Working with Males Victims of Abuse

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Working with Males Victims of Abuse

• Rick Carroll, Ph.D., L.P.C., A.C.S.
• Virginia State CASA Conference
• November 8, 2008

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CAC Victims Served
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CAC from 2003-2007
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Childrens Advocacy Center of Bristol/Washington
Co. VA2007-08 Annual Report
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Age of Victim
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Ethnicity of Victim
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Type of Abuse
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Relationship of Abuser to Victim
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Age of Abuser
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Perpetrators By the NumbersValente, S. M. (2005)

• Male53-94 (Majority identify themselves as
  heterosexual)
• Female perps. are generally adolescent
  babysitters.
• Family members54-89
• Not known to the family21-40
• Family members were more likely to abuse before
  the age of six.
• Physical force of sexual abuse10-25
• Grooming features

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Why cant Billy focus?
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Working with Male Victims of Abuse (Part II)

• Dr. Rick Carroll
• Virginia State CASA Conference
• November 8, 2008

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Maslows Hierarchy of Needs
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Biological (puberty)

• Puberty during adolescence
• Surging hormones (i.e. a rise in adrenal and
  gonadal hormones).
• Boys facial pubic hair acne voice changes
  physical and social awkwardness (stripling)
  noct. emissions.
• Girls Increase in pubic hair, acne, start of
  menstruation.
• Both genders self-conscious in social
  situations learning to negotiate developing
  bodies.
• Precocious emergence of sexual characteristics
  during this stage makes youth (especially girls)
  vulnerable to mental health issues (Oetzel et
  al., 2003).

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Cognitive (Jean Piaget)

• Four stages of cognitive development
• 1) Sensorimotor (birth to age two). One uses
  senses motor abilities to understand world.
• 2) Preoperational (ages 2-7 years). One uses
  symbols (words) to represent objects and creative
  play (e.g., using checkers as cookies). The child
  is egocentric. 
• 3) Concrete Operational (ages 7-11). One uses
  logical operations or principles when solving
  problems.
• 4) Formal Operational (12 ). Increasingly
  competent at adult-style thinking. Hypothetical
  thinking. Ability to generate why certain events
  occur, plan for the future.
• During adolescence, just because the child has
  the ability to utilize hypothetical thinking
  (i.e. future planning), does not mean they
  exercise this.

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Moral (Lawrence Kohlberg)

• Preconventional Level (up to age nine)
• Self-focused morality
• Stages 1-2 is where youths morality is towards
  obedience and avoiding punishment. i.e., Little
  contesting back-scratching
• Conventional Morality (early teens)
• Other Focused Morality
• Stages 3-4 Maintaining good interpersonal
  relationships and social order. Good
  behaviorlove, empathy, trust for/with others
• Postconventional Morality
• Higher Focused Morality 
• Stages 5-6 Social Contract/Individual Rights and
  Universal Principles
• judge self and others on higher levels of
  morality

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Psychosocial (Erik Erikson)
Developmental Crisis
Ego Quality Gained

• Trust vs. Mistrust Hope (meet basic needs)
• Autonomy vs. Shame Doubt Will Power (free
  choice)
• Initiative vs. Guilt Purpose (pursue goals)
• Industry vs. Inferiority Competence (tasks)
• Identity vs. Role Confusion Fidelity (loyalty)
• Intimacy vs. Isolation Love (devotion)
• Generativity vs. Stagnation Care (concern for
  others)
• Ego Integrity vs. Despair Wisdom (reflection)
• Stages are epigenetic

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Psychosexual Sigismund Schlomo Freud

• Oral, Anal, Phallic, Latency Genital (puberty
  on)
• Id, Ego Superego vs.
• Two basic instincts (Thantos and Eros)
• Defense Mechanisms

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The Cycle
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Self-Concept Shavelsons (1976) Model
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Assessment of Symptoms

• Externalizing vs. Internalizing
• ODD, Conduct vs. Depression, Anxiety
• Cruelty to animals or younger children
• Hypersexual, precocious
• Sleep and appetite disturbances
• Fire-setting
• Self-mutilating behaviors
• Self-medicating (i.e., drugs used to neutralize
  ill feelings)
• School and social performance
• Mood swings
• Enuresis and encopresis
• Crying spells
• Unusual fears or anxieties

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Connecting Considerations

• Look for non-verbal cues (Eye contact
  posturing)
• Take an personal inventoryoften
• Transference and Countertransference
• Biopsychosocial (can you add spiritual?)
• Narrative approach
• Co-editing the story
• Bridge generation gap and connect on their level
• Delineate limits of confidentiality
• Work through the silence (somethings happening)
• Never make false promises

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Considerations cont.

• Focus on all aspects of life not just the abuse
• Cultural sensitivity
• Work through the bravado and defenses
• Cool pose and Machismo
• Alphas Omegas
• Identify appropriate boundaries with each child
• All children experience abuse differently

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Graph of Life(Child Adolescent Version)

• Physical health
• 1 2 3 4 5 6 7 8 9 10 
• Physical appearance
• 1 2 3 4 5 6 7 8 9 10 
• Friendships
• 1 2 3 4 5 6 7 8 9 10
• Family (parents)
• 1 2 3 4 5 6 7 8 9 10 
• Family (siblings)
• 1 2 3 4 5 6 7 8 9 10 
• School performance
• 1 2 3 4 5 6 7 8 9 10
• Happiness in life
• 1 2 3 4 5 6 7 8 9 10 
• Faith (relationship to higher power)
• 1 2 3 4 5 6 7 8 9 10 
• Self Confidence
• 1 2 3 4 5 6 7 8 9 10 
• Diet and exercise

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References

• Ellis, A. (1962). Reason and emotion in
  psychotherapy. Secaucus, NJ Citadel.
• Kolb, D. (1984). Experiential learning
  Experience as the source of learning and
  development. Englewood Cliffs, NJ Prentice-Hall.
  
• Peters, S.D., Wyatt, G.E., Finkelhor, D.
  (1986). Prevalence. In D. Finkelhor (Ed.), A
  sourcebook on child sexual abuse. (pp. 15-59).
  Beverly Hills Sage.
• Skinner, B. F. (1953). Science and human
  behavior. New York Macmillan.
• Valente, S. M. (2005). Sexual abuse of boys.
  Journal of Child and Adolescent Psychiatric
  Nursing, 18, pp. 10-16.