Intervention and Rehabilitation for Sexual Abuse Trauma
Presenting Problem
The case is about an adult woman’s struggle to get over her trauma for the sexual abuse she suffered in her childhood. Apparently, her painful memories of such a traumatic experience were triggered when she and her workmates visited a friend’s farm in the country. While in the farm, she had flashes of her painful childhood memories which she thought she has forgotten over the years. However, the sights, smells, sounds, etc. of the farm only made the flashbacks more vivid.
Sherry was only four years old when her grandfather began sexually molesting her in his barn. He did this to her until she was nine years old when she and her family had to move to another city due to her father’s employment. Sherry used to adore her grandfather because he brought her on trips around the country side and had ready treats for her every time she and her parents came to visit him and her grandmother. It is in the barn when he would sexually abuse her in the guise of pretend play. Sherry did not enjoy that kind of play at all and felt uncomfortable with her grandfather’s touch. Even if she was already toilet trained, she would sometimes soil her underwear in the hope that her grandfather will not rape her. Although he told her that it was their secret and she was not supposed to tell anyone, she tried to tell her mother when she was five years old, and in response, she was spanked, in the belief that she was lying. She never told anyone again.
Bowlby’s Attachment Theory (1969) is one theory that explains the development of attachment of children to their significant others. It posits that a person’s real relationships in the earliest stages of life shape his or her survival functions as he or she grows and develops throughout the life span. To Sherry, her attachment relationships to both her grandfather and mother may have been shattered by her disappointment in them. Ringel (2012) contends that children like Sherry develop disorganized attachments alternating between ambivalent and avoidant behaviors as well as dissociative behaviors like freezing and repetitive behavior. The dissociative processes used by the child have been developed from his or her dysregulated, traumatic interactions with the people they are attached to. These provide protection from overwhelming and unacceptable affects like being fearful or angry towards the significant other. Dissociation can also mean adopting alternate and disconnected identities, developing bodily sensations and conflicts in relationships. The individual may realize that such dissociative behavior is very unlike his or her character (Ringel, 2012). In Sherry’s case, if she developed dissociative behaviors (such as soiling her underwear when she was with her grandfather), it was to cover up the fear and anger she keeps for her grandfather, who violated her, and her mother, who did not believe her and instead, rejected her.
Trauma theories point to the victim trying to control the resurfacing of the memory of the painful event and stashing it away in some part of the brain to enable him/her to focus on living day to day. However, such memories can still be triggered by physical factors from the environment causing the individual to react physically to the memory, be it conscious or not. Nonverbal messages are conveyed by facial, gestural body language (Jacobs, 1994).
Recently, with the old pain being resurrected, Sherry always felt stressed out. She would feel palpitations and sudden episodes of intense fear that makes her unable to concentrate on her work. She also felt worthless, as if she is “damaged goods”. Her self-esteem became so affected that she feels she has lost the former confidence she exuded. She does not feel like socializing with others and would rather be alone. That was the reason why she sought professional help.
Proposed Intervention
In designing the most appropriate intervention for Sherry, who has been through such an intense trauma and is in need of more understanding and less judgment from a counsellor or therapist, it is important to remember that gaining her trust necessitates a more humanistic approach such as the one advocated by Rogers’ Person-Centered model. This emphasizes unconditional positive regard and the quest for congruence of self to achieve authenticity, meaning the integration of the person’s public and actual selves. This approach has great respect for a person’s subjective views and potential for self-actualization. It offers a fresh and hopeful perspective on its views on human nature no matter how dire his or her past experiences may be (Weiten & McCann, 2006).
The intervention should target all aspects of Sherry’s development, namely her socio-emotional, cognitive, physical and even spiritual aspects. The intervention includes counselling sessions with a competent counsellor or therapist who can accurately empathize with Sherry’s subjective experiences on an interpersonal, cognitive and affective level to fully unlock her perceptions, feelings and motivations for her behaviors (Corey, 2005). Sherry will find in Person-centered therapy a trustworthy and accepting friend who is ready to listen but not judge her painful past. She will be encouraged to express her innermost feelings, both positive and negative, and feel assured that she remains acceptable to the counsellor. Eventually, the goal is for her to overcome her trauma by being reassured that it was not her fault, nudged to move on and finally, begin her healing by deciding on a positive action towards self-actualization.
A huge part of Sherry’s healing is forgiveness. This releases her from the heavy burden she has been struggling with all her life that she has managed to keep it repressed in her unconscious. The counsellor may help her process this huge step and support her when she finally makes that step to forgive her grandfather for the damage he has done to her person as well as her mother for not believing in her and losing her trust.
Since Sherry’s trauma not only brings about emotional and mental anguish but manifests physical symptoms as well, the intervention should also address that. One therapy for trauma victims is the Observed & Experiential Integration (OEI). This requires keen observation of the client’s responses to their experiences brought up during therapy. Counselors provide continuous feedback to their clients as to the physical and emotional changes observed while processing shared traumatic experiences. Even minute changes such as the reddening or moistening of the eyes, blushing, tension in the jaw may depict higher levels of emotional or somatic responses while hesitations, brow furrowing, inconsistencies in narration of incidents may denote confusion or emotional conflict (Bradshaw et al., 2011). Making the client aware of her bodily responses will make it easier for her to manage them. Walsh (2009) provides specific guidelines in helping clients deal with stress namely relaxation skills and stress prevention training. This involves the joint processing of relaxation skills and the agreement of relaxation techniques that work for the client such as listening to music or deep breathing exercises to calm the bodily reactions to the traumatic memories that surface. It also teaches the client to prevent further stress by avoiding things that would trigger stress in her system.
Evaluation
Evaluation of the effectiveness of the intervention can only be done after a certain period of time when Sherry has totally moved on from the ghosts of her past. The effectiveness will be apparent in how she manages her behaviors and attitudes. If she can effectively live her life without being bothered anymore by her painful memories, if she can talk about it with deep wisdom and understanding and most importantly, if she has forgiven her grandfather for his transgressions and patched up her strained relationship with her mother. She should also manifest her old confidence and positive disposition as well as sustain her healthy relationships with her family and friends while also expanding her social network. If all of that happens after the designed intervention, then it can be considered effective.
