In recent years, as alcohol and drug counselors have recognized the significant overlap between the addiction and abuse populations and their treatment issues, many have come to believe that people who have suffered severe abuse and neglect as children may not be able to stop abusing substances until they deal with abuse issues early in the treatment process. Two treatment models of this sort are available--the integrated model and the concurrent model. In the integrated model, which addresses dual diagnosis i.
The provider might also serve as a mental health counselor or address abuse issues from a psychoeducational perspective in conjunction with the substance abuse treatment. A comprehensive dual diagnosis model of this sort labeled "the dual recovery model" has been proposed Evans and Sullivan, In a concurrent treatment model, referrals are made as appropriate for needed mental health services while the substance abuse treatment continues.
In this model, staff members who are not substance abuse treatment professionals may deliver mental health treatment. In any situation where clients are receiving services from different providers, all parties involved should work together to act in the best interests of the clients. The Consensus Panel believes that each case must be evaluated separately. There will be cases in which clients need to address an underlying mental disorder before they are capable of maintaining abstinence, as well as times when an extended period of abstinence from 6 months to a year will be required before clients are ready to address past trauma.
This issue continues to be a subject of debate, especially since third-party payors generally allow a limited number of visits for substance abuse treatment Marlatt and Gordon, Regardless of how treatment is structured, a comprehensive assessment is needed first to determine what kind of treatment is most appropriate and to systematically address the needs of the individual client. The type of treatment that is most suitable to the individual can be determined in a number of ways.
Although traditional Step approaches emphasize a linear model of recovery in which abstinence takes priority over all other issues, research data are not yet available to indicate the superiority of this approach. Yet, even if the linear model is the superior one, a reasonable compromise is needed for issues of childhood abuse and neglect. The overlap between addiction and violence in families should be discussed throughout treatment, in conjunction with more customary discussions about dysfunctional families and family roles. Addressing multiple issues simultaneously rather than in a step-like manner may actually be indicated and potentially more effective for many people.
If an individual has active and acute trauma-specific i. If an individual does not have acute or debilitating symptoms, he may be able to establish abstinence before addressing trauma-related concerns. If he fails to establish abstinence first, despite indications that a non-trauma-focused treatment seemed most appropriate initially, then that may indicate the need to address trauma issues first. In addition, direct therapeutic intervention for childhood abuse and neglect issues will often have to be included at some point in treatment, although precisely when depends on the needs and status of the clients.
The first stage of substance abuse treatment occurs during detoxification and the first 30 days afterward, the period in which clients are becoming engaged in treatment. In-depth attention to issues of childhood abuse and neglect is generally not appropriate during this stage. The second stage of recovery may last anywhere from 30 days to 2 years, during which clients are establishing new and "sober" relationships, securing employment, participating in support groups such as Step programs, and possibly reconnecting with family.
During this second stage, clients may feel a need to address childhood abuse and neglect issues but should not be expected to do so. The third stage is, in many ways, the rest of the clients' lives, during which they are recovering from their substance abuse disorders. In this stage, clients generally can better deal with a broader range of issues.
Although progress through these stages can differ substantially for each client, the primary focus of treatment can be expected to change eventually from substance abuse to other psychological issues such as those associated with childhood abuse and neglect. For some clients, this transition can occur relatively early in treatment; for many others, these issues will need to wait until sobriety has been achieved and they have spent some time working on issues surrounding their substance abuse.
Whatever the sequence and time, it can be very helpful to ask clients to identify the issues to be addressed and in which order, and to develop short- and long-term goals for doing so. Such a treatment plan would also address what steps clients need to take to implement the plan and the identification of potential relapse triggers. For clients who are not yet stable in their recovery or who cannot yet tolerate such exploration, developing such a plan helps maintain their focus on immediate recovery issues and establish some direction regarding when and how to address childhood abuse in the future.
It also assists in redirecting clients who are insistent on working with abuse and trauma-related issues at the outset of treatment, before sobriety is achieved. The counselor should understand and empathize with the clients' sense of urgency. Clients may be desperately trying to get rid of profound emotional pain and debilitating symptoms.
The counselor must be able to express an understanding of the clients' urgency while simultaneously encouraging them to "stay the course" and to "make haste slowly;" that is, address abuse and trauma issues at a pace that is tolerable and that does not lead to regression or relapse. Clients may approach treatment with a great deal of mistrust and skepticism.
They might start by asking the counselor such questions as, "Can you promise me that my life will be better if I stop using, or if I face my abuse and trauma issues? Clients may think that the counselor wants to take away their primary means of coping, leaving them unable to function because of the severity of their emotional pain and symptoms.
