MGG2602 Exam Summaries.

MGG2602 Exam Summaries. MGG2602 - Sexual Trauma. THEME ONE - DEFINING STRESS, CRISIS AND TRAUMA Stress: The strain we feel at different times in our lives or in different situations. A set of external forces impinging on an individual (unemployment, high crime rate) A set of psychological and physiological reactions experienced – sweaty hands, racing heart, negative self-talk. Nerves, anxiety, panic, tension, pressure. Stress should be considered an opportunity for growth; the spark that pushes us to challenge the situations we find ourselves in and to find new ways of coping. The extent to which the individual experiences stress depends on: The event itself The individual’s personality The individual’s ability to cope Crisis: A normal reaction that an individual has to a difficult experience that they have not had to face before. When a person is in a crisis they feel confused, overwhelmed and unable to cope. It may be an external event - work related, losing money; or an internal event caused by development – becoming a wife etc. Crisis can be a turning point – an opportunity for an individual to discover and use inner strengths to adjust to a changing world, find relevant supportive resources and learn new skills that can be generalised to resolve future crises. Trauma: Situations “in which the victims are rendered powerless and great danger is involved” A profound deviation from normal life experiences Sudden, overwhelming and unanticipated. Individual experiences fear, helplessness. Loss of control and extreme powerlessness. The trauma inducing situations suggests a threat of injury or death of the person or others around them. Expected loss – parent, job. Loosing several family members, or an accident, natural disaster = unexpected, overwhelming, out of the ordinary. Judith Herman: “Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptions to life” Involve threats to life or bodily integrity, or close personal encounter with violence and death. Individual feels helplessness and terror MGG202X – Sexual Trauma Exam Summaries Page 2 of 87 The effects of trauma: Because of intensity and magnitude, trauma overtaxes the human’s ability to cope. May damage the mental health. Traumatised people feel and act as though their nervous systems have been disconnected from the present. Person is left with a persistent expectation of danger, an imprint of the traumatic event that does not want to fade and a numbing response of giving up that becomes generalised. Impact of trauma on psyche has major influence on the individual’s normal ways of thinking and feeling – so previous coping mechanisms are no longer effective / functional. Traumatic events may impact on the person’s personhood, individuality and humanity. The impact of the trauma may be aggravated by the insensitive handling of those who deal with them after their traumatic event. Different kinds of trauma Caused by nature – natural disaster: flood, fires, hurricanes Caused by humans – an atrocity – man made catastrophes: war, terrorism, bus disasters, civil unrest Unintentional violence – car accident, culpable homicide Intentional violence – physical assault, sexual assault, domestic violence, hijacking – all of which encompasses forms of victimisation involving a threat to life, health and limb. Sexual trauma falls within this category. Direct vs indirect trauma Traumatic event may affect witnesses and those who have direct contact with the direct victim = indirect traumatisation. Any person who witnesses a death, rape, assault of another is at risk of being traumatised. Symptoms experienced by victims of indirect trauma can be identical to those of the victims of direct trauma. Policeman, journalists, helping professionals – need to take precautions against this; have access to debriefing sessions Loved ones and family members / children of victims of trauma also can suffer indirect trauma. An individual can be both a direct and indirect victim of trauma. i.e. child witnesses mother being raped (indirect) whilst being held hostage during a robbery (direct) Single vs Multiple trauma Single event – armed robbery / loss of a limb / cancer Multiple – a person who has been hijacked several times. MGG202X – Sexual Trauma Exam Summaries Page 3 of 87 Continuous vs complex trauma Continuous traumatic stress: where people are exposed to on-going trauma. i.e live in areas of high levels of violence and constantly exposed and constant threat. They appear to develop a ‘numbing’ response to any new or additional traumatic events, making it more difficult to detect they are traumatised. May be mistakenly regarded as being lethargic / depressed. As they don’t understand what is happening to them – they don’t ask for help. Complex trauma: situations in which victims experience prolonged repeated traumatic events; usually a relationship between the victim and the offender . Marital rape / child who is sexually abused by parent. Very damaging – victim is under the control of the offender and cannot escape for extended periods People respond differently to all experiences of stress / crises. What is stressful to one person, may be regarded as a crisis by another, and as trauma by another. There is a hypothetical continuum that plots stress, crisis