SpearR_MFT6105_A6

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Preparation for Intervention: Narrative Perspective Assists with Past Trauma Rachael Spear Northcentral University MFT6105 Couples and Sex Therapy Dr. Padjen 11/05/2023

Preparation for Intervention: Narrative Perspective Assists with Past Trauma Part 1: Description Childhood Sexual Abuse (CSA). Childhood Sexual Abuse comprises of any interaction between an adult or an older child and a child for the purpose of sexual stimulation of either the adult, the child or the older child, and that results in sexual gratification. Childhood Sexual Abuse can consist of any of the following:  Kissing  Fondling  Genital Exposure  Masturbation  Fellatio  Cunnilingus  Digital or penile penetration  “Dry intercourse” (an interaction in which the offender rubs their genital area against the victim’s genital area, inner thighs, or buttocks.)  Pornography  Nude photography Childhood Sexual Abuse can cause compromised functioning in young children, adolescents, and adults. These impairments can include Depression, Post-Traumatic Stress Disorder, substance abuse, low self-esteem, sexual dysfunction, low relationship quality, inappropriate sexual behavior, the perception of being worthless, shame or guilt, or revictimization. Men and women can experience both similar and differing impairments. For instance, men with CSA often

experience personality disorders, suicidal ideation, conduct disorders, depression, anxiety, PTSD, relationship difficulties, difficulty expressing emotions, shame, intrusive memories, and identity confusion. Women may also experience the afore mentioned impairments as well as a lack of empathy and the inability to express and accommodate their own needs in a relationship (Laughlin and Rusca, 2019). Victims of CSA may also experience what is referred to as Dissociative Collusion. Dissociative Collusion occurs in both the survivor and an unintended perpetrator and is a form of self-defense. Both parties may distance themselves from each other, they may exhibit expressions of anger, rigidity, inhibition or recklessness, and sexual malfunction. It is also noted that a weakening of the victim’s self-worth and sense of identity may likewise be experienced Kleiner-Paz and Nasim, 2020). Research indicates that the spouse of a trauma survivor such as a military veteran, can become affected by the spouse’s trauma through what is referred to as vicarious trauma. In this case the spouse may experience symptoms of depression, anxiety, PTSD, relationship dissatisfaction, adjustment disorders, burnout and even substance use such as alcoholism (Doncaster, et al., 2019). Additionally, survivors of sexual assault and/or torture such as is reported in the Democratic Republic of the Congo have described experiencing behavioral shifts that pose a negative affect on romantic relationships as wells as feelings of shame, grief, anger, fear, and confusion which are often expressed through manifestations of aggression or hostility, and even isolation (Morgan, et al., 2018). Part 2: The Narrative Approach

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Developed in the 1970’s and 80’s by Australian Michael White and New Zealand born David Epston, Narrative Therapy is a therapeutic approach that emphasizes the client’s experience as principal importance. This approach focuses on situated concepts within the client’s narrative wherein the therapist acts as a collaborator in the discovery of a more positive narrative (White and Epston, 1990). Not-Knowing Stance- Wherein the therapist utilizes a not-knowing stance in regard to questions directed to the client(s). When the therapist takes the position of not-knowing the therapist is able to better maintain focus on the clients narrative (story) without the incumbrance of having to lead the conversation in any particular direction (Glass, n.d.). Deconstructive Listening- A narrative therapist may find that asking additional questions to better understand a client’s narrative can be helpful as some of the client’s narrative may be unclear. The therapist will then ask questions regarding the meaning behind elements of the client’s story (Glass, nd). Externalization- This intervention is used to separate the client from the presenting problem. The therapist guides the client is perceiving the problem as external, ensuring the client that they are not the problem, they are merely an individual with a problem. Through externalization, a client can separate themselves from the problem allowing themselves to better see a solution (Glass, nd). Reframing- Reframing is a form of support provided by the therapist in which the therapist restates the narrative in a way that helps the client see the positive aspects of their narrative, challenging them to overcome it.

“Outside Witnessing”- This form of narrative intervention is best utilized while working with a trauma survivor. Using “outside witnessing” enables a narrative therapist to take an active role in explaining new or alternate narratives that the client(s) may be experiencing. Through this intervention the couple’s sense of anger, betrayal, shame, and even trust can be restructured, decreasing internal dissociation (Kleiner-Paz and Nasim, 2020). Resiliency Stories (Listening for Unique Outcomes)- A narrative therapist will often identify moments in which the client’s presenting problem did not exist or wasn’t as severe as it is currently presented. Listening for unique outcomes aids the client(s) in exploring their hopes and dreams for the future while also exploring ways in which the client(s) can overcome their presenting problem, visualizing a future without the problem (Glass, n.d.). Constructing new meanings- A narrative therapist may support their client in deconstructing their principal narrative in order to create or re-author a new narrative that uses the client’s past encounters to build a guide for their future narrative (Johnson, et al, 2019). Narrative Group Therapy- Narrative therapy can also be applied to groups wherein the focus is primarily on the client’s life problems and how couples can create and change their life stories to facilitate a more satisfying quality of life (Glass, n.d.).

References Engel, B. (2022). What Constitutes Child Sexual Abuse? Psychology Today. What Constitutes Child Sexual Abuse? | Psychology Today Doncaster, E., Hiskey, S., McPherson, S., & Andrews, L. (2019). "I’m still fighting for the two of us:” How partners of UK veterans construct their experience of living with combat-related trauma. Journal of Marital and Family Therapy, 45 (3), 464- 479. Glass, V. (n.d). Narrative Family Therapy. An Introduction to MFT. Retrieve from: An Introduction to MFT (virdocs.com)

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Johnson, D.J., Holyoak, D., and Cravens Pickens, J. (2019. Using narrative therapy in the treatment of adult survivors of childhood sexual abuse in the context of couple therapy. American Journal of Family Therapy, 47(4), 216-231. Kleiner-Paz, I.I., and Nasim, R. (2020). Dissociative collusion: Reconnecting clients with histories of trauma in couple therapy. Family Process, 60(1), 32-41. Laughlin, C.F., and Rusca, K.A. (2019). Strengthening vicarious resilience in adult survivors of childhood sexual abuse: A narrative approach to couple’s therapy. The Family Journal, 28(1), 15-24. Morgan, E., Wieling, E., Hubbard, J., & Kraus, E., (2018). The development and implementation of a multi-couple therapy model with torture survivors in the Democratic Republic of the Congo. Journal of Marital and Family Therapy, 44 (2), 235-247. White, M. & Epston, D. (1990). Narrative means to therapeutic ends. New York: WW Norton

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