Cognitive-behavioral treatments for couples affected by childhood sexual abuse

151 Pages·2016·0.49 MB·English

by  Justin K. Donovan

Pacific University
CommonKnowledge
School of Graduate Psychology College of Health Professions
4-18-2014
Cognitive-behavioral treatments for couples
affected by childhood sexual abuse: An extension of
the literature
Justin K. Donovan
Pacific University
Recommended Citation
Donovan, Justin K. (2014). Cognitive-behavioral treatments for couples affected by childhood sexual abuse: An extension of the
literature (Doctoral dissertation, Pacific University). Retrieved from:
http://commons.pacificu.edu/spp/1124
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Cognitive-behavioral treatments for couples affected by childhood sexual
abuse: An extension of the literature
Abstract
Past research regarding cognitive-behavioral therapy (CBT) for childhood sexual abuse (CSA) survivors
tended to focus on individual treatments even though it has been suggested that couples therapy may be
beneficial or even necessary for CSA survivors in serious relationships. There is empirical support for CBT
treatments for couples impacted by several forms of trauma, but past couples research generally neglected
specific issues related to CSA. The purpose of this dissertation is to determine how CBT used for CSA
survivors may translate into working with CSA survivors seeking couples therapy. Research on CBT for
individual CSA survivors and couples impacted by trauma are reviewed and critically analyzed to determine
potential adaptability for couples impacted by CSA. A proposed treatment combining findings from research
on individual CSA treatments and couples trauma treatments is presented.
Degree Type
Dissertation
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This dissertation is available at CommonKnowledge:http://commons.pacificu.edu/spp/1124
COGNITIVE-BEHAVIORAL TREATMENTS FOR COUPLES AFFECTED BY
CHILDHOOD SEXUAL ABUSE: AN EXTENSION OF THE LITERATURE

A DISSERTATION
SUBMITTED TO THE FACULTY
OF
SCHOOL OF PROFESSIONAL PSYCHOLOGY
PACIFIC UNIVERSITY
HILLSBORO, OREGON
BY
JUSTIN K. DONOVAN
IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE
OF DOCTOR OF PSYCHOLOGY
APRIL 18, 2014
Abstract

Past research regarding cognitive-behavioral therapy (CBT) for childhood sexual
abuse (CSA) survivors tended to focus on individual treatments even though it has been
suggested that couples therapy may be beneficial or even necessary for CSA survivors in
serious relationships. There is empirical support for CBT treatments for couples
impacted by several forms of trauma, but past couples research generally neglected
specific issues related to CSA. The purpose of this dissertation is to determine how CBT
used for CSA survivors may translate into working with CSA survivors seeking couples
therapy. Research on CBT for individual CSA survivors and