COUNSELLING WOMEN WHO EXPERIENCED CHILDHOOD SEXUAL ABUSE:

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COUNSELLING WOMEN WHO EXPERIENCED CHILDHOOD
SEXUAL ABUSE CONSIDERATIONS FOR CLINICAL
PRACTICE AND THE DEVELOPMENT OF A WEB RESOURCE
Margaret Taylor, B.A., B.Ed., MC (coursework
completed) Campus Alberta Applied Psychology
Counselling Initiative margarett_at_abcounsellored.ne
t Judy Chew, Ph. D. University of Calgary Tom
Strong, Ph. D. University of Calgary 3rd
International Conference Multimedia
and Information Technologies Communication
Technologies in Education June 8 10, 2005
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CAMPUS ALBERTA GRADUATE PROGRAM IN COUNSELLING
c/o Division of Applied Psychology, Faculty of
Education, University of Calgary, Education
Tower 302, 2500 University Dr. N.W. Calgary,
Alberta CANADA T2N 1N4 The following Internet
URL provides a link to the CAAP website which
describes our unique collaboration of Alberta
universities providing online national and
international long distance Masters level
programs Campus Alberta Applied Psychology
CAAP Counselling Initiative
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ABSTRACT
Clients and counsellors often turn to the
Internet for information on matters of clinical
concern. As part of a Campus Alberta Master of
Counselling research project, a prerequisite
checklist was developed, the purpose of which was
twofold 1) to evaluate the credibility and
ethicality of potential web resources, and 2) to
ensure the design of an ethical and credible
Internet starter kit for counsellor-trainees
who work with women with childhood sexual abuse
(CSA) histories.
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ABSTRACT (contd)
This virtual presentation focuses on the
credibility criteria and web resource design
guidelines synthesized from existing human
service- and educational- standards to firstly
establish a general web resource credibility list
adaptable as a type of peer review instrument,
and secondly, to develop a Top-Ten CSA-specific
psychology web resource credibility checklist.
The CSA checklist was then applied to the design
of the CSA starter kit web resource to ensure a
final product that meets important ethicality
and credibility standards.
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RESEARCH PROBLEM 1
WHO IS MINDING THE NET?
Clients and counsellor-trainees rely on resources
found in a context where an immense amount of
material can be accessed, including material of
dubious quality and credibility that may not meet
recognized ethical standards that guide Canadian
psychologists and counsellor-trainees.
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RESEARCH PROBLEM 2
WHY IS RESOURCE CREDIBILITY AND ETHICALITY SO
IMPORTANT?
Counsellor-trainees possess an ethical
responsibility to provide competent services to
clients who have experienced CSA. In part,
counsellor competency lies in becoming familiar
with CSA symptomatolgy and treatment
considerations. Thus, the potential implications
for the use of a counsellor-trainee CSA-specific
web resource checklist and starter kit are
extensive. The starter kit described in this
presentation furthers the discipline of applied
psychology by providing ethical and credible
information and training to counsellors.
Ultimately, the starter kit increases the
counsellors ability to protect a vulnerable
client population from harm.
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KEY ETHICAL STANDARDS APPLYING TO COUNSELLOR USE
OF CSA WEB RESOURCES

The Canadian Code of Ethics for Psychologists
(2000) 1 includes the following directives
(click on link for in-depth information)
Be sufficiently sensitive to and knowledgeable
about CSA, individual, group, community, and
cultural differences and vulnerabilities to
discern what will benefit and not harm persons
involved in their activities (II.14,
Risk/benefit analysis section, 2).
Keep themselves up to date with a broad range of
relevant knowledge, research methods, and
techniques, and their impact on persons and
society, through the reading of relevant
literature, peer consultation, and continuing
education activities, in order that their service
or research activities and conclusions will
benefit and not harm others (II.9, Competence
and self-knowledge section, 4).
Researchers seek to design research in such a
way that they contribute to the fair distribution
of benefits to individuals and groups, and that
they do not unfairly exclude those who are
vulnerable or might be disadvantaged (I.11,
Non-discrimination section, 3).
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RESEARCH PROBLEM 3
WHAT ARE THE EVALUATIVE CRITERIA?
Given the online resources available to
counsellors and their clients who experienced
CSA, what evaluative criteria can be used to
provide resources (including the starter kit
itself) that are useful, ethical and credible?
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RESEARCH PROBLEM 4
WHAT WEB-BASED CSA RESOURCES ARE RELEVANT FOR THE
HEALING PROCESS?
Using our newly-established evaluative
criteria, what CSA resources did we identify as
being relevant to counsellor-trainees and to
women who experienced CSA?
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METHOD
A literature review on the evaluation of web
resource credibility was conducted to ascertain
that web resources (including the
counsellor-trainee CSA starter kit itself) will
meet academic, ethical and clinical utility
considerations. An exhaustive search of the
credible, academic, and peer-reviewed resources
from the PsycINFO database revealed that a gap
exists in mental health web resource credibility
evaluation. Queries to psychology associations
revealed that no web resource credibility
guidelines exist because most organizations
web-publish articles obtained exclusively from
their peer-reviewed journals.
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METHOD
Regrettably, peer-reviewed psychology journal
articles are unavailable to non-subscribers of
the journal or non-members of the
organization. Extensive preliminary research
efforts eventually generated human service- and
education- related 2, 3, 4 web resource
evaluation tools. Those tools were then adapted
by the first author with the assistance of the
project supervisor, Judy Chew, Ph. D. The
resultant CSA-specific web content and design
selection inclusion criteria checklist then aided
in developing the counsellor-trainee CSA web
resource starter kit project.
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PRELIMINARY EFFORTS IN DEVELOPING CRITERIA FOR
REVIEWING THE CREDIBILITY AND ETHICALITY OF WEB
RESOURCES

