Developmental couple therapy for complex trauma: Results of an implementation pilot study.

This pilot study examined the process and outcome of Developmental Couple Therapy for Complex Trauma (DCTCT) with seven couples. DCTCT is a novel form of couple therapy designed to address complex posttraumatic stress disorder symptomatology and couple-level distress in trauma survivors and their partners. These couples showed statistically significant improvements in overall trauma symptoms, emotion regulation capacities, and reductions in attachment-related anxiety. These results suggest that DCTCT may be a promising approach to intervention. Future directions include the development of a sequential care model, because resource limitations may not allow for all couples to receive the full treatment model over 40 weeks; it will also be important to address measurement issues in relation to mentalizing, to allow for observational coding across the course of therapy.

Where are We Now? A Consolidation of the Research on Long-term Impact of Child Sexual Abuse.

This manuscript provides an introduction to the special issue: Where are we now? A consolidation of the research on long-term impact of child sexual abuse. Over the past thirty years, there has been an explosion of research about the long-term impacts of childhood sexual abuse (CSA) on adult functioning and wellbeing. However, the consolidation of this vast literature has not kept up with the creation of new research despite the complexity and sophistication of these newer investigations. We have compiled a special issue of the Journal of Child Sexual Abuse to summarize and analyze this vast literature into a cohesive, consolidated whole. The goal of this issue was to consolidate recent research about the effects of CSA on alcohol and substance use in survivors, revictimization, sexual risk and sexual well-being and couple and parenting functioning.

Couple and parenting functioning of childhood sexual abuse survivors: a systematic review of the literature (2001-2018).

In this review, 55 unique empirical studies of the impacts of a history of CSA on couple and parenting functioning were identified and analyzed according to assumptions considered in an earlier review. Overall, this current systematic review supported earlier assumptions that CSA survivors would evidence insecure attachments in their adult couple relationships; that CSA survivors would be less likely to marry and more likely to divorce; and that partners would also experience difficulties in relation to their partnership with a CSA survivor. Assumptions about parenting functioning included: that CSA survivors would have different attitudes toward their children; that CSA survivors would function poorly as parents; and that children of CSA survivors would be at increased risk for sexual abuse. Evolutions in the literature since that first review included methodological improvements, as well as the inclusion of male survivors in some studies. More sophisticated statistical modeling allowed for a greater understanding of mediators and moderators in the relationship between CSA and later interpersonal functioning in couple relationships and in parenting. Recommendations for future research and clinical implications were proposed.

A Review of Mediators in the Association between Child Sexual Abuse and Revictimization in Romantic Relationships.

Child sexual abuse (CSA) is a widespread adverse experience that has multiple detrimental impacts in the long-term, affecting mental, sexual, and physical health of survivors. In addition, CSA may impede interpersonal functioning, and be associated with a heightened risk of revictimization. Recent review articles have summarized the possible risk factors associated with sexual revictimization, yet an increasing body of literature suggests that CSA may be a key risk factor for multiple forms (i.e., psychological, physical, sexual) of victimization occurring specifically in the context of intimate relationships, either in adolescence (dating violence) or adulthood (partner violence). Our understanding of the mechanisms linking CSA and dating violence or intimate partner violence is still limited. This systematic review of the literature is aimed at summarizing the identified mediators of the association between CSA and revictimization in romantic relationships in past empirical reports. A total of 18 studies meeting criteria were identified. Apart from PTSD, few potential mediators have been explored in more than one study. In addition, few studies have investigated protective factors that may reduce the risk of revictimization. Several limitations in the current literature were identified including issues related to definitions and measurement. Studies relying on longitudinal designs with representative samples are clearly needed to orient future prevention efforts and break the revictimization trajectory.

"As Time Went On, I Just Forgot About It": Thematic Analysis of Spontaneous Disclosures of Recovered Memories of Childhood Sexual Abuse.

This study was a thematic analysis of transcripts of interviews of child sexual abuse survivors discussing their experiences of recovered memories. This study included 27 English-speaking participants from 3 major Canadian cities: Montreal, Toronto, and Ottawa. Seven participants identified as male and 20 as female. Participants ranged in age from 31 to 69 with a mean age of 47. The educational background of participants ranged from 9th grade to doctoral levels. Out of the sample of 27, 21 participants reported some period of amnesia for their CSA experiences. Three primary global themes emerged in the transcripts of participants describing adult emergent recovered memories: flashbacks, triggers, and denial. Three global themes emerged in the transcripts of participants describing partially discontinuous memories: dreams/nightmares as the "how" of memory recovery, triggers, and active processes of forgetting.

Dissociative identity disorder and the process of couple therapy.

Couple therapy in the context of dissociative identity disorder (DID) has been neglected as an area of exploration and development in the couple therapy and trauma literature. What little discussion exists focuses primarily on couple therapy as an adjunct to individual therapy rather than as a primary treatment for couple distress and trauma. Couple therapy researchers have begun to develop adaptations to provide effective support to couples dealing with the impact of childhood trauma in their relationships, but little attention has been paid to the specific and complex needs of DID patients in couple therapy (H. B. MacIntosh & S. Johnson, 2008 ). This review and case presentation explores the case of "Lisa," a woman diagnosed with DID, and "Don," her partner, and illustrates the themes of learning to communicate, handling conflicting needs, responding to child alters, and addressing sexuality and education through their therapy process. It is the hope of the author that this discussion will renew interest in the field of couple therapy in the context of DID, with the eventual goal of developing an empirically testable model of treatment for couples.

Emotionally Focused Therapy for couples and childhood sexual abuse survivors.

This study explored Emotionally Focused Therapy (EFT) for couples with childhood sexual abuse survivors (CSA) and their partners. Half of the couples in this study reported clinically significant increases in mean relationship satisfaction and clinically significant decreases in trauma symptoms, and thematic analyses identified numerous areas where trauma survivors were challenged in fully engaging in the therapy process. In particular, trauma symptoms such as affect dysregulation and hypervigilance were identified to play a role in the challenges that survivors experienced in fully engaging in the EFT process. Results of these thematic analyses yielded clinical recommendations for working with CSA survivors and their partners in EFT for traumatized couples. Recommendations for future study were articulated.

Twenty years of progress in the study of trauma.

In this article, the authors argue that studies investigating the nature of traumatic memory have made the greatest contribution to trauma research in the past 20 years. Neuroimaging studies provide empirical support for the diagnosis of posttraumatic stress disorder and have important implications for the treatment of trauma survivors. In the future, the authors hope to see an empirically derived model of trauma that incorporates both mediating and moderating factors to predict outcome.

Mediators of the link between childhood sexual abuse and emotional distress: a critical review.

A history of childhood sexual abuse (CSA) is a risk factor for adult emotional distress, including symptoms of depression, anxiety, dissociation, and trauma. However, CSA is likely associated with adult distress indirectly through an impact on mediating variables. In a review of the empirical literature, the authors found support for the roles of shame or self-blame, interpersonal difficulties, and avoidant coping strategies as mediators. In addition, emotional distress appears to mediate links between CSA and other adverse outcomes, such as alcohol abuse and revictimization. The authors conclude with a number of methodological and conceptual recommendations.