Trauma: Selected Cohort

The trauma that individuals experience in childhood can have lasting and damaging impacts. This is particularly true if the individuals are not provided with appropriate care and support. One of the primary elements of the mandate of social workers is to help individuals deal with trauma. It is critical for the workers to persuade the trauma survivor to disclose all details that will be needed for the development of effective interventions and approaches. While all forms of abuse can cause trauma, childhood sexual abuse (CSA) causes wounds and pain that may never heal. Victims of this form of abuse are often left with scars which require attention, love and compassion for complete healing to occur. The case of Nelson, one of the clients with whom I have engaged, highlights the importance of assessing the needs of trauma survivors and administering treatments which promise to facilitate full recovery.

Selected Cohort 

As noted above, Nelson is among the patients that I have encountered in my job as a social worker. He is an 18 year old who is originally from Africa and has suffered sexual abuse. Thanks to the lengthy discussions that we held, I was also able to determine that Nelson’s academic performance has been on a decline and that there have been attempts to recruit him into a gang. Nelson represents thousands of disadvantaged students who are recovering from the ill effects of childhood sexual abuse.

Dynamics of Abuse 

To gain a full understanding of Nelson’s case, it is critical to begin with an examination of the dynamics of childhood sexual abuse. In their article, Singh, Parsekar and Nair (2014) observe that CSA is a widely prevalent problem. They note that over 70 million boys and 180 million girls across the globe have suffered sexual abuse. In the US, the prevalence of CSA has been on a steady decline over the last few years. However, the number of CSA survivors remains unacceptably high. In addition to damaging the lives of the survivors, CSA also has adverse impacts on the economy. When a child succumbs to the injuries sustained through CSA, the US incurs as much as $1.5 million (Letourmeu et al., 2018). The economic burden of CSA highlights the need to spare no resource of effort in tackling this scourge. Another significant aspect of the dynamics of CSA is the reluctance and failure by victims to report the abuse that they have suffered. It has been observed that most victims stay quite (Cox, 2018). While some are motivated by fear, others understand that their report of abuse will be greeted with skepticism and hostility.

No discussion of the dynamics of CSA would be complete without an examination of the role that sociocultural factors play. Poverty is one of these factors. Most victims of CSA tend to be from poor communities where access to support and treatment services are severely limited (Banwari, 2011). Nelson embodies poverty and vulnerability. He was sexually abused because his family’s poverty exposed him to sexual predators. Furthermore, his community failed to provide the services that he needed to resolve the negative outcomes that resulted from the CSA. From the discussion this far, what is clear is that the dynamics of CSA are numerous and complex. In addition to the issues already discussed, CSA has also been linked to poor mental health outcomes. Survivors of CSA tend to develop such mental disorders as depression (Dunlop et al., 2015). The fact that CSA can lead to mental health problems should challenge social workers to join forces with mental health practitioners in responding to the plight of adult survivors of CSA.

Intervention Approaches/Techniques 

A number of interventions have been developed and are being implemented as part of efforts to restore the dignity and wellbeing of survivors of CSA. Building the capacity of families and communities so that they are better equipped to tackle CSA is one of these interventions (Olafson, 2011). For instance, various stakeholders can partner with communities to eradicate poverty and create an environment that facilitates healthy child development. Empowering victims to report abuse is another intervention (Olafson, 2011). While this approach does not undo the effects of CSA, it ensures that perpetrators face the law. Cognitive behavioral therapy (CBT) is another approach that has shown promise. Essentially, this intervention aims to transform the mindset of CSA survivors so as to discourage such unhealthy behaviors as substance abuse (Passarela, Mendes & Mari, 2010). Furthermore, CBT is also used to treat the symptoms of such conditions as post-traumatic stress disorder which is common among survivors of CSA.

The impacts of CSA are often seen in adulthood. For example, the survivors are usually unable to develop healthy relationships. This inability can hamper their capacity for parenthood. Perinatal interventions have been shown to be effective in helping the survivors to recover and to provide them with the skills that they need to become effective and loving parents (Stephenson et al., 2018). Basically, the perinatal interventions empower the survivors to protect their children and ensure that they do not suffer the same sexual abuse. Another intervention that practitioners can adopt is counseling (Karakurt & Silver, 2014). As was evidenced by the case of Nelson, CSA can have devastating effects on the victim. The effects are compounded when the victim is not provided with support. Through counseling, social workers and mental health professionals can provide survivors with a platform for sharing their stories and shedding light on the damage that CSA causes. Furthermore, counseling allows the practitioner to rebuild the victim’s confidence and establish a healthy relationship.

