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Adults with histories of being abused as children present unique challenges for counselors. For instance, these clients often struggle with establishing and maintaining a therapeutic alliance. They may rapidly shift their notion of the counselor from very favorable to very unfavorable in line with concomitant shifts in their emotional states.
Furthermore, they may anxiously expect the counselor to abandon them and thus increase pressure on the counselor to prove otherwise. The motivating factor for many of these clients is mistrust of people in general — and often for good reason. This article explores the psychological and interpersonal aspect of child sexual abuse by a parent and its treatment, with a particular focus on its relationship to betrayal trauma, dissociation and complex trauma. Child abuse of any kind by a parent is a particularly negative experience that often affects survivors to varying degrees throughout their lives.
However, child sexual abuse committed by a parent or other relative — that is, incest — is associated with particularly severe psychological symptoms and physical injuries for many survivors. For example, survivors of father-daughter incest are more likely to report feeling depressed, damaged and psychologically injured than are survivors of other types of child abuse. They are also more likely to report being estranged from one or both parents and having been shamed by others when they tried to share their experience.
Additional symptoms include low self-esteem, self-loathing, somatization, low self-efficacy, pervasive interpersonal difficulties and feelings of contamination, worthlessness, shame and helplessness. One particularly damaging result of incest is trauma bonding, in which survivors incorporate the aberrant views of their abusers about the incestuous relationship.
As a result, victims frequently associate the girls incest with a distorted form of caring and affection that later girls incest influences their choice of romantic relationships. This can often lead to entering a series of abusive relationships. Incest that begins at a young age and continues for protracted periods — the average length of incest abuse is four years — often in avoidance-based coping skills for example, avoidance of relationships and various dissociative phenomena.
These trauma-forged coping skills form the foundation for present and future interpersonal interactions and often become first-line responses to all or most levels of girls incest circumstances. It is of little surprise then that only 30 percent of incest cases are reported by survivors. The most reliable research suggests that 1 in 20 families with a female child have histories of father-daughter child sexual abuse, whereas 1 in 7 blended families with a female child have experienced stepfather-stepdaughter child sexual abuse see the revised edition of The Secret Trauma: Incest in the Lives of Girls and Women by Diana E.
Russell, published in InDavid Finkelhor, known for his work on child sexual abuse, indicated that among males who reported being sexually abused as children, 3 percent reported mother-son incest. However, most incest-related research has focused on father-daughter or stepfather-stepdaughter incest, which is the focus of this article. In comparison with nonincest controls, survivors experienced sexual intercourse earlier, had more sex partners, were more likely to have casual sex with those outside of their primary relationships and were more likely to engage in sex for money.
Thus, survivors of incest are at an increased risk for revictimization, often without a conscious realization that they are being abused. This issue girls incest creates confusion for survivors because the line between involuntary and voluntary participation girls incest sexual behavior is blurred. An article by Sandra Stroebel and colleagues, published in in Sexual Abuse: Girls incest Journal of Research and Treatmentindicates that risk factors for father-daughter incest include the following:. Finally, some qualitative research notes that in limited cases, mothers with histories of being sexually abused as wittingly or unwittingly contribute to the causal chain of events leading to father-daughter incest.
Furthermore, in cases in which a mother chooses the abuser over her daughter, the abandonment by the mother may have a greater negative impact on her daughter than did the abuse itself. Beyond the physical and psychological harm caused by father-daughter incest, Courtois notes that the resulting family dynamics are characterized by:.
Furthermore, victims are less likely to receive support and protection due to family denial and loyalty than if the abuser were outside the family or a stranger. Together, these circumstances often create for survivors a distorted sense of self and distorted relationships with self and others. If the incest begins at an early age, survivors often develop an inherent sense of mistrust and danger that pervades and mediates their perceptions of relationships and the world as a whole.
