Psychological First Aid for People with Intellectual Disabilities Who Have Experienced Sexual Abuse

A Step-by-Step Programme

Aafke Scharloo, Simone Ebbers-Mennink, Martine Spijker-van Spijker-van Vuren

• Publisher: Jessica Kingsley Publishers
• ISBN:
  9781784504168
• Topic: Medicine
• Subtopic: First Aid & Safety

People with intellectual disabilities are particularly vulnerable to sexual abuse, and offering them psychological support at the earliest possible moment greatly increases their ability to cope with the event and return to daily life. This book provides a complete, structured, evidence-based programme for providing this help to survivors of sexual abuse with developmental disabilities, both adults and children.

Step-by-step session plans, as well as comprehensive background information and downloadable worksheets, provide the means by which to offer effective help to clients and recover their feelings of safety and trust. Sessions are also included for helping parents and caregivers to cope with their own reactions and emotions on the discovery of the abuse. Each session is adaptable for the needs of people with severe, moderate and mild intellectual disabilities in order to provide exceptional care to every individual who needs it.

Chapter 1

THE SOS HANDBOOK

PSYCHOLOGICAL FIRST AID AFTER SEXUAL ABUSE

Introduction

Sexual abuse of children, young people and adults with an intellectual disability can present professional caregivers and others surrounding the victim with feelings of confusion and powerlessness. A research report into the prevalence of sexual abuse in an institution for people with an intellectual disability once bore the title ‘impossibly true’,1 as a reference to a statement made by a respondent who aptly described the feelings arising from the issue. People around the victim sway back and forth between the will to deny and the will to rush to help. Dealing with sexual abuse, however, requires thoughtful action, which is not a simple task when people find themselves in a state of confusion.2

Fortunately, care organisations possess protocols and guidelines in which step-by-step actions are described. Codes for reporting and protocols concerning (suspected) sexual abuse provide many practical guidelines about how to act immediately after (suspicion of) sexual abuse has come to light.

Alongside practical action there is also a great need for adequate psychological support in the following period. Until now this been limited, although countless scientific research reports from the past 20 years show that such support is essential for the coping process of those involved.3 With regard to issues around sexual abuse, many professionals and managers do not feel sufficiently capable of effectively implementing support for those involved after such experiences. If a police statement takes place, there seems to be tension between the support of the client and good professional care on the one hand, and the police investigation and/or the legal process on the other hand. This handbook provides concrete measures for making first aid support possible for clients and their systems (parents, relatives and the care team).

1.1 Target group of the SOS handbook

The SOS handbook has been developed for victims (both children and adults) of sexual abuse who have an intellectual disability. In the support of these victims it is important to make a distinction between clients who have experienced sexual abuse once and clients who have repeatedly been sexually abused over a longer period of time.

In the first case, the client is overwhelmed by the incident. A single incident of sexual abuse takes place so unexpectedly that the client cannot use defence mechanisms. A sense of powerlessness and disruption is experienced. In this case, the client usually recovers from the most serious symptoms within half a year, with the help of a safe and supporting environment.

In cases of long-term sexual abuse, multiple incidents of sexual abuse, and in situations involving violence or threats of violence, the client will often have developed defence reactions. The client will have needed these reactions in order to tackle the abusive situation and to protect themselves against painful experiences. This can include avoidance reactions, identity problems, relationship problems and difficulty with regulating emotions (lack of feeling, strong emotions and/or depression).4 These reactions are often deeply embedded in the behavioural pattern and are not easy to change. In most cases of sexual abuse involving people with an intellectual disability, the abuse has been taking place for a longer period of time. It is also known that people with an intellectual disability stand a higher chance than others of becoming more frequent victims of sexual abuse.5 This means that new situations of abuse will often cause memories of earlier abuse to arise and even more overwhelming symptoms to occur. Chapter 2 addresses the prevalence and causes of sexual abuse concerning people with an intellectual disability.

The SOS handbook can be used in situations of single or multiple abuse. It is possible that using this book will be sufficient for the victim to be able to resume daily life again. This will most surely not be the case for the second category of clients. Long-term therapy aimed at treating chronic trauma is generally indicated in such cases.

The SOS handbook has been written for the support of the client with an intellectual disability. The programme makes a distinction between clients with a severe intellectual disability (IQ 0–35), clients with a moderate intellectual disability (IQ 35–50) and those with a mild intellectual disability (IQ 50–70 or 70–85).

The programme can be used for clients of all ages; the help book provides exercises which are adapted for the various levels of cognitive functioning and range of ages. A selection should be made from the various exercises, depending on the situation of the specific client. It goes without saying that not only the cognitive level of functioning should be taken into account when choosing the exercises.

The SOS handbook has been developed for the support of people with an intellectual disability who have been sexually abused. The method is – with a few small adaptations – also suitable to use for people with an intellectual disability who have experienced other forms of abuse, such as physical or emotional maltreatment.

1.2 The importance of the system

The SOS handbook is not only aimed at supporting the client with an intellectual disability: the programme also includes sessions with the parents/guardians and professional caregivers as well as with the client themselves. Significant others in the life of a person with an intellectual disability are referred to in the book by the collective term ‘system’.

