Physical and
Sexual Abuse
(a) insults,
ridicule, humiliation, name calling and insults or ridicule specially with
regard to not having a child or a male child; and
(b) repeated threats
to cause physical pain to any person in whom the aggrieved person is
interested.
Sexual abuse - It includes any conduct of a
sexual nature that abuses, humiliates, degrades or otherwise violates the
dignity of a woman.
Consequences of
Physical and Sexual Abuse Clients
1. Occurrence of emotional and behavioural
issues relating to anxiety and depression.
2. Genital injuries and frequent urinary
tract infections.
3. Increased risk of drug and alcohol
abuse.
4. Trauma has a long-term detrimental
effect on the brain and heart.
5. Increased risk of eating disorders,
sexual dysfunction, self-harming, suicidal ideation and severe preoccupation
with physical appearance.
6. Flashbacks, guilt and nightmares.
7. Survivors become very expressive
(anger, sadness), disoriented (disbelief, denial), or controlled (distant,
calm).
Counselling
Physical and Sexual Abuse Clients
Counselling with special cases, such
as physical and sexual abuse, is a challenging experience. Counsellors who work
with these populations must be well-trained and experienced in trauma-informed
care. They must be able to create a safe and supportive environment for their
clients, and they must be able to help their clients process their experiences
and develop coping mechanisms.
Assessment
Prior to Psychological Interventions
It is important to
obtain a detailed history and assessment of the child, including information on
family and school context, developmental level and functionality, emotional and
behavioural issues (pre- and post-sexual abuse), circumstances of the alleged
abuse, the child's experience and understanding of the abuse and other related
problems.
Objective of
Assessment
The objective of the
Psychosocial and Mental Health Assessment is to establish that abuse has
occurred and to know the nature of abuse, i.e., contact versus non-contact,
penetrative versus non-penetrative abuse with a view to making decisions
regarding medical interventions, as well as posttraumatic stress disorder
(PTSD) interventions, as necessary.
Introduction
and rapport building
During this phase, it is imperative
for counsellors to maintain a high level of empathy to create an environment of
acceptance and comfort. Many survivors of sexual assault struggle with feelings
of shame, guilt, embarrassment and defectiveness, and have a decreased level of
trust in others who are outside their identified support systems.
1. Greet the client and tell him/her your
name and then, ask his/her name
2. Engage in neutral conversation few
minutes for example what did you eat in the morning today? How did you come
here today? Who are these people who have come with you?
3. Introduce the space and the purpose of
the client being there, including your role.
4. Explain the need for a video camera/microphone
(in case you are using such equipment) – “As you can see, we have a video
camera and microphones here. They will record our conversation so I can
remember everything you tell me. Sometimes, I forget things and the recorder
allows me to listen to you without having to write everything down.” (In case
you are taking notes, you may provide a similar explanation to the client).
5. Encourage clients to provide detailed
responses early in the interview as this enhances their descriptive responses
to open-ended prompts in other parts of the interview, particularly those
related to the abuse incident. [It is very important that you tell me
everything you remember about things that have happened to you. You can tell me
both good things and bad things].
Abuse Enquiry
Now shift to substantive
issues to enable the client to provide you with the narrative by using open
questions such as:
“Now that I know a
little about you, I want to talk about why (you are here) today”
“I heard you
talked to “X” about something that happened – tell me what happened”
“I see you have (a
bruise, a broken arm, etc.,) – tell me what happened”
“I heard you saw
(the doctor, a policeman, etc.) last week – tell me how come/what you talked
about”
“I understand
someone might have troubled you – tell me what happened”
“I understand
someone may have done something that wasn’t right – tell me what happened”
“I understand
something may have happened at (location) – tell me what happened”
Psychological
Interventions (Counselling)
Cognitive
Interventions
1. Identify thought patterns that lead to
self-deprecating perceptions and triggering responses. Some of the cognitive
distortions that clients commonly reported are “I am damaged”; “I will never be
the same”; “I should have done something different”; “Nothing good ever happens
to me.”
2. Work toward positive and realistic
reframes while continuing to focus on developing coping skills.
3. Ask them to keenly observe their
thought pattern and remain aware of it as long as you can.
4. Once awareness is practiced, then
encourage the client to begin with slight modifications in their thought
patterns. The modification of thought patterns should not be sudden rather it
should be gradual. Sudden modification is likely to relapse.
5. Finally, ask the client to remain focused
on her new thought process. Engage yourself in it more often, combine it with
relaxation therapies [explain some relaxation therapies] and remain
self-motivated.
Psychological
Interventions (Counselling)
1. Gestalt interventions – These are primarily focused on
bodily sensations and re-experiencing physiological reactions. For this focus,
encourage clients to practice body scanning on a regular basis but especially
when experiencing more intense emotional reactions. The purpose is to have
clients become better acquainted with specific aspects of their emotional
functioning and the associated feelings linked to their bodies. This
intervention allows in-the-moment understanding of how certain emotions
manifest physiologically and encourages increased awareness of clients’
specific responses to emotions in triggering conditions.
2. Trauma narrative - Encourage survivors of sexual
assault to begin writing out their trauma narratives, which occurs in session.
Retelling their stories has been empirically proven to decrease the severity of
the trauma response. It also allows clients to apply new meaning to their
experiences and incorporate new and positive self-views and language. A client
may feel hesitant to write about painful experiences and consequently store
them. Ask her/him to write but if you don't like it then tear it away.
3. Art-based therapy – In this intervention technique the
survivor is encouraged to draw whatever you feel like to draw using different
colours. At the outset, the survivor may face cognitive resistance to do this
but gradually she/he may take up the job. This helps in the identification of
survivors thought process and perception. This can technique can also be used
during the assessment process. Art provides psychological ducts for expressing
without narrating. It helps in freeing the survivor from the guilt of
confession.
Common
Interventions
1. Help the client to learn healthy
communication and conflict resolution strategies (If you can solve a problem,
Why worry? Strategy).
2. Reduction of intensity and frequency of
expectations.
3. Identification of self-worth, focus on
growth, celebrate the success of growth, and move on.
4. Reframing perception (for example,
taking failure as an opportunity) helps in enhanced self-esteem and core
motivation.
*********
No comments:
Post a Comment