and trauma and demonstrates the increase in intensity from stress to trauma. Each person perceives his or her individual experiences in a unique way and practitioners should never use their definition of stress crisis and trauma, but the client’s definitions. Defining Sexual Trauma i. It’s a trauma of a sexual nature ii. The trauma creates emotional turmoil for the survivor iii. The trauma may impair the trauma survivors functioning in certain areas, such as selfesteem, relationships and others with sexuality. iv. These problems may only manifest much later, when the4 survivor develops an understanding of the wrongness of the activities he or she participated in, given that his or her participation my even have been passive. Sexual trauma often involves not just one single event, but a series of events. Sexual trauma affects a person’s sexual adjustment, wounds their soul, and impacts on many areas of his or her social functioning, creates havoc with health (HIV after rape) Critical issue: the extent to which a person is affected by an unanticipated outcome. It is trauma when it is unanticipated, the victim experiences a sense of powerlessness and has to deal with perceived threats to the self of loves ones. Rape and child sexual abuse Physiological origins of sexual trauma Theories – impotence, cancer of the genitals, HIV, infertility – all create a sense of helplessness, they are unplanned and unexpected, thereby creating confusing in the lives of MGG202X – Sexual Trauma Exam Summaries Page 4 of 87 their victims. They impact on self-esteem, relationships with others, sexuality and can be life threatening (HIV, Cancer) Female Genital mutilation – a traditional practice in some African cultures – may result in sexual trauma. The impact of Trauma Trauma is a blend of different behaviours, feelings and physical responses. You cannot stereotype survivors with a set of responses. Symptoms should always been seen as normal responses to abnormal situations. Vast variables at work when individual is traumatised: age at the time of incident, relationship with the perpetrator; their gender; duration of trauma, amt. of violence involved, psychological history, perspective of the trauma. The body’s response to an abnormal amount of stress Threat arouses the sympathetic nervous system, causing an adrenalin rush, and the threatened person to go into a state of alert; Invokes feelings of fear and anger, person becomes poised for strenuous action to fight or to escape the threat. When the person is unable to resist, escape, then a traumatic reaction occurs. Person’s self-defence system becomes confused and disorganised, resulting in person having prolonged changes in physical arousal, emotion, cognition and memory. These individuals startle easily and usually have strong reaction to stimuli that may be associated with the traumatic event. The increase in arousal effects sleep and wakeful times. Responses to fight and escape described as approach and avoidance (Roth & Cohen) Processes may be unconscious, conscious or both. Approach enables the person to be prepared for the acute stressful event. They enable the person to gather information necessary to take action and provide an opportunity for affective release. This response allows individuals to integrate the experience into their perceptions of themselves and the world; it also produces difficulties as it increases the experience of negative effects, to a potentially dangerous level, resulting in the person having heightened anxiety reactions and non-productive worry. Avoidance reduces the emotional impact of the event; • It protects the individual from becoming emotionally overwhelmed and dysfunctional. • But it may result in blocking out of information needed to lead to productive action. • Prolonged use of the avoidance strategy tends to create emotional numbness and avoidance of certain aspects of the self and of life. MGG202X – Sexual Trauma Exam Summaries Page 5 of 87 Shattering fundamental assumptions Individuals have assumptions about themselves and the world they live in, that they use to recognise, plan and act upon in all situations that they are called to deal with. Assumptions are their reality. Persons are not fully aware of these beliefs of assumptions – but they form a back drop that influences the way they approach situations and the way they feel about the world they find themselves in. Assumptions are usually positive and reassuring. Trauma affects a person physically and emotionally, as well as upsetting their beliefs about the self, human nature and the nature of the world. Because the assumptions are challenged, the individual is likely to experience further psychological distress. Person is left with doubt about whom or what can be trusted and what they should believe. Three assumptions a victim is forced to consider: 1. they are personally invulnerable – trauma causes “It can’t happen to me “ to change to “it’s happened once before, who says it can’t happen again” 2. the world is orderly and meaningful ; people generally assume that by being careful, honest, good they can avoid disasters. The assumption is that bad things do not happen to good people. When disaster strikes they ask “why did it happen to me”, they must have done something wrong? Or they have been singled out to be taught a lesson: an assumption that leads to self-blame. 