Almost everybody who has been confronted by sexual abuse in their surrounding environment is affected by it. This is definitely true for parents/guardians. A process of support and guidance is needed, aimed at the consequences for them – in their role as parent and in the caring for/upbringing of their child. Incidents of abuse also affect the professional caregivers involved to such an extent that support in coping with the situation is required. In addition, they often need support for a longer period of time in order to be able to care for the client adequately and not become caught up in their own transfer responses, which are unavoidable in working with victims of sexual abuse. The personal process of the parents/carers and professional caregivers involved also plays a crucial role in the recovery process of the client. Research shows that coping with sexual abuse for a person with an intellectual disability is strongly connected to the way in which significant others cope with the abuse.6 This is logical when considering the relational and environmental dependence in which people with an intellectual disability function. Many people with an intellectual disability have a close emotional connection to their family, often into old age, as this is the constant factor in their lives.

Also in the case of adults of all ages with an intellectual disability, the parents/guardians and professional caregivers play a crucial role in coping with the situation. The lower the victim’s level of functioning, the more the emphasis lies on the ‘coping interventions’ of the surrounding system.

1.3 Task of the professional

The SOS handbook has been written for the professional who works in the care and support of people with an intellectual disability. We have chosen to assign this task to the professional as, due to their training, this group is sufficiently qualified to provide this type of help. Additionally, their position makes them sufficiently involved with the client, but at enough of a distance so as not to be too much a part of the system. This professional distance is necessary in order to be able to adequately deal with the emotions of those involved.

However, if there is not an adequate professional distance, then the SOS programme should not be performed by this person but instead by a professional colleague. In order to clearly apply this programme, the attitude of the practitioner is critically important. A direct and inviting attitude is needed, in which the process is initiated in a structured manner and a feeling of safety for people who are upset (by what they have experienced) is created. It is also important that the practitioner is aware of the fact that they will be functioning as a role model for those involved. The subject of sexual abuse is often burdened with shame and silence. Demonstrating an active approach, which does not avoid explicit discussion of the issues, will help those involved to express their experiences and emotions. It is also important to show kindness and capability, and to state that nothing is too crazy to talk about and that absolutely everything can be said. It helps clients to know that their professional often talks to people who have been sexually abused and they are not the only one in this situation! It is the task of the practitioner to ensure an atmosphere which is not too strongly emotionally charged. For this purpose it helps to use (suitable) humour.

The fact that this programme has been written for professionals does not mean that we assume that they will conduct the programme alone. We emphasise the fact that dealing with situations of sexual abuse requires a multidisciplinary approach. When this includes support for the professional caregivers involved, the tasks and close involvement of the responsible manager is certainly also required!

It is essential that the organisation ensures that the professional is facilitated in conducting the programme. It is recommended to include the SOS programme in the organisation’s vision and policy on sexual abuse.

1.4 Aims of the SOS handbook

The SOS handbook has been developed as a first aid programme in the support of (or involvement with) people with an intellectual disability who have been made victims of sexual abuse. The SOS programme is emphatically not meant to replace later treatment or therapy. It is a guideline for conduct, after a report has been made according to the reporting code and/or protocol in (suspected) sexual abuse.

The SOS programme is immediately implemented after the disclosure or discovery of a situation (or suspicion) of sexual abuse. Research shows that fast and active intervention initiated by third parties proves most effective in guiding and benefiting the coping process.7 Using the SOS handbook can prevent or break through the isolation of the victim or system. It provides a safe situation for the client in which they can ‘talk’ about what has happened and where all doubts and concerns can be expressed. In using this programme, it is possible to help those involved to tolerate and order primary stress reactions as a consequence of sexual abuse. The natural coping process is supported and this prevents the process stagnating, with all of the consequences this brings. At the same time it is also possible to consider the type, intensity and progress of the stress reactions. Possible problems can be recognised at an early stage, making adequate responses possible.

The SOS handbook can be used after a disclosure and/or discovery of a situation of (suspected) sexual abuse. Those involved sometimes think that sexual abuse should first be proved before taking action. The fact that it may not yet have been proved does not actually mean that professional caregivers cannot do their work. The perceptual experience of suspected victims can be supported without evidence or a judicial ruling.8

1.5 Structure of the SOS handbook

Prior to the practical layout of the sessions, three chapters of background information are provided which the professional must be aware of before conducting the programme.

•Chapter 2 describes the prevalence, definition and implication of sexual abuse in people with an intellectual disability.

•Chapter 3 contains information about reporting codes, protocols, law and regulations, minimum fact interviews, statements (or reports) to the police, medical examinations and dealing with the media.

•Chapter 4 provides background information about types of trauma, the neurobiological aspects of trauma, trauma reactions, secondary traumatising, and coping with trauma. Special attention is paid to trauma and coping with trauma in people with an intellectual disability.

The SOS programme focuses on the client, the parents/carers or other significant people and also the professional caregivers involved. The starting point is that the client’s next of kin, according to the protocol in sexual abuse, have been informed about the sexual abuse or the suspicion of such. The professional organises four sessions for each of the three different target groups (client, parents/carers and professional caregivers). The conversations with the client take approximately 45 minutes, depending on the capacity and concentration ability of the client. For the sessions with the parents and the team, approximately 90 minutes are required per session.

The first contact takes place as soon as possible, preferably within a week after the disclosure/discovery (and after the minimum fact interview). The second session follows about a week later. The first two sessions with those involved take place independently: a session with the client, a session with the parents/carers and a session with the professional caregivers involved. The third session is a joint session in which the client, their system and the professional caregivers involved share their experiences and (learn to) communicate with each other about what ha...