Betrayal trauma theory is often associated with incest. Psychologist Jennifer Freyd introduced the concept to explain the effects of trauma perpetrated by someone on whom depends. Freyd holds that betrayal trauma is more psychologically harmful than trauma committed or caused by a noncaregiver. Betrayal trauma theory is based on attachment theory and is consistent with the view that it is adaptive girls incest block from awareness most or all information about abuse particularly incest committed by a caregiver. Otherwise, total awareness of the abuse would acknowledge betrayal information that could endanger the attachment relationship.
Under these circumstances, survivors often are unaware that they are being abused, or they will justify or even blame themselves for the abuse. In severe cases, victims often have little or no memory of the abuse or complete betrayal blindness.
Under such conditions, dissociation is functional for the victim, at least for a time. As an adult, Ann had little to no memory of the abuse. As a result of the abuse, she had developed nine alternate identities, two of which contained vivid memories of the sexual and physical abuse. Through counseling, she was able to gain awareness of and access to all nine alternate identities and their functions.
Although Ann expressed revulsion and anger toward her father, she also expressed her love for him. This was an intermittent longing for Ann that occurred throughout counseling and beyond. Thus, understanding attachment concepts is critical for understanding betrayal traumas such as incest. For many survivors, the caregiver-abuser represents the best and the worst of her life at various times. She needs empathy and support, not blame. Survivors of incest often experience some of the most severe types of dissociation, such as dissociative identity disorder and dissociative amnesia the inability to recall autobiographical information.
Dissociative experiences often are triggered by perceived threat at a conscious or unconscious level. As ly noted, betrayal trauma theory holds that for incest survivors, dissociative amnesia serves to maintain connection with an attachment figure by excluding knowledge of the abuse betrayal blindness. This in turn reduces or eliminates anxiety about the abuse, at least in the short run. Conversely, many survivors of childhood incest report continuous memories of the abuse, as well as the anxiety and felt terror related to the abuse.
Often, these individuals will find a way to leave their homes and abusers. This is less frequently the case for survivors who experience dissociative amnesia or dissociative identity disorder. For example, clients who have experienced incest often report that their external world, including people, shapes, sizes, colors and intensities of these perceptions, can change quickly and dramatically at times.
Furthermore, they may report that they do not recognize themselves in a mirror, causing them to mistrust their own perceptions. But as I improved in counseling, my perceptions of my inside and outside worlds became clearer, more stable, and brighter and more distinct than before counseling. It all came to make more sense and feel right. It took me years to see the world as I think other people see it. From time to time I still experience that disconnection and confusion, but so much less frequently now than before. Initially, some real or perceived threat triggers these distorted perceptions of self and outer reality, but eventually they become a preset manner of perceiving the world.
Reports such as this one are not uncommon for survivors of incest and often are exacerbated as these individuals work through the process of remembering and integrating trauma experiences into a coherent life narrative. For many survivors, a sense of coherence and stability is largely a new experience; for some, it can be threatening and trigger additional dissociative experiences.
The severity of dissociation for survivors of incest is related to age onset of trauma exposure and a dose-response association, with earlier onset, more types of abuse and greater frequency of abuse associated with more severe impairment across the life span. Incest is associated with the most severe forms of dissociative symptoms such as dissociative identity disorder.
Approximately 95 to 97 percent of individuals with dissociative identity disorder report experiencing severe childhood sexual and girls incest abuse. Yet this fragmented sense of self contributes to a sense of emptiness and absence, memory problems and dissociative self-states.
The latter from the cumulative effect of lifelong struggles related to the incest for example, interpersonal problems and emotional dysregulation. Dissociation, especially if it involves ongoing changes in perceptions of self and others, different presentations of self and memory problems, may result in difficulty forming and maintaining a therapeutic alliance. Dissociation disrupts the connection between the client and the counselor. If these clients do not perceive themselves and their surroundings as stable, they will mistrust not only their counselors but also their own perceptions, which create ongoing confusion.
Changes in voice tone quality and cadence from verbally engaged to silent or in body posture open versus closed are other s of possible dissociative phenomena. Of course, all or none of these changes may be indicators of dissociative phenomena.
