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Section 14
Track #14 - Self-Harm and the 'Saying Goodbye' Technique

Question 14 | 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 traits of anxiety related to sexual abuse and techniques to deal with the anxiety.

On this track, we will examine the depression that many sexually abused boys experience and techniquessexually abused boys Treating Sexually Abused Boys psychology continuing education to facilitate recovery. In the area of family history, rewards, self-esteem, self-harm, anger issues, and losses.

Depression is probably the most pervasive of symptoms when dealing with boy sexual abuse. It leaks into every aspect of the client's life: school, friends, and family. Irritability and sullenness often accompany depression. Clients who exhibit these symptoms hold the dogma that "If I pretend not to care about anything and if I keep myself distant from people, then I won't be hurt again or lose anything else that is important to me."

Six Issues Indicating Depression

Many times, this can also occur in a client who feels guilt or responsibility for the abuse. Ultimately, he has given up all sense of control and has made the decision to be passive and helpless. When a client is indicating depression, there are six issues that may need to be addressed: family history, rewards, self-esteem, self-harm, anger issues, and losses.

Share on Facebook Issue # 1: Family History
First, I consider if the client has a history of depression in the family. This is of course important because, should there be an indication of familial history, medication might be needed in the early stages of therapy. Also, if there is a depressive adult that consistently comes into contact with the client, that adult could be detrimental to the boy's development.

This is especially true in the case of a depressive parent. Obviously, the client is not learning healthy coping skills from that parent. Also, the depressive parent does not provide a stable support system that is essential for a depressed boy. If you should discover that there is currently a depressive adult in the client's household that is not seeking treatment, you might consider that the parent be referred for treatment. In the meantime, it is important that the client find a more efficient supportive adult (i.e. a counselor, another parent, or relative).

Stan, an eleven year old sexual abuse client of mine, was exhibiting symptoms of depression. To find out if he happened to have a history of depression in his family, I asked Stan, "Did an aunt or an uncle act real sad after a traumatic event? What about your mom or your dad?" Stan told me that, since his father lost his job, he's been drinking much more than he used to.

Stan stated, "He gets mad real easy too, at least when he's not sleeping. He sleeps a lot more now. Sometimes, he sleeps until three in the afternoon." In such a case, I didn't believe medication was necessary, but I did recommend that Stan stay with his aunt, who he was close to. I also spoke with his father and referred him to a colleague of mine.

Share on Facebook Issue # 2: Depression for a Purpose
Secondly, after history, I examine the family's influence on the client and if they are unintentionally rewarding his depression. Commonly, parents tend to pamper the client, especially after such a traumatic experience as child sexual abuse. While this does provide nurture and support that is needed for recover, many times, parents do not realize that their lack of boundaries is encouraging the client's depressive moods.

Kyle was a 9 year old client of my colleague, Dr. Krussel. Kyle's parents were much more lenient with him after the abuse occurred. If he broke the rules, he was not punished while his siblings were. Kyle constantly skipped chores. If he was reprimanded, he became sullen and his parents attributed it to the abuse, not their own lack of discipline. In therapy, Dr. Krussel wasn't as indulgent as his parents.

When Kyle wanted to continue playing video games for the third session in a row, Dr. Krussel told him no. Kyle became sullen, but since Dr. Krussel stayed firm, Kyle decided that his show wouldn't work for him and soon became cooperative. In this case, the parents were the cause of the depressive behavior.

Dr. Krussel talked to them and asked them to make a strict contract with Kyle over which chores he will have to do. If he should break this contract, there would be consequences. By establishing stricter control over their son, Kyle soon dropped his depressive act.

Share on Facebook Issue # 3: Understanding the Impact on their Self-Esteem
In addition to family history and rewards, the third area to consider when facing a depressive sexual abuse male client is whether they understand the impact of the abuse on their self-esteem. As you know, sexual abuse can destroy a young boy's self-image. The shame and humiliation felt soon manifest themselves through depression.

Brian, age 17, was exhibiting signs of depression. He had played high school varsity soccer until he had been raped by an uncle at Christmas. Because he was an athlete, much of Brian's self-esteem lay in his physical prowess and the validation won by his trophies and medals. What Brian needed to establish was an unconditional self-esteem, something that wasn't certified by titles or tournaments. To help him do this, I found the "Aspirations and Affirmations" technique helpful.

