Responding to therapists' sexual abuse of adult incest survivors: Ethical and legal considerations.

Adult survivors of incest are high-risk candidates for subsequent sexual abuse by their therapists. As with incest, therapists' sexual abuse of their patients has become known as "the problem with no name." In addition, many of the ways in which the profession of psychology and the judicial system respond to patients' allegations of sexual abuse by their therapists often parallel the responses family members and authority figures made to the original allegations of incest. This article discusses some of the complex interactions among therapeutic dynamics and ethical and legal issues associated with this professional dilemma, and outlines ways in which the profession might begin to address this dilemma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Jurors’ discussions of a defendant’s history of child abuse and alcohol abuse in capital sentencing deliberations.

We tested a novel theoretical model explaining the psychological processes underlying jurors’ discussions about a defendant’s history of child abuse and alcohol abuse in a capital case. We coded the extent to which jurors used child abuse and alcohol abuse as mitigating factors, as aggravating factors, or argued that they should be ignored. Relying on attribution theory, we coded the extent to which jurors rendered controllable or uncontrollable and stable or unstable attributions regarding the defendant’s history of child abuse and alcohol abuse. Jurors were more likely to argue that child abuse and alcohol abuse should not be used as mitigators or to even use them against the defendant as aggravators than they were to use them as mitigators. Jurors made more controllable than uncontrollable attributions regarding child abuse and more stable than unstable attributions regarding both child abuse and alcohol abuse. The more jurors supported the death penalty, the more they argued to discount child abuse and alcohol abuse as mitigators or use them as aggravators and the more controllable and stable attributions they made. Political orientation predicted discussions and attributions about alcohol abuse, but not child abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing victim attributions and outcomes for workplace aggression and sexual harassment.

In 2 studies, we investigated victim attributions (Study 1) and outcomes (Study 2) for workplace aggression and sexual harassment. Drawing on social categorization theory, we argue that victims of workplace aggression and sexual harassment may make different attributions about their mistreatment. In Study 1, we investigated victim attributions in an experimental study. We hypothesized that victims of sexual harassment are more likely than victims of workplace aggression to depersonalize their mistreatment and attribute blame to the perpetrator or the perpetrator's attitudes toward their gender. In contrast, victims of workplace aggression are more likely than victims of sexual harassment to personalize the mistreatment and make internal attributions. Results supported our hypotheses. On the basis of differential attributions for these 2 types of mistreatment, we argue that victims of workplace aggression may experience stronger adverse outcomes than victims of sexual harassment. In Study 2, we compared meta-analytically the attitudinal, behavioral, and health outcomes of workplace aggression and sexual harassment. Negative outcomes of workplace aggression were stronger in magnitude than those of sexual harassment for 6 of the 8 outcome variables. Implications and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of sexual abuse allegations in child custody cases.

Family courts frequently rely on the expertise of mental health professionals to assess allegations of sexual abuse within the context of child custody evaluations. Such evaluations are complex and require knowledge of techniques used in sexual abuse and sexual offender evaluations, as well as knowledge of child custody practices. Preliminary findings from a national survey of 84 psychologists indicated that respondents tend to adhere to the child custody guidelines of the American Psychological Association. However, few practitioners followed formal models, protocols, or guidelines when evaluating alleged victims or alleged perpetrators of sexual abuse in conjunction with child custody disputes. Implications for professional practice are discussed, along with a proposed comprehensive model for assessing sexual abuse allegations in child custody cases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison between the effects of medial septal lesions and entorhinal cortex lesions on performance of nonspatial working memory tasks and reversal learning

Two studies explored the relationship between cognitions and long-term symptoms in adult child sexual abuse (CSA) survivors. In Study 1, an American sample of 43 survivors completed questionnaires assessing attributional style and dysfunctional beliefs in cognitive themes affected by victimization, as well as measures of posttraumatic symptoms. Survivors' attributions of negative events were more internal, stable, and global than those of 29 comparison subjects without a history of CSA. However, only the globality scale was significantly related with severity of long-term symptoms. High correlations between dysfunctional beliefs concerning safety, trust, esteem, or intimacy, and posttrauma symptoms were found. The latter finding was replicated in Study 2 with a German sample of 35 CSA survivors, even when controlling for frequency of abuse.     

