This assignment is a discussion on the topic of effective group treatment of sexual assault in military and civilian populations. The discussion pays special attention to the treatment models which have been empirically proved to be effective in the treatment of sexual assault victims. In the discussion, it will be argued that sexual assault is a leading cause of mental diagnosis like Post-Traumatic Stress Disorder (PTSD), Major Depressive Disorder, depression and sleep related mental diagnosis. The empirically based group treatment modalities to be discussed include Seeking Safety group, Cognitive Processing Therapy (CPT) and Cognitive Behavioral Therapy for Insomnia (CBT-I).
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The Problem of Sexual Assault
Sexual assault is any form of sexual harassment to a victim by an assailant or aggressor. It may be in form of rape, unanticipated sexual advances, touching of sexual organs or genital areas or using sexually intimidating language when communicating. An action qualifies to be a sexual assault if it leads to a sexual encounter, either physically or otherwise without the mutual agreement between the parties involved.
The worst and most common form of sexual assault is rape. Rape can happen in various places and contexts including workplace, social places or even in marriage. The most common cause of rape is psychological imbalance on the part of the rapist. Other causes may include provocative dressing and sexual starvation (Petrak &Hedge, 2002).
Many victims of rape are usually women. This is because it is easier for a man to rape a woman that it is possible and practical for a woman to rape a man. This does not however mean than men are not raped but rather means that women are more willing to report cases of rape than men. The reason is that it may be difficult for a man to provide evidence that he has been raped.
Most important is that men are culturally expected to be strong, courageous and able to defend themselves than women. This makes most men fear reporting that they have been raped for the fear of being regarded as cowards or weak and therefore unable to defend themselves. Men are also known to be very egoistic in nature and therefore an act like reporting a rape incident could damage their ego (Petrak &Hedge, 2002).
Most of the sexual assaults which are reported are usually committed by men, either to their fellow men or to women. This is because men are known to be very aggressive, egoistic and therefore unable to reconcile their ego demands with reality. Women rarely rape men because the women are generally weaker than men and therefore unable to commit the assault. Men are also known to easily give in to the sexual advances from women. Even when a man is raped by a woman, it is hard to prove because there is usually no evidence in terms of injuries as is the case when a man rapes a woman or another man.
Due to its complexity and sometimes stigma, sexual assault is rarely reported. This is because many women victims in the civilian population feel ashamed of reporting it or they fear for their lives especially if the assailant is a person in authority. This means that many victims of rape stay with the problem without reporting (Petrak &Hedge, 2002).
According to the center for deployment psychology, the prevalence rate for sexual victimization in the general US population is 17% for women and 3% for men. In the military, the rate of sexual victimization among women is estimated at 28% (Schulz, 2011).
Mental Diagnosis Associated With Sexual Assault
Major depressive disorder (MDD)
The Diagnostic and Statistical Manual of Mental Diagnosis bases its definition of MDD majorly on the criteria of consistence and persistence of symptoms. The criteria distinguish MDD from depression by describing MDD as occurring in a prolonged manner, usually for a period of two weeks. It defines MDD as a form of depression in which the patient experiences feelings of disturbed moods in a recurrent manner. The mood disturbance cause disruption of the patient’s normal mood and makes him or her unable to adjust or behave accordingly in school, family setting as well as in work (Schulz, 2011).
The criteria of Diagnostic and Statistical Manual of Mental Diagnosis does not have any kind of diagnosis for MDD but relies on observation of the patient, the patient’s own account of changes in mood as well as reports by close friends or relatives on the observed changes in mood in the patient (Martinowich & Lu, 2008. pp.342-348).
The most notable symptoms which are relied on in diagnosing for MDD include day to day mood changes lasting for more than two weeks, lack of interest in virtually all daily activities even those which are very interesting, instances of daytime sleep (hypersomnia), loss of appetite which leads to loss of body weight, or a weight gain by more than 5 kilograms, inability to concentrate or think aptly, fatigue which leads to feelings of tiredness even after waking up, occasional thoughts about death which are accompanied by feelings of worthlessness, and suicidal or homicidal tendencies.