I understand that as they determine the approaches to implement, practitioners need to rely on scholarly literature. While I agree that the literature is insightful and its role cannot be dismissed, I find that personal and professional experience enables practitioners to identify approaches that are most appropriate and hold the greatest promise. I have been working with Nelson for several weeks now. One of the interventions that I have adopted involves home visitations. I make weekly visits to his foster home where I speak with his foster mother. Furthermore, I discuss his progress with his teachers. I have observed that the home visits enable me to ensure that Nelson is making progress and that they are an effective intervention.

Theoretical Foundation of Integrated Approaches 

All the interventions discussed above are effective. Since they function differently, these approaches can be combined to create an integrated approach which leverages the strengths of each intervention. There is a solid theoretical basis for an integrated intervention. The theoretical basis is founded on the fact that there are overlaps in the way the different approaches function (Cohen, Mannarino & Deblinger, 2017). For instance, counseling and trauma-focused cognitive behavioral therapy involve speaking with parents about the damage that CSA causes to the physical and mental health of their children. Since these two approaches involve the application of similar measures and techniques, they can be combined to achieve better results. Another issue that makes up the theoretical base of an integrated approach is the fact that the different interventions focus on different aspects of CSA and other forms of abuse against children (Cohen, Mannarino & Deblinger, 2017). By addressing various elements of the abuse, the integrated approach enables children and their parents to witness holistic healing. For example, suppose that as part of their efforts to help a child survivor of abuse to deal with trauma, a social worker combines counseling with home visitation. While the counseling will enable the child to understand that the abuse they suffered was not their fault, the home visitation makes it possible for the social worker to establish that the child’s home environment does not pose a threat to the healing process.

Relevant Approaches 

There is evidence to show that all the interventions identified above are effective. However, various constraints such as limited funding make it difficult to implement all the approaches. Therefore, a social worker needs to select the most promising interventions. Additionally, and more importantly, the social worker should ensure that the selected interventions are consistent with the needs and unique characteristics of individual clients. Nearly all the approaches would help Nelson to overcome the trauma and the other challenges that he grapples with. Home visitation and counseling appear to be the most appropriate and promising interventions. As part of our discussions, Nelson stated that his home environment warm and accepting. However, he told me that he fears that since he shares the home with other foster children, the home could become toxic. For example, he has been approached by one of the foster children who tried to persuade him to experiment with marijuana. Without support from such professionals as social workers, Nelson will undoubtedly yield to the pressure to become involved in risky behaviors. Home visitation will play a vital role in ensuring that his home environment promotes his wellbeing. For instance, as part of the home visitation, I intend to speak with his foster mother about the need for a safe home environment. Furthermore, I hope that during my visits, I will be able to identify the hazards that expose Nelson to the risk of further abuse. In addition to conducting home visits, I will also counsel Nelson and try to persuade his foster mother to participate in the counseling initiative. I am convinced that counseling holds the key to helping Nelson find healing. He is a deeply troubled young adult who is seeking friendship and understanding. Through counseling, I will offer him the assurances and the warmth that he desperately desires. Moreover, I believe that counseling will allow us to identify other problems and develop interventions for addressing them. Apart from the fact that they are effective, I have selected home visitation and counseling because of their ease of implementation. I find that the other approaches are rather complex and require advanced skills and knowledge. I am already using counseling and home visitation as the primary interventions. As I gain deeper insights and enhance my competencies during the internship, I know that I will be better placed to focus these interventions on fixing the numerous problems that define Nelson’s life.

Social Work Skills, Client Strengths, Transference and Countertransference 

If I am to be effective in my application of the interventions addressed in the discussion above, I need to leverage my social work skills and make considerations for such issues as the dynamics of Nelson’s case, his strengths and issues of transference and counter-transference. Empathy, cultural competence and effective communication are some of the key skills that I believe will play critical roles in facilitating the administration of the interventions. For example, cultural competence will help me to understand that I must be sensitive to the Nelson’s culture. African Americans tend to distrust health professionals owing to the injustices that they have suffered in the past (Kennedy, 2007). While it is true that Nelson is technically not African American, I observed that he shared the black community distrust of the medical profession. I expect to encounter some pushback from Nelson and his family as I apply the interventions. Leveraging my cultural competence skills, I will assure Nelson and the family that the interventions are simply designed to safeguard his wellbeing. Empathy and communication skills will enable me to create a strong relationship with Nelson. Unless a social worker and their client have a warm relationship, it is nearly impossible for any meaningful progress to occur. The communication skills will also be helpful in enabling me to respond to any and all questions and concerns that Nelson raises.

