Clinical Outpatient Psychodynamic & child/adol

Common symptoms

• Shame
• Self-blame
• Loss of self-confidence and self-esteem
• Changes in view of self, others, and the world
• Lifestyle changes
• Depressed mood
• PTSD symptoms
• Somatic complaints

other factors that may affect responses to trauma

Cultural differences

Life-stage and developmental issues

Previous victimization experiences

Responses of service providers

“Recovery environment”

Social supports available to victim

Child Sexual Abuse Accommodation Syndrome

• Secrecy
• Helplessness
• Entrapment and Accommodation
• Delayed, Conflicted and Unconvincing Disclosure
• Retraction

• Summit, 1983

dynamics in adolescent sexual assault

Adolescents face particular difficulties with sexual abuse given their developmental tasks.

• Traumatic sexualization
• Feelings of betrayal
• Disempowerment
• Stigmatization

Long-term Health Effects: ACE Score

NEUROBIOLOGY OF TRAUMA

Amygdala:

• Fear area of the brain that detects and responds to threat
• Fight/Flight/Freeze/Tend & Befriend response is not consciously determined

Hippocampus:

• Memory consolidation
• Interrupted during trauma due to high levels of emotion
• Aspects of trauma encoded into memory that can trigger amygdala’s FFF response post-trauma

Frontal Lobe:

• Responsible for higher order thinking, planning, and sequencing behavior
• After trauma, brain develops rigid beliefs about oneself, others, and the world for protection

Misunderstood Victim Presentations

• Flat or inappropriate affect
• Delayed reporting
• Return to routine activity
• Continued contact with the assailant
• Concern for the assailant

Intersectionality and Sexual Assault

• Intersectionality uniquely impacts the experience and prevalence of interpersonal violence
• Different communities experience different rates of violence
• Survivors may experience specific barriers and opportunities based on their intersectional identities

Being Culturally Responsive

Don't

• Don’t make assumptions about the survivor or their experience.
• Don’t demand information.
• Don’t ask survivors to “teach you” about their culture.
• Don’t pressure them to share about any particular identity.

Do

• Approach them with curiosity and openness.
• Invite survivors to share with you what feels comfortable.
• Inquire about what feels important to them right now.
• Consult about your reactions.

implications for interventions

Working with Parents

Stabilize & support parent

• Establish rapport and exercise empathy
• Project calmness, competence, firmness, encouragement & hope
• Maintain non-judgmental attitude
• Stress that self blame and fears are common
• Emphasize normalcy of the emotional reactions to the intense experience
• Emphasize resiliency of the human body, psyche and spirit

In working with adolescents

Helpful Adolescent Considerations

• Recognize the adolescent’s need for “partial accountability”
• Understand and work with teens’ need for power and control
• Allow for emotional breaks (distancing, changing subject)
• Be straight-forward about what you cannot provide
• Be inclusive whenever possible/ appropriate (e.g. calling DCFS with teen in room)

In Session