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Do not fill this in! ==Treatment== {{Main article|Post-assault treatment of sexual assault victims}} The initial approach to treating a person who has been a victim of sexual abuse is dependent upon several important factors: *Age at the time of presentation *Circumstances of presentation for treatment *Co-morbid conditions The goal of treatment is not only to treat current mental health issues, and [[Psychological trauma|trauma]] related symptoms, but also to prevent future ones. ===Children and adolescents=== Children often present for treatment in one of several circumstances, including criminal investigations, custody battles, problematic behaviors, and referrals from child welfare agencies.<ref name=NCCAN>{{Cite book|author1=Cynthia Winn |author2=Anthony J. Urquiza |title=Treatment For Abused And Neglected Children: Infancy To Age 18 β User Manual Series |publisher=Diane Pub Co |year=2004 |isbn=978-0-7881-1661-2 }}{{page needed|date=November 2013}}</ref> The three major modalities for therapy with children and adolescents are [[family therapy]], [[Group psychotherapy|group therapy]], and [[psychotherapy|individual therapy]]. Which course is used depends on a variety of factors that must be assessed on a case-by-case basis. For instance, treatment of young children generally requires strong parental involvement and can benefit from family therapy. Adolescents tend to be more independent; they can benefit from individual or group therapy. The modality also shifts during the course of treatment; for example, group therapy is rarely used in the initial stages, as the subject matter is very personal and/or embarrassing.<ref name=NCCAN/> In a 2012 systematic review, [[Cognitive behavioral therapy|cognitive behavior therapy]] showed potential in treating the adverse consequences of child sexual abuse.<ref>{{Cite journal|last1=G|first1=Macdonald|last2=Jp|first2=Higgins|last3=P|first3=Ramchandani|last4=Jc|first4=Valentine|last5=Lp|first5=Bronger|last6=P|first6=Klein|last7=R|first7=O'Daniel|last8=M|first8=Pickering|last9=B|first9=Rademaker|date=2012-05-16|title=Cognitive-behavioural Interventions for Children Who Have Been Sexually Abused|journal=Cochrane Database of Systematic Reviews|volume=2012 |issue=5|pages=CD001930|language=en|doi=10.1002/14651858.CD001930.pub3|pmc=7061273|pmid=22592679}}</ref> Major factors that affect both the pathology and response to treatment include the type and severity of the sexual act, its frequency, the age at which it occurred, and the child's family of origin. Roland C. Summit, a medical doctor, defined the different stages the victims of child sexual abuse go through, called [[child sexual abuse accommodation syndrome]]. He suggested that children who are victims of sexual abuse display a range of symptoms that include secrecy, helplessness, entrapment, accommodation, delayed and conflicted disclosure and recantation.<ref name="Summit">{{cite journal|last=Summit|first=Roland C.|title=The child sexual abuse accommodation syndrome|journal=Child Abuse & Neglect|date=January 1983|volume=7|issue=22|pmid=6605796|doi=10.1016/0145-2134(83)90070-4|pages=177β93|s2cid=4547031 }}</ref> ===Adults=== Adults who have been sexually abused as children often present for treatment with a secondary mental health issue, which can include [[substance abuse]], [[eating disorders]], [[personality disorders]], [[Depression (mood)|depression]], and conflict in romantic or interpersonal relationships.<ref name="Swaby-">{{Cite journal| last1 = Swaby | first1 = AN. | last2 = Morgan | first2 = KA. | title = The relationship between childhood sexual abuse and sexual dysfunction in Jamaican adults | journal = J Child Sex Abuse | volume = 18 | issue = 3 | pages = 247β66 | year = 2009| doi = 10.1080/10538710902902679| pmid = 19856732 | s2cid = 33062149 }}</ref> Generally, the approach is to focus on the present problem, rather than the abuse itself. Treatment is highly varied and depends on the person's specific issues. For instance, a person with a history of sexual abuse and severe depression would be treated for [[Major depressive disorder|depression]]. However, there is often an emphasis on [[cognitive restructuring]] due to the deep-seated nature of the trauma. Some newer techniques such as [[eye movement desensitization and reprocessing]] (EMDR) have been shown to be effective.