3. they are good and strong people - being victimised leads to a loss of positive selfimage. They are overcome by helplessness, vulnerability and powerlessness, all of which has a negative impact on self-esteem. Trauma causes victims to blame themselves. Term ‘victim’ is disempowering, suggests damaged, always different due to what has happened to them. Trauma and Post-Traumatic Stress Disorder (PTSD) Continuum range: Brief stress reaction that a person can deal with and recover from on his own – to a much more intense reaction described as trauma. DSM-IV = Diagnostic and Statistical manual of mental disorders) PTSD = psychological disorder associated with severely traumatic experiences giving rise to a cluster of recognisable symptoms: Person experiences extreme trauma and develops 3 clusters of symptoms 1. Re-experiencing the trauma 1. Avoidance of the trauma related stimuli 2. Symptoms of increased arousal. Symptoms must be present for more than one month and significantly impair the person functioning. Symptoms are caused by the intensity and duration of the event and the meaning of the event to the survivor and their loved ones. It DOES NOT depend on a person’s mental state – it can happen to ANYONE – even the strong and “in control” personality. MGG202X – Sexual Trauma Exam Summaries Page 6 of 87 The origins of the symptoms are caused by: 1. the intensity and duration of the stressful event and 2. the meaning attached to the event by the survivor and significant others. 3. PTSD can be acute or have delayed onset (from one year – up to 40 years) DSM-IV criteria for Post-Traumatic Stress Disorder Exposure to a traumatic event involving actual or threatened death or injury, to which the person responds with horror and feelings of helplessness. The person re-experiences the trauma in the form of dreams, flashbacks, and intrusive memories. The person displays evidence of avoidance behaviour, a numbing of emotions and reduced interest in others and the outside world. They experience physiological hyper-arousal, shown in insomnia, agitation, irritability, outbursts of rage. Symptoms last longer than a month Symptoms affect individual victims functioning in different areas of their life such as work, relationships with loved ones, and their self-esteem. NB: the above merely is an aid to make a diagnosis – it is NOT a description of the victims psychological experience. These criteria should be regarded as an ‘aid to diagnosis’ rather than a description of the victim’s psychological experience. PTSD is a disorder that usually strikes psychologically healthy individuals after extreme life events, but it can exacerbate pre-existing psychological problems. One cannot rely solely on the above classification to understand all the experiences of survivors of trauma. PTSD experienced by holocaust survivors war veterans refugees victims of violent crimes survivors of sexual abuse Accidents Community disasters Losing a loved one tragically Nonsexual assaulted Battered woman in shelters Rape victims. MGG202X – Sexual Trauma Exam Summaries Page 7 of 87 Recovery from Trauma “Resilience” – the survivor’s ability to thrive in difficulties Some people are able to survive trauma and proceed without permanent emotional scarring. Resilience is likely to develop from both internal (person’s temperament, warm, easy going, positive self-esteem, good problem solving skills, sociability) and environmental factors (supportive relationships, congenial work environment, positive community responses and resources available) Survivors carry the scars of their trauma for diff. lengths of time. Some people deny their traumatic experiences for a long length of time – and then get caught by a small, less significant event that reminds them of the supressed event. This can trigger emotional reactions and cause unexpected chaos. Some survivors may be preoccupied with their trauma for the first year and then put it behind them and move on due to loving support received at the time. Trauma recovery deals with reworking the trauma so as to enable survivors to integrate the trauma into their lives. To achieve healing they have to disabuse their minds of notions that they are dysfunctional and different. Healing is said to begin when these persons start to: • reconnect with their strengths , • identify defences that previously kept them “locked into” the trauma and • find ways of dismantling these defences. These survivors adopt a more rational pattern of thinking and behaving. Survivors don’t need to be ‘fixed’, rather they benefit from supportive assistance to enable them to mobilise their own inner healing and creative powers. Trauma counselling is a process whereby traumatised people are enabled to work through their distressing memories to the point where they feel better. Unless they have a chance to address their feelings regarding their abuse, these feelings may impact on their relationships with friends, lovers, children, their selfesteem, their relationships with their bodies and their career performance. Goal in recovery is → to enable the survivor to achieve “ordinary levels of effective functioning” The ability to give energy to everyday life Experiencing