Problems in Health Care for Abuse Survivors
Oct 7, 2012
Abundant research now exists demonstrating that those who suffered trauma during childhood are at increased risks for suffering not only adult mental disorders, but chronic physical disorders throughout their lives. On my website I have provided access to my earlier research proposal which briefly reviews some of the history of this research (some of the early work being done by Felletti and colleagues [LINK]. Locally, similar research results have been obtained through the Christchurch longterm developmental study, especially the work of Professor Kate Scott [LINK].
Further aggravating the plight of survivors, however, is the factor that often they have difficulties in a broad range of relationships, including such "instrumental" relationships as relationships with care providers, including providers of medical care. Fortunately, the Canadian Psychiatric Association has been one professional society to address this problem and has developed guidelines for how primary care providers (GPs as we refer to them colloquially) and such guidelines are available here -- Schachter et al (2009) [LINK].
In a recent research article Hovey and colleagues Hovey (2011) [LINK] summarize the findings of a multiphased qualitative study about survivors’ experiences in healthcare settings. The study informed the development of the Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse (Schachter, Stalker, Teram, Lasiuk, & Danilkewich, 2009), which is intended to help healthcare providers from all disciplines understand the effect of child sexual abuse on some survivors’ abilities to access and benefit from health care. The Hovey paper discusses what psychotherapists can learn from the healthcare experiences of the male survivors who participated in this project. It also offers practical suggestions for supporting male clients who experience difficulty seeking treatment for physical health concerns.
Another recent study has examined similar ground, this time looking at the effects of attachment difficulties on the quality of therapeutic engagement for women -- Smith et al (2011) [LINK] This study study examines how attachment orientation (i.e. anxiety and avoidance) and development of the working alliance are associated with treatment outcomes among depressed women with histories of childhood sexual abuse. Seventy women seeking treatment in a community mental health center who had Major Depressive Disorder and a childhood sexual abuse history were randomized to Interpersonal Psychotherapy or treatment as usual. It was found that
greater attachment avoidance and weaker working alliance were each related to worse depression symptom outcomes; these effects were independent of the presence of comorbid Borderline Personality Disorder and Post-Traumatic Stress Disorder. The effect of avoidant attachment on outcomes was not mediated by the working alliance. Further, working alliance had a stronger effect on depression outcomes in the Interpersonal Psychotherapy group. The authors conclude "understanding the influence of attachment style and the working alliance on treatment outcomes can inform efforts to improve the treatments for depressed women with a history of childhood sexual abuse." Personally, I have no doubt that the same could be said of male survivors' experiences, as implied in my research proposal, though this has not yet been studied.