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Section 7
Track #7 - Using the 'What If?' Exercise to Brainstorm about Potentially Dangerous Situations

Question 7 | Answer Booklet | Table of Contents | Child Abuse CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, MFT CEU

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On the last track, we discussed the effect of male sexual abuse on sexual identity.

On this track, we will examine the condition of rape trauma syndrome in boys and its two phases: acute and long term.

As you may already know, rape trauma syndrome is a form of post-traumatic stress disorder and was first described in 1974 by Ann Burgess and Dr. Larry Holstrom of Boston College. Initially, the condition is divided into two phases: acute and long term.

Two Phases of Rape Trauma Syndrome

Share on Facebook #1 Characteristics of the Acute Phase

Characteristics of the acute phase include extreme fear, upheaval, physical trauma, skeletal muscle tension, gastrointestinal irritability, genitourinary disturbance, and a range of emotional reactions and sensitivity. These symptoms reflect the client's bodily reactions to a severe trauma.

Marshall, age 14, had flashbacks of the repeated acts of sodomy, nightmares of suffocation and death, and marked detachment from his family and friends.He suffered weeks of initial insomnia and fears of sleeping alone. Showering became an ordeal for him as he feared someone behind the shower curtain attacking him. In order to sleep, he had to lay on his side, lying prone or supine made him feel vulnerable to another attack.

Share on Facebook Technique: What if?
Because Marshall was experiencing feelings of PTSD type powerlessness and uncertainty, I found the "What If?" exercise beneficial. I asked Marshall to brainstorm about potentially dangerous situations. I asked him to write down the situations on index cards with each phrase starting with "What if…".

Some of the situations that Marshall wrote down were:
-- "What if a teacher repeatedly asked you to stay after school to help, and you felt weird about being alone with her?"
-- "What if your older brother had friends over to the house when your parents were not home, let them use alcohol or drugs, and joined them in looking at magazine pictures of naked women?"

Then, I asked Marshall to brainstorm ideas in which he handles the potentially dangerous situation and write them down on index cards which he can keep and look at anytime he needs to. Some of the solutions he included were:
# 1. Be alert, aware, and careful at all times.
# 2. Avoid dangerous situations.
# 3. If someone attempts to approach or abuse you, you can do the following things:
-- Get away.
-- Yell, "Fire"
-- Say no.
-- Tell the person you will tell.
-- Find an adult immediately and ask for help; if the first adult does not respond, find another.
-- Pay attention to how the person looks in case you are asked questions later.

Share on Facebook #2 Characteristics of the Long-Term Phase
The second phase of rape PTSD trauma syndrome is the long-term phase. This stage is characterized by the client's attempts to reorganize their lives after the period of severe upheaval. Most notably, the impacted reactions include: increased motor activity, disturbing dreams and nightmares, and "trauma-to-phobia" which, as you know, includes the fear of indoors if the client was abused in bed, fear of outdoors if the client was abused outside of his home, fear of being alone, fear of crowds, fear of people walking behind him, and a fear of engaging in consensual sexual activity.

Jim, age 14, was going through his long-term phase of his rape trauma syndrome. He stated, "I'm afraid. I don't think I ever leave my house without feeling some fear. Even if I try not to think about it, there's that feeling that I'm at risk, especially at night. Nothing goes on around me that I'm not aware of. I have a hard time even paying attention. I get distracted very easily because I'm always watching."

As you can see, Jim is hyper vigilant? Think of your hypervigilant client. Could they be suffering from rape trauma syndrome?

Share on Facebook Technique: Problem Solving
To address Jim's feelings of fear, I found the "Problem Solving" Therapy Strategy beneficial. By learning how to be responsible for the problems that arise during his own life, Jim can begin to feel confident and less anxious about his surroundings. I recommend doing this exercise over the course of two sessions. In the first session, I explained to Jim the process for solving problems and practicing steps involved.

Some of the steps included the following:
Step # 1. Define the problem as clearly and specifically as possible. Break it down into its separate components or manageable pieces. What is happening right now?
Step # 2. Describe the resolution. What would you like to be happening?
Step # 3. Identify the factors that are contributing to the problem. What is keeping you from creating the desired situation?
Step # 4. Brainstorm ways to overcome the barriers and turn the desired situation into reality.
Step # 5. Evaluate the ideas listed. Choose one to try-something that might change the current situation into the desired situation and something that you can actually do.
Step # 6. Figure out what you need in order to act on your choice. Decide who or what can help you; then get the necessary resources.
Step # 7. Examine the potential consequences of your choice, in terms of both positive and negative outcomes.
Step # 8. Rehearse the option you selected.
Step # 9. Carry out the selected option.
Step # 10. Evaluate the outcome: How have things changed? Has the problem been resolved? Have you created the desired situation?

In the second session, I asked Jim to recall a problem that he wished to solve. I then asked him to use the steps we had discussed previously and to try and solve his problem. Jim related the following problem solving sequence:

Jim stated, "First, I described my problem: every time I thought about taking a shower or a bath, I got scared and started shaking. This is because my uncle abused me while I was in the bathtub. I would like to feel safe and unafraid when I want to clean myself. I think that I associate water with my abuse keeps me from bathing. I thought of thinking of relaxing things before I take a shower; repeating to myself that nothing can happen to me; having someone I trust sit outside the bathroom door to make sure I have someone who will save me if something should happen.

"I decided to do a combination. For the first few days, I asked my mom to sit outside the bathroom and talk to me soothingly. It worked, I felt a lot better knowing that she was out there, caring about me and keeping somebody bad from getting me. I also thought of relaxing things. Soon, I didn't need my mom out there at all, and my relaxing thoughts like the beach or my favorite hero movie was all I need. I feel like I am starting to solve the problem."

As you can see, Jim has addressed one of his greatest emotional burdens by organizing his thoughts. By giving himself a sense of order, Jim was better capable to deal with his abuse.

On this track, we discussed the condition of rape trauma syndrome in boy clients and its stages: acute and long-term.

On the next track, we will examine the ways in which social pressures affect a sexually abused boy's development: gender role identity, double standard, and age-disparate heterosexual abuse.

QUESTION 7
What are examples of "trauma-to-phobia?" To select and enter your answer go to Answer Booklet

 
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