psychological comfort, instead of constantly experiencing pain and distress The ability to experience gratification, to enjoy life’s pleasure when they happen Developing hopefulness regarding the future, being able to plan for the future, displaying commitment to these plans The ability to adequately perform social roles as parent, spouse, member of community. MGG202X – Sexual Trauma Exam Summaries Page 8 of 87 For some – trauma leaves an imprint on the survivor’s perceptions about themselves and life; in order to move on they need to rework these perceptions. The trauma will never be completely cured and forgotten, but the survivor will reach a stage where it will cease to cause as much pain and disruption as it once did. The trauma counsellor – personal qualities. The quality of the helper’s presence is the most critical healing component. The role of the counsellor is one of a facilitator rather than teach or doer. Emphasis is placed on developing a special kind of relationship with the survivor, one built on four conditions identified by Carl Rogers – a Phenomenologist – who developed the Person Centred Approach to helping. Personality qualities – the C O R E of a counsellor: (Rogers) C = Unconditional Positive Regard O = Personal Power R = Respect E = Empathy These conditions are: 1. The unconditional acceptance and respect for the person 2. A deep regard and understanding of his or her experiences 3. A commitment to being fully transparent and genuine in this relationship 4. An appreciation of the person’s personal power to find unique and relevant solutions to his or her troubles. The relationship built is free from advice giving, instructing, coercing and manipulating. It acknowledges the survivors inherent capacity to heal and refrains from dictating the pace of therapy. Emphasis is placed on listening and empathising with survivors, and when indicated, suggesting ways to help them regain control of their lives. The helper is not preoccupied with skills to treat the survivor, but more concerned about their ‘way of being’ with the survivor. Helpers Qualities Warm, Sensitive, Caring, Nurturing attitude Essential qualities as they reassure survivors that they are understood, respected and within the context of the helping relationship, safe enough to lower their defences and review the impact that the trauma has had on every area of their lives. Helper must be sensitive to the survivor’s emotions and courageous enough to deal with their pain and helplessness. Positive approach to life, good problem solving skills and flexibility are vital to give hope. Demonstrate a strong belief in the survivor’s inherent potential to heal and recover. MGG202X – Sexual Trauma Exam Summaries Page 9 of 87 Helpers need to be fully aware of their own motivation for working in this field. Should they be survivors of trauma, they can still work in this field but they must pay attention to: Be self-aware of the impact that the abuse has had on their personal life. Take special care of their physical, psychological, emotional and social health Arrange regular debriefing consultations with professional colleagues regarding the counselling they are rendering. Be able to deal with their personal issues outside the context of work. Helpers should not assume that their trauma makes them any more or less able to deal with the trauma of others. Knowledge needed to work in the field of sexual trauma. Knowledge protects survivors from experiencing further pain - it also protects the counsellor when dealing with the law and service providers. NB: Well trained counsellors have: a systematic body of knowledge of sexual abuse coping skills – assertiveness ; anger and stress management; relaxation Medication knowledge – referral to doctors Gender sensitivity training Code of ethic – Professional Values (RICS) o R = Respect o I = Individualisation (uniqueness) o C = Confidentiality o S = Self determination Understanding of the law Therapeutic skills: o Listening o Probing o Empathy o Advanced communication skills o Immediacy The general tasks of the helper Help survivors rework the trauma and track its impact on their physical, psychological and social areas of functioning. Counsellors empower the survivor to develop, rediscover coping skills. Survivors are supported whilst they admit the trauma and identify the harmful ways it has impacted on their lives, accept that they were not responsible for the abuse, and introduce changes to enable them to adjust to their new reality. MGG202X – Sexual Trauma Exam Summaries Page 10 of 87 Goals of treatment (adult & children) Enable the survivor to freely express thoughts and feelings in a safe, trusting context. Help survivors to understand why they feel like they do, to assist them to master their emotions. Reduce / eliminate symptoms of Post-traumatic stress Assist survivors to be more confident, competent, in control of their lives. Correct any misconceptions survivors have about trauma Relieve survivors feeling of self-blame Enable survivors to re-establish trusting, healthy relationships Assist survivors (directly / indirectly) to cope with interface between them and the process in the criminal justice system. MGG202X – Sexual Trauma Exam Summaries Page 11 of 87 THEME TWO - SEXUALITY Sexuality