1. Kathleen Yates Consultant Adult Psychotherapist Tayside NHS, Scotland

2. The Substance Without and the Monster Within Groupwork with men who suffer the sequelae of early adverse experience Kathleen Yates

3. Contents  The Study  The Impact of Childhood Sexual Abuse  Goals of Treatment  Group Psychotherapy

4. Figures  3% - 31% males have been sexually abused  6% - 61 % females have been sexually abused

5. 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)

6. 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.

7. 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

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

9. Early Adverse Experience  Difficulties in Relationships  Conflicts regarding Masculinity  Conflicts regarding Sexuality  Difficulties containing affects

10. 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

11. 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)

12. – The Adult Sequelae of early trauma -Emotional Effects  Depression  Low Self Esteem  Guilt  Anxiety  Compulsivity  Anger  Hopelessness

13. 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

14. 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

15. 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

16. 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

17. Psychic Defenses  Hold the mind together  In the context of CSA  Primative defences are used  The centre cannot hold

18. Space for Thought  Thinking becomes difficult  Action replaces thought  Self Medication  Deliberate Self Harm  Violence

19. The Patients  Acquire numerous Axis 1 diagnosis  Are Treatment Resistant  Acquire Personality Disorder Diagnosis

20. Patient Details

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

22. 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

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

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

25. 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

26. Essential Features of Group Psychotherapy  Strong Framework  Consistency  Formation of Group Matrix  Containment  Creation of space for thought

27. 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.