Adult Treatment Planner
35: Sexual Abuse
SNOMED Terms
- Adult victim of non-domestic sexual abuse
- Adult victim of sexual abuse
- Avoidant personality disorder
- Dependent personality disorder
- Generalized anxiety disorder in remission
Goals
- Resolve the issue of being sexually abused with an increased capacity for intimacy in relationships.
- Begin the healing process from sexual abuse with resultant enjoyment of appropriate sexual contact.
- Work successfully through the issues related to being sexually abused with consequent understanding and
control of feelings.
- Recognize and accept the sexual abuse without inappropriate sexualization of relationships.
- Establish whether sexual abuse occurred.
- Begin the process of moving away from being a victim of sexual abuse and toward becoming a survivor of
sexual abuse.
Behavioral Definitions
- Vague memories of inappropriate childhood sexual contact that can be corroborated by significant others.
- Self-report of being sexually abused with clear, detailed memories.
- Inability to recall years of childhood.
- Extreme difficulty becoming intimate with others.
- Inability to enjoy sexual contact with a desired partner.
- Unexplainable feelings of anger, rage, or fear when coming into contact with a close family relative.
- Pervasive pattern of promiscuity or the sexualization of relationships.
Diagnoses
- Alcohol Dependence
- Polysubstance Dependence
- Dysthymic Disorder
- Major Depressive Disorder
- Generalized Anxiety Disorder
- Dissociative Identity Disorder
- Dissociative Disorder NOS
- Sexual Abuse of Child, Victim
- Sexual Abuse of Adult, Victim
- Avoidant Personality Disorder
- Dependent Personality Disorder
Objectives and Interventions
- Tell the story of the nature, frequency, and duration of the abuse.
- Actively build the level of trust with the client in individual sessions through consistent eye
contact, unconditional positive regard, and warm acceptance to help increase his/her ability to
identify and express feelings.
- Gently explore the client's sexual abuse experience without pressing early for unnecessary
details.
- Ask the client to draw a diagram of the house in which he/she was raised, complete with where
everyone slept.
- Identify a support system of key individuals who will be encouraging and helpful in aiding the process of
resolving the issue.
- Help the client identify those individuals who would be compassionate and encourage him/her to
enlist their support.
- Encourage the client to attend a support group for survivors of sexual abuse.
- Verbalize an increased knowledge of sexual abuse and its effect.
- Assign the client to read material on sexual abuse (e.g., The Courage to Heal by Bass and Davis;
Betrayal of Innocence by Forward and Buck; Outgrowing the Pain by Gil); process key concepts.
- Assign and process a written exercise from The Courage to Heal Workbook (Davis).
- Identify and express the feelings connected to the abuse.
- Explore, encourage, and support the client in verbally expressing and clarifying feelings associated
with the abuse.
- Encourage the client to be open in talking of the abuse without shame or embarrassment as if he/she
was responsible for the abuse.
- Decrease the secrecy in the family by informing key nonabusive members regarding the abuse.
- Guide the client in an empty chair conversation exercise with a key figure connected to the abuse
(e.g., perpetrator, sibling, parent) telling them of the sexual abuse and its effects.
- Hold conjoint session where the client tells his/her spouse of the abuse.
- Facilitate family session with the client, assisting and supporting him/her in revealing the abuse
to parent(s).
- Describe how sex abuse experience is part of a family pattern of broken boundaries through physical contact
or verbal suggestiveness.
- Develop with the client a genogram and assist in illuminating key family patterns of broken
boundaries related to sex and intimacy.
- Verbalize the ways the sexual abuse has had an impact on life.
- Ask the client to make a list of the ways sexual abuse has impacted his/her life; process the list
content.
- Develop with the client a symptom line connected to the abuse.
- Clarify memories of the abuse.
- Refer or conduct hypnosis with the client to further uncover or clarify the nature and extent of the
abuse.
- Facilitate the client's recall of the details of the abuse by asking him/her to keep a journal and
talk and think about the incident(s). Caution him/her against embellishment based on book, video, or
drama material, and be very careful not to lead the client into only confirming therapist-held
suspicions.
- Decrease statements of shame, being responsible for the abuse, or being a victim, while increasing
statements that reflect personal empowerment.
- Assign the client to read material on overcoming shame (e.g., Healing the Shame That Binds You by
Bradshaw; Shame by Kaufman; Facing Shame by Fossum and Mason); process key concepts.
- Encourage, support, and assist the client in identifying, expressing, and processing any feelings of
guilt related to feelings of physical pleasure, emotional fulfillment, or responsibility connected
with the events.
- Confront and process with the client any statements that reflect taking responsibility for the abuse
or indicating he/she is a victim; assist the client in feeling empowered by working through the
issues and letting go of the abuse.
- Assign the client to complete a cost-benefit exercise (see Ten Days to Self- Esteem! by Burns), or a
similar exercise, on being a victim versus a survivor or on holding on versus forgiving; process
completed exercises.
- Identify the positive benefits for self of being able to forgive all those involved with the abuse.
- Read and process the story from Stories for the Third Ear (Wallas) titled "The Seedling" (a story
for a client who has been abused as a child).
- Assist the client in removing any barriers that prevent him/her from being able to identify the
benefits of forgiving those responsible for the abuse.
- Recommend that the client read Forgive and Forget (Smedes).
- Express feelings to and about the perpetrator, including the impact the abuse has had both at the time of
occurrence and currently.
- Assign the client to write an angry letter to the perpetrator; process the letter within the
session.
- Prepare the client for a face-to-face meeting with the perpetrator of the abuse by processing the
feelings that arise around the event and role-playing the meeting.
- Hold a conjoint session where the client confronts the perpetrator of the abuse; afterward, process
his/her feelings and thoughts related to the experience.
- Increase level of forgiveness of self, perpetrator, and others connected with the abuse.
- Assign the client to write a forgiveness letter and/or complete a forgiveness exercise (see
Forgiving by Simon and Simon) and to process each with therapist.
- Increase level of trust of others as shown by more socialization and greater intimacy tolerance.
- Teach the client the share-check method of building trust in relationships (i.e., share only a
little of self and then check to be sure that the shared data is treated respectfully, kindly, and
confidentially; as proof of trustworthiness is verified, share more freely).
- Use role-playing and modeling to teach the client how to establish reasonable personal boundaries
that are neither too porous nor too restrictive.
- Report increased ability to accept and initiate appropriate physical contact with others.
- Encourage the client to give and receive appropriate touches; help him/her define what is
appropriate.
- Ask the client to practice one or two times a week initiating appropriate touching or a touching
activity (i.e., giving a back rub to spouse, receiving a professional massage, hugging a friend,
etc.).
- Verbally identify self as a survivor of sexual abuse.
- Reinforce with the client the benefits of seeing himself/herself as a survivor rather than the
victim and work to remove any barriers that remain in the way of him/her doing so.
- Give positive verbal reinforcement when the client identifies himself/herself as a survivor.
Index