has as much to do with total personality and non-genital functioning, as it does with erotic responses and reproductive functioning. There are many factors that affect sexual functioning. Factors: Genetic Physical health Knowledge about genitals Understanding the mechanics of sex Knowledge about sexual diseases, pregnancy Attitudes about the body and bodies of others Beliefs about rights and responsibilities of people Religious and cultural values regarding sexuality The psychosexual perspective of a person is not static and plays a role in shaping lifelong sexuality. The psychosexual perspective is that part of human sexuality that reflects cultural, ethical values and norms of the society in which the person lives. Historical perspectives on sexuality Sexual values and norms have, and will continue to, change rapidly as society evolves. Judaism influenced sexual behaviour as rules for sexual conduct were defined: Adultery was forbidden Homosexual acts condemned Sex considered neither good or bad – not restricted to reproduction purposes Ancient Greece – adult male responsible for adolescent boy’s intellectual and moral development and permitted to engage in homosexual acts with adolescent. Yes exclusive acts of homosexuality between adults frowned upon. Acts with prepubescent boys was illegal. Woman considered “chattels” (possessions of men) and “gynes” – bearers of children. Christianity considered celibacy as ideal. Sex lust was recognised to have come from the downfall of Adam and Eve and this lust separated man from God. Islamic, Hindu, ancient Oriental sexual attitudes were more positive. Sexuality and sexual pleasure were seen as an integral part of Eastern religions. Sex was viewed as important blending of energies that helped humans with their spiritual transformation. Sexual revolution – 1960’s – Advances in media technology, birth control measures and reproductive technologies, human rights movement and feminism. These changes challenged modern societies to unveil the secrecy surrounding sexuality. Lowe refers to the change as a transition from traditional morality to New Morality . MGG202X – Sexual Trauma Exam Summaries Page 12 of 87 Traditional morality versus the “New Morality” People are generally more open and permissive regarding premarital sexual intercourse, same sex sexuality and extramarital sexual intercourse. New morality regards sex as a normal drive, entitled to some form of expression. Sexual standards are no longer considered to be the main source strengthening the moral fibre of society. Human sexuality is acknowledged as a basic human function that can be expressed in un-harmful ways. Changed values of sexual behaviour New morality proposes more openness around issues of: masturbation, same gender sexuality, premarital sexuality, sex aids, sexual development and contraception. New morality proposes responsible actions from everyone so that they behave in sexually moral ways. Morality is the ability to respect and care for your fellow human beings. It has little to do with the way you enjoy your sexuality, unless you break a special trust or violate the rights of others for your own gratification. Morality is firmly entrenched in the recognition of, and appreciation and respect for, human rights. There are two main ways of influencing human sexual behaviour, 1. sexual scripting 2. gender role typing / gender role socialisation 1. Sexual scripting Social rules are explicitly defined, by law, or they implicitly defined by implied social expectations. Common law crimes – rape, indecent assault, bestiality, incest and crimen injuria. Statutory laws - regulating prostitution, defilement, sex with a minor etc. All clearly defined in the law therefore explicitly spelt out. Implicitly implied / unspoken sexual expectations – sexual behaviour is a private matter, sex should only take place in a committed relationship, pregnancy should occur within wedlock. Implicitly prescriptive sexual expectations change to suite the times. Principles inherent in the New Morality: Faithfulness to, and consideration for others, is highly valued. Coitus should only be couple with friendship and love. Love and not marriage becomes the prerequisite of sexual needs. Exploitation of a sexual partner is rejected. A high standard of respect for self and others. High standards of morality do not necessarily correspond to traditional and religious standards. Actions such as gossiping, using others for one’s personal gain, winning at all costs, greed, are considered greater social violations than premarital sex. MGG202X – Sexual Trauma Exam Summaries Page 13 of 87 2. Gender Role Socialisation Gender is socially and culturally constructed. At each stage of life (infancy, early childhood, latency, adolescent, adulthood) religion, culture and even socioeconomic status shape the lives of males and females differently; these influences impact human sexuality. Gender stereotypes are a possible factor contributing to sexual victimisation. Two poles of the stereotyping continuum are: patriarchal and expressive. PATRIARCHAL EXPRESSIVE Men own everything, including woman and children People do not own people Sex is considered a biological drive . Sexual satisfaction of men is regarded as a prerequisite for their health. Woman’s