Share on Facebook Using the Aspirations and Affirmations Technique
I asked Brian to make a list of the opportunities that lay before him and the abilities that exist within him. On this list, he included: College, Foreign Travel, Stamina, Ambition, Loyalty, and Love.

I then asked Brian to place this list where he would be able to see it at least twice a day. He put it on the inside of his medicine cabinet, which he opened everyday to get out his toothbrush and razor. This list helped to remind him of his worthiness.

Share on Facebook Issue # 4: Potential for Self-Harm
The fourth issue to consider when treating a depressive sexual abuse client is the boy's potential for self-harm due to suicidal thoughts, anger, desire for revenge, ongoing hopelessness, or guilt. Theo, age 14, was referred to me after he revealed to his counselor that he had suicidal thoughts after being abused by his baseball coach.

I explained to Theo that there is a difference between acknowledging his feelings and choosing to act on them. Because he felt that he could not control his impulses, I sat down with Theo and wrote out a plan in case he felt unable to control himself. This included who he would tell (in this case, it was his supportive step-mother), what he would tell himself, and ways to cope with the oppressive feelings of disempowerment, which we discussed on track 2.

Share on Facebook Issue # 5: Understanding the link between Depression and Anger
The fifth issue to consider is whether or not the client understands the connection between anger and depression. As we discussed earlier, the inability to express angry feelings can lead to profound depression. Refer to track 11 for more information on how suppression of angry thoughts can lead to a depressive state.

Share on Facebook Issue # 6: Emotional Losses
In addition to family history, rewards, self-esteem, self-harm, and anger issues, the last concern when a client is in a depressive state is the losses the client has experienced as a result of the abuse. Often, boy clients think of loss as a sense of the physical, not emotional. They do not consider such things as childhood, self-esteem, peer relationships as things to be lost. Matthew, age 16, was a sexual abuse client of my colleague Ronald.

Matthew was going through the painful loss of a father, who had molested him, and through a loss of security and safety. He stated, "I can't feel safe in my own house anymore. I'm always on edge and I know it's because of what my dad did to me. I shouldn't feel this way, and I know in my head that what I'm feeling has no basis, but I feel it all the same." Many times, when experiencing this type of loss, a state of grieving needs to follow in order for recovery to take place.

Share on Facebook Saying Goodbye Technique
To help Matthew understand that he was going through a loss of security as well as a loss of a strong father figure, Ronald found the "Saying Good-bye" technique helpful. Ronald asked Matthew to take the losses of his father and security and create a symbol or metaphor that exemplifies those losses. Matthew, who was an excellent writer, wrote a description of two lion cubs playing on the savannah.

He explained to Ronald, "See, they're playing and relaxed in the most dangerous landscape of all. I mean, they are two huge water buffalo not 100 feet away from them that could squash them at any moment, yet they're totally ignorant of that. I miss that. I miss that ignorance."

Ronald then told Matthew to do whatever he wanted with the story to help him cope with loss. Matthew decided to laminate his story and bury it in the backyard, so, as he said, "When I get through my therapy, I can just dig it up and remind myself of how I came through without security."

On this track, we discussed the depression that many sexually abused boy clients experience and techniques to facilitate recovery.

QUESTION 14
What are six issues that need to be considered when dealing with depression in a young male sexual abuse client? To select and enter your answer go to Answer Booklet.

This CD has covered such topics as: Isolation, Disempowerment, Individual over Group Therapy, Family Participation in Therapy, Therapeutic Challenges, Sexual Identity, Post Traumatic Stress Disorder, Social Pressure, Environment Concerns, Anger Issues, Anger Management, the Causes of Anger, Anxiety, and Depression with Sexually Abused Boys.

I hope you have found the information to be both practical and beneficial. We appreciate that you've chosen the Healthcare Training Institute as a means for receiving your continuing education credit.

Other Home Study Courses we offer include: Treating Self Mutilating . . . Teen "Cutters" "Physical Pain Stops My Pain" Treating Teen Self Mutilation; Treating Post Holiday Let-Down and Depression; Living with Secrets: Treating Childhood Sexual Trauma; Interventions for Anxiety Disorders with Children and Adults; and Balancing the Power Dynamic in the Therapeutic Relationship.

I wish you the best of luck in your practice. Thank you. Please consider us for future home study needs.

 
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Answer Booklet for this course | Child Abuse CEU Courses
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