• Charnock Shepperds medical- and
  health-evaluation instrument entitled DISCERN
  2 represents an adaptable web resource
  credibility tool for the CSA starter kit.
• Important web design credibility criteria worthy
  of consideration in the design of the CSA starter
  kit are provided by Tillman 3 .
• Tillmans advice to effectively evaluate a web
  site is aptly
• addressed by Fogg et al., 4.

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When viewing or designing web resources for
teaching or counsellor-trainee purposes the
following Top-Ten synthesized checklist of
general credibility standards can be used to help
the reader decide whether the resource is worthy
of consideration. In essence, the following
checklist provides a type of peer review by
human service and educational professionals
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TOP-TEN GENERAL CREDIBILITY STANDARDS
The following standards represent a type of peer
review to examine or design web resources in
general (not CSA-specific)

• The ease of identifying the authority of authors,
  the currency, the last update, and what was
  updated is ensured 3

• Browser and plug-in limitations are considered
  (i.e., memory-intensive media or special software
  required) 3

• Appropriate materials for the target audience
  (i.e., counsellor-trainees) are provided and
  non-target audiences are informed of whom the
  intended target audience is 3

• Credentials, telephone number, physical address,
  and email address associated with the website,
  credentials within its content, and links only to
  credible websites are provided 4

• Citations, references and source material are
  provided 4

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TOP-TEN GENERAL CREDIBILITY STANDARDS (contd)

• Professional-looking sites that are easy to use,
  useful, and are free of errors of all types
  including broken web links are provided 4

• Areas of uncertainty are mentioned 2

• The nature of treatment is described 2

• The benefits of treatment are described 2

• The risks of treatment are described 2

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MAIN RESEARCH PROBLEM AND SOLUTION
According to Mertens 5 the general contention
surrounding web resource credibility is the lack
of peer review. The following CSA-specific
checklist, which was developed by a
counsellor-trainee and psychologist supervisor,
and peer-reviewed by Campus Alberta Applied
Psychology faculty and graduate students offers a
type of peer review for counsellor-trainees
working with CSA concerns.
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TOP-TEN CRITERIA FOR WEB RESOURCE INCLUSION AND
DESIGN FOR THE STARTER KIT
The design of the CSA starter kit web resource
and/or web resource inclusions must meet the
following credibility and ethicality criteria

• Provide a type of informed consent by
  identifying, cautioning, and informing of
  controversial issues, information, or resources
  in an annotated bibliography prior to linking a
  resource

• Provide a comprehensive CSA perspective by
  identifying and then linking to web resources
  presented by licensed multi-disciplinary
  professionals

• Present both classic and current (last 10 years)
  contributions to CSA research

• Offer target audience appropriate levels of
  reading and information

• Include resource highlights in the annotated
  bibliography

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TOP-TEN CRITERIA FOR WEB RESOURCE INCLUSION AND
DESIGN FOR THE STARTER KIT (contd)

• Operate within a scope of expertise by excluding
  issues adjunct to the introductory nature of the
  starter kit or direct readers to disregard
  linked web resource information that
  inadvertently contains information about
  recovered memories, Dissociative Identity
  Disorder (DID), ritual abuse, males who
  experienced CSA and other issues beyond the scope
  of the starter kit

• Limit resources to recognized treatment
  approaches and interventions

• Stress an eclectic effective and efficacious
  approach

• Ensure that 'survivor' insight resources stem
  from sources meeting these web resource
  credibility and ethicality guidelines