Therefore, the counselor must search for and apply any available leverage to help motivate clients for treatment while getting through the short-term pain until some treatment benefits can be realized. Clients must be engaged in a way that will give them hope and increase their beliefs in their own power to overcome and resolve abuse issues to create a new life. Some clients may actually succeed in stopping their substance abuse without relapsing but without apparently ever confronting their childhood abuse issues.
It should not be assumed that such clients have not dealt with those issues; in some cases they may simply have not done so openly. In other cases, these clients may not be ready to discuss issues of abuse and trauma. In still others, clients recoil from emerging memories of abuse and may need to recant often several times over and struggle with the possible reality of their memories before arriving at a point of acceptance.
Such "resistance" functions as protection and often yields as clients become less vulnerable and more able to face and accept the situation. Clients should never be forced to confront these issues if they do not feel ready.
The psychological impact of clergy-perpetrated child abuse | Psychlopaedia
Forcing clients to do so may recreate an abusive situation and retraumatize the client. It is also important for the counselor to accept that some clients may not require or desire intense focus on abuse issues in order to facilitate their substance abuse treatment. The determination of whether to address childhood abuse is often dependent upon the clients' symptoms and ability to stay sober and is ultimately the client's and not the counselor's choice. It is noteworthy that this sequenced model of treatment is consistent with the contemporary treatment model for posttraumatic conditions Courtois, ; Herman, ; van der Kolk et al.
The model for posttrauma treatment is also sequenced and begins by focusing on the clients' personal safety and the stabilization of personal functioning and outstanding life stresses and difficulties including dependency ; developing the therapeutic relationship is also addressed.
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In the first phase of treatment, clients are encouraged to defer attention to the traumatic material in favor of personal safety and stabilization. If clients are actively suffering from posttraumatic symptoms as well as other symptoms such as depression and anxiety , these are treated first with cognitive-behavioral strategies aimed at increasing self-management and with psychotropic medication as needed. Clients are also taught skills for identifying and expressing feelings and for modulating and coping with strong feelings. The traumatic event s and reactions are addressed only as they support clients' stabilization and from an educational perspective.
Clients are given definitions for various terms such as trauma and child abuse and neglect and are taught about the human response to trauma to normalize posttraumatic reactions. The second phase of treatment incorporates much more direct attention to trauma and its effects. Clients are taught to address the trauma without the use of negative coping methods including substances and processes such as dissociation but must also learn that exposure must be carefully monitored so that they are not overwhelmed and retraumatized.
Facing traumatic material is usually the most difficult and painful part of the treatment, and clients often relapse to old coping methods. For this reason, they are actively engaged in relapse planning, including the identification of triggers and strategies to use when they feel overwhelmed.
As the trauma is processed and resolved, clients gradually move into the work of the third phase, which focuses on life choices and on a life less encumbered by the effects of trauma. This phase may last long after the client completes treatment. The counselor must be aware of personal and interpersonal developmental deficits see "Challenges to Accurate Screening and Assessment" in Chapter 2 and must work to remediate these issues through skill development and through the counseling relationship.
Clients with a history of child abuse or neglect typically have feelings of abandonment and betrayal that often become funneled into rage. In addition, substance use that began at an early age--between 8 and 18 years, when children should be learning to develop intimacy and deal with their feelings--can result in arrested emotional development and an inability to deal with strong emotions while abstinent.
Assisting these clients to develop life management skills begins with helping them to identify and understand the intensities of their feelings. It is the unfortunate legacy of childhood abuse that victims must learn to repress their emotions to survive. Victims tend to become vigilant to the emotional states of others at the expense of being aware of their own. In cases of repeated abuse, the victims become constantly alert to the abuser's every move and nuance in order to avoid sparking another abusive incident.
That ability, which served them well in childhood, has now been carried over into adulthood and interferes with the ability to function with a full range of feelings. For victims of abuse, problems in forming attachments are often paramount. The abuse has led to feelings of distrust, betrayal, and abandonment and has caused a disconnection from other human beings. Substance abuse only compounds this rift by creating a false sense of belonging. The process of reattaching--or attaching for the first time--to other individuals, to a community, or to a spiritual power may take a long time, but it does have great therapeutic value.
