There is recovery [and] there is hope that people can experience even after having a horrific experience. Nancymarie Bride, an LPC, certified clinical mental health counselor and adjunct faculty member at Kean University in New Jersey, says individuals who have experienced domestic violence are often marginalized by the general public and even by mental health professionals.
Other clients assume that the term abuse should be applied only if a spouse or intimate partner has hurt them physically. These clients do not necessarily recognize psychological, verbal or other nonphysical forms of abuse as abuse. But a lack of recognition is not the only thing that keeps clients from bringing up a history of abuse with counselors, Murray says. Many victims and survivors feel a sense of shame or embarrassment about these experiences.
Some even feel they are somehow to blame for being the target of abuse. Others fear being judged or are otherwise unsure of how a counselor might react to their revelation. And some clients try to keep the truth hidden for safety reasons, Murray says, having been threatened with further harm by their perpetrators should they ever tell anyone. He suggests that counselors talk to clients about what it would look like if there were a problem. Once the counselor establishes what the client views as abuse, the counselor can begin to challenge those beliefs, Ballantyne says.
He adds that open-ended questions are most useful. For example, he says, ask the client how his or her personal definition of a healthy relationship is working out. What has it led to? Has it led the person to counseling? Clients who have a history with domestic violence can present with myriad related issues, Crowe says. For instance, they may have symptoms of posttraumatic stress disorder PTSD , including feeling unsafe, experiencing flashbacks or being jumpy, she says. The counselors interviewed for this article also mentioned helping these clients with issues such as anxiety, depression, panic attacks, emotional withdrawal, feelings of helplessness and low self-esteem.
The self-blame and guilt associated with not leaving an abusive relationship sooner, especially if that relationship also involved children, is another major issue that counselors and clients must commonly work through together, Crowe says. Providing psychoeducation and teaching clients what a healthy relationship looks like are basic but useful techniques that counselors can use, she says. Crowe and Murray recently surveyed and interviewed more than domestic violence survivors male and female for a research project.
The duo is preparing to publish its findings in an educational journal, as well as through a website seethetriumph. Through their research, Murray and Crowe heard from domestic violence survivors who felt stigmatized not just in general society but also by the professionals they had turned to for help.
In another case, a police officer asked a victim of domestic violence out on a date when she came to the station to file a report. Understand that simply giving your business card to an abuse victim can put that person in danger should an overcontrolling spouse or partner see the card and lash out in anger, Bride warns. For example, counselors should use caution when working on assertiveness with a client who is still in a relationship with his or her abuser. If a client were to go home and try being more assertive with his or her partner, that action might spark more abuse, she points out.
Counselors should create and talk through a safety plan with their clients. This intervention can be done with children and adults, victims and perpetrators. For victims of intimate partner abuse, a safety plan might include keeping an extra house key and change of clothes in the car in case their spouse or partner throws them out during an argument.
Murray recommends the Safety Strategies website DVsafetyplanning. Treading gently: A client who has been involved in abuse has been traumatized, and discussions about the abusive situation can trigger PTSD-like symptoms, Murray says.
In addition, counselors must guard against judging these clients or even coming across as judgmental, Murray says. Victims or survivors of intimate partner abuse will talk about that abuse only when they are ready, Bride adds. Instead, she recommends asking more behavior-specific questions: Has your partner ever called you names?
Who makes the decisions in the relationship? Does your partner check up on you? Have you ever been injured in a fight with your partner? Counselors can also help clients learn coping mechanisms to deal with co-parenting children with an abusive ex-spouse or returning to the dating scene after an abusive relationship.
Also touch base and network with other professionals in your community, such as law enforcement personnel and social workers, who have frequent contact with victims of abuse. Counselors should also learn the basics regarding how a client would file a police report or restraining order. Journaling can be another useful therapy tool, she says, as can trauma-focused approaches such as developing coping resources, dealing with stress, goal-setting, relaxation, self-reflection and self-care.
Ask them to describe what they think a healthy relationship looks like. Ballantyne advises developing strategies to help these clients regulate their feelings, such as learning coping skills that will aid them in calming down and working through their sadness, anger or anxiety in a positive way. View access options below. You previously purchased this article through ReadCube. Institutional Login.
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Log in to Wiley Online Library. Purchase Instant Access. View Preview. Learn more Check out. Abstract Objective: To generate a framework of healing by male survivors of childhood sexual abuse. Design: Qualitative using grounded theory methodology. Citing Literature. Volume 28 , Issue 4 December Pages Related Information. Close Figure Viewer. Browse All Figures Return to Figure. Previous Figure Next Figure.
