Service and Treatment Victims of Sexual Trauma

Introduction
Sexual abuse and assault is a fundamental public health and social issue in the United States and across the globe. The longstanding adverse consequences more often than not linked with sexual abuse mandate that effective treatment and prevention programs be developed (Morrison et al., 2004). Imperatively, sexual abuse acts are in violation of the trust, safety and development that ought to be a natural part of the life of a child or adolescent. Its regularity and extensively harmful effect make it one of the most severe psychosocial issues with potentially pervasive longstanding costs and problems to persons, families and communities as a whole (Lesmana, Suryani, and Tiliopoulos, 2015). Childhood and adolescence sexual abuse can have long-term and overwhelming effects on individual and relational growth and development. Sexually abused children have a tendency to portray greater rates of poor school performance, belligerent behavior, posttraumatic stress disorder, or depressive symptoms, in addition to social and interpersonal insufficiencies. The trauma that comes after this kind of abuse can further have an impact on mental development and functioning, exasperating mental or physical problems in adulthood (Lesmana, Suryani, and Tiliopoulos, 2015). Therefore, this places great significance to the treatments and services rendered to victims of sexual abuse. In addition, the different cultural contexts and societies in which sexual abuse practices take place also play a significant role and are potent factors of perpetuating sexual abuse. The main purpose of this paper is to investigate the services or treatment rendered to victims of sexual trauma and the manner in which culture and society influence how such services or treatments are managed.
Sexual Abuse Services and Treatments
The effects of sexual abuse on individuals in terms of their mental health have gained traction in the past decade. Research studies have substantiated that sexual assault facilitate significant levels of psychological and behavioral problems amongst young individuals and has strong links of interpersonal and mental problems. It is imperative to have cognizance into effective practices and interventions for utilization when it comes to treatment of sexual abuse survivor. With mounting sexual assault and traumatization instances, the necessity for knowledge, comprehension and execution of effective treatment and service practices becomes palpable (Underwood, Stewart, and Castellanos, 2007).
Lawson (2017) conducted an evidence-based case study concerning the treatment of adults with complex trauma. Research indicates that victims of such trauma have a greater and higher risk of interpersonal revictimization across their life span. Revictimization more often than not is linked with mounting ruthlessness of traumatic events in addition to symptom intricacy beyond the effect of several kinds of trauma exposures. What is more, the intergenerational diffusion of abuse every so often is a crucial component in complex trauma. For instance, a mother’s history of child sexual abuse is the sole strongest forecaster of child sexual abuse in the forthcoming generation. In fact statistics indicate that the daughters of such mothers have higher risk of child sexual abuse that is 3.6 times higher. When combined with the usage of drugs, this level of risk goes up to 24 times. Lawson (2017) makes the argument that with the multifaceted nature of complex trauma from sexual abuse, interruptions in normal child development and the distinctive profile of every individual, treatment of such sexual assault also needs to be multifaceted and adapted to every individual.
In accordance to Briere and Scott (2013) treatment and services for sexual abuse and sexual assault lay emphasis not only on the reduction of symptoms but also on the development of individual capacities in regards to aspects such as identity, relatedness as well as affect regulation. Imperatively, restricted self-capacities intensify and aggravate the severity of symptoms and their chronicity. Majority of the treatment models for sexual assault and sexual abuse are relationship-based, trauma focused, cognitive behavior therapy that include at least three key stages, which are safety, stabilization as well as formation of alliances. The models may comprise of couple counseling and family counseling. Notably, strength-oriented interventions, for instance the identification of solution behavior, are pivotal in every phase (Briere and Scott, 2013; Lawson, 2017).
Deblinger, McLeer and Henry (1990) conducted a study investigating the efficacy of a cognitive behavioral treatment program intended for sexually abused children suffering from post-traumatic stress disorder. In the investigation, 19 different girls who experienced contact sexual abuse and satisfied DSM-III-R criteria for PTSD were incorporated into the research study. These participants included girls of ages ranging from 3 years old to 16 years old. Structured interviews were undertaken to evaluate the presence or lack thereof of post-traumatic stress disorder symptoms, before, during as well as after the sexual abuse. What is more, the parents of the girls involved in the study filled the Child Behavior Checklist and the research subjects with the age of at least 6 years were administered the Child Depression Inventory and the Spielberger State-Trait Anxiety Inventory at the preliminary assessment and once more just about two to three weeks afterwards prior to the initiation of treatment. The results of the study indicated significant improvements for the participants on all measures (Deblinger et al., 1990).
