Practice Profile: Psychotherapy with Adults Sexually Abused in Childhood

This practice comprises therapeutic approaches for adults who were sexually abused in childhood, and is designed to improve psychological distress, reduce maladaptive behavior, or enhance adaptive behavior through counseling, structured or unstructured interaction, or a predetermined treatment plan. The practice is rated Promising for decreasing posttraumatic stress disorder, trauma, and internalizing and externalizing symptoms.

Practice Goal/Target Population

Psychotherapy for adults sexually abused in childhood is intended to address the psychological consequences of child sexual abuse. These therapeutic approaches are designed to improve psychological distress, reduce maladaptive behavior, or enhance adaptive behavior through counseling, structured or unstructured interaction, or a predetermined treatment plan (Weisz et al. 1987). The practice target adults, ages 18 or older, who experienced some form of child sexual abuse (penetrative or non-penetrative) that was perpetrated by a biological caregiver, family friend, neighbor, sitter, or another familiar adult. Some or all participants meet the DSM-IV diagnostic criteria for posttraumatic stress disorder (PTSD), depression/mood disorder, or various other disorders.

The goals of psychotherapy targeting adults sexually abused as children are to 1) reduce the symptoms of PTSD, trauma, or other more specific problems (e.g., anxiety, anger, self-blame); and 2) improve physical, psychological, and social functioning (Martsolf and Draucker 2005).

Practice Components

Psychotherapeutic approaches for adults experience sexual abuse in childhood often include individual cognitive–behavioral approaches such as cognitive–behavioral therapy or insight–experiential therapy. Other relevant treatment types include prolonged exposure, stress inoculation training, supportive counseling, brief prevention programs, imagery rehearsal therapy, cognitive-processing therapy, and eye movement desensitization reprocessing.

The treatment is often conducted by trained professionals, professionals in training, and paraprofessionals. These psychotherapeutic approaches can be offered as individual, group, couple, or mixed group therapy and take place in a variety of clinical or nonclinical settings, such as a research university.

The duration of treatment, number of sessions, session length, and frequency of sessions may vary, depending on the requirements of the type of therapy offered and the needs of the participants. Such approaches may be manualized, semi-structured, or unstructured. Therapy may or may not include homework outside of the clinical setting, and the process can be dialogue-based, instructional, or self-directed.

Taylor and Harvey (2010) conducted additional tests (called moderator analyses), to assess whether characteristics of the samples, treatments, and methods included in the analysis impacted the mean effect sizes and thereby improved outcomes. They found that modality (group, individual, or mixed), context, and the source and type of measurement had an impact on effect sizes. Their analyses suggested that 1) individual therapies (especially cognitive–behavioral therapies) were consistently associated with larger effects than group approaches, as were interventions that included homework; and 2) information sourced from professionals during an interview (typically structured interviews for posttraumatic stress disorder) indicated stronger mean effects than those from participants using self-report measures. The authors also found that better outcomes were associated with experimental study designs, random assignment to conditions, session lengths of 91–120 minutes, and manualized approaches.

These sources were used in the development of the practice profile:

These sources were used in the development of the practice profile:

Ehring, Thomas, Renate Welboren, Nexhmedin Morina, Jelte M. Wicherts, Janina Freitag, and Paul M.G. Emmelkamp. 2014. “Meta-Analysis of Psychological Treatments for Posttraumatic Stress Disorder in Adult Survivors of Childhood Abuse.” Clinical Psychology Review 34:645–57.

Martsolf, Donna S., and Claire B. Draucker. 2005. “Psychotherapy Approaches for Adult Survivors of Childhood Sexual Abuse: An Integrative Review of Outcomes Research.” Issues in Mental Health Nursing 26(8):801–25.

Weisz, John R., Bahr Weiss, Mark D. Alicke, and M.L. Klotz. 1987. “Effectiveness of Psychotherapy with Children and Adolescents: A Meta-Analysis for Clinicians.” Journal of Consulting and Clinical Psychology 55(4):542–49.

Following are CrimeSolutions-rated programs that are related to this practice:

Eye Movement Desensitization and Reprocessing (EMDR) for Traumatized Young Women

Trauma Affect Regulation: Guide for Education and Therapy (TARGET)

Prolonged Exposure Therapy

Cognitive-Processing Therapy for Female Victims of Sexual Assault

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?