Healing from Sexual Abuse Healing from Sexual Abuse TraumaTrauma : Model and Measure: Model and Measure

NASMHPD Research Institute NASMHPD Research Institute 13th Annual Conference on 13th Annual Conference on

Services Research and Evaluation:Services Research and Evaluation:Developing an Evidence-Based Culture to Reform Developing an Evidence-Based Culture to Reform

SystemsSystemsFebruary 9-11,2003February 9-11,2003

Supported in part by the Center for the Study of Supported in part by the Center for the Study of Issues in Public Mental Health NIMH Grant: Issues in Public Mental Health NIMH Grant: 2P50MH513592P50MH51359

Healing from Sexual Abuse TraumaHealing from Sexual Abuse Trauma : : Model and MeasureModel and Measure

Mary Jane Alexander, Ph.D.Mary Jane Alexander, Ph.D.11

Jeanne Dumont, Ph.D.Jeanne Dumont, Ph.D.Kristina Muenzenmeier, M.D.Kristina Muenzenmeier, M.D.22

Mary Auslander, M.S.W.Mary Auslander, M.S.W.33

11Nathan Kline Institute for Psychiatric ResearchNathan Kline Institute for Psychiatric Research22Bronx Psychiatric CenterBronx Psychiatric Center33Maine Department of Mental Health, Mental Retardation, Alcohol and Maine Department of Mental Health, Mental Retardation, Alcohol and

Substance Abuse Services Substance Abuse Services

Supported in part by the Center for the Study of Issues in Public Mental Supported in part by the Center for the Study of Issues in Public Mental Health NIMHHealth NIMH

Trauma Exposure and Trauma Exposure and DistressDistress

General General Users of Public Mental Users of Public Mental Population Population Health Services Health Services

%% %%

Any ExposureAny Exposure 5050 51 – 9851 – 98

3 Events or More3 Events or More 1515 5050

PTSD/Distress,PTSD/Distress, ImpairmentImpairment 8 8 4242

Common EventsCommon Events witness bad injury/death witness bad injury/death sexual assault - adult sexual assault - adult fire, flood, natural disaster sexual assault - childfire, flood, natural disaster sexual assault - child

car or work accidentcar or work accident attack with weaponattack with weapon

More than PTSDMore than PTSD

Besides symptoms of PTSD, survivors of pervasive Besides symptoms of PTSD, survivors of pervasive

trauma seek help fortrauma seek help for

depressiondepression

angeranger

self destructive behavior self destructive behavior

feelings of shamefeelings of shame

self blame self blame

mistrustmistrust

More than PTSDMore than PTSD

Complex Post Traumatic Stress changes a person’s: Complex Post Traumatic Stress changes a person’s:

Ability to regulate their affective arousalAbility to regulate their affective arousal

Attention and consciousnessAttention and consciousness

Perception of oneself and the perpetratorPerception of oneself and the perpetrator

Relationship to othersRelationship to others

Systems of meaningSystems of meaning

Experiencing somatic distressExperiencing somatic distress

Paradigm ShiftParadigm Shift

Trauma has largely been overlooked in:Trauma has largely been overlooked in:

Explaining behaviorExplaining behavior

Designing environmentsDesigning environments

Designing policiesDesigning policies

Paradigm shift: Paradigm shift: Increasing Increasing awareness of the impact of trauma awareness of the impact of trauma

Federal SupportFederal Support 1994 – present1994 – present

NASMHPD Resolution NASMHPD Resolution 19981998

State Agency SupportState Agency Support 11 States with 11 States with Trauma InitiativesTrauma Initiatives

Consumer voicesConsumer voices 1994 - present1994 - present

Collaboration: Collaboration: Consumer/survivors, Consumer/survivors, Clinicians, ResearchersClinicians, Researchers Develop a model of healing Develop a model of healing

from childhood sexual from childhood sexual abuse based on concept abuse based on concept mappingmapping

Develop a measure of Develop a measure of healing using the model and healing using the model and concept map dataconcept map data

Develop a roadmap for Develop a roadmap for healinghealing

Validate the measure and Validate the measure and further develop the theoryfurther develop the theory

Participant survivors Participant survivors collaborate with study collaborate with study team to:team to:

Generate itemsGenerate items

Interpret maps; name Interpret maps; name dimensions of healingdimensions of healing

Review draft measureReview draft measure

Concept Mapping MethodConcept Mapping Method

Brainstorm statementsBrainstorm statements

Sort statementsSort statements

Rate statementsRate statements

Analyze sorted statementsAnalyze sorted statements (Multi Dimensional Scaling; Cluster Analysis)(Multi Dimensional Scaling; Cluster Analysis)

