Kathleen Yates Consultant Adult Psychotherapist Tayside NHS, Scotland

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

Highest Dimensional Scores at Baseline  Psychoticism  Somatization  Paranoid ideation  Depression  Interpersonal sensitivity

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

Patient Details

Goals of Treatment  An Adult who can take care of himself in a better way than he was cared for as a child

Healing from sexual trauma  Abuse reactive life decisions  Unconscious coping strategies conscious  Flashbacks of abuse  Chronic somatic complaints  Proactive life decisions  Personal autonomy increases  Reclaimed memories  Signals for unmet physical/emotional needs

Features of Group Psychotherapy  Shared Common Experience  Shared Empathy  Confrontation of Sadism

Group Psychotherapy  Instillation of Hope  End to Isolation  Reinforcement of Common Values

Eight Transference/ Countertransference Positions Uninvolved non-abusing parent Neglected Child Sadistic Abuser Helpless impotently enraged victim Idealized omnipotent rescuerEntitled child who demands rescuing Seducer Seduced

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.