Log in with your society membership Sigma Membership Login. Email or Customer ID. Forgot your password? However, follow-up studies on treatment outcomes are rare Lamoureux et al. Those that are described in the literature, for example, trauma-focused cognitive behavioral therapy TF- CBT Deblinger et al. Other treatment modalities that were developed and are used by professionals do not have clear protocols, nor have they been scientifically tested for their effectiveness Trask et al.
Nevertheless, evidence indicates that symptom reduction is often temporary Trask et al. To achieve persistent recovery, all aspects, psychological and physiological, must be targeted. This led Lev-Wiesel Lev-Wiesel, to suggest and clinically implement the specific treatment of creative art psychotherapy model that aims to restore integration between body and mind. The model uses the physical expression through art means to process the energy stored in the body, which resets the neurological system into better balance.
It also enables the appearance of conscious and unconscious meaningful symbols, which in turn encourages verbalism. This modality answers the body and mind dimensions only. It does not consider the brain dysfunction that has been found to occur.
Therefore, based on the previous evidence indicating that CSA is a unique trauma resulting in a damaged brain, a wounded body, and a distressed mind, a more comprehensive approach was required, including a metabolic intervention that is capable of inducing brain neuroplasticity. Thus, healing as the final objective of the intervention means integration between the dissociative subsystems of the victim's personality, reduction or elimination of symptoms, and reconnectivity between brain areas.
Since the quantitative data including the brain scanning was presented previously, we show here the emotional process of participants as reflected throughout the study in their diaries. All women had already underwent psychotherapy for at least a year prior to their inclusion and fulfill fibromyalgia diagnosis criteria for at least 5 years prior to their inclusion. The mean age was After signing an informed consent form, participants underwent baseline evaluation which included medical history, physical examination, psychological interview, questionnaires and brain imaging.
I was married to a narcissist for 12 years — and I had NO idea
The dual treatment included HBOT and psychotherapy concurrently. HBOT is conducted in a multi-place hyperbaric chamber. As mentioned above, in addition to the quantitative measurements and brain scanning measures that were used in the study this paper is based upon, participants kept a daily journal reporting their sensations, emotions, and experience of the treatment. This data was analyzed. Also, examples of participants' treatment summaries given to authors during a group meeting 6 months after the termination of the dual treatment, are presented.
Interpretative phenomenology involves a conversation that brings together the discourse of the participants, the questions posed by the researcher, the interpretations offered by the participants themselves, and the interpretations provided by the researcher. The data written daily journals were analyzed using the procedures of hermeneutic phenomenology, as outlined by van Manen , namely the selective highlighting approach. Following these methodological guidelines, the search for themes or structures of the experience involved selecting and highlighting sentences or sentence clusters that stood out as essential to the experience.
It is important to note that the daily journals were sent every day, via email, to the therapist who was assigned to accompany the participant during the research. Thus, it was first read by the therapists and was later reread by the researchers, as the data accumulated and the broader clusters of themes gradually emerged. The participants' accounts were read and reread as a whole, in the process of hermeneutically interpreting these texts as inscriptions of lived experience, to identify relevant and significant expressions, to identify emerging themes, to note connections and then to group them thematically.
A Publication of the American Counseling Association
Following this initial reading and rereading of the journals as a whole, they were read, again, with special attention to precise phrases and changes in feelings, sensations, and cognition over time that related to the experience of participants within and outside the hyperbaric chamber. In the course of this focused reading phase, highlighted expressions were identified and clustered into recurrent themes that revolved around significant aspects of the participants' lived experience. The analysis aimed to create a comprehensive account of the themes which seemed significant to the therapeutic procedure.
On completion of the individual analysis, lists of themes were compared from all journals and assembled as themes within higher-order categories. At the point of saturation, which became evident when there was a recurrent replication of data concerning the emerging essential themes, marginal themes were dropped, and more prominent themes, which were found to be fundamental and distinctly related to the participants' experience, were expanded.
The following is an example of concerns and thoughts raised by colleagues at the discussion: To what extent variables such as the age of CSA onset, use of meditation techniques prior and during the HBOT session, present age, might impact the length of each phase? This section is divided into two parts: the first focuses on the themes emerged from the daily journals including drawings ; the second part presents participants' summaries of the treatment experience and outcome, 6-months following termination of the dual treatment.
The experience of receiving HBOT was divided into three phases, each consisting of about 20 sessions. The first phase was characterized by acute experiences of diffuse physical pain followed by recovered negative dissociative traumatic memories. The second phase was often characterized by body relaxation, reduction of symptomatology and recall of positive memories. The third phase was characterized by physical energy, feeling of aliveness, change of time perception concerning eager anticipation to the future.
In the first phase between 1 and 20 hyperbaric oxygen treatments , participants reported bodily pain during treatment which was usually limited to the time in the oxygen chamber. Sometimes the physical pain was so severe that participants cried and felt the need to escape. This was followed by painful memories, including retrieval of forgotten or dissociated memories. For example, one participant reported experiencing flashbacks of being sexually molested.