Incest, betrayal trauma and dissociative disorders are often features of a larger diagnostic categorization — complex trauma. Incest survivors rarely experience a single incident of sexual abuse or only sexual abuse. It is more likely that they experience chronic, multiple types of abuse, including sexual, physical, emotional and psychological, within the caregiving system by adults who are expected to provide security and nurturance.
Currently, an official diagnostic category for complex trauma does not exist, but one is expected to be added to the revised International Classification of Diseases ICD that is currently in development. Among the criteria she highlighted for complex trauma are:.
Early onset of incest along with chronic exposure to complex trauma contexts interrupts typical neurological development, often leading to a shift from learning brain prefrontal cortex to survival brain brainstem functioning. As explained by Christine Courtois and Julian Ford, survivors experience greater activation of the primitive brain, resulting in a survival mode rather than activation of brain structures that function to make complex adjustments to the current environment. As a result, survivors often girls incest an inclination toward threat avoidance rather than being curious and open to experiences.
Regular or intermittent complex trauma exposure creates an almost continual state of anxiety and hypervigilance and the intrinsic expectation of danger. Incest survivors are at an increased risk for multiple impairments, revictimization and loss of support. Although a comprehensive description of treatment is well beyond the scope of this article, I will girls incest with a general overview of treatment concepts.
Treatment for incest parallels the treatment approaches for girls incest trauma, which emphasizes symptom reduction, development of self-capacities emotional regulation, interpersonal relatedness and identitytrauma processing and the addressing of dissociative experiences. Compromised self-capacities intensify symptom severity and chronicity. Among these self-capacities, emotional dysregulation is a major symptom cluster that affects other self-capacity components.
For example, if a survivor consistently struggles with low frustration tolerance for people and copes by avoiding people, responding defensively, responding in a placating manner or dissociating, she likely will not have the opportunity to develop fulfilling relationships. The following core concepts, published in the May Psychiatric Annalswere suggested by Alexandra Cook and colleagues for consideration when implementing a treatment regimen for complex trauma, including with incest survivors and with adaptations for clients with dissociative identity disorder.
Emphasis should be placed on development of interpersonal skills such as assertiveness, cooperation, perspective taking, boundary and limit setting, reciprocity, social empathy and the capacity for physical and emotional intimacy.
Typically, these components are delivered within a three-phase model of counseling that is relationship-based, cognitive behavioral in nature and trauma focused:.
The relational engagement component is particularly critical because for many survivors, to be attached often has meant to be abused. Additionally, it is important for counselors to attend to client transference issues and counselor countertransference issues. Courtois suggests that ignoring or assuming that such processes are irrelevant to the treatment of survivors can undermine the treatment process and outcome.
In addition, strength-based interventions are critical in each phase to help survivors develop a sense of self-efficacy and self-appreciation for the resources they already possess. A strength-based focus also contributes to client resilience. For girls incest clients, dissociated self-states or parts will emerge.
Counselors should assume that whatever is said to one part will also be heard by the other parts. Therefore, addressing issues in a manner that encourages conversation between parts, including the core self-structure, is critical.
It is also important to help parts problem-solve together and support each other. This is not always an easy proposition. Some survivors eventually experience full unification of parts, whereas others achieve a workable form of integration without ever fully unifying all of their alternate identities for more, see Treating Trauma-Related Dissociation: A Practical, Integrative Approach by Kathy Steele, Suzette Boon and Onno van der Hart. Furthermore, the frequent push-pull dynamics girls incest counselor and client can be exhausting, both physically and mentally for counselors.
Therefore, it is important for counselors to frequently seek supervision and consultation and to engage in self-care physically, psychologically and spiritually. Knowledge Share articles are developed from sessions presented at American Counseling Association conferences. David M. His research focuses on childhood sexual and physical abuse, complex trauma and dissociation related to trauma.
He also maintains an independent practice focusing on survivors of posttraumatic stress disorder and complex trauma. Contact him at dml aol. Letters to the editor : ct counseling. Opinions expressed and girls incest made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association. This helped me to see some of why I have behaved as I have in my last 65 years.Girls incest
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