Name clusters and interpret mapsName clusters and interpret maps

Healing from Sexual Abuse Healing from Sexual Abuse TraumaTrauma Awareness & Awareness &

validationvalidation Confidence in Confidence in

judgments judgments

Skills and safe Skills and safe environments to:environments to: identify triggers identify triggers diminish dissociation diminish dissociation experience and experience and

manage the whole manage the whole range of emotions range of emotions

Build & reconnect Build & reconnect with community, with community, normalizationnormalization

Optimism and hope, Optimism and hope, look to the futurelook to the future

““Placing” the abuserPlacing” the abuser

Reach out, help Reach out, help others, advocateothers, advocate

Dimensions of Healing: WomenDimensions of Healing: Women

Personal EmpowermentPersonal EmpowermentPPower and control to say no effectivelyower and control to say no effectivelyChallenge authorityChallenge authority

Positive Struggle ZonePositive Struggle ZoneSelfSelf acceptance; Self love acceptance; Self love

Minimal needsMinimal needsFFill in the gaps of time and eventsill in the gaps of time and events

Reconstruct sexualityReconstruct sexuality

Enjoyment; Choice, Diminish GuiltEnjoyment; Choice, Diminish Guilt

Competence as a parentCompetence as a parent

Trust self to make choicesTrust self to make choicesCompetence in social rolesCompetence in social roles

Identify triggersIdentify triggers

Cope with EmotionsCope with EmotionsAcknowledge that abuse Acknowledge that abuse happenedhappened Diminish substance abuseDiminish substance abuse

Self Acceptance & ConfidenceSelf Acceptance & ConfidenceStopped self-blameStopped self-blameConfidence in distinguishingConfidence in distinguishing internal from external realityinternal from external reality

Dimensions of Healing: WomenDimensions of Healing: Women

Awakening and self validationAwakening and self validationBelieving that sexual abuse Believing that sexual abuse

happenedhappened

Building support/ self helpBuilding support/ self helpI surround myself with positive, I surround myself with positive,

nurturing peoplenurturing peopleNo hole anymore in my heart or No hole anymore in my heart or

bodybody

Gaining wisdomGaining wisdomI believe I can make good I believe I can make good

judgmentsjudgmentsI acknowledge my feelings, even at I acknowledge my feelings, even at

times of joytimes of joy

Forgiving the perpetratorsForgiving the perpetrators

Dimensions of Healing: MenDimensions of Healing: Men Awareness, beginning understandingAwareness, beginning understanding

Identify as survivor, not as victimIdentify as survivor, not as victimStop self blame for abuseStop self blame for abuse

Change thoughts and feelings Change thoughts and feelings Experience and express vulnerabilityExperience and express vulnerabilityDiminish self abuse Diminish self abuse

Learn & understand about sexual Learn & understand about sexual abuse abuse Mourn the loss of childhoodMourn the loss of childhood

Process of normalization Process of normalization Abuse as a pathway to mental illnessAbuse as a pathway to mental illness

Diminish victim behaviorDiminish victim behavior

Identify and cope with triggersIdentify and cope with triggersStop self pityStop self pity

Accept love & trust from self & othersAccept love & trust from self & others RRe-establish family tiese-establish family tiesExperience connection to othersExperience connection to others

Self CareSelf CareSupport personalSupport personal achievements achievementsDiminish self harm in crisis Diminish self harm in crisis

Overcoming & fulfillmentOvercoming & fulfillment Personal empowermentPersonal empowermentMotivation to help othersMotivation to help others

Diminish fear & increase Diminish fear & increase assertivenessassertiveness

AdvocacyAdvocacy

Models of RecoveryModels of Recovery

Mental IllnessMental Illness

~Anguish~Anguish~ Awareness & insight~ Awareness & insight~Action plan~Action plan~Determination to be well~Determination to be well~ Well being / recovery~ Well being / recovery

~Reestablish social roles & ~Reestablish social roles & decision making capacity decision making capacity through socialthrough social supportsupport

Complex PTSDComplex PTSD

~Safety ~Safety

~Remembrance & ~Remembrance & Mourning Mourning

~Reconnection with ~Reconnection with ordinary ordinary

life & life & commonality commonality

Healing from Sexual Abuse:Healing from Sexual Abuse: Implications for Systems Implications for Systems

ValidationValidation

SafetySafety

Self CareSelf Care

CommunityCommunity

Empowerment Empowerment

Healing from Sexual Abuse: Healing from Sexual Abuse: Men’s concept mapMen’s concept map

Healing from sexual abuse:Healing from sexual abuse:Women’s concept Women’s concept

mapmap