The flashbacks during treatment sessions, often started with unbearable sexual arousal, accompanied by shortness of breath and other symptoms of panic attacks. Fragments of memories appeared, in which several of her peers were raping her. Unexpected to her, she recovered a total repressed dissociated memory of having repeatedly been molested and raped by classmates, at the age of fourteen.
She undressed me, ordered me to open my legs and then began to abuse my genitals. These memories of abuse by her mother had not surfaced before the HBOT, nor during psychotherapy given before the dual treatment. Although having the oxygen mask, I wonder whether something is wrong with the mask or is it me…I suddenly saw myself in my underwear at about four years old…my brother helped me dressing up, and suddenly he laid me on the bed and shoved his penis into my throat…I could not breathe.
Some participants created drawings during the HBOT treatment in the oxygen chamber and included it in their daily journals, while others drew after the treatment. Here are two drawings see Figures 1 , 2 that were drawn by two participants during this first phase:.
Emotional and Psychological Trauma
Figure 1. A drawing made by a years-old participant, who had been sexually abused by her father. Figure 2. A drawing drawn during the first phase of HBOT by a years-old participant, who had been sexually abused during childhood by a family member. The two drawings reveal distress, fear, sadness, and entrapment.
Whereas, the traumatic sexual abuse event seems apparent in the first drawing, the figure of the little girl is caught by a kind of monster in the second drawing. Participants described the second phase between 20 and 40 HBOT sessions as the soothing phase. Participants described the following changes: They began to feel better physically, sleeping difficulties and disturbances were significantly reduced, nightmares were gone, they felt like they had more energy during the day, and they breathed better.
Regarding the painful memories, additional dimensions of observation and interaction were added to these memories, in which the study participants interacted with their younger selves, and their younger selves revealed more to them. During this phase physical pains vanished, participants' dissociative memories fully recovered, and feelings of sorrow and compassion for oneself increased, replacing the previous old feelings of horror, fear or disgust. Also, good positive memories emerged.
The following are two drawings drawn during the second phase see Figures 3 , 4. Figure 3. A drawing made during the second phase by a years-old participant, who had been sexually abused by her father. Figure 4. A drawing drawn during the second phase of HBOT by a years old participant, who had been sexually abused during childhood by a family member. The two drawings reveal a sense of relaxation and safety. In the first drawing, the inside figure lies in the chest-stomach area as floating. In the second drawing, the girl is protected by a tree trunk yet open to the world.
Although she seems not ready yet to hand her hands hands behind her back , she can see and be seen by the world. During the third phase between 40 and 60 sessions , participants reported a dramatic reduction of physical Fibromyalgia and emotional depression, anxiety, distress, dissociation symptoms, as well as a great increase in energy, in the ability to enjoy life, and in creativity, in the sense of coming up with new ideas of what they would like to achieve and do.
Figure 5. A drawing made during the third phase of HBPT, by a years-old participant, who had been sexually abused by her father. Figure 6. A drawing drawn during the third phase of HBOT by a years old participant, who had been sexually abused during childhood by a family member. The figures in the drawings look happier compared to the drawings in the previous phases, facing the world smiling and not hiding in a shelter. Both look very feminine emphasizing beauty and serenity and kind of decisiveness. About 6-months following the therapy completion, participants were invited to a group meeting to share their experience.
They were also asked to narrate their experience. Twenty-three women attended the meeting. Five could not participate due to previous commitments, two turned down the invitation one of these women dropped out after 50 sessions complaining of headaches worsening. From the group meeting and the narratives submitted, it seems that the dual treatment dramatically changed participants' wellness in different life domains. I had a long history of treatments 20 years of every kind of treatment-dynamic psychotherapy, EMDR, hypnosis, mind, and body treatments, many years of meditations, etc, not even mentioning the attempts to treat myself through all sorts of opiates.
Within three months of the receiving HBOT and intensive art psychotherapy, I began to feel different, gained strength, started to relate to myself as a worthiness person, a person that remember the past but not sank into it. I have a future. Believe in a better future, an optimistic future for my family and for me.
This wasn't always easy. There were times that I needed a lot of support from my therapist, a daily, sometimes day and night support. To overcome the vivid memories that awakened, the physical pain, the fears, the sense that the world is not a safe place- a feeling that I acquired at a very young age. I broke into uncontrolled weeping from at the beginning of the treatment during the HBOT treatment. Slowly, and with the daily accompaniment of writing and meaningful therapy sessions, the memories were cast into words and drawings, I could shed layer after layer: weightiness, depression, anxiety, helplessness, denial, and numbness.
I am happy to say today that everything changed for me, how I look, the way I perceive myself, the way I cope with hardships, the life I would like to lead. I used to be afraid of losing control.