Group Psychotherapy in Sexually Abuse Women
Sexual Abuse and Group Psychotherapy
Sexual abuse is a universal and global issue causing long life and sometimes lasting Psychiatric and Psychological impact; Many of these victims are most often women and children. The risk factors for adult sexual assault includes younger age, being female, been divorced, sexual abuse in childhood, and physical assault during adulthood. In clinical practice, Group Psychotherapy is a preferred treatment of choice for women of different cultural backgrounds and history of sexual abuse.
Group setting is a better way of healing sexual trauma, creating a safe and structured environment where they are heard, believed, and supported by peers; provides the atmosphere and opportunity for dealing with anger, self-esteem, sexuality, family-of-origin issues, assertiveness, relationships, spirituality, perpetrators, and confrontation .
Studies showed Group Psychotherapy was significantly effective in reducing depression, anxiety, feelings of stigma, isolation, and shame, and posttraumatic stress disorder symptoms in sexually abused women.
Statistical analysis of the prevalence of Child sexual abuse in adults from 22 countries reported 7.9% of men, 19.7% of women had experienced sexual abuse before age 18; in the united States of American, sexual assault during adulthood was 22% of women and 3.8% of men; sexual prevalence of 11-37% in the adolescent population.
(Sayin, A., Candansayar, S., & Welkin, L., 2013).
Group Work and Psychotherapy
Group Psychotherapy is a therapeutic modality broadly used in community and institutional treatments; an effective treatment for a wide range of problems –individual and group (Tasca, G. A., 2014).
Provides a rich environment to study attachment processes – the nature, quality, complexity of interactions; therapeutic factors that facilitate change in group therapy; group cohesion – a bond or attraction between an individual and the group (Tasca, G. A., 2014).
Attachment theory and psychotherapy has been linked to the clinical treatment of individuals, couples, and families; influenced a wide range of interpersonal functioning, psychotherapy treatment, and group dynamics; influence the development of cohesion and associated with positive outcomes for those with greater attachment anxiety to facilitate changes in attachment, and promote healing (Marmarosh, C. L., 2014).
Group Work and Therapy
Childhood Sexual Abuse (CSA) – is a pervasive and egregious crime, a sexual act between an adult and a child, the child is utilized for sexual satisfaction of the perpetrator
32% of women and 14% of men in the United States reports been sexually abused as children; 10% of victims being abused between birth and age of three years, 54% between age 4 to 11; 36% over the age of 12
Childhood disclosure of CSA is relatively uncommon, many survivor do not receive clinical treatment until they reach adulthood
Evidence showed that Adult Survivors of CSA are at increased risk for mental health issues – depression, anxiety, and post-traumatic stress disorder (PTSD); risk-taking behaviors – substance abuse, self-mutilation, and unprotected sex.
Female survivors have higher incidence of physical health issues – breast cancer, sexual dysfunction, and headaches than their non-abused peers (Willen, J. S., Littell, J. H., & Salanti, G., 2017).
Overview of the Article: Group Psychotherapy in Women with a History of Sexual Abuse
The article’s overview is the cohort study and research on the effectiveness and benefits of group psychotherapy on women (Turkish) with history of sexual abuse
Type of Psychotherapy Used – the Eclectic Method of Group Psychotherapy including Cognitive Behavioral therapy, interpersonal therapy, Narrative Therapy, Psychoeducation, and Expressive Techniques.
The Participants in the group – are 47 Turkish women with the history of childhood and / or adulthood sexual abuse who had applied for Psychiatric outpatient or inpatient treatment
Settings of the Group are the Psychiatric Department of Gazi University Hospital (Inpatient or Outpatient)or staying at the domestic violence shelter houses and / or private patients of two of the authors
Selection – was based on the goal of the study to observe the similarities and differences in response to sexual trauma-related issues and group therapy setting between Turkish women and women from other countries reported in the literature. Culture , socio-demographic characteristics, previous psychiatric treatment and sexual abuse history.
The group meeting and the duration of the group therapy was Weekly, 90 minutes sessions for 12 weeks; each session has an agenda
The Curative Factors
The curative factors important for this group:
* Having a total of five groups of 8-10 members
* Same Socio-demographic variables, sexual trauma history
* Subjects were given Hamilton Depression Rating Scale, The Hamilton Anxiety Rating Scale, the Clinical Administered Post-traiumatic Stress Disorder Scale, The Dissociative Experiences Scale, the Childhood trauma Questionnaire and The Group Therapeputic Factors Questionnaire
* Re-evaluation was done after the 6th and 12th session and 6-months follow-up session
The Exclusion Criteria – For Study Participants
The exclusion criteria the authors mentioned:
* Being Younger than 16 years of age
* Having a Psychotic Disorder
* Active alcohol or Substance Dependence
* Mental Retardation
* Severe Suicidal Thoughts
* Not signing the written Informed Consent Form
The findings /Outcomes of the Study in the article
The study was among 47 women with history of Sexual abuse, most were children when the sexual trauma occurred, most common perpetrators were first-degree family members, husbands/lovers, most of the women were raped, most were traumatized more than once by the same perpetrator, some revictimized, some had never talked about the sexual assault before this therapy and no professional help after the assault.
32 of the women completed the whole group process, 7 of the subjects never attended group after screening, 8 of the subjects dropped out
Outcome of the treatment was 78.1% efficacious for these women; effective for women of different cultural background and socio-demography.
Most of the group members had significantly less depressive, anxiety, and post-traumatic stress disorder symptoms, both immediately after and six months after this therapy; The results show that group psychotherapy was effective in accordance with previous literature.
This practice will translate into my practice and care for my client groups based on the existential factors, universality, and cohesiveness reported by this group and other literatures. A high level of motivation for treatment and an environment of help, support, and mutual feelings of support, being heard, and believed which lessened the feelings of stigma, isolation, and shame (Sayin, A., Candansayar, S., & Welkin, L., 2013).
The limitations of the Study
The Sample size for the study is small and was not controlled or compared with other treatment
One of the therapist interpreted the study and it could be regarded asd biased
The women included in this study are Turkish women in the Capital city – Ankara alone and they might have a different understanding and beliefs compared to the women in the Suburbs and low income area and also as compared to the Western Countries like the United States of American.
More studies are required in other countries to make it applicable to my immediate environment. Sexual abuse is a universal and global problem and the limitations of the study will not impact my ability to use the findings /outcomes presented in the article.
Marmarosh, C. L. (2014). Empirical research on attachment in group psychotherapy: Moving the field forward. Psychotherapy. 51(1), 88-92. doi:10.1037/a0032523
Sayin, A., Candansayar, S., Welkin, L. (2013). Group Psychotherapy in women with a history of sexual abuse: What did they find helpful? Journal of Clinical Nursing. 22(23/24). N3249-3258. doi:10.1111/jocn.12168
Tasca, G. A. (2014). Attachment and group psychotherapy: Introduction to a special section. Psychology. 51(1), 53-56. doi:10.1037/a0033015
Wilen, J. S., Littell, J. H., & Salanti, G. (2017). Psychosocial interventions for adults who were sexually abused as children. The Cochrane Database of Systematic Reviews, 2017(1), CD010099.