Sinanan (2015) conducts a research study examining trauma and treatment of child sexual abuse. Psychotherapy helps as the initial model of a healthy association with numerous victims of sexual abuse. Imperatively, this treatment is beneficial as it can offer a model of healing, cultivating relationship, where the victim is able to discover the ability to experience trust once again. This treatment offers the victim with a chance to transform the trauma into a healthier sense of self. On the other hand, cognitive therapy lays emphasis on educating victims how to pinpoint, assess and reframe the dysfunctional cognitions associated to the specific trauma and its other elements that add to the intense adverse emotions and behavioral reactions. Sinanan (2015) established that cognitive behavioral therapy gives rise to positive outcomes with respect to the treatment of sexually abused children. In a research study including 100 children as participants, a comparison of four different treatment conditions was undertaken with 12-week abuse-focused CBT model for the child only, CBT for the parent only, CBT for the both the child and the parent, and a collection that only experienced standardized community care. There was an improvement that took place in each treatment condition, with the most benefit resulting from the therapy with the child alone. In addition, other research studies also demonstrate significant improvement in PTSD symptoms and general functioning in sexually abused children obtaining cognitive behavioral therapy in comparison to nonspecific treatment strategies and wait-list controls (Sinanan, 2015).
Impact of Culture and Society on the Treatment and Services for Victims of Sexual Abuse
Cultural norms have an impact on the disclosure as well as reporting of sexual abuse and are influenced in different ways by religion and international cultural trends. Practices associated with reporting sexual abuse are impacted by fear, sensitivity, and attitude, tolerable practices and discrimination in addition to passivity within the community, and insufficiencies and shortcomings of the legal system. Overall perceptions and attitudes towards sexual assaults against children add to a significantly subdued and quiet reaction to child sexual abuse (Shafe and Hutchison, 2014). Individuals from difference ethnic cultures in the United States may vary to some extent in how child sexual abuse is delineated or comprehended, which would without a doubt influence their reporting behavior. In accordance to research conducted by Fontes and Plumer (2010), cultural norms have an influence on the probability that child sexual abuse or sexual assault will be discovered by an adult or divulged by a child. In addition, cultural norms influence whether the families of children who have been sexually abused will report such incidences of assault to authorities. For instance, the research undertaken by Fontes and Plumer (2010) established that whereas adults from the African American and Latin cultures proclaimed forthrightly that they would report sexual abuse by a stranger when they discovered about it, when questioned about reporting abuse undertaken by a friend or a loved one, they proclaimed that they would deal with it through unofficial ways.
Ho and Kwok (1991) outline that children are deemed to be property of their parents or their guardians in a number of cultures and this may elucidate the practice of “Xiao”, which asserts that children ought to obey their parents devoid of asking any kind of questions or giving any opinions that are contradictory to their say. Such practices are largely prevalent in numerous non-western cultures. In the same manner, child keeping, which is a practice or action of provisionally altering the residence of children to that of relatives in the course of or during a spell of stress is a common cultural practice in African American communities. Such cultural adaptations facilitate the high correlation that exists between child sexual abuse and females who are with their non-biological parents.
Other cultural practices that hamper treatment of sexual abuse and also aggravate it is the pursuit of wealth and also the cure of diseases and arranged marriages. For instances, in the Tanzanian culture, it is believed that traditional witch doctors give suggestions to men in such communities seeking wealth to have sexual intercourse with virgin girls. In the same manner, having sex with virgins is also recommended to individuals who are suffering from acquired immune deficiency syndrome (AIDS) as it is deemed to be a cure. In fact, statistics indicate that this wrong perception was a leading factor that was responsible for the sexual abuse and rape of approximately sixty children in the South African community. What is more, the manner in which children are perceived facilitates other practices such as arranged marriages to be common. This is especially common in the African, Middle Eastern and Asian cultures where girls are given away to men into marriages devoid of their consent. It is imperative to note that this significantly hampers the treatment and services rendered to victims of sexual abuse because such acts are justified and deemed to be appropriate in the society (Shafe and Hutchison, 2015).
