Couples Therapy for Women Survivors of Child Sexual Abuse Who Are in Addictions Recovery: A Comparative Case Study of Treatment Process and Outcome
Trute, Barry, Docking, Bobbie, Hiebert-Murphy, Diane, Journal of Marital and Family Therapy
Treatment for women who are survivors of child sexual abuse and who have a history of substance abuse has largely involved gender-specific interventions. This study examines the use of conjoint couple therapy with a cohort of women who were survivors of child sexual abuse and who are in addiction recovery and with their partners. A comparative case study analysis incorporated standardized clinical measures with client and therapist interviews. Brief conjoint therapy was found to assist couples in the specific relationship skill areas of communication and mutual problem solving. Further, substantive gains were found in the realm of affective relations. The women reported an increase in support from their male partners, and the men reported a decrease in negative emotional atmosphere in the relationship.
The long-term effects of childhood sexual abuse have been well documented (e.g., Beitchman et al., 1992). One of the major effects is sexual problems in adulthood, the suggested prevalence of which is 55%-82% (Douglas, Matson, & Hunter, 1989; Herman, 1981). Approximately 25 % of abuse survivors who have sexual difficulties in adulthood have serious, long-term sexual dysfunction (Fritz, Stoll, & Wagner, 1981; Russell, 1986). Follette and Pistorello (1995) suggest that sexual abuse survivors often suffer a disruption in trust in intimate relationships. This may explain their higher rates of separation and divorce and their lower levels of satisfaction with conjugal relations and sexuality (Browne & Finkelhor, 1986; Courtois, 1988). Women who were abuse victims are described as less able to provide adequate parenting and as offering less emotional support to their male partners (James & Nasjleti, 1983); they are seen to have higher levels of triangulation within their families of procreation and less spousal intimacy (Carson, Gertz, Donaldson, & Wonderlich, 1990); and they are more likely to hold unresolved emotional attachments to their families of origin and to have less well-established emotional attachments to their partners (Herman, 1981). Carson et al. (1990, p. 165) suggest that their findings for women who were incest victims "point to a lack of trust, empathy and respect for others in the family system, problems in the assertive expression of feelings, and inappropriate coping skills in the area of grief and conflict resolution." Wilson and James (1992) highlight the importance of clinical treatment for these women as a deterrent to long-term family distress and child abuse.
For many women who have been sexually victimized as children, the psychological effects can be dormant until there is a major developmental shift in their lives, such as when they realize that they are in a committed and long-term relationship, when they have a child, or when life circumstances are reminiscent of the intensity of their relationship with the person who perpetrated their sexual abuse (Gelinas, 1983; Herman, 1992). In this respect, it can come as an unexpected difficulty to their partners (Maltas & Shay, 1995), who often find it difficult to provide comfort and support. Many partners seem to "provide additional opportunities for suffering" (Nadelson & Polansky, 1991, p. 482) rather than facilitating healing and recovery. Reid, Wampler, and Taylor (1996) contend that conjoint therapy should be adjunctive to victim treatment and see its purpose as addressing dyadic issues and ensuring the partner's support of the victim's healing. They note that relationship issues will emerge as a result of the individual treatment of the victim and that these can be most adequately addressed in couple therapy. This is consistent with prevailing clinical opinion (e.g., Douglas et al., 1989; Nadelson & Polonsky, 1991) that whenever past sexual abuse experiences remain a major preoccupation in couple and family therapy, it is wise to employ individual therapy for the partner who experienced the abuse before embarking on conjoint therapy. …