<ref>{{Cite journal| last1 = Edmond | first1 = T. | last2 = Rubin | first2 = A. | title = Assessing the long-term effects of EMDR: results from an 18-month follow-up study with adult female survivors of CSA | journal = J Child Sex Abuse | volume = 13 | issue = 1 | pages = 69β86 | year = 2004 | doi = 10.1300/J070v13n01_04| pmid = 15353377 | s2cid = 28012364 }}</ref> Although there is no known cure for pedophilia,<ref name=SetoReview>{{cite journal | author = Seto MC | year = 2009 | title = Pedophilia | journal = Annual Review of Clinical Psychology | volume = 5 | pages = 391β407 | doi=10.1146/annurev.clinpsy.032408.153618 | pmid=19327034| s2cid = 241202227 }}</ref> there are [[Pedophilia#Treatment|a number of treatments for pedophiles and child sexual abusers]]. Some of the treatments focus on attempting to change the sexual preference of pedophiles, while others focus on keeping pedophiles from committing child sexual abuse, or on keeping child sexual abusers from committing child sexual abuse again. [[Cognitive behavioral therapy]] (CBT), for example, aims to reduce attitudes, beliefs, and behaviors that may increase the likelihood of sexual offenses against children. Its content varies widely between therapists, but a typical program might involve training in self-control, social competence and empathy, and use [[cognitive restructuring]] to change views on sex with children. The most common form of this therapy is [[relapse prevention]], where the patient is taught to identify and respond to potentially risky situations based on principles used for treating addictions.<ref name="seto171">{{cite book |last= Seto |first= Michael |date= 2008|title= Pedophilia and Sexual Offending Against Children |url= https://archive.org/details/pedophiliasexual00seto |location= Washington, DC |publisher= American Psychological Association|page= [https://archive.org/details/pedophiliasexual00seto/page/n182 171]|isbn= 978-1-4338-0114-3 }}</ref> The evidence for cognitive behavioral therapy is mixed.<ref name="seto171" /> A 2012 [[Cochrane Collaboration|Cochrane Review]] of randomized trials found that CBT had no effect on risk of reoffending for contact sex offenders.<ref name="cochrane">{{cite journal |vauthors=Dennis JA, Khan O, Ferriter M, Huband N, Powney MJ, Duggan C | year = 2012 | title = Psychological interventions for adults who have sexually offended or are at risk of offending | journal = Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | pages = CD007507 | doi = 10.1002/14651858.CD007507.pub2| pmid = 23235646 }}</ref> Meta-analyses in 2002 and 2005, which included both randomized and non-randomized studies, concluded that CBT reduced recidivism.<ref>{{cite journal |vauthors=LΓΆsel F, Schmucker M | year = 2005 | title = The effectiveness of treatment for sexual offenders: a comprehensive meta-analysis | journal = Journal of Experimental Criminology | volume = 1 | issue = 1 | pages = 117β46 | doi=10.1007/s11292-004-6466-7| s2cid = 145253074 }}</ref><ref>{{cite journal |vauthors=Hanson RK, Gordon A, Harris AJ, Marques JK, Murphy W, etal | year = 2002 | title = First report of the collaborative outcome data project on the effectiveness of treatment for sex offenders | journal = Sexual Abuse | volume = 14 | issue = 2 | pages = 169β94 | doi=10.1177/107906320201400207| pmid = 11961890 | s2cid = 34192852 }}</ref> There is debate over whether non-randomized studies should be considered informative.<ref name=SetoReview/><ref name="rice2012">{{cite book |vauthors=Rice ME, Harris GT | year = 2012 | chapter = Treatment for adult sex offenders: may we reject the null hypothesis? | title = Handbook of Legal & Ethical Aspects of Sex Offender Treatment & Management |veditors=Harrison K, Rainey B | location = London | publisher = Wiley-Blackwell}}</ref> More research is needed.<ref name="cochrane" /> Sexual abuse is associated with many sub-clinical behavioral issues as well, including [[re-victimization]] in the teenage years, a bipolar-like switching between sexual compulsion and shut-down, and [[cognitive distortion|distorted thinking]] on the subject of sexual abuse (for instance, that it is common and happens to everyone). When first presenting for treatment, the patient can be fully aware of their abuse as an event, but their ''appraisal'' of it is often distorted, such as believing that the event was unremarkable (a form of [[Isolation (psychology)|isolation]]). Frequently, victims do not make the connection between their abuse and their present pathology. Summary: Please note that all contributions to Christianpedia may be edited, altered, or removed by other contributors. If you do not want your writing to be edited mercilessly, then do not submit it here. You are also promising us that you wrote this yourself, or copied it from a public domain or similar free resource (see Christianpedia:Copyrights for details). Do not submit copyrighted work without permission! Cancel Editing help (opens in new window) Discuss this page