Lesmana, Suryani, and Tiliopoulos (2015) point out that cultural execution is a potential and systematic contributing factor into holistic and sensitive interventional models for the treatment of mental illness consequences of childhood and adolescence sexual abuse and traumatization. In different regions of the world, for instance in Bali, where a comparatively standardized collectivistic cultural and spiritual mixture pervades all facets of life, these sorts of treatments and therapies need to adhere to an assimilated, multimodal, and synergic approach to intervention. This kind of an approach would assemble contemporary psychotherapeutic techniques and medication, while valuing and sensibly capitalizing on the customary health practices and religious beliefs. Lesmana et al. (2015) make the argument that the practical and methodical execution of all-inclusive and culturally competent strategies, a growth of mental health deployment-focused models can be attained that offer a reasonable and effective service to the population.
Cultural deliberations are hardly ever or superficially taken into consideration in sexual abuse treatment approaches. Western-educated psychoanalysts and clinical psychologists have a tendency to disregard or take too lightly such factors in cross-cultural settings, giving rise to interventional determinations that might hamper with traditional methods to healing, and possibly giving rise to a trans-generational sequence of trauma. Dayal (2018) examines the socio-cultural context of India with respect to sexual abuse. For instance, in the nation, there are strong cultural taboos and proscriptions that are linked with deliberating upon sex and sexual violence, which might give rise to greater emotional distress or a sense of relief from the prospect to openly deliberate upon one’s experience. What is more, parents in India customarily have a tendency to be largely involved in the decision making of their children, and as a result the children might not feel comfortable to independently make decisions that encompass the aspect of informed consent.
Shafe and Hutchison (2015) outline that the treatment of sexual abuse continues to be significantly challenging, owing to the perception of sexual abuse in different cultures. For instance, in a review of sexual practices and transgressions in the Indian culture, it was reported that in the course of trials, suspected sexual offenders more often than not stated that they were not cognizant that they committed an offense. In a number of cultures, there is strong belief and conviction sexual abuse and sexual assault is warranted on the basis of how girls dress and not being adherent to the customary values. This significantly impacts the treatment and services rendered to victims of sexual abuse owing to the reason that the level of openness is impacted by sensitivity that is linked to sexual abuse and the general impact on the household unit (Shafe and Hutchison, 2015). For instance, in China, which is a less open cultural context, the victims of sexual abuse may not volunteer information regarding their abuse as a result of cultural reasons. Furthermore, invasion of sexual privacy may be accepted and embraced where there is insufficient education and information is every so often attained with challenges from unenthusiastic information who are in fear of the cultural implication of the information that they disclose. This makes the treatment and services rendered to such victims much harder to diagnose. Furthermore, child abuse in Jordan is solely recognized and acknowledged for treatment only when there is severe damage. This implies that treatment for sexual abuse is overlooked for numerous other victims (Shafe and Hutchison, 2015).
Children as well as adolescents continue to be subjected to sexual abuse for cultural reasons that comprise of patriarchal philosophy, which is worsened and aggravated by age-associated hierarchies in a number of societies such as Africa and Asia. This significantly hampers the treatment and services provided to the victims of sexual abuse owing to the reason that there is diminished reporting of such sexual assault incidences. In addition, treatment is not deemed necessary and is even discouraged because some of the instances are in fact justified in such cultural contexts. For instance, the child abuse patterns may be as a result of forced marriages. Alignment toward a certain group, family structure, and conformism to norms and the problem of shame continue to be key significant factors and play a major role in reporting and dealing with sexual abuse practices. Cultural and community practices continue to be strong forces in exacerbating sexual abuse and hampering the treatment and services rendered to victims of sexual abuse (Shafe and Hutchison, 2015).




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