Post-traumatic stress disorder (PTSD)
This is a form of anxiety disorder which occurs as a result of exposure to psychological disturbance. Patients who are diagnosed with PTSD show symptoms such as inability to sleep or being overly concerned with their safety or security. One of the main encounters in life which lead to PTSD is sexual assault. The victims of sexual assault usually experience the trauma of the sexual encounter, mostly in form of rape through having nightmares, flashbacks of the encounters and gender bashing (avoiding a particular sex, especially the one which committed the assault on the victims). Other causes of PTSD include the witnessing of a nasty encounter, war, accidents and terrorism.
Depression is a collection of symptoms which are mainly characterized by feelings of distress by the affected individual (Beck & Alford, 2009). There are two types of depressions namely unipolar and bipolar depressions. Although the two are not usually distinguished, unipolar depression is the most common form of depression and is characterized by hyperactivity, inappropriate behavior, lack of sleep and troubled speech among others (Andrews, 2009).
Depression is a mental disorder which affects various segments of the society including the aged, the young and the adults. According to the center for disease control, most U.S citizens aged over 50 years have either short lived or lifelong depression, with a sizable number being victims of sexual assault (Andrews, 2009). Many victims of sexual assault usually suffer depression in form of manic especially when they remember the encounters with their assailants.
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Acute stress disorder
This is a form of mental diagnosis which is caused by experiencing a life threatening event or episode either on self or on others. Such life threatening events may include rape, witnessing death or a fatal accident. The disorder is usually diagnosed within a period of four weeks after the episode. Patients with acute stress disorder show dissociative symptoms linked to the event. This means they may have very vivid memories of the event or they may become emotionally insensitive.
According to the Psych Central weekly newsletter, the general symptoms of acute stress disorder include detaching oneself from one’s body, difficulty in concentrating, dissociative amnesia , re-experiencing the episode through illusions and flashbacks, avoiding anything which reminds the individual of the event, hyper vigilance, irritability, difficulty in sleeping, motor restlessness and poor concentration (Psych central, 2011).
Empirically-Based Group Treatment Modalities for Sexual Assault Victims
The most common form of intervention used in assisting victims of sexual assault both in the military and civilian populations is counseling. Counseling can be defined as an interaction between a client (who is presumed to be in need of assistance) and a counselor (who is presumed to be ready, willing qualified and competent enough to offer assistance to the client). Clients may be faced with various problems or distress emanating from their internal or external environment. They may have grief, anxiety, suicidal tendencies, low self-esteem, relationship problems, work related problems, family issues and many more.
The counselor is trained to have the necessary skills of helping the clients get relieved from the distress they have due to internal or external forces. There are various approaches to counseling, all of which aim at helping clients solve their problems. However, it may not be easy for a counselor to be an expert in all of them, but it is essential that the counselors are at least able to help the clients, and in some situations in which they may be unable, they may refer the clients elsewhere, so long as the clients will be assisted to solve their problems. In all theories or approaches, trust, confidentiality and openness are very essential for successful counseling. Counselors are also supposed to avoid judging their clients, but rather accept and understand them in their situations and plight (Corey, 2008).
In counseling, theories act as frameworks for guiding counselors in their interventions during counseling. The Various theoretical approaches employ different strategies in addressing problems facing clients. It is for the counselor to choose which theoretical approach to use based on the case.
Clients are faced with different problems which are manifested through the expression of some symptoms by the clients. The symptoms may be in form of behavior, feelings or self-expressions. In some cases, clients use the symptoms as alternatives for coping with the problems they are faced with. This means that the clients exhibit some behaviors which help them run away from the problems or live with the problems. In this case, the symptoms of the problem in question may be described as adaptive in the sense that the behaviors accompanying the symptoms are not innate, but are just acquired as a means to some end (Corey, 2008).
The symptoms therefore play the function of helping the clients cope or carry on with life, despite the challenges or the difficult situations they may be going through. For example, a husband who is not able to provide for his family may become a drug addict or an alcoholic, so as to avoid the stress related to the problems he is faced with (Corey, 2008).