Holographic reprocessing: Empirical evidence to reduce posttraumatic cognitions in women veterans with PTSD from sexual trauma and abuse.

Holographic reprocessing (HR) facilitates holistic reappraisal of attributions regarding interpersonal violence and maltreatment. The authors tested the feasibility to train therapists to run a protocol using HR to reduce negative thoughts associated with posttraumatic stress disorder (PTSD) in women veterans who have had sexual trauma or abuse. The study assessed pre- and postscores on the Posttraumatic Cognitions Inventory (PTCI) in a naturalistic clinical setting with 5 therapists. The protocol consisted of screening for PTSD, followed by an average of 9 HR treatment sessions. Twenty-two women were referred to the study; 17 enrolled and completed treatment (0% dropout rate). Significant decreases were found on all scales of the PTCI, with large effect sizes: total negative thoughts, t(16) = 4.42, p     

Anger as a vehicle in the treatment of women who are sexual abuse survivors: Reattributing responsibility and accessing personal power.

Some clinicians view client anger as a problematic symptom to be reduced, whereas others view it as an opportunity for therapeutic development. The present authors describe how client anger, a fitting emotional response to abuse, can work as a vehicle to help sexual abuse survivors reattribute responsibility and develop personal efficacy. The role of anger in the healing process of the sexual abuse survivor is explored through 2 case studies. It is suggested that by reframing anger as a vehicle for recovery rather than a symptom, therapists can learn to effectively incorporate anger work (which involves successfully negotiating any dynamics that cause therapist discomfort) into the treatment of survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parenting difficulties in sexual-abuse survivors: A theoretical framework with dual psychodynamic and cognitive-behavioral strategies for intervention.

Systematic investigations of the consequences of sexual abuse and clinical literature on interventions with survivors have frequently neglected the impact of sexual abuse on parenting. Grounded in both object-relations and trauma theory, this article presents a case illustration to depict the unconscious repetition of one 30-yr-old mother's childhood abusive relationship with her own child. We explore how this survivor's parenting conflicts became increasingly salient during specific developmental stages of the child, as themes of sexuality and aggression triggered unresolved conflicts, distorted cognitions, and trauma reactions. The reenactment impairs parenting in critical ways, hence increasing the risk for sexual abuse in the next generation. Strategies for interventions to modify the mother's poor parenting responses are described using a therapeutic approach that integrates concepts from psychodynamic and cognitive-behavioral theories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for chronic psychiatric patients who are survivors of child sexual abuse.

Discusses the efficacy of psychotherapy for patients with severe, chronic mental illnesses who are survivors of child sexual abuse. Three case illustrations taken from work with outpatients in a day-treatment center show how therapeutic work on childhood abuse can help impulsive, acting-out borderline patients moderate their intense affects and gain some control over their impulses. Psychotherapy can be useful in understanding and alleviating the psychotic symptoms of chronic schizophrenic patients, and even brief therapeutic work can be helpful to chronic mental patients who are suffering from chronic low self-esteem associated with abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual abuse trauma among Chinese survivors

OBJECTIVE: As an initial effort to examine Chinese sexual abuse trauma in relation to the cultural construction of sexual victimization of women, this study applies Finkelhor and Browne's (1985) traumagenic dynamics model to examine post-abuse trauma among Chinese child and adolescent survivors in Taiwan. In analyzing sexual abuse trauma in the context of Chinese patriarchal familialism and cultural fetish for female chastity, this study attempts to explore cultural constructional process of sexual abuse in Chinese society. METHOD: This study conducted in-depth interviews with 19 survivors of, and three social workers on, sexual abuse in Taiwan. These interviews were guided by a semi-structured questionnaire on sexual abuse incidents and post-abuse responses/concerns, and had generated a total of 84 pages of written reports, which serve as the text-data for the analysis. RESULTS: This study identifies sexual stigmatization and senses of disempowerment and betrayal as the most pervasive trauma complex among Chinese sexual abuse survivors in Taiwan. This study found that, in addition to lowering self-esteem, sexual stigmatization results in polarized sexuality among adolescent survivors, as manifested in aversion to and preoccupation with sexuality. The abuse-induced disempowerment is manifested in the survivors' fear for personal safety and heightened sense of vulnerability to re-victimization. The sense of betrayal results in interpersonal difficulties as manifested in self-imposed isolation from others and/or suspicious attitudes toward others, which further impair the survivor's efficacy in meeting her abuse-induced clinging need. CONCLUSIONS: Overall, this study observes similar traumatic symptoms between Chinese survivors and their American counterparts as documented in the literature. Nevertheless, this study observes the sexual stigmatization represents the most prevailing post-abuse trauma among Chinese sexual abuse survivors, and reflects the patriarchal fetish for female chastity in the Chinese cultural construction of sexual victimization.     

