RESUMEN
OBJECTIVE: To compare the effectiveness of 10 sessions of group therapy with that of 10 sessions of individual therapy in a sample of 86 adult women seeking treatment for the effects of childhood sexual abuse. METHOD: Participants were randomly assigned to the 2 treatment modalities and tested at assessment, pretherapy following a 10-week wait condition, posttherapy, and 6-month and 12-month follow-up. RESULTS: Participants had fewer symptoms and better psychosocial functioning posttherapy and were further improved at the 6- and 12-month follow-up. Neither treatment modality was superior to the other. Approximately one-half of the sample sought further treatment during the follow-up periods. CONCLUSIONS: Improvement in symptoms and functioning was associated with short-term treatment in both modalities, but many patients remained distressed and required further treatment. Future research should investigate whether sexually abused women who meet criteria for specific diagnoses require more focused and/or longer-term therapy.
Asunto(s)
Abuso Sexual Infantil/terapia , Psicoterapia Breve/normas , Psicoterapia de Grupo/normas , Adulto , Análisis de Varianza , Niño , Abuso Sexual Infantil/psicología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Aceptación de la Atención de Salud , Estudios Prospectivos , Psicometría/métodos , Psicoterapia Breve/métodos , Psicoterapia de Grupo/métodos , Autoimagen , Sobrevivientes/psicología , Factores de Tiempo , Resultado del Tratamiento , Mujeres/psicologíaRESUMEN
BACKGROUND AND PURPOSE: The high rates of prevalence of childhood sexual abuse in the United States and Canada suggest that physical therapists work, often unknowingly, with adult survivors of childhood sexual abuse. The purposes of this qualitative study were to explore the reactions of adult female survivors of childhood sexual abuse to physical therapy and to listen to their ideas about how practitioners could be more sensitive to their needs. The dynamics and long-term sequelae of childhood sexual abuse, as currently understood by mental health researchers and as described by the participants, are summarized to provide a context for the findings of this study. SUBJECTS AND METHODS: Twenty-seven female survivors (aged 19-62 years) participated in semistructured interviews in which they described their reactions to physical therapy. RESULTS: Survivors' reactions to physical therapy, termed "long-term sequelae of abuse that detract from feeling safe in physical therapy," are reported. Participant-identified suggestions that could contribute to the sense of safety are shared. CONCLUSIONS AND DISCUSSION: Although the physical therapist cannot change the survivor's history, an appreciation of issues associated with child sexual abuse theoretically can increase clinicians' understanding of survivors' reactions during treatment. We believe that attention by the physical therapist to the client's sense of safety throughout treatment can maximize the benefits of the physical therapy experience for the client who is a survivor.
Asunto(s)
Actitud Frente a la Salud , Abuso Sexual Infantil/psicología , Modalidades de Fisioterapia/métodos , Sobrevivientes/psicología , Adulto , Actitud del Personal de Salud , Imagen Corporal , Niño , Empatía , Femenino , Humanos , Persona de Mediana Edad , Evaluación de Necesidades , Participación del Paciente , Relaciones Profesional-Paciente , Seguridad , Encuestas y CuestionariosRESUMEN
This study examined internal working models of attachment as assessed by the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1984) and self-other differentiation as assessed by the Description of Significant Other (Marziali & Oleniuk, 1990) in a clinical sample of 40 women reporting a history of childhood sexual abuse. Although there was some relationship between the two measures, the association was not strong. The Cannot Classify category of the AAI, which is increasingly being assigned in clinical samples, needs refinement to increase the usefulness of the AAI for clinical purposes. Integration of concepts from objects relations theory may also enhance the value of the AAI in studies of clinical samples.
Asunto(s)
Abuso Sexual Infantil/psicología , Individualismo , Salud Mental , Apego a Objetos , Adulto , Análisis de Varianza , Niño , Femenino , Humanos , Persona de Mediana EdadRESUMEN
OBJECTIVE: To explore the possible associations among attachment organization, current functioning and Axis II personality disorder. METHOD: Attachment organization was assessed using the Adult Attachment Interview in a clinical sample of 40 women with a history of childhood sexual abuse. The Global Assessment Scale yielded measures of current psychosocial functioning and the Structured Clinical Interview for Diagnosis on DSM-III-R was used to assess presence of personality disorder. RESULTS: Preoccupation with attachment issues was evident in 68% of the subjects; 60% of the subjects were unresolved in respect to loss and/or trauma; and 88% of the subjects met criteria for one or more Axis II disorders. A relationship between Borderline Personality Disorder and the Unresolved attachment classification is suggested. CONCLUSIONS: Women who have experienced childhood sexual abuse require intervention that focuses on resolution of trauma and loss and responds to individual differences in attitudes toward attachment issues.
Asunto(s)
Abuso Sexual Infantil/psicología , Apego a Objetos , Desarrollo de la Personalidad , Trastornos de la Personalidad/psicología , Adaptación Psicológica , Adulto , Trastorno de Personalidad Limítrofe/clasificación , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/psicología , Niño , Femenino , Estudios de Seguimiento , Humanos , Individualidad , Persona de Mediana Edad , Determinación de la Personalidad , Trastornos de la Personalidad/clasificación , Trastornos de la Personalidad/diagnóstico , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicologíaRESUMEN
Thirty-three couples with severe marital discord referred to a psychiatric outpatient department were randomly assigned to Cognitive Marital Therapy or a control group. Cognitive Marital Therapy is a brief, structured couple therapy, which involves spouses in reciprocal self-disclosure of personal constructs. The control group received the same number of sessions of self-disclosure from a programmed marital enhancement text. Personal distress, marital adjustment, marital quality, and aspects of self-disclosure were measured before and after treatment. Symptoms of depression as well as somatic and compulsive complaints showed significant improvement in both groups. The wives exhibited a trend suggesting that they were making more self-disclosures to their spouses after counseling. No discernable differences in outcome were found between the marital therapy group and the control group. Marital intimacy and marital satisfaction did not improve significantly over the course of 10 therapy sessions. This study suggests that the role of self-disclosure in marital therapy needs further clarification.
Asunto(s)
Terapia Cognitivo-Conductual/normas , Terapia Conyugal/normas , Matrimonio/psicología , Autorrevelación , Estrés Psicológico/terapia , Adaptación Psicológica , Adulto , Terapia Cognitivo-Conductual/métodos , Femenino , Humanos , Masculino , Terapia Conyugal/métodos , Persona de Mediana Edad , Estrés Psicológico/diagnóstico , Estrés Psicológico/psicología , Encuestas y CuestionariosRESUMEN
Preliminary data from a randomized study of the effectiveness of combined marital therapy and antidepressant medication in the treatment of dysthymic married women is presented. The study compares doxepin with placebo, and a marital therapy designed to enhance intimacy through facilitating self-disclosure between spouses with a more supportive and educational therapeutic approach. After ten weeks of combined treatment, the dysthymic women show statistically significant improvement on all the depression measures as well as on the intimacy scale. A trend is developing for greater reduction of depressive symptomatology in the group treated with self-disclosure. The evidence appears to suggest the possibility that the presence of a patient's husband as a supportive figure may of itself be a potent therapeutic manoeuvre in the treatment of dysthymic women.