• Issue a rationale for the inclusion of each
  resource

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The CSA STARTER KIT PROVIDING RELEVANT
INFORMATION FOR THE HEALING PROCESS

• CSA Definitions
• Symptomatology
• Interventions
• Resiliency and Hope
• Insights
• Resources
• Referrals to Accredited Therapists

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EXCERPTS FROM THE CSA STARTER KIT WEB RESOURCE
The following section presents excerpts from the
CSA starter kit. You may take this
opportunity to test your web credibility
evaluation skills by applying the previous
TOP-TEN CRITERIA FOR CSA-WEB RESOURCE INCLUSION
AND DESIGN (Slides 17 18) to each starter kit
excerpt and its corresponding web resource. Did
we meet the established criteria?
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EXCERPTS FROM THE CSA 'STARTER KIT'

• CSA Definitions

The following Internet URL link to The World
Health Organization (WHO) provides a
comprehensive definition of CSA that offers
counsellor-trainees clear, specific and detailed
information necessary for understanding the
parameters of CSA.
WHO definition of child sexual abuse 6
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EXCERPTS FROM THE CSA 'STARTER KIT'

• Symptomatology

The following Internet URL links to an
experienced and licensed therapist who presents a
concise list of the commonly-observed long-term
effects of CSA. Although this website briefly
refers to 'recovered memories it does so in an
ethical and sensitive manner while satisfying the
remaining CSA credibility criteria.
Carol Boulware, Ph.D.Licensed Marriage, Family
Therapist-MFCT11632Board Certified Expert in
Traumatic StressABS Certified Sex Therapist
Adult Survivors of Childhood Sexual Abuse 7
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EXCERPTS FROM THE CSA 'STARTER KIT' WEB RESOURCE

• Interventions

Eye Movement Desensitization Reprocessing (EMDR)
Although controversy exists as to the efficacy
and effectiveness of EMDR, and whether or not the
eye movement component is of benefit, an Internet
URL is provided for counsellor-trainees for their
consideration. However, in hopes of dispelling
the eye movement controversy, Marcus, Marquis and
Sakai 8 report that this subject has been
addressed in theoretical work and empirical work
testing a variety of neurobiological hypotheses,
demonstrating that eye movement affects imagery
strength, emotional disturbance, and memory.
A Brief Description of EMDR - EMDR Institute,
Inc. 9
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EXCERPTS FROM THE CSA 'STARTER KIT' WEB RESOURCE

• Resiliency and Hope

The following Internet URL links to an exemplary
website that represents a current international
undertaking by multi-disciplinary professionals
to provide a definition, and insight into the
qualities of resilience of at-risk child and
youth populations in different cultural contexts.
The International Resilience Project 10
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EXCERPTS FROM THE CSA 'STARTER KIT' WEB RESOURCE

• Insights From Women Who Experienced CSA

The following Internet URL links to an article by
Ms. Dusty Miller, a clinical psychologist who
overcame the effects of CSA. The article provides
counsellor-trainees and women who have
experienced CSA with a credible source of insight
into the aftermath of CSA through Dusty Millers
'lived experiences'
Dusty Miller, Ed.D., is director of the Atrium
Consultation and Training Institute in
Northampton, Massachusetts. Shes the author of
Women Who Hurt Themselves Your Surviving Spirit
A Workbook of Spiritual Resources for Coping with
Trauma and numerous other publications on trauma
and addiction. Shes also the co-director of the
Willing Spirit Retreat Center in Cape Cod,
Massachusetts.
The End of Innocence Reconsidering Our Concepts
of Victimhood by Dusty Miller 11
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EXCERPTS FROM THE CSA 'STARTER KIT' WEB RESOURCE

• Resources

The following Internet URL provides insight to
counsellor-trainees regarding vicarious
traumatization and subsequent 'burnout' that
afflicts experienced trauma therapists, but
particularly those who treat individuals who
experienced CSA.
Adams, Matto, and Harrington. (2001). The
Traumatic Stress Institute belief scale as a
measure of vicarious trauma in a national sample
of clinical social workers. Families in Society,
Jul/Aug.
The Traumatic Stress Institute Belief Scale as a
Measure of Vicarious Trauma in a National Sample
of Clinical Social Workers 12
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EXCERPTS FROM THE CSA 'STARTER KIT'

