Sexual abuse is a pervasive problem with alcoholics and substance abusers. Although studies have varied widely in the last decade, it is thought that as many as 64% of substance abusers have sexual abuse in their background. Furthermore, sexual abuse is the single strongest predictor of alcohol dependence in young girls and women, even stronger than family history. In order for me to help many of my clients have a better chance at succeeding at sobriety, it is important that I have a good understanding of the issue of sexual abuse and the survivors of sexual abuse. Solution-focused Brief Therapy and later, Rapid Trauma Resolution, have been found to be effective methods to combat the long-term effects of sexual abuse.
The use of solution-focused brief therapy began with Milton Erickson and others at the Mental Research Institute in Palo Alto, California in 1972. It had gained some independent popularity by therapists during the 1960’s, but began to be more organized at the Mental Research Institute. However, it was the work of Steve de Shazer and others, who were inspired by Erickson’s work to move the therapeutic strategy forward and began to use brief therapy techniques in a therapeutic setting. They were the first to give the therapeutic strategy a name and to create specific steps so that it could be put to practical use.
Solution-Focused Brief Therapy (SFBT), also called simply Solution- Focused Therapy, was further developed by de Shazer (1940-2005) and his wife, Insoo Kim Berg (1934-2007), and their colleagues beginning in the late 1970’s in Milwaukee, Wisconsin at the Brief Family Therapy Center. SFBT is based on decades of theoretical development, clinical practice, and empirical research.
Since that early development, SFBT has not only become one of the leading schools of brief therapy, it has become a major influence in such diverse fields as business, social policy, education, criminal justice services, child welfare, and domestic violence offenders treatment. Described as a practical, goal-driven model, a hallmark of SFBT is its emphasis on clear, concise, realistic goal negotiations. The SFBT approach assumes that all clients have some knowledge of what would make their life better, even though they may need some (at times, considerable) help describing the details of their better life and that everyone who seeks help already possesses at least the minimal skills necessary to create solutions.
The first technique that de Shazer used was to ask clients to pay attention to what was better between Session 1 and Session 2. He found that two thirds reported improvements and half of the third that didn’t, noticed later things that were better, even though they had initially gone unnoticed. This led de Shazer to realize that a client’s problems or issues were not presenting all the time. In short, he found that a client did not always feel the problem they came to therapy to resolve. At that time de Shazer and his colleagues shifted their approach from problems to solutions. This is when de Shazer came to the realization that when therapy shifted strictly to solutions, the need for exploring the client’s past, essentially became a waste of time and effort. However, in the intervening years this has also caused some concerns and criticism that solution-focused brief therapy pays little attention to the client’s history, missing an opportunity to get to know the patient in a more intimate way and thereby thumbing its nose at clinical wisdom. This is countered by the argument that SFBT’s allows therapy to be effective and efficient, not needing twenty-five sessions to help clients to improve. In fact, its efficiency allows it to be learned by the therapist in a simple and practical manner.
An additional aspect of solution-focused brief therapy is the fact that the client, not the therapist, determines the goals of the therapy. Further, de Shazer, et al, thought it important that the therapist’s job was to be to help the client to identify when the condition improved or no longer existed and to identify what the client had done to help the improvement occur. He did this through an initial five-step session which did the following: 1) established the client’s goal in concrete, positive terms; 2) through asking the “miracle question”, presented a hypothetical picture of what life would be like if the problem no longer existed; 3) explored when the problem improved or went away, and what the client did to make that happen; 4) the client explored their present progress and assessed what could be done for additional improvement or complete success; and, 5) it concluded with a positive message towards the client’s improvements and gives them homework.
There are many symptoms that a survivor of sexual abuse might indicate. They include, but are certainly not limited to, sleep disturbances, flashbacks, difficulty concentrating, a lowered level of self esteem, hyper alertness, sexual dysfunction, sexual compulsivity, eating disorders and substance abuse. In our residential treatment facility we find an extremely high percentage of patients reporting childhood sexual abuse. Often some of the “red flags” of sexual abuse come out in the bio-psychosocial, hidden in discussions on eating disorders, sexual compulsivity, and difficulty concentrating.
Another aspect of working with a patient who is a sexual abuse survivor is that of depression leading to suicide attempts. Many of our patients come into treatment having multiple attempts, and although we’re not a hospital per se’, we have specific protocol for those who have identified past attempts. Usually it begins with a contract between the patient and the facility as to what is expected if the patient is having suicidal thoughts. In further regards to self-destructive behaviors, self-mutilation is a symptom of a sexual abuse survivor. In practice we find it a common instance, particularly in patients under the age of twenty-five.
Since my clients are substance abusers, it is important to discuss sexual abuse survivor’s drug and alcohol abuse. The statistics vary, and may be inaccurate due to the nature of the subject, but substance abuse is often a method of survivors dealing with the negative self-perceptions, flashbacks, depression, and low self esteem that are common in sexual abuse survivors. Although it is known that survivors use many different drugs to accomplish this, commonly they drown out their emotional, and sometimes physical, pain with alcohol to a greater degree than other drugs. I should note that the symptoms I have discussed are only a sampling of the symptoms exhibited by survivors of sexual abuse.
Hypnosis is an excellent tool to help the patient with their emotional pain. It is the use of hypnosis which first piqued my interest in solution-focused brief therapy. Over the last three years I was trained and became a certified practitioner of “Clinical Hypnosis with Rapid Trauma Resolution”. Rapid Trauma Resolution (RTR), also known as Rapid Resolution Therapy, is a form of brief therapy developed by Dr. Jon Connelly in Jupiter, Florida.
Dr. Connelly is a long-time psychologist in New York and Florida who has developed methods that are similar in nature to Solution-focused Brief Therapy. They include “clearing” of a problem in very few sessions (usually one with RTR), and they do it by using “symbols for the present”, visual metaphors and models, a form of the miracle question, and culminating in hypnosis. While Dr. Connelly does not credit SFBT, or any other therapeutic strategy, the similarities are obvious. Additionally, Dr. Connelly developed RTR while operating the Institute for Survivors of Sexual Violence. With that in mind, in addition to the sexual abuse in my client population, the text “Resolving Sexual Abuse” was an obvious choice for me.
One of the great challenges in working with those who have been sexually abused is in helping them to have some hope that they won’t be crippled by the events that have overwhelmed their thoughts for many years. Solution-focused strategies and interventions and Rapid Trauma Resolution are both interventions that are useful in such circumstances.