TRAUMATIC SYMPTOMS AND OVERALL WELL BEING IN THOSE ABUSED BY CHURCH WORKERS

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1 TRAUMATIC SYMPTOMS AND OVERALL WELL BEING IN THOSE ABUSED BY CHURCH WORKERS Jessica Punzo, Psy.D. VA San Diego Healthcare System Janna Henning, J.D., Psy.D., F.T., B.C.E.T.S. Adler School of Professional Psychology APA 2014 Annual Conference

2 Introduction Childhood Sexual Abuse 25% of girls and 17% of boys in the U. S. were sexually abused before the age of 18 90% of childhood sexual abuse goes unreported (NSVRC, 2012) Sexual Abuse within the Church Different than other abuses (Wells, 2003; Hindman, 1989; McLaughlin, 1994; and Rossetti, 1995) Covered up: much more with this type of abuse at many different levels, especially systemically. Under-reported, given the nature of the relationship between victim and perpetrator.

3 Purpose Clergy-perpetrated sexual abuse has not been thoroughly studied Large number of survivors, yet lack of quantitative research Aid in developing a better understanding of this population in order to better serve them in treatment

4 Literature Review Complex PTSD Type I vs. Type II trauma DSM-IV-TR PTSD diagnosis did not fully cover range of symptoms that survivors of chronic interpersonal trauma were displaying Also called DESNOS & DTD (Developmental Trauma Disorder) Implications for treatment Childhood Sexual Abuse Varying statistics and reporting issues Abused children are more symptomatic than nonabused children (Kendall-Tackett, Williams, & Finkelhor, 1993)

5 Literature Review Childhood Sexual Abuse by Church Workers 10,667 claims of clergy-perpetrated sexual abuse in the U.S. were reported between 1950 and 2002 (John Jay Research Team, 2004) Only a handful of published studies; most qualitative in nature All demonstrate ongoing difficulties in those abused by church workers Unique symptoms (Farrell studies): include themes of theology, spirituality, and existentialism Spiritual and existential trauma themes include: difficulty praying, political anger, generalized sense of inner emptiness, conflict with God, fearful of death and/or dying, and generalized uncertainty surrounding the purpose of life.

6 Literature Review Role of priest-parishioner-congregation : the dynamics in the hierarchical relationship that exist between clergy members and parishioner, and the parish as a whole; feeding into the societal problem; other members denying this abuse took place, blaming victim, etc. The relationship between priest and victim (usually a member of the congregation): priest is an extension of god, a father-like figure (very similar to incest). Also has the power to determine if you "get into heaven."

7 Literature Review Effects of Trauma on Spirituality & Religion Religion and Spirituality Definitions More frequently, decreases in religiousness/ spirituality as a result of trauma, rather than increases in religiousness/spirituality (Walker, Reid, O Neill, & Brown, 2009; Falsetti, Resick, and Davis, 2003) Uniqueness in Catholic Religion : sex before marriage as a sin, so sexual abuse would make someone a sinner; homosexuals are sinners (male on male perpetrated sexual violence) Biblical references to condoning rape of women

8 Literature Review Treatment Type I vs. Type II treatment (Herman, 1997) Type II treatments Stage-oriented Cognitive Procession Therapy (CPT) Dialectical Behavior Therapy (DBT) Skills Training in Affect and Interpersonal Regulation with Modified Prolonged Exposure (STAIR) Treatment for Survivors of Clergy Abuse EMDR study (Farrell, Dworkin, Keenan and Spierings, 2010) Solace for the Soul (Murray-Swank & Pargament, 2008) Familiarity with theology

9 Literature Review Competence Trauma Psychologists tend to rate their training and knowledge on how to treat childhood sexual abuse as poor (Pope & Feldman-Summers,1992) Only 71 programs offer trauma-specific training or have a faculty who is an expert in trauma (APA Division 56) Lack of training can cause harm to clients and therapists Spirituality Divide between psychology and religion Psychologists least religious professors 85% of clinical psychologists reported that the topic of religion was not frequently discussed in their training (Shafranske & Malony, 1990)

10 Study Hypotheses 1. Differences would be seen between SNAP group members and a clinically normed population in the following areas: Overall traumatic symptoms (higher) Overall quality of life (lower) Both quality of life and traumatic symptoms by: Gender (no difference) Age (older age now: lower trauma symptoms; higher quality of life) Age at onset of abuse (older age at abuse: lower trauma symptoms; higher quality of life) Duration of abuse (longer duration: higher trauma symptoms; lower quality of life) Years since abuse ended: (more time since abuse ended: lower trauma symptoms; higher quality of life).

