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Ethics - Cognitive Dysfunction
you know, people who have been severely traumatized often have difficulty maintaining
attention and concentration. Capturing the essence of the "intrusive"
phase, or post-traumatic stress disorder, cognitive dysfunction refers to intrusive
thoughts, flashbacks, nightmares, and unwanted images that may be so vivid they
seem to be occurring in the present. Mary was continually tormented by such intrusive,
unbidden cognitions. She was unable to work or carry on a social life.
Noel writes, "I was a wreck. As each day and night went by, I couldn't shake
the pictures in my mind. I barely slept. Just when I'd find a comfortable place
in my pillow, I'd sit up again, recalling the events of the sexual encounter with
refer to the third, or final, phase of therapy as "recollection". The client's shame lessens or eliminates their energy and initiative. Mary stated,
"I can't get over it." The goal is to assist the client to regain his
or her assertiveness, self-esteem, self-respect and self-control. Once this has
started to occur, at some level survivors are more ready to move out into the
world and reconnect with others.
This may mean renewing or repairing relationships,
increasing intimacy with loved ones, making new friends, or getting involved with
other survivors. Survivors often look back at their helplessness and powerlessness in the abusive situation and are proud of the courage, strength, and adaptability
that enabled them to escape and then transcend their abuse.
Ethics - 3 Obstacles to Healing
there are many obstacles to the process of healing. They can involve the survivor's
own issues with shame, embarrassment, and self-blame; lack of support by the victim's
family; lack of community support for the victim; and even silencing.
Obstacle 1: Shame
her abuse, Mary felt consumed by guilt and shame. She withdrew from relationships
and believed that the people she dated viewed her as withdrawn and secretive.
She could not confide in friends or colleagues as she felt the information could
be used against her. Subsequent therapists did not believe that she had been abused.
Mary found that finding a health care professional who believed her, and wanted
to help in a way that would be best for her, to be an extremely difficult task.
She saw six therapists ranging from one to about a dozen visits before our sessions
began. With one male therapist, she thought she might be victimizedagain. Two
therapists she felt did not seem to believe her. Three did not want to get involved,
which varied from mild disinterest to outright rejection. Thus, Mary's attempts
at lodging complaints were met with resistance and procrastination.
Obstacle 2: Minimizing Another
obstacle Mary experienced (common to abuse victims) is she minimized it at first,
knowing that others have suffered worse. Lastly, she let it develop a life of
its own by letting the abuse affect current work and personal relationships.
abuse victims I have worked with describe similar experiences, commonly going
through a long period when they submerged all or most of their feelings and thoughts
about the abuse. Then, related to stresses or life changes, they found themselves
suddenly bombarded by a variety of symptoms including severe anxiety, guilt, shame,
panic attacks, nightmares, depression, plummeting self-esteem, various physical
symptoms, poor concentration, and feelings of alienation.
Obstacle 3: Depression
have experienced more immediate effects developing during the abuse or shortly
after termination. Severe depression, eating disorders, alcoholism, and drugabuse,
as you know, are among the problems suffered. Mary described severe depression,
and alcoholism. She began to lose weight during the time that she was being sexually
exploited by her therapist. During this period her career was irreparably damaged.
Looking back over that extremely painful time, she states, "Everything was
out of control. I couldn't concentrate, couldn't sleep, couldn't think, and couldn't
plan. My emotions were all over the place. I was divorced, my career was shattered.
It seemed like the only thing I could control was my eating."
went through a period when she felt that some of her treatment had been helpful,
and in the end, viewed the relationship with the mental health professional as
destructive. She stated, "I really think he saw my vulnerability and took advantage of it. I felt like an object."
A Series of Traumatic Events
you know for many abuse victims, their abusive experience sets into motion
a series of terrible losses or traumatic events. These included loss of employment
or destruction of career; marital breakup; deterioration in relationships with
children; disastrousremarriages or abusive relationships; financial problems;
poverty; loss of homes or other accommodation; and loss of physical or mental
health, to hospitalization in some cases.
Younger abuse victims, as you know feel
that they have lost their innocence or youth; some feel that impaired trust has
sabotaged their ability to enter into intimate relationships, and have consequently
deprived them of the opportunity to have children. In the same way that a rock
dropped into a pond causes ever-widening concentric ripples, so an abusive experience
with a mental health professional can affect every aspect of the victim's lifestyle,
relationships, health, and well-being.
Ethics - 3 Phases of Healing The three phases of healing
for the survivor of abuse are: 1. Remembering the trauma, 2. Getting in
touch with the feelings, and 3. Developing a survivor rather than a victim
the immediate stress has been removed when the client leaves the abusing therapist,
other strategies included catharsis, cognitive restructuring, and behavioral contracting.
Boundary Crossings and Violations in Clinical Settings
- Krishnaram, V., Aravind, V., & Thasneem, Z. (2012). Boundary Crossings and Violations in Clinical Settings. Indian Journal of Psychological Medicine, 34(1), p. 21-24. doi:10.4103/0253-7176.96151
Ethics CEU QUESTION
13 What are three phases of healing for the survivor of abuse? To select
and enter your answer go toEthics CEU Answer
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