This may involve an activity--such as taking a class in writing or painting, working with animals, or joining a Step group or a church--that fosters feelings of belonging. Daily affirmations--the reflection on positive statements about oneself--may help foster spiritual growth. For clients, spirituality may be in the form of an organized religion or activity in which participation makes them whole, centered, and connected to some superior or overarching force Whitfield, Clients who grew up in an abusive household have learned survival skills that allowed them to function in an often hostile and unpredictable environment, one in which they needed to be hypersensitive to others' moods and behaviors.
Fears of intimacy are likely to hinder them, and the counselor must respect these clients' boundaries and limitations. Clients' fears of intimacy will often manifest themselves in concern about losing control or being abandoned or attacked Sheehan, Counselors may need to explain to clients how the problems in their past can affect their relationships in the present and how proper skills training can help them to overcome these deficits.
Counselors should reassure clients that these deficits are understandable in light of their history and should be prepared to help them develop needed interpersonal skills. Helping clients develop interpersonal skills involves enabling them to interact empathetically with others, to understand and be understood, to be able to ask for what they need, to draw personal boundaries by saying no, and to cope with interpersonal conflict Whitfield, Other skills highly useful for this population include anger management, learning how to recognize unhealthy relationships, assertiveness training, and conflict resolution.
The development of such skills allows clients to establish and maintain interpersonal relationships while keeping their self-respect. Because of the central role of interpersonal relationships in women's development, women with substance abuse disorders and histories of child abuse are particularly vulnerable to interpersonal stress--and responsive to interpersonally focused interventions.
Because the support networks of these women are typically impoverished, interventions that provide an immediate support network as well as foster improvement in interpersonal skills are essential first steps in shoring up the women's social networks and bonds Luthar and Suchman, ; Luthar and Suchman, in press. One of the most important roles of the counselor is to model behaviors in healthy relationships. Many abuse survivors never learned this in childhood and have to learn the most basic skills. The counselor should make it a point to show up on time and have expectations for clients to do so as well; he should also always behave in a warm and respectful manner.
By simply being there, the counselor models key aspects of a healthy relationship: Group therapy can be a good setting for interpersonal skills training, but because of the highly volatile and sensitive nature of childhood abuse and neglect, group therapy may not be appropriate for many clients dealing with these issues see the "Group Therapy" section later in this chapter.
Seminal writings about the therapist's contribution to the therapeutic interaction Rogers, ; Traux and Carkhuff, suggest that certain characteristics are essential for effective treatment across therapeutic modalities: Although many would argue that these are not sufficient for positive outcomes, there is evidence that these characteristics are important to establishing a working alliance with the client.
For example, research has shown that an empathic therapist style is associated with more positive long-term outcomes Miller and Sovereign, ; Miller et al. For effective treatment, clients must be motivated for change. A counselor may need to address motivation before change can occur. For the counselor, the pace of some clients may seem so slow that it appears the clients are avoiding the issue.
Nevertheless, the counselor must respect the clients' boundaries regarding how much and when to talk about abuse or neglect. To force the issue or to confront clients about abuse would be to reenact the violating role of the perpetrator. In dealing with clients with histories of child abuse and neglect, the counselor must strike a delicate balance between allowing clients to talk about the abuse when they are ready and not appearing to maintain the conspiracy of silence that so often surrounds issues of child abuse. The counselor also must be prepared for the possibility that clients may disclose their childhood abuse or neglect without being asked about it.
Disclosure of past abuse or neglect sometimes happens spontaneously in counseling sessions, without any intentional elicitation from the counselor or preplanning on the part of clients. In some cases, clients believe that the sooner they address the abuse, the sooner they can resolve it. Exposure to the issue in the media may have led others to believe that this is typical, that is, "what they are supposed to do. They may attempt to pressure treatment providers into addressing abuse issues prematurely--before they have adequate coping skills to manage the potential effects of such exploration.
However, counselors must maintain appropriate pacing and teach clients to develop skills in self-soothing techniques so they can manage uncomfortable or volatile feelings.
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When working with adult survivors of childhood abuse, the counselor can help clients situate the abuse in the past, where it belongs, while keeping the memory of it available to work with in therapy. Emphasizing a distinction between the emotions of the client as child victim and the choices available to the adult client can help this process. Recognizing this separation, clients can learn to tolerate memories of the abuse while accepting that at least some of its sequelae will probably remain. Regardless of how or when clients talk about their abuse histories, the counselor must handle such disclosures with tact and sensitivity.
Children who have been abused, especially at a young age by parents or other caretakers, will usually find it difficult to trust adults. When children's first and most fundamental relationship--that between themselves and one or both parents--has been betrayed by physical, emotional, or sexual abuse, they are likely to grow up feeling mistrustful of others and hypervigilant about the possibility of repeated betrayals.