11 Methods Sample 72 SNAP members (36 male/36 female) Procedures Online survey Demographics Questionnaire (gender, current age, age of onset of abuse, duration of abuse, time since abuse ended, type of perpetrator, if they were a member of a religious organization at the time of the abuse, and current affiliation if any) Traumatic Stress Inventory, Second Edition (TSI-2) World Health Organization Quality of Life, Brief Version (WHOQOL-BREF)

12 Results Numerical Findings On average men tended to score higher on the TSI-2, with the exception of Dissociation scale, Sexual Disturbance scale, and the Sexual Disturbances- Dysfunctional Sexual Behavior subscale (SXD-DSB). The Sexual Disturbance scale taps into sexual distress and dysfunction, such as shame during sex. The Sexual Disturbances-Dysfunctional Sexual Behavior subscale (SXD-DSB) measures sexual behavior that is dysfunctional, problematic, or compulsive. Examples: indiscriminate sexual contact, sexual attraction to dangerous persons, unsafe sex, and sexual risk-taking. Males on average scored lower than women on three out of the four WHOQOL-BREF domains (Physical Health, Psychological, and Environment), but scored higher on the Social Relationships domain

13 Results On average the study sample scored higher on the TSI-2 than the clinical cut-off sample, with the exception of Dysfunctional Sexual Behavior The study sample scored lower on all WHOQOL- BREF domains than the clinical cut-off sample, with the exception of Physical Health

14 Discussion Large difference between males and females Male-on-male sexual violence Against societal norms Can create confusion in regards to sexual orientation and aspects of masculinity The priest or bishop had been a mentor Females scoring higher on Dissociation, Sexual Disturbance, and Dysfunctional Sexual Behavior. Dissociation as a conditioned response Abused women may be more likely to act out sexually or avoid sexual contact entirely: perhaps because women tend to be more objectified in regards to sex (higher rates of female sex trafficking and sex workers) Perhaps men may pretend to engage in sex in a "normal way" - may serve as avoidance Men scored higher on Defensive Avoidance & Intrusive Experiences More acceptable way of coping for men Men scoring higher on Rejection Sensitivity and Self Disturbance factor Fear of rejection due to stereotypes of male perpetrated sexual violence

15 Discussion Males scoring higher on Social Relationships than women Men more active in SNAP SNAP members scoring significantly higher than the clinical sample on majority of TSI-2 scales Except Sexual Dysfunction The clinical cut off sample was half females. Therefore, the male participants could have skewed the data when comparing to an allfemale sample. Moreover, as noted above, females in this study showed significantly more sexual dysfunction than males. SNAP members scored significantly lower on WHOQOL-BREF domains: Overall, statistical significance was robust even with a small sample size; the sample population is doing much worse than a clinical population who experienced sexual abuse Except Physical Health The sample population still scored higher on TSI-2 scales that measured physical pain or general medical concerns. Perhaps the WHOQOL-BREF sample had more chronic medical issues. It could also be that SNAP members are more active in taking care of their physical health. Again, SNAP members doing much worse than the overall population

16 Discussion Overall, the older participants were currently, the worse off they were. Suggests that abuse by clergy stays with a survivor for a long time. Possibly, symptoms get worse over time without treatment. Perhaps older people who are still experiencing symptoms still feel the need to be part of a supportive community like SNAP, or were more likely to want to fill out a survey on clergy sexual abuse. Significant gender differences: overall, men tended to show positive correlation with age and symptoms on most scales; however, some of the scales were negatively correlated with women This is in contrast to what the previously published research literature states: that usually older participants are better off

17 Discussion Duration of abuse was not associated with reduced severity of symptoms Suggests that abuse is abuse, no matter if it occurred once or multiple times The longer it had been since abuse ended, the more severe symptoms were reported by the sample. Survivors of clergy sexual abuse not finding relief of symptoms as time passes Symptoms getting worse over time Older people still experiencing symptoms still need support, and more likely to fill out survey

18 Discussion Limitations Small sample size even smaller when broken down by gender Recruitment strategies: recruitment. Those who did not have access to the Internet or who did not have an address were excluded. I was even asked by someone in SNAP headquarters if it would be possible to print out the survey in order to distribute it to interested members who did not have internet or capabilities. All members had to be a part of the SNAP organization; these individuals may have more support than those who are not members. On the other hand, being a part of the SNAP organization may encourage members to be vocal about their symptoms. Moreover, SNAP members could easily be triggered by participating in a support meeting and hearing each other s abuse stories.

