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Healing from Sexual Abuse Trauma : Model and Measure

Healing from Sexual Abuse Trauma : Model and Measure

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Healing from Sexual Abuse Trauma : Model and Measure

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  1. Healing from Sexual Abuse Trauma: Model and Measure NASMHPD Research Institute 13th Annual Conference on Services Research and Evaluation:Developing an Evidence-Based Culture to Reform Systems February 9-11,2003 Supported in part by the Center for the Study of Issues in Public Mental Health NIMH Grant: 2P50MH51359

  2. Healing from Sexual Abuse Trauma: Model and Measure Mary Jane Alexander, Ph.D.1 Jeanne Dumont, Ph.D. Kristina Muenzenmeier, M.D.2 Mary Auslander, M.S.W.3 1Nathan Kline Institute for Psychiatric Research 2Bronx Psychiatric Center 3Maine Department of Mental Health, Mental Retardation, Alcohol and Substance Abuse Services Supported in part by the Center for the Study of Issues in Public Mental Health NIMH

  3. Trauma Exposure and Distress General Users of Public Mental Population Health Services % % • Any Exposure 50 51 – 98 • 3 Events or More 15 50 • PTSD/Distress, Impairment 8 42 • Common Events witness bad injury/death sexual assault - adult fire, flood, natural disaster sexual assault - child car or work accident attack with weapon

  4. More than PTSD Besides symptoms of PTSD, survivors of pervasive trauma seek help for • depression • anger • self destructive behavior • feelings of shame • self blame • mistrust

  5. More than PTSD Complex Post Traumatic Stress changes a person’s: • Ability to regulate their affective arousal • Attention and consciousness • Perception of oneself and the perpetrator • Relationship to others • Systems of meaning • Experiencing somatic distress

  6. Paradigm Shift Trauma has largely been overlooked in: • Explaining behavior • Designing environments • Designing policies

  7. Paradigm shift: Increasing awareness of the impact of trauma Federal Support 1994 – present NASMHPD Resolution 1998 State Agency Support 11 States with Trauma Initiatives Consumer voices 1994 - present

  8. Develop a model of healing from childhood sexual abuse based on concept mapping Develop a measure of healing using the model and concept map data Develop a roadmap for healing Validate the measure and further develop the theory Participant survivors collaborate with study team to: Generate items Interpret maps; name dimensions of healing Review draft measure Collaboration: Consumer/survivors, Clinicians, Researchers

  9. Concept Mapping Method • Brainstorm statements • Sort statements • Rate statements • Analyze sorted statements (Multi Dimensional Scaling; Cluster Analysis) • Name clusters and interpret maps

  10. Awareness & validation Confidence in judgments Skills and safe environments to: identify triggers diminish dissociation experience and manage the whole range of emotions Build & reconnect with community, normalization Optimism and hope, look to the future “Placing” the abuser Reach out, help others, advocate Healing from Sexual Abuse Trauma

  11. Personal Empowerment Power and control to say no effectively Challenge authority Positive Struggle Zone Self acceptance; Self love Minimal needs Fill in the gaps of time and events Reconstruct sexuality Enjoyment; Choice, Diminish Guilt Competence as a parent Trust self to make choices Competence in social roles Identify triggers Cope with Emotions Acknowledge that abuse happened Diminish substance abuse Self Acceptance & Confidence Stopped self-blame Confidence in distinguishinginternal from external reality Dimensions of Healing: Women

  12. Awakening and self validation Believing that sexual abuse happened Building support/ self help I surround myself with positive, nurturing people No hole anymore in my heart or body Gaining wisdom I believe I can make good judgments I acknowledge my feelings, even at times of joy Forgiving the perpetrators Dimensions of Healing: Women

  13. Awareness, beginning understanding Identify as survivor, not as victim Stop self blame for abuse Change thoughts and feelings Experience and express vulnerability Diminish self abuse Learn & understand about sexual abuse Mourn the loss of childhood Process of normalization Abuse as a pathway to mental illness Diminish victim behavior Identify and cope with triggers Stop self pity Accept love & trust from self & others Re-establish family ties Experience connection to others Self Care Support personal achievements Diminish self harm in crisis Overcoming & fulfillment Personal empowerment Motivation to help others Diminish fear & increase assertiveness Advocacy Dimensions of Healing: Men

  14. Mental Illness ~Anguish ~ Awareness & insight ~Action plan ~Determination to be well ~ Well being / recovery ~Reestablish social roles & decision making capacity through socialsupport Complex PTSD ~Safety ~Remembrance & Mourning ~Reconnection with ordinary life & commonality Models of Recovery

  15. Healing from Sexual Abuse: Implications for Systems • Validation • Safety • Self Care • Community • Empowerment

  16. Healing from Sexual Abuse: Men’s concept map

  17. Healing from sexual abuse: Women’s concept map