This vigilance is, in many ways, a resilient strength for children, who lack many of the protective resources of adults.
The psychological impact of clergy-perpetrated child abuse
As adults, however, it often stands in the way of forming intimate and trusting relationships. The counselor must take care not to tear down this defense prematurely, because to do so may result in discrediting or invalidating the experience of the abuse and in some cases may be perceived as abusive in itself. Patience and consistency help to reassure clients of the counselor's trustworthiness. Counselors should not assume that they have the clients' confidence simply because a disclosure has been made; with victims of childhood abuse, trust is often gained in small increments over time.
When the treatment does focus on issues of past abuse, the Consensus Panel recommends that the counselor support clients for what they can recall while reassuring them that it is quite normal to have uncertainties or not to remember all of what happened in the past.
More important than the accuracy of the memory is the emotional reaction to, and consequences of, the experience; memories over time may be distorted, especially when remembered through the eyes of a child, but the feelings they engender are the most significant aspect of the experience. This last point is especially important because many survivors fear that if they disclose their histories, whomever they tell will deny that it happened. Even if the counselor finds clients' accounts difficult to believe, he can look for and respond to the emotional truth of it.
Moreover, the counselor should remember that until some degree of abstinence is achieved, clients' perceptions of reality are likely to be limited and their judgment poor. When clients disclose histories of past abuse before abstinence has been achieved, the counselor should note the information on childhood abuse and neglect, realizing that it will be important to explore this matter more thoroughly when clients have achieved a period of abstinence.
When the topic is revisited later, the counselor should explain what parts of the story are the same and what parts differ, because this information may be therapeutically important. It is not unusual for trauma survivors to remember more with the retelling of their stories; however, the counselor should make note of major inconsistencies in order to discuss them with clients over the course of treatment. For example, the abuse may have been perpetrated by someone other than the person whom the client first remembered. Information such as this can have an extremely important bearing on family counseling, as well as other aspects of treatment.
Counseling techniques for treating substance abuse in clients with a history of child abuse or neglect include interviewing from a stance of supportive neutrality.
Treatment Issues
By asking, for example, what clients believe was both good and bad about the substance abuse, the counselor explores clients' perspectives and elicits rather than conveys information. The counselor's goal should be to motivate clients to explore their own issues and determine for themselves how the history of abuse relates to their substance abuse.
Clients' motivations--for dealing with either abuse or substance abuse--will waver, but that is part of the process. Although group treatment, including Step programs and group therapy, is generally the treatment of choice for individuals who abuse substances Barker and Whitfield, ; Washton, , some individuals with childhood abuse issues may not do well in group settings. They may either find themselves unable to function or else try to undermine the group process to protect themselves from painful issues they would rather not face.
This kind of behavior may point to hidden issues that the counselor should explore further. Alexa Actionable Analytics for the Web. AmazonGlobal Ship Orders Internationally. Amazon Inspire Digital Educational Resources. Amazon Rapids Fun stories for kids on the go. Amazon Restaurants Food delivery from local restaurants. ComiXology Thousands of Digital Comics. East Dane Designer Men's Fashion. Shopbop Designer Fashion Brands. Withoutabox Submit to Film Festivals.
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Amazon Renewed Refurbished products with a warranty. American research has identified post-traumatic stress disorder PTSD as a common psychological effect of clergy-perpetrated child abuse. Victims are also more likely to be affected by self-harming and suicidal behaviours, alcohol misuse, depression and anxiety. Yet there is ample evidence that this trust and reverence was sadly misplaced and the same caution that would be applied to other members of society needs to be applied to members of the clergy.
Because their faith, which is often a source of great meaning and comfort, has been shattered and there are corresponding dramatic changes to how children see themselves, the way they respond and adapt to stressful events and understand the world will have been largely destroyed and needs to be rebuilt. Start typing to search. So what separates clergy-perpetrated abuse from other types of child abuse? Crisis of faith In contrast with the large body of evidence examining the prevalence and health consequences of child sexual abuse occurring in the general community, very little research has looked specifically at clergy-perpetrated abuse.
Another victim remarked to an American study: Double betrayal In addition to betrayal by the religious institution, many victims feel betrayed by family members who struggle to understand what has happened. If you or anyone you know need assistance please contact: Find a Psychologist icons Feedback Signup for news and updates Email: Great news, we've signed you up. Sorry, we weren't able to sign you up. Please check your details, and try again.