sexual functioning is related to procreation, not sexual satisfaction. Sex is considered a basic human function, equally appropriate to men and woman. All forms of sexuality are acceptable as long as they occur only between consenting adults. Communication and intimacy are highly regarded. Men are considered to have sexual drives whilst women are expected to be passive sexual beings who need to fulfil their male partners sexual needs The sexual drives of men and woman are considered to be equal. Ejaculation is considered important for men and orgasm unimportant for women. Satisfactory sexual experiences are equally important for both genders. There is less emphasis on orgasm or climaxing and more emphasis on mutual stimulation and pleasure. Non-marital sexual relationships are acceptable for men, but certainly not for woman. The emphasis is on mutual fidelity and legitimate pursuit of sexual pleasure for all persons. Extramarital sex is not condoned because of the breach of fidelity. Men are the breadwinners and women are economically dependent on their partners. The duty of the woman is to keep her partner happy. A more egalitarian relationship is considered appropriate. The couple work together to ensure that their needs, and the needs of their family, are fulfilled. Children’s sexual development Humans start having sexual feelings from as early as being in the uterus – in the most basic sense. MGG202X – Sexual Trauma Exam Summaries Page 14 of 87 Sex games involve curiosity and making comparisons and contrasts. Feeling, penetrating parts of the body with fingers, objects. Infancy through to preschool: Male foetus can have spontaneous erections accompanied by ‘generalised pleasure response’. Once born, male babies have penile erections. Female babies experience similar responses – but we are less aware. Children touch their genitals as it feels good. They are curious, and enjoy the sensation and stimulation hasn’t been abused, but one should be alert to the possibility. Appropriate adult management: Rules of acceptable social and sexual behaviour should be taught in such a way that children do not feel ashamed of their sexuality and genitals. The child should be gently stopped so that they do not feel later inhibited to ask about sexual matters, gender differences. Normal sanctions should be applied, just like those used to address others transgressions of important family rules. Respect for other people’s bodies an their right to privacy should be clearly instilled. Questions about bodies and sexual behaviour should be simply answered using language the child understands. Long explanations are not appropriate to preschoolers level of cognitive and emotional development. The primary school child: Children of this age remain curious about sexual behaviour, even though they remain highly critical of nudity. Quick to sense adults discomfort or unwillingness to discuss sexual topics. Sex education can be misleading as parents talk about the boys’ penis and testicles, but don’t refer to the vulva of the girl (they refer to vagina – incorrect) Children are exposed to sexual matters through the media - if parents respond with panic it conveys the message that sex is dirty and should be kept secret. Children should have it explained that adult activity is reserved for caring couples who are mature enough to consider the consequences of their actions. By the time children start attending school, they should have learned rules about sexual behaviour and body privacy. Children past the age of five who rub their genitals frequently, or engage with other children in adult-like sexual behaviour might be dealing with emotional anxieties that my have little to do with sex, or may be indicating they are being sexually exploited, emotional abused. Appropriate adult responses Younger children should be reminded of the rules about body privacy and sexual touching. If inappropriate behaviour persists, then sanctions should be put in place. MGG202X – Sexual Trauma Exam Summaries Page 15 of 87 If child is masturbating / exposing himself in public – then gentle limit setting “I know it feels really good, but the pace to do it is in the privacy of bedroom/bathroom” Acknowledge the child sensations and prescribe appropriate ways of dealing with the need. Encourage children to talk to adults about a range of topics, allows children to feel they can trust adults to provide them with accurate info. Boys should be informed about girl’s genitals and vice versa. When children ask a question about sex, very important for parent to ask child why they think the answer is, as often they have created an answer in their own mind. This will provide clues about the extent of the information the child needs to hear. Adults must not overwhelm young children with biological facts about sex that they cannot understand, or have no need to know till they are older. A five year old does not need to know about fallopian tubes, but does need to know that babies are born through the vaginal opening rather than mother’s bottom. Children must be taught the proper names for things they can see and touch and it should be acknowledged that touching or rubbing their genitals can feel quite nice. This will give the message that it’s permissible to talk about