• Referrals to Accredited Therapists

Take immediate steps to obtain consultation or
to refer a client to a colleague or other
appropriate professional, whichever is more
likely to result in providing the client with
competent service, if it becomes apparent that a
clients problems are beyond their competence
1 (Canadian Code of Ethics for Psychologists,
2000, II.8, Competence and self-knowledge
section, 3).
The following Internet URL links to the American
Association for Marriage and Family Therapists
(AAMFT) 'Therapist Locator' website. This site
provides referrals to accredited and licenced
professionals who are members in good standing
with the AAMFT, and thus, provides an excellent
referral service for counsellor-trainees when
ethics dictate to refer the client to a competent
professional in the local area (available in
Canada, USA and Overseas).
AAMFT Therapist Locator 13
Each excerpt meets the applicable design and
inclusion credibility criteria
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A DISCUSSION OF THE BROADER IMPLICATIONS OF
EVALUATING INTERNET RESOURCES AS EDUCATIONAL OR
SELF-HELP INFORMATION
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DEVELOPING CRITERIA FOR REVIEWING THE CREDIBILITY
AND ETHICALITY OF WEB RESOURCES
CSA-specific criteria were developed and
synthesized from web evaluation efforts by human
service and educational professionals. The
broader implication remains that all
professionals must select and/or design credible,
ethical and useful educational or other resources
in their work (with a particular emphasis on
self-help resources). What challenges do you face
from a lack of accessibility to web resources
that meet the ethical and credible guidelines of
your discipline?
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CONCLUDING THOUGHTS
Thank you for taking the time to consider the
issue of web resource credibility. It is our
sincere hope that you find this virtual
presentation to be beneficial and insightful for
your future development and consideration. We
hope that you find the evaluation criteria useful
and adaptable - generally to the web resources
you view - or specifically to the work in your
discipline. However, our main purpose is to
develop ethical criteria and credible web
resources to assist in any work with individuals
who experienced CSA. Margaret Taylor, Judy Chew
and Tom Strong margarett_at_abcounsellored.net
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REFERENCES

1 Canadian Psychological Association. (2000).
Canadian Code of Ethics for Psychologists, 3rd
Edition. Retrieved April 2, 2005 from,
http//www.cpa.ca/ethics2000.html 2 Charnock,
D., and Shepperd, S. (1997). The DISCERN
instrument. Retrieved April 11, 2005 from,
http//www.discern.org.uk/discern__instrument.htm
3 Tillman, H. (2003). Evaluating quality on
the Net. Retrieved April 11, 2005 from,
http//www.hopetillman.com/findqual.html 4
Fogg, B.J., et al. (2002). Stanford web
credibility research Stanford guidelines for web
credibility. Persuasive Technology Lab. Retrieved
April 1, 2005 from, http//credibility.stanford.ed
u/
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REFERENCES

5 Mertens, D. (1998). Research methods in
education and psychology Integrating diversity
with quantitative and qualitative approaches.
Thousand Oaks, CA Sage. 6 World Health
Organization. (2005). Child abuse and neglect.
Retrieved April 5, 2005 from, http//www.who.int/
violence_injury_prevention/violence/neglect/en/
7 Boulware, C. (1998). Adult survivors of
childhood sexual abuse. Retrieved April 6, 2005
from, http//www.psychotherapist.net/adultsurvivor
s.html 8 Marcus, S., Marquis, P., and Sakai,
C. (2004). Three- and 6-Month Follow-Up of EMDR
Treatment of PTSD in an HMO Setting.
International Journal of Stress Management.
11(3)195-208. Retrieved Feb. 25, 2005 from,
Journals_at_Ovid Full Text.
33
REFERENCES

9 EMDR Institute, Inc. (2004). EMDR A brief
description. Retrieved April 3, 2005 from,
http//www.emdr.com/briefdes.htm 10
International Resilience Project. (2005). The
International Resilience Project. Retrieved April
11, 2005 from, School of Social Work, Dalhousie
University website, at http//www.resilienceprojec
t.org/cmp_text/?TargetID4strCompnameresearch
11 Miller, D. (2003). The End of Innocence
Reconsidering Our Concepts of Victimhood.
Psychotherapy Networker. Retrieved April 4, 2005
from, http//www.psychotherapynetworker.org/endofi
nnocence.htm
34
REFERENCES

12 Adams, K., Matto, H., and Harrington, D.
(2001). The Traumatic Stress Institute belief
scale as a measure of vicarious trauma in a
national sample of clinical social workers.
Families in Society, Jul/Aug. Retrieved April 13,
2005 from, http//www.findarticles.com/p/articles/
mi_qa3625/is_200107/ai_n8999785/pg_1 13
American Association for Marriage and Family
Therapy. (2002). AAMFT Therapist Locator.Net.
Retrieved April 10, 2005 from, http//www.aamft.or
g/TherapistLocator/index.asp