The dynamics of the case of Nelson and the numerous strengths that he possesses will also shape how I implement the interventions. As noted earlier, Nelson is a young who is reeling from the effects of sexual abuse. He struggles with substance abuse and poor academic performance. I will gear the counseling and home visitation at solving these problems. For example, the counseling will involve sensitizing Nelson on the damage that substance abuse can cause to his mental and physical health. Enabling him to grieve the loss of his brother is another function that the counseling will serve. On the other hand, the focus of the home visitation will be to identify hazards and to determine if the home is so unstable that placing Nelson in foster care is warranted. In essence, how I deliver counseling and conduct the home visits will be guided largely by the particulars of Nelson’s case. I observed that he possesses a number of strengths which will facilitate the adoption of the two interventions. Among these strengths include resilience, high self-esteem and a desperate desire for personal growth. Despite the challenges that he has encountered, Nelson has remained positive and hopeful. I feel that I can exploit these strengths to encourage him to commit to the counseling and participate fully in the home visitations. Another strength that I intend to leverage involves Nelson’s understanding that the current path only leads to destruction. He admitted that he recognizes that his substance abuse and failure to commit to his studies will cause serious devastation if he does not take action. I am confident that Nelson will dedicate all his effort to ensure that the treatments are effective.

As stated earlier, transference and countertransference issues will also influence the integration of the interventions into treating Nelson. For the most part, these issues had damaging effects on our relationship. For example, one of the transference issues that I observed was that Nelson was distrustful and reluctant to participate in our sessions. I blamed this behavior on his poor relationship with his biological mother. As regards countertransference, I noticed that I expressed my frustrations and disappointment instead of managing my emotions professionally. To ensure that the transference and countertransference issues do not impede progress, I will strive to maintain high levels of professionalism and guide Nelson in a way that enables him to view matters objectively.

Conclusion 

Left untreated, trauma can have devastating effects. It is therefore important for social workers to focus their efforts on helping children who have developed trauma as a result of sexual abuse. Sexual violence has been shown to be a serious problem that affects millions of children in the US and across the globe. Apart from pushing children into such destructive behaviors as substance abuse and crime, child abuse also leads to poor academic performance and the development of mental health problems. Fortunately, there is wide range of effective interventions that social workers can use to treat trauma. For Nelson, I chose counseling and home visitation. I am positive that when I implement these interventions, I will help Nelson to fully overcome the hardships that he currently faces.

References

Banwari, M. (2011). Poverty, child sexual abuse and HIV in the Transkei region, South Africa. African Health Sciences, 11 (Suppl 1), S117-S121.

Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents. Second Edition. Guilford Publications.

Cox, E. (2018). The silent epidemic: child sexual abuse . U.S. News. Retrieved December 10, 2018 from https://health.usnews.com/health-care/for-better/articles/2018-06-01/the-silent-epidemic-child-sexual-abuse

Dunlop, B. W., Hill, E., Johnson, B. N., Klein, D. N., Gelenberg, A. J., Rothbaum, B. O., Thase, M. E., & Kocsis, J. H. (2015). Mediators of sexual functioning and marital quality in chronically depressed adults with and without a history of childhood sexual abuse. The Journal of Sexual Medicine, 12 (3), 813-823.

Karakurt, G., & Silver, K. E. (2015). Therapy for childhood sexual abuse survivors using attachment and family systems theory orientations. American Journal of Family Therapy, 42 (1), 79-91.

Kennedy, B. R., Mathis, C. C., & Woods, A. K. (2007). African Americans and their distrust of the health care system: healthcare for diverse populations. Journal of Cultural Diversity, 14 (2), 56-60.

Letourneau, E. J., Brown, D. S., Fang, X., Hassan, A., &. Mercy, J.A. (2018). The economic burden of child sexual abuse in the United States. Child Abuse & Neglect, 79 , 413.

DOI: 10.1016/j.chiabu.2018.02.020

Olafson, E. (2011). Child sexual abuse: demography, impact, and interventions. Journal of Child & Adolescent Trauma, 4 (1), 8-21.

Passarela, C. M., Mendes, D. D., & Mari, J. J. (2010). A systematic review to study the efficacy of cognitive behavioral therapy for sexually abused children and adolescents with posttraumatic stress disorder. Archives of Clinical Psychiatry, 37 (2). DOI: http://dx.doi.org/10.1590/S0101-60832010000200006

Singh, M. M., Parsekar, S. S., & Nair, S. N. (2014). An epidemiological overview of child sexual abuse. Journal of Family Medicine and Family Care, 3 (4), 430-5.

Stephenson, L. A., Beck, K., Busuulwa, P., Rosan, C., Pariante, C. M., Pawlby, S., & Sethna, V. (2018). Perinatal interventions for mothers and fathers who are survivors of childhood sexual abuse . Child Abuse & Neglect, 80, 9-31.