things sexual. Information does not promote experimentation; it enables people to make informed decisions. Customs, beliefs, values and rules about sexual behaviour must be made explicit to children and explained. The older primary child needs to be prepared for puberty. Caring relationships with high levels of respect, honesty and support are critical for this stage of development. Sex education is ineffective on its own. It is a part of a much more involved life education process that needs to incorporate communication skills, relationship skills and social responsibilities towards the self and others. The teenager: Adolescents are acutely aware of the physical changes they experience; they have to integrate these changes into their existing identity to form an integrated whole. The way they view their body is intricately linked with how they view themselves, and the way others see them. Strong and urgent sexual feelings, often coupled with peer pressure to engage in sexual activity. Masturbation increases in frequency, too shy to ask for reassurance and try to work out their sexual attitudes, basing their decisions on what they have learnt from their peers. It’s critical that they have access to reliable sex education during this stage. Peer group pressures vary from one community to another and also reflect the ethnic and economic subcultures within communities. At this age – they believe that STI’s, HIV/AIDS and pregnancy can happen to other people, not them. MGG202X – Sexual Trauma Exam Summaries Page 16 of 87 They tend to want to be involved in adult behaviour and are therefore prone to being coerced into situations they cannot manage. Appropriate adult management Affirming and reaffirming adolescents helps them to feel positive about themselves. Keep lines of communication open; give full information and guidance when needed. Parents should help children grow up to feel comfortable about their own sexuality and be responsible about it. When asked a question of a sexual nature, parent should ask the adolescent what they think, with acknowledges that their opinions are also respected. Sexual leaning must include an emphasis on values and attitudes. Adolescents should be taught the difference between good sex (being respectful to their partner, and being responsible) and bad sex (where others are used for their own gratification) Healthy families • Healthy sexuality involves more than healthy anatomy. • Communication open, responsive and affirming • Respect for individuality of members • Family boundaries and the role that each family member has to play is clearly defined. • Sexuality is conveyed as something normal and pleasurable. Engagement of children in sexual acts strictly prohibited. • Each family members rights and responsibilities are made explicit • Rules and guidelines for sexual behaviour made clear to family members • Age appropriate info. About sexuality given • Strong extrafamilial support from other members of extended community MGG202X – Sexual Trauma Exam Summaries Page 17 of 87 THEME THREE - THEORETICAL APPROACHES 1. Psychoanalysis 2. The medical model 3. The feminist perspective 4. Systems theory 5. Child sexual abuse syndrome 6. Abuse-related accommodation 1. Freud and Psychoanalysis Hysteria – focus of scientific interest in latter stages of 19th century. Father of study of hysteria = Jean-Martin Charcot – French neurologist. First person to document the characteristic symptoms of hysteria (motor paralysis, sensory losses, convulsions, amnesia) Relied on female patients for live demonstrations. Believed symptoms were psychological because they could be induced and relieved through hypnosis. Freud studied under Charcot, with Breuer, concluded that hysteria was a condition caused by psychological trauma that could affect “even people of the cleverest intellect, strongest will, greatest character, highest critical power” Breuer, Freud and Janet – strong competitors to unravel the mystery of hysteria. All three believed that: Unbearable emotional reactions to traumatic events produced an altered sense of consciousness, which in turn induced hysterical symptoms. Janet and Freud believed relief could come by bringing suppressed memories to the fore. Freud created a safe therapeutic context for trauma suffers to recover their traumatic memories and verbalise the intense feelings associated with them. This method became the basis of psychoanalysis. He explored the sexual lives of his patients, and revealed that the underlying source of pain precipitating patient’s hysteria involved one or more occurrences of premature sexual experience. Called the seduction theory. Freud asserted that most of his female patients reported being molested as children, by adult relatives. Respected members of society. Social implications of Freud’s theory – hysteria was so common and so, by implication, it suggested perverted acts against children were endemic among the poor and rich. Work was repudiated. Only when he reformulated his ideas did he receive positive recognition. New theory suggested that children’s conflict over their own sexual fantasies towards a parent induced their trauma. Young boy’s sexual interest as the Oedipus complex Young girl’s sexual fantasy about her father as the Electra complex.