from others, inadequate self, reassured self, external shame, depression, anxiety, stress, or post-traumatic stress symptoms. The pilot program demonstrated good acceptability as measured by attendance and attrition rates and participant feedback.Study three involved adapting the eight-week CFT-SA group program based on outcomes and feedback from study two. CFT-SA became a 12-session weekly program with a three-month follow-up session and increased emphasis on core target variables relating to self-compassion, shame, and trauma symptoms. The adapted program was delivered across four groups (n = 30 pre to post; n = 25 pre-follow-up). Significant results were demonstrated across all outcomes, including core target variables, from pre- to post-intervention, with medium to large effect sizes (d=.56 to 1.60) and were maintained at follow-up (d=.55 to 1.36). Varying results were identified via reliable and clinical change analysis, with between 20% and 57% demonstrating reliable change pre- to post-intervention and 22% to 57% from pre-intervention to follow up. A similar pattern was observed for clinical change scores. Low attrition and high session attendance, in addition to positive participant feedback, suggest the program has high acceptability. The fourth study provided post-intervention qualitative analysis regarding participants’ experience of the CFT-SA program, utilising an interpretative phenomenological approach. Outcomes revealed that overall participants reflected positively on the experience. Superordinate themes represented a process categorised as: Wary but Hopeful: Starting the Group; Feeling Safe and Engaged; Trying it Out; Feeling the Difference; and Bittersweet: Leaving the Group. This study provided valuable feedback relating to therapeutic considerations to help maintain participant motivation and engagement in the program and beyond.Taken together, these studies provide significant preliminary support for the effectiveness and acceptability of CFT as an intervention for adult female survivors of CSA and justifies further research and a clinical trial. CFT may offer a way to minimise the debilitating psychological impact of CSA by helping survivors relate to themselves with compassion rather than shame, self-blame, and self-criticism.

ABSTRACTThe present study examined the possibility of different groups of child sexual abuse (CSA) survivors based on their different patterns of attachment and sexual problems. A sample of 324 CSA survivors and 484 participants who did not report any child maltreatment experiences completed online questionnaires. A cluster analysis on attachment and sexual outcomes revealed that CSA survivors formed two distinct profiles. The first profile included CSA survivors with elevated attachment anxiety and low to moderate scores on attachment avoidance, sexual compulsion, and sexual avoidance. The second profile comprised CSA survivors with high scores on attachment anxiety, attachment avoidance, sexual compulsion, and sexual avoidance. These groups were then compared on CSA severity, gender differences, and other child maltreatment experiences. As compared to CSA survivors of the first profile, survivors from the second profile reported more intrusive and extrafamilial CSA, higher rates of psychological maltreatment and witnessed parental violence, and experienced more personal and couple distress. These results suggest that CSA survivors form a heterogeneous population and that sexual abuse is differentially associated with the complex unfolding of the attachment and sexual systems within two distinct subgroups.

Childhood sexual trauma has been demonstrated to increase survivors' risk for engaging in unrestricted sexual behaviors and experiencing adolescent sexual assault. The current study used the sexual self-schema construct to examine cognitive representations of sexuality that might drive these behavioral patterns. In Study 1 (N=774), we attempted to improve the content validity of the Sexual Self Schema Scale for child sexual abuse (CSA) survivors, introducing a fourth sexual self-schema factor titled the "immoral/irresponsible" factor. In Study 2 (N=1150), the potential differences in sexual self-views, as assessed by the four sexual self-schema factors, between CSA survivors and non-victims were explored. In addition, Study 2 evaluated how these sexual self-schema differences may contribute to participation in unrestricted sexual behaviors and risk for sexual assault in adolescence. Results indicated that a history of CSA impacted the way women viewed themselves as a sexual person on each of the four factors. CSA survivors were found to view themselves as more open and possessing more immoral/irresponsible cognitions about sexuality as compared to women who did not have a CSA history. In addition, the CSA survivors endorsed less embarrassment and passionate/romantic views of their sexual selves. The interaction of CSA severity and the sexual self-schemas explained variance in adolescent sexual assault experiences above and beyond the severity of CSA history and participation in risky sexual behaviors. The findings suggest that sexual self-views may serve to moderate the relationship between CSA and adolescent sexual assault. Implications of these findings and directions for future research are discussed.

TRAUMATIZED SEXUALITY – UNDERSTANDING THE UNIQUE CHALLENGES FACED BY CHILD SEXUAL ABUSE SURVIVORS DURING SEXUAL ACTIVITY

This integrative review aimed to synthesize both qualitative and quantitative research on the (re)experiencing of post-traumatic stress disorder (PTSD) symptoms during the perinatal period for childhood sexual abuse (CSA) survivors. Whittemore and Knafl's framework, which includes problem identification, literature review, data evaluation, data analysis, and results dissemination, was used. A search in four databases (i.e., PsycINFO, MEDLINE, Scopus, and ProQuest Dissertations and Thesis Global) yielded an initial sample of 3420 articles. After screening and deduplication, 16 articles met our inclusion criteria (i.e., history of CSA, minimum 8 weeks pregnant, reported quantitative statistics or qualitative findings, discussed PTSD symptoms) and were retained in the final sample. CSA survivors (re)experienced PTSD symptoms as a result of (1) aspects of their medical care (vaginal examinations, male medical providers, lack of control, and restraint), (2) physical sensations during pregnancy, childbirth, and breastfeeding, and (3) sex of the child (worries over child becoming an abuser/abused, male genitalia). CSA survivor's PTSD symptoms of intrusion, dissociation, avoidance, and hyperarousal were significantly greater throughout the perinatal period compared with individuals without CSA or with other traumas. CSA survivors are at increased risk of (re)experiencing PTSD symptoms throughout the perinatal period, which may be due to several internal and external triggers. Further research is needed to understand external triggers outside of medical care, and how the unique context of pregnancy may differ from other life contexts for survivors of CSA. Findings point to the relevance of adopting trauma-informed practices with CSA survivors during their perinatal period.