Sexually abused girls' verbalizations in counseling: An application of the client behavior system.

The Client Behavior System was used to evaluate the therapeutic process with 27 sexually abused 7–17-yr-old girls enrolled in psychoeducationally based individual counseling. Based on ratings collected for the session in which the topic of sexual abuse was formally introduced, it was found that girls were more likely to provide abuse-related answers in response to questions pertaining to child sexual abuse, regardless of whether they were treated by a male or female counselor. These findings provide reason to reconsider previous recommendations that sexually abused girls are best treated by female counselors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic relationship as the foundation for treatment with adult survivors of sexual abuse.

Survivors of sexual abuse enter psychotherapy with special needs that challenge some of the traditional therapeutic assumptions. The therapeutic relationship, which is the foundation for treatment with abuse survivors, often must shift in nature and quality to address these needs. The main goal of treatment is the integration of self and affective experience. To facilitate this process the authors discuss the establishment and maintenance of an "affective edge" that allows for direct attention to and intervention with the trauma memories and the accompanying affect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on adult survivors of childhood sexual abuse.

Sexual abuse researchers need to use more complex models of abuse and more sophisticated research designs for studying long-term effects and for evaluating treatment programs. The articles that comprise this special section integrate the study of sexual abuse with perspectives on adult victimization, developmental psychopathology, and attachment theory and also offer specific methodological suggestions for improving research on long-term effects and therapy with the abuse survivor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonepileptic seizures and childhood sexual and physical abuse

Nonepileptic seizures (NES) must be distinguished from epilepsy to avoid the adverse effects of unnecessary antiepileptic drugs and to initiate appropriate psychiatric treatment. A higher frequency of prior sexual abuse has been suspected in NES, although no prospective controlled study has compared patients with NES and epilepsy. A series of patients with conversion disorder presenting as epilepsy and 140 patients with complex partial epilepsy (CPE) without evidence of conversion were selected from a series of consecutive admissions to a comprehensive epilepsy center. The groups did not differ with respect to age, years of education, race, or marital status, but the percentage of women was greater in the conversion NES group (73.2%) than in the CPE control group (50.7%; p < 0.002). The frequency of a history of sexual or physical abuse was greater in the NES group (32.4%) than in the CPE controls (8.6%; p < 0.000). Severity of sexual but not physical abuse was significantly greater in the NES group relative to controls (p < 0.05). There was a trend for a closer relationship of the perpetrator of sexual abuse to the victim among the NES patients compared with CPE controls (p < 0.1). These results support the impression that childhood abuse is more common among patients with conversion NES than with epilepsy, and suggests that in some cases childhood abuse may be a contributory pathogenetic factor.     

Graduate-level education and training in child sexual abuse.

