Wednesday, January 6, 2010

Abuse, Sexual Health and Recovery

Recent discussions have keenly reminded me of the tremendous affects of abuse on sexual behavior, mental health, and chemical dependency recovery. I refer the reader to other entries in the blog regarding extended conversations about types of abuse. Here I simply want to acknowledge the big three: sexual, physical and emotional. While these are helpful labels, they are far from black and white. I also think of abuse in terms of overt (recognizable) and covert (hidden). The experience of sexual abuse has so much shame associated with it that we never talk about it. The Hollywood version of abuse hides the experiences of innuendo, harassment and manipulation. People often recognize when they are physically hit, but clients also recognize the concept of “the look” or the statement “wait until your father gets” home. Both experiences introduce the experience of unease, of fear, to outright terror suggesting linkages to abuse. The experience of emotional manipulation belies the difficulty in defining emotional abuse.

I encourage my clients to think about the following indictors. If you know you’ve been abused, I ask you to think about which symptoms are present. If you don’t know you’ve been abused, I ask clients to consider which symptoms are often present. What types of experiences trigger the symptoms? If there are patterns to the experience, I encourage the individual to look further into the issue.

Some consequences/indicators that trigger further work include:

• Displays agitation or anger, uncontrollable behaviors, tantrums.
• Displays anxious behaviors (nail biting, teeth grinding, rocking, etc.).
• Often belittles self (“I’m bad, naughty, evil, etc.”).
• Resists authority or desperately tries to please because they fear repercussions.
• Exhibits excessive guilt.
• Shows fear of a particular person or place.
• Thoughts involve themes of sexual acts, torture, bondage, humiliation and/or abuse.
• Hurts others sexually or physically.
• A child mimicking adult sexual behavior (such as intercourse, French kissing, etc.)
• A child having age-inappropriate sexual knowledge.
• Increased chemical use.
• Increased sexual behavior.
• Individual has lots of fears.
• Shows inappropriate emotions or no emotions at all.
• Fearful others hate them, are angry, want to hurt them, punish them or kill them.
• Fearful someone is “after them” or going to hurt them; wary of strangers.
• Has low self-esteem.
• Struggles with forming or maintaining friendships.
• Engages in self-destructive behaviors; intentionally inflicts harm on self.
• Appears to be “in a fog.”
• Experiences excessive mood swings.
• Suicidal thoughts, statements or gestures

Recovery from abuse is a bit of a process. I highlight the broad themes here.

1) Find Safety. If you are in immediate or ongoing danger, you’ll need to be in a safe place. There are treatment programs, and/or shelters available for this area. Look for Domestic Abuse or Sexual Violence programs in your local area.
2) I encourage you to find a therapist/professional help. My experience is that this can be a significant process for many clients. For clients who have severe experiences, the treatment process is rather entailed.
3) Once stable, tell your story. And then tell your story again and again. Group support/therapy is helpful. The decrease in shame, fear and isolation that occurs through group can be powerful. Understanding that “I’m not alone” and “Someone understands” is a powerful source of hope. I often have clients complete an “abuse history” describe the life history of abuse. Lest that scare you, remember the next step.
4) Take it slow. This is a long process. Sharing your story once is only the start. Moving forward sometimes requires 3 steps forward, 2 back. I start the assignment on the abuse history by focusing on 4 events: “Describe 4 (or whatever number) events.” Or, simply acknowledging “I’ve been abused” is the first step.
5) Identify triggers. Once you know your history, understand what triggers flashbacks and struggles in your current daily functioning. You’ll need to develop plans to address the triggers.
6) Move forward. What do you want your life to look like? This is hardest place to get to in therapy. The level of fear and lack of hope will need to be resolved prior to this place.
7) Put a plan in place. Follow the plan. Developing healthy intimacy and health sexual expression is in of itself difficult. My last two posts describe this process.
8) Journal, Journal, Journal. Journaling is both for the therapy process, as well as reminders of your progress. When frustrated, recognizing where you’ve been, what you’ve come through, and where you’re going is helpful. Some clients “beat” themselves up because they can’t talk to everyone at a party because they are uncomfortable. A journal can highlight how simply getting to an event is amazing progress. Journaling doesn’t have to mean writing; given technology this can include video recordings, or art or other forms of expression.

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