Resilient child sexual abuse survivors: Cognitive coping and illusion

Sexual problems are very prevalent among survivors of child sexual abuse (CSA). Yet, various approaches to therapy do not seem to address this issue when treating these individuals. Traditional sex therapy may also not suit the experiences of CSA survivors, as CSA was not considered when the most well-known and frequently used techniques were developed. The present review sought to identify (1) theory-based therapeutic approaches that address sexual problems among CSA survivors and offer treatment protocols (including an outline of specific therapy stages, sessions, or techniques) to treat these sexual problems and (2) identify therapeutic approaches that include a protocol for treating sexual problems among CSA survivors that was empirically tested and validated. In total, six approaches for treating sexual dysfunctions among CSA survivors that provide detailed guidelines for implementing the approach within sex therapy for CSA survivors were identified in the literature. Only two of the studies conducted a randomized controlled trial to test the intervention. This overview concludes with important issues to address when treating sexual problems among CSA survivors and a call for additional evidence-based practices for treating sexual problems among survivors of CSA.

A randomized experimental evaluation found support for the effectiveness of eye movement desensitization and reprocessing (EMDR)in reducing trauma symptoms among adult female survivors of childhood sexual abuse. Fifty-nine women were assigned randomly one of three groups: (1) individual EMDR treatment (six sessions); (2)routine individual treatment (six sessions); or(3) delayed treatment control group. A MANOVA was statistically significant at both posttest and follow-up. In univariate ANOVAs for each of four standardized outcome measures EMDR group members scored significantly better than controls at posttest. In a three-month follow-up, EMDR participants scored significantly better than routine individual treatment participants on two of the four measures, with large effect sizes suggestive of clinical significance. Key words: childhood sexual abuse; EMDR (eye movement desensitization and reprocessing); practice effectiveness; trauma This article reports the results of a randomized experimental evaluation of the effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing trauma symptoms among adult female survivors of childhood sexual abuse. These survivors, who suffer a variety of symptoms that are persistent and at times debilitating, comprise a large target population for social workers. Although the literature is replete with information on the prevalence and effects of childhood sexual abuse and on practice wisdom about its treatment, very little information is available that examines treatment efficacy. Numerous clinical accounts of treatment with adult survivors of childhood sexual abuse have been published, but controlled treatment research rarely has been conducted with this population (Gordon & Alexander, 1993). Of the studies found that examine treatment efficacy exclusively with this population, none involved the use of random assignment (Alexander, Neimyer, Follette, Moore, & Hatter, 1989; Apolinsky & Wilcoxon, 1991; Jehu, 1988, 1989; Roberts & Lie, 1989). EMDR is a relatively new treatment approach that has from its beginning been fraught with controversy, largely because of its unusual use of eye movements and dramatic claims of rapid efficacy with severely traumatized individuals. According Shapiro (1995), EMDR is interactive, intrapsychic, cognitive, behavioral, body-oriented therapy whose goal is to rapidly metabolize the dysfunctional residue from the past and transform it into something useful (pp. 52-53). Given its claims of dramatic successes within relatively few treatment sessions in this era of managed care, given the promise of the early experimental studies of its effectiveness with traumatized individuals, and given its compatibility with existing practice wisdom about trauma work, testing the effectiveness of EMDR with adult survivors of childhood sexual abuse is both important and timely. EMDR consists of an eight-phase treatment approach accompanied by specific protocols for different treatment issues. The eight phases involve (1) obtaining a thorough client history and from that developing a sound treatment plan; (2) preparing the client for using EMDR; (3) assessing the target issue components be addressed; (4) desensitizing the target material with eye movements or an alternate form of stimulation; (5) installing the desired positive cognition; (6) conducting a body scan determine if any residual material from the target issue remains; (7) closure; and (8) re-evaluation (Shapiro, 1995). Phase three is particularly important in that it is when the components of the treatment target are identified. The components of the target include the presenting problem, the memory connected the presenting problem, a picture or image of the memory be held in mind (both the negative and desired positive self-assessments associated with the memory), the emotions connected the memory, as well as any accompanying physical sensations. …

Given the high prevalence and severe consequences of childhood sexual abuse, it is essential to identify ways to support adult survivors. One potential and relatively unexplored resource available to survivors is the human-pet relationship. In the literature, the human-pet relationship is linked to many positive benefits to physiological regulation, mental health, physical health, and social support – areas of functioning where survivors of childhood sexual abuse may be particularly at risk. Despite existing evidence, there is little research on human-pet relationships among survivors of childhood sexual abuse. To help address this gap, this qualitative study explored the lived experience of human-pet relationships among adult survivors of childhood sexual abuse. Utilizing data collection and analysis methods from Interpretative Phenomenological Analysis, semi-structured interviews were conducted with 10 adult survivors of childhood sexual abuse. The following themes were developed from the data: (a) close bond with pet; (b) idiosyncrasies within the human-pet relationship; (c) moral responsibility; (d) fundamental differences between pets and humans; (e) safety in the human-pet relationship; (f) resource for coping with painful experience; (g) positive impact on well-being; (h) buttress for human-human social interaction; (i) medium for skill and knowledge development; and (j) shortcomings of the human-pet relationship. Findings are discussed in the context of the existing literature, along with considerations for practice and future research with childhood sexual abuse survivors.