The purpose of this article is to further graduate-level education and training in child sexual abuse. Two graduate-level courses that focus on child sexual abuse are considered as well. The following points are made: (a) Training in child sexual abuse should be incorporated into professional training programs; (b) research and theory courses on child sexual abuse are indicated; (c) the topic of child sexual abuse should be mainstreamed into existing practica; (d) the multidisciplinary nature of the field necessitates consideration of resources and references beyond those specific to psychology as well as professional engagement with individuals from many disciplines; and (e) training in child sexual abuse elicits strong emotional responses in trainees and others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual abuse and the subsequent development of alcohol problems

The literature on sexual abuse and alcohol problems has been reviewed. Various methodological issues are relevant in determining whether there is merely an association or also a causal relationship. These include the definition of sexual abuse, the degree and timing of abuse, the methods of data collection, sample selection, the presence or absence of control groups, possible recall bias, difficulties with prospective studies for this subject, and the definition of alcohol misuse or dependence. Results with community and victim samples are conflicting, but studies on samples of problem drinkers suggest an association between severe alcohol problems and previous sexual abuse, at least in women. The association may be especially strong for earlier and more severe forms of sexual abuse. Possible mechanisms for an association were examined and are: (1) sexual abuse as a cause of alcohol misuse; (2) alcohol misuse predisposing people to sexual assault; (3) sexual assault and alcohol misuse both resulting from another factor; (4) sexual abuse predisposing to other conditions associated with alcohol misuse; and (5) an artefactual association. Regardless of the role of sexual abuse in causing alcohol problems, the available evidence suggests that victims of sexual abuse may present to services with more problematical patterns of drinking and more concurrent psychiatric disorder.     

Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single-chamber atrial or ventricular pacing

OBJECTIVE: In the present study, physical and sexual abuse among incarcerated youth were examined with respect to sexual activity, contraceptive use, and pregnancy. METHOD: The self-report survey data were collected from 62 females and 334 males who were incarcerated in Nevada youth correctional facilities in the summer of 1994. Of the males, 46.8% (n = 156) reported a history of physical abuse and 9.9% (n = 33) reported sexual abuse. A surprisingly high 73% (n = 46) of the females reported a history of physical abuse and 68.3% (n = 43) reported sexual abuse. RESULTS: The analyses indicated that females who reported a history of sexual abuse had an earlier mean age of first intercourse than those who reported no sexual abuse. In addition, male and female respondents with a history of physical and/or sexual abuse reported using no method of contraception as compared to youth with no history of abuse. CONCLUSIONS: Implications of these results for detention-based counseling and prevention programming are discussed.     

Relationship of childhood sexual, physical, and combined sexual and physical abuse to adult victimization and posttraumatic stress disorder

OBJECTIVE: Prior research has suggested that women who experience childhood sexual abuse are at increased risk for sexual victimization and Posttraumatic Stress Disorder (PTSD) in adulthood. However, previous studies have paid insufficient attention to the overlap of childhood sexual and physical abuse. In the present study we disentangled the separate and combined effects of childhood sexual and physical abuse by comparing groups of participants who reported contact childhood sexual abuse only (SA), sequelae of childhood physical abuse only (PA), combined childhood sexual and physical abuse (CA), or no child abuse (NA). METHOD: A sample of 475 female college students completed measures of sexual and physical abuse in childhood (before age 15) and adulthood (after age 15), PTSD and trauma symptoms, and demographic variables. Of these participants, 27 were assigned to the SA group, 53 to the PA group, 31 to the CA group, and 211 to the NA group. RESULTS: The highest rate of adult sexual and/or physical victimization was reported by the CA group, followed by the PA group, with lower rates reported by the SA and NA groups. Using adult victimization as a covariate, the analyses revealed that the CA group reported significantly higher rates of PTSD and trauma symptoms compared to the NA group. CONCLUSIONS: The results suggest that prior reports of differences in rates of adult victimization and PTSD between women who experienced childhood sexual abuse and women who did not may be attributable to the inclusion of participants with a history of combined childhood sexual and physical abuse in childhood sexual abuse groups. The importance of separating physical and combined forms of victimization from sexual abuse is discussed.     

The challenge of defining child sexual abuse.

Although child sexual abuse has been a concern for many researchers, therapists, and advocates for the past 3 decades, several fundamental issues regarding child sexual abuse remain unresolved. In particular, the term child sexual abuse has never been unequivocally defined. The lack of a commonly accepted definition of child sexual abuse continues to inhibit research, treatment, and advocacy efforts. Early researchers used broad and inclusive definitions of child sexual abuse—definitions that often continue to be used today. The consequences of these definitions are discussed, and strategies for developing other definitions of child sexual abuse are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)