19 Discussion Item wording The researcher was contacted via by some participants who noted that they were confused by some of the wording used in the study. Some felt as if the term abuse was not specific enough and would have wanted clarification if it was sexual in nature or not. Lack of control of snowball sampling: Once the link was sent to chapter leaders, there was no control over who the leaders might send the link to, or if they sent it at all. Therefore, people may have obtained the link to participate even if they were not a part of a local SNAP group. Moreover, because the link was sent directly to SNAP leaders, there may have been a higher proportion of leaders in the sample than group members, which could have skewed results. Disproportionate representation of Catholics

20 Discussion Implications for Future Research Larger sample size Did not collect data on the type of abuse (sexual vs. non sexual abuse) - some participants noted this. Participants thanking me for doing a study like this demonstrates that they are willing to be part of more studies and want to contribute to the research. It would be interesting to look more closely at how religion or spirituality impacted or played a role in symptoms/recovery. More training and education for trainees and therapist!

21 Dissertation Committee CHAIR: Janna A. Henning, J.D., Psy.D., F.T., B.C.E.T.S. COMMITTEE MEMBERS: Catherine McNeilly, Psy.D. Mark Killmer, Psy.D.

22 References Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70, Farrell, D. P. (2003). Idiosyncratic trauma characteristics experienced by survivors of sexual abuse by clergy or religious. (Unpublished doctoral thesis). Manchester Metropolitan University, Manchester, UK. Farrell, D. P. (2004). An historical viewpoint of sexual abuse perpetrated by clergy and religious. Journal of Religion and Abuse Advocacy, Pastoral Care & Prevention, 6(2), Farrell, D. P. (2009). Sexual abuse perpetrated by Roman Catholic priests and religious. Mental Health Religion & Culture, 12(1), Farrell, D. P., Dworkin, M., Keenan, P.,.& Spierings, J. (2010) Using EMDR with survivors of sexual abuse perpetrated by Roman Catholic priests. Journal of EMDR Practice and Research, 4(3), doi: / Farrell, D. P., & Taylor, M. (1999). Sexual abuse by clergy and the implications for survivors. Changes An International Journal of Psychology and Psychotherapy, 17(1), Falsetti, S. A., Resick, P. A., & Davis, J. L. (2003). Changes in religious beliefs following trauma. Journal of Traumatic Stress, 16(4), Hindman, J. (1989). Just before dawn: From the shadows of tradition to new reflections in trauma assessment and treatment of sexual victimization. Boise: AlexAndria Associates. Herman, J. (1997). Trauma and recovery. New York: Basic Books. The John Jay College Research Team (2004, February 27). The nature and scope of the problem of sexual abuse of minors by Catholic priests and deacons in the United States: A research study conducted by the John Jay College of Criminal Justice (National Clergy Sex Abuse Report). Retrieved September 12, 2011, from Kendall-Tackett, K. A., Williams, L. M. & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical findings. Psychological Bulletin, 113, McLaughlin, B. R. (1994). Devastated spiritually: The impact of clergy sexual abuse on the survivor's relationship with God and the church. Sexual Addiction & Compulsivity, 1(2),

23 References Murray-Swank, N. A., & Pargament, K. I. (2008). Solace for the soul: Evaluating a spiritually-integrated counseling intervention for sexual abuse. Counseling and Spirituality, 27(2), Pope, K. & Feldman-Summers, S. (1992) A national survey of psychologists abuse history and their evaluation of training and competence in the area of abuse. Professional Psychology: Research and Practice, 23(5) Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60(5), Rossetti, S. J. (1995). The impact of child sexual abuse on attitudes toward God and the Catholic church. Child Abuse & Neglect, 19(12), Shafranske, E. P. & Malony, H.N. (1990) Clinical psychologists religious and spiritual orientations and their practice of psychotherapy. Psychotherapy, 27, Walker, D. F., Reid, H. W., O Neill, T. & Brown, L. (2009). Changes in personal religion/spirituality during and after childhood abuse: A review and synthesis. Psychological Trauma: Theory, Research, Practice, and Policy, 1(2), doi: /a Wells, K. (2003). A needs assessment regarding the nature and impact of clergy sexual abuse conducted by the Interfaith Sexual Trauma Institute. Sexual Addiction & Compulsivity, 10,

RESPONDING TO THE UNSEEN VICTIM OF SEXUAL EXPLOITATION: HELPING WHEN HIS SEXUAL DECEPTIONS TRAUMATIZE HER

RESPONDING TO THE UNSEEN VICTIM OF SEXUAL EXPLOITATION: HELPING WHEN HIS SEXUAL DECEPTIONS TRAUMATIZE HER Barbara Steffens PhD LPCC-S Assistant Professor, Liberty University basteffens@liberty.edu Barbara@DrBarbaraSteffens.com