The Substance Without and the Monster Within Groupwork with men who suffer the sequelae of early adverse experience Kathleen Yates
Contents The Study The Impact of Childhood Sexual Abuse Goals of Treatment Group Psychotherapy
Figures 3% - 31% males have been sexually abused 6% - 61 % females have been sexually abused
Males under represented in Clinical Settings Compared to Community based samples Dhaliwal et al. (1996) Women are more likely seek help than males Violato and Genius (1993)
Core Evidence Evaluation of Outcome in a Dynamically Orientated Group for Adult Males Who have Been Sexually Abused, Audrey Morrison and Linda Treliving, British Journal of Psychotherapy, Autumn2002.
The Study 29 males Baseline SCL 90 R questionnaire Derogatis (1994) 13 attended mean time 17 months 7 attended mean time 3months 5 new to group 4 did not enter treatment
Early Adverse Experience Difficulties in Relationships Conflicts regarding Masculinity Conflicts regarding Sexuality Difficulties containing affects
The Fragile Self The development of self is interrupted Lack of a good internal object The mind protects itself Via splitting The centre cannot hold
Childhood Sexual Abuse – What is Childhood Sexual Abuse? CSA is not a diagnosis. CSA is an experience The experience impacts on child’s mind and body The long term effects of that experience will vary “It is likely that if untreated any form of sexual victimisation in childhood increases the risk of later mental health problems.” (Berliner, 1991)
– The Adult Sequelae of early trauma -Emotional Effects Depression Low Self Esteem Guilt Anxiety Compulsivity Anger Hopelessness
Childhood Sexual Abuse – Adult Sequelae Behavioural Effects Self Destructive Behaviours Deliberate Self Harm Increase Risk of Suicide Substance Abuse Sexual Acting Out Physical and Sexual Effects
Childhood Sexual Abuse – PTSD Physiological arousal Upsurge of adrenaline Disruption of neurophysiological processes of memory Cognitive memory severed from emotion The brain is so overwhelmed so many times…. By negative stimulation it cannot integrate all the information Flashbacks and body memories and lack of conscious recall
Childhood Sexual Abuse – Prognostic Indicators characteristics associated with greater trauma Abuse at an early age Multiple perpetrators Penetration of the child’s body Physical force and concurrent physical abuse Abuse involving bizarre features The victims sense of responsibility for the abuse Victim’s feelings of powerlessness, betrayal and stigma at time of abuse
Childhood Sexual Abuse –The Effects of Trauma on the Developing Mind In normal development The Infant’s anxieties are put into the mother The mother contains and metabolises these fears The infant is soothed The infant learns to cope with frustration The infant internalises via the mother the transformed anxieties The infant develops a fragile self
Psychic Defenses Hold the mind together In the context of CSA Primative defences are used The centre cannot hold
Space for Thought Thinking becomes difficult Action replaces thought Self Medication Deliberate Self Harm Violence
The Patients Acquire numerous Axis 1 diagnosis Are Treatment Resistant Acquire Personality Disorder Diagnosis
Essential Features of Group Psychotherapy Strong Framework Consistency Formation of Group Matrix Containment Creation of space for thought
References Betrayed as Boys: Psychodynamic Treatment of Sexually Abused Men. R. Gartner, 1999, Guilford Evaluation of Outcome in a Dynamically Orientated Group for Adult Males Who have Been Sexually Abused, Audrey Morrison and Linda Treliving, British Journal of Psychotherapy, Autumn 2002.
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