Healing from Sexual Abuse Trauma : Model and Measure NASMHPD Research Institute 13th Annual Conference on Services Research and Evaluation: Developing an Evidence-Based Culture to Reform Systems February 9-11,2003 Supported in part by the Center for the Study of Issues in Public Mental Health NIMH Grant: 2P50MH51359

Healing from Sexual Abuse Trauma : Model and Measure Mary Jane Alexander, Ph.D. 1 Jeanne Dumont, Ph.D. Kristina Muenzenmeier, M.D. 2 Mary Auslander, M.S.W. 3 1 Nathan Kline Institute for Psychiatric Research 2 Bronx Psychiatric Center 3 Maine Department of Mental Health, Mental Retardation, Alcohol and Substance Abuse Services Supported in part by the Center for the Study of Issues in Public Mental Health NIMH

Trauma Exposure and Distress Trauma Exposure and Distress General Users of Public Mental Population Health Services %  Any Exposure 5051 – 98  3 Events or More1550  PTSD/Distress, Impairment 842 Impairment 842  Common Events witness bad injury/death sexual assault - adult fire, flood, natural disaster sexual assault - child fire, flood, natural disaster sexual assault - child car or work accident car or work accident attack with weapon attack with weapon

More than PTSD Besides symptoms of PTSD, survivors of pervasive trauma seek help for depression depression anger anger self destructive behavior self destructive behavior feelings of shame feelings of shame self blame self blame mistrust mistrust

More than PTSD Complex Post Traumatic Stress changes a person’s: Ability to regulate their affective arousal Ability to regulate their affective arousal Attention and consciousness Attention and consciousness Perception of oneself and the perpetrator Perception of oneself and the perpetrator Relationship to others Relationship to others Systems of meaning Systems of meaning Experiencing somatic distress Experiencing somatic distress

Paradigm Shift Trauma has largely been overlooked in: Explaining behavior Explaining behavior Designing environments Designing environments Designing policies Designing policies

Paradigm shift: Increasing awareness of the impact of trauma Federal Support 1994 – present NASMHPD Resolution 1998 State Agency Support 11 States with Trauma Initiatives Consumer voices present

Collaboration: Consumer/survivors, Clinicians, Researchers Develop a model of healing from childhood sexual abuse based on concept mapping Develop a model of healing from childhood sexual abuse based on concept mapping Develop a measure of healing using the model and concept map data Develop a measure of healing using the model and concept map data Develop a roadmap for healing Develop a roadmap for healing Validate the measure and further develop the theory Validate the measure and further develop the theory Participant survivors collaborate with study team to: Generate items Interpret maps; name dimensions of healing Review draft measure

Concept Mapping Method Brainstorm statements Brainstorm statements Sort statements Sort statements Rate statements Rate statements Analyze sorted statements Analyze sorted statements (Multi Dimensional Scaling; Cluster Analysis) Name clusters and interpret maps Name clusters and interpret maps

Healing from Sexual Abuse Trauma Healing from Sexual Abuse Trauma Awareness & validation Awareness & validation Confidence in judgments Confidence in judgments Skills and safe environments to: Skills and safe environments to: identify triggers identify triggers diminish dissociation diminish dissociation experience and manage the whole range of emotions experience and manage the whole range of emotions Build & reconnect with community, normalization Optimism and hope, look to the future “Placing” the abuser Reach out, help others, advocate

Dimensions of Healing: Women Personal Empowerment Personal Empowerment P ower and control to say no effectively Challenge authority Positive Struggle Zone Positive Struggle Zone Self acceptance; Self love Minimal needs Minimal needs F ill in the gaps of time and events Reconstruct sexuality Reconstruct sexuality Enjoyment; Choice, Diminish Guilt Competence as a parent Trust self to make choices Competence in social roles Identify triggers Cope with Emotions Acknowledge that abuse happened Diminish substance abuse Self Acceptance & Confidence Stopped self-blame Confidence in distinguishing internal from external reality

Dimensions of Healing: Women Awakening and self validation Awakening and self validation Believing that sexual abuse happened Building support/ self help Building support/ self help I surround myself with positive, nurturing people No hole anymore in my heart or body Gaining wisdom Gaining wisdom I believe I can make good judgments I acknowledge my feelings, even at times of joy Forgiving the perpetrators Forgiving the perpetrators

Dimensions of Healing: Men Awareness, beginning understanding Awareness, beginning understanding Identify as survivor, not as victim Stop self blame for abuse Change thoughts and feelings Change thoughts and feelings Experience and express vulnerability Diminish self abuse Learn & understand about sexual abuse Learn & understand about sexual abuse Mourn the loss of childhood Process of normalization Process of normalization Abuse as a pathway to mental illness Diminish victim behavior Diminish victim behavior Identify and cope with triggers Stop self pity Accept love & trust from self & others R e-establish family ties Experience connection to others Self Care Support personal achievements Diminish self harm in crisis Overcoming & fulfillment Personal empowerment Motivation to help others Diminish fear & increase assertiveness Advocacy

Models of Recovery Mental Illness Mental Illness~Anguish ~ Awareness & insight ~Action plan ~Determination to be well ~ Well being / recovery ~Reestablish social roles & decision making capacity through social support Complex PTSD ~Safety ~Remembrance & Mourning ~Reconnection with ordinary life & commonality

Healing from Sexual Abuse: Implications for Systems Validation Validation Safety Safety Self Care Self Care Community Community Empowerment Empowerment

Healing from Sexual Abuse: Men’s concept map

Healing from sexual abuse: Women’s concept map