Many victims of sexual assault usually suffer from PTSD as well as major depressive disorder. There are no discriminations in terms of civilian or military populations. However, as mentioned above, women in the military have greater chances of suffering from sexual assault than their male counterparts. There are several empirically group based treatments of victims of sexual assault. These modalities have been tested and shown good results in terms of symptoms disappearance. They include Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE) and Cognitive Behavioral Therapy for Insomnia (CBT-I) (Schulz, 2011).
Cognitive Processing Therapy (CPT)
This mode of intervention is the same as the cognitive behavioral therapy, but done in a group setting. The CPT is based on the philosophy that the cause of trauma among patients is their poor understating and conceptualization of their traumatic experiences, which makes them to ever remember such experiences. If they are educated to modify their thinking and the memories associated with a certain traumatic experience, they are able to live better. The underlying principle is that the patients should be assisted to view the traumatic encounters as something which could have befallen anybody else, but not something which was made for them. Others tend to blame themselves for the sexual assault by thinking that they should have been more careful or aggressive in their defense (Schulz, 2011).
In treating both civilian and military victims of sexual assault, the therapy usually constitutes of 12 sessions in which the patients are taken through a systematic process which culminates in the complete elimination of the believes about themselves and the traumatic experiences which hinder their recovery from the trauma (Follette, 2006).
In one of the significant stages of the process, clients are asked to write down their worst forms of trauma which they have undergone in their lives. After writing them down, they are asked to read and narrate them to the therapist. The idea behind this is that the writing down of the experiences and narrating them decreases their chances of avoiding similar situations in life and helps the victims have the courage to dissipate similar experiences, which in turn leads to recovery by making the clients get back to normalcy in terms of emotional adjustment. The therapists also use what is referred to as Socratic dialogue to engage the clients in speaking about their experiences. This helps them reduce the rate of self-blame and increase their ability to appreciate that the experiences could have befallen any other person. This leads to recovery.
Seeking Safety group
This model was introduced as a therapeutic approach by Najavits. In its original form, the model was introduced as an integrative approach to the problems of trauma, drugs and substance abuse. The model comprises a total of 25 topics covered in four main areas namely behavioral, cognitive, case management and interpersonal. The model works well for groups as well as for individual therapy for both sexes. It is offered in sessions of one and half hours twice a week, which can be conducted for a period of up to three months (Follette, 2006).
The philosophy behind the model is that clients suffering from trauma are more likely to recover if they are helped to detach themselves from their personal safety issues and be overly concerned with the safety of everybody else. It is usually done in groups so as to allow the victims of traumatic episodes like sexual assault realize that they are not the only people who are undergoing such experiences, but it is a natural phenomenon which can affect anybody else. This makes the clients diffuse their fear and get rid of the memories of their traumatic episodes, thus leading to recovery (Follette, 2006).
This model has proved to be very effective especially for sexual assault women victims in the civilian populations due to its flexibility. The therapists in this model usually try as much as possible to fix themselves in the schedules of the patients. This is usually aimed at helping them establish rapport with the patients so that they may have a good therapeutic relationship which is very crucial for effective therapeutic intervention (Follette, 2006).
Cognitive Behavioral Therapy for Insomnia (CBT-I)
This treatment method is based on the philosophy that traumatic experiences are associated with sleep diagnosis. According to Krishnan, both ‘decreased REM latency’ and ‘decreased slow wave sleep’ are known to be major contributors of MDD. This is because upon the necessary intervention to deal with them, most patients show improvement in the severity of symptoms of MDD (Krishnan, 2010).
Many civilian and military victims of sexual assault show symptoms which are consisted with this type of disorder. The therapy therefore intends to educate the victims on good sleep habits so that they may eliminate nightmares or flashbacks of their traumatic experiences. Many victims of sexual assault who are treated for their sleep diagnosis tend to show improvement in the elimination of the symptoms by up to 50% (Perlis, 2005).
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