Survivors of Abuse
Issues of Abuse
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The Prominent feature in all forms of
abuse is power.
Most abusers are fearful of losing control.
Abuse escalates during pregnancy.
There is a CYCLE OF VIOLENCE.
Cycle does not apply to sexual abuse.
Helpful responses to Abuse
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Ask if abuse is occurring
Identifies described behavior as abuse
Acknowledges the seriousness of abuse
Being directive in exploring resources
informing about shelters, other resources
 support groups
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Active listening
Unhelpful responses to Abuse
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Displays of anger toward abused
Blaming victim
Giving advise
Ignoring abuse
Aligning with the abuser
Refusing to help the person until they
leave the abuser
Other Issues
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Family violence is accompanied by
brainwashing
Hostage Syndrome
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Victims always blame themselves
Feel unworthy of help
fear they will not be believed
Most common form of abuse is sibling
abuse
Family violence
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Elder Abuse
Parent abuse by violent adolescents
LOW COST TO PERPETRATORS
Two Types of Violence in Couples
Expressive Violence and Instrumental
Violence
Instrumental and Expressive
violence
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Expressive violence is
mutual combat
Goal is to express
emotions/and hurt
Role of victim and
perpetrator are not fixed
Partners share
responsibility for violence
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Instrumental violence
is unequal conflict
Goal is CONTROL
another
Role of victim and
perpetrator is fixed
Victim is ALWAYS
trying to please and
placate
Treatment issues
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Couple counseling is inappropriate for
Instrumental violence
Victim must be safe/ Arrest policies very
important/Danger is real
Groups very important modality
Progress is made when victim starts defining her
strengths
Assess for alcohol and drug use
LONG term goal: Change self concept from
victim to survivor status
Child Abuse
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DEFINITION
CHARACTERISTICS OF PARENTS
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May have been abused as a child
Lack of knowledge of normal development
Lack of parenting skills; no role models
Socially isolated, stress, low self esteem
Lack of trust in the system
Abuse of alcohol and drugs
Characteristics of the Child
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Position of child, sex of child
Product of difficult labor and delivery
Physically ill, hyperactive, sleeplessness
Temperament of child performing tasks
Environment
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Chronic stress, divorce, financial stress
Instability; absence of support system
Socioeconomic level may influence
Paternalistic culture: Rule of thumb
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Spare the rod, spoil the child
Assessment: nursing care
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Physical evidence of abuse
Conflicting stories about the “accident”
Child with concussion fell out of bed.
 6 month old turned on hot water
 Concern about a cold when burns are present
 excessive delay in seeking treatment
 parent absent when you try to question
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Assessment Cont:
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Inappropriate response of the child
Little or no response to pain
 Excessive fear of being touched
 Excessive or lack of separation anxiety
 Indiscriminate friendliness to strangers
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Previous reports of abuse
Repeated visits to the ER for injuries
Legal Aspects
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When must we report abuse
Who must report. Professionals are held to
a higher standard
It is not enough to just report abuse to
the Health Care Provider (MD or FNP) and
hope for the best
School nurses observe abuse and must
report
When to Report
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A Child or Elder; Abuse Neglect or Exploitation
Adults: it is up to the individual to report
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Toll Free Hotline 1-877-786-7263
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(1-877-STOP ANE)
Local telephone: (512) 424-6716
Facsimile (512) 424-6700
Email abuseneglect@tjpc.state.tx.us
Address
4900 North Lamar, 5th floor
Austin Texas 78751
http://www.rockwallcountytexas.com/DocumentView.asp?DID=541
Characteristics of the family
Maslow's hierarchy of needs
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Security
Self Value
Strokes (Recognition)
Stimulation
Structure
Self actualization
The Healthy Family
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Each member works on
basic tension of:
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Problems, but the family
owns them
Like an orchestra
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How can I maintain a
sense of self and remain in
this family.
everyone is playing their
own instrument but are
playing the same tune
Open System
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Each person can get their
needs met.
Each spouse can function
without the other
Open and flexible;
members have other
relationships in the
community
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An open system vs. a
closed system
The Unhealthy Family
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The basic unit is:
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immature and needy
low self-esteem
not in the relationship by choice
enmeshment
A closed system
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Dependent on each other to get needs met
Communication is triangulated
Triangles in Communication
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Mother talks to child
about problems with
Father
Child tries to support
mother and meet her
needs
Child also tries to support
father and meet his
needs
Mother needs to talk to
Father and not the child
The Dysfunctional Family:
CO-DEPENDENT
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Appears insecure; hides strength
Submissive, humble
Hates decisions
Individual blames self
Other centered
I understand this is just a front
I will just try harder
Insecure, angry and shamed
Dysfunctional Family:
COUNTER DEPENDENT
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Self-centered
Insensitive and proud of it
Intrusive and intimidating
Insecure, angry and shamed
Appears secure, hides fear
Grandiose, power dominance
Who do I trust: me
Who is at fault: them
Deny weakness
Boundaries
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Emotional and physical space between you and
another person
Where you stop and the next person begins
A Limit that others are not allowed to cross
because of the negative impact
Allows for appropriate closeness in the
relationship
Boundary within a family:
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If a bathroom or bedroom door is shut
Knock and wait
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http://www.homespunhealers.com/setting-healthy-boundaries
Healthy Boundaries
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The right and need for the individual to:
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To explore
Interests
 Hobbies
 Outlets
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Make their own mistakes
Bring back to the family:
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My unique personality to enrich our lives
Healthy Boundaries
Prevent
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Enmeshment
Dissociation
Excessive Detachment
Incest Family Dynamics
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Multigenerational and Multifaceted
Mother
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Father
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Parentified in family of origin
Low self-esteem
Immature and dependent
Needs mothering
Self-centered
Relationship
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She “mothers” him
Children place stress on the relationship
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Less time to take care of the father
Needs are left unmet
Incest Family Dynamics
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Mother becomes overwhelmed
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Increases if family
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Has increased stress
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Several children
Financial problems
Chronic illness
A child becomes parentified
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helps mother in caretaker role
helps to meet father’s needs
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Father feels neglected by mother
Looks to child for affection
Incest occurs gradually as child begins to take on the
mother’s roles
Family places the child’s needs last
Incest
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Confusion created by the perpetrator
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Child believes it is their fault
Father coerces child to keep secret
Father perceives child as sexual peer
Closed system
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Isolated family
Must keep the secret
Mother and child relationship
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Mother denies sexual abuse is happening
Ambivalence
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Love for the mother
Anger about the lack of protection from abuse
Survivors of Childhood Sexual
Abuse
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Adult perpetrator is most often known and trusted
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Fathers, brothers, camp councilors, coaches, religious leaders
Most often male perpetrator
92% of females: male perpetrator
38% of males: female perpetrator
Average length of time of when an adult begins to perpetrate children
and they get caught is 9 years
Abuse most often begins before the age of 7
Childhood sexual abuse
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15% to 30% of girls
4% to 16% of boys
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More difficulty reporting
Fear of being labeled gay or weak (male perpetrator)
They are supposed to like it (female perpetrator)
Incest
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Incest (p.488)
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Sexual victimization of a child or adolescent
Perpetrator does not seek occupations for access to victims
Relationships by
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Perpetrator looks to the child for
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Blood or Marriage
Gratification
Fulfillment
Power and control
Child may feel special
Distorted thinking
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Teaching the child about sexuality
Giving the child pleasure
Pedophilia
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Pedophilia (p.487)
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Primary sexual attraction is to children
The victim is younger than 13
Pedophile
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16 years or older
5 years older than victim
Expressed towards either same-sex or opposite-sex children
Pedophile
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May need to feel power over the victim
Provides more control than relationships with adults
Attracted to children
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Less than 13 years old
Lack of secondary sex characteristics
Sexual Abuse
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All Survivors are not the same
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Differs from physical abuse
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Effect of sexual abuse varies with factors
not cyclical
Neglect can play a powerful role
Effects of Abuse
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Can contribute to:
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Depression
Personality problems
Achievement
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May marry abusive spouses
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Grades and achievement drop
Super-achiever; often care takers
Use alcohol and drugs
Develop mental illness
Problems with trust
DSM IV DX
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Anxiety Disorders
Major Depression
Post Traumatic Stress Disorder and Acute
Stress Disorder
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(reviewed in the crisis module)
Dissociative Identity Disorder
Dissociative Identity Disorder
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Presence of 2 or more distinct personalities
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At least 2 of these personalities take control of the
person’s behavior
Very difficult to diagnose
Response to severe abuse in CHILDHOOD
In order to be multiple, must be able to
dissociate.
The greater the severity of dissociative
symptoms, the smaller the left hippocampus is.
Dissociative Phenomena
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All of us dissociate
Dissociation is the defensive device by which
people split off from conscious awareness
different aspects of experience
 Aspects are: cognitive, affective, behavioral
and somatic
 Ever been bored and “left class”
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S.A.N.E.
Sexual Assault Nurse Examiner
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This Registered Nurse is educated to be able to:
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Provide comprehensive care to sexual assault
survivors
Demonstrate competency in conducting a forensic
exam to include evaluation for evidence collection
Have the expertise to provide effective courtroom
testimony
Show Compassion and sensitivity to survivors of
sexual assault
http://www.oag.state.tx.us/victims/sapcs.shtml
Unhelpful Responses
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Displays of anger toward abused
Giving advise
Ignoring abuse
Aligning with the abuser
The Therapeutic Relationship:
Helpful Responses
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Ask if abuse is occurring
Identifies described behavior as abuse
Acknowledges the seriousness of abuse
Acknowledge feelings
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Being directive in exploring resources
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Seeing you hurt upsets me
informing about shelters, other resources
support groups
Active listening
The Milieu
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Provide a safe environment
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Clients can be comforted by the locked environment
Inpatient Psychiatric Units
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Consistency
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Response to the client’s behavior is always the same
Communicate the staff are here to keep you safe
Be careful with the use of touch
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Misunderstood
Abreaction
 Recall of a repressed traumatic experience
 Client re-experiences the abuse
Client will test to see if the Nurse will remain therapeutic or become
abusive
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Remain nonjudgmental
Objective
Non-threatening
Therapy for the Survivor
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Group therapy
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Rape Support Groups
Incest Survivor Support Groups
Survivors of Childhood Sexual Abuse
Sexual Abuse and Children
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Memories change over time
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“I should have stopped it”
“Bad Girl”
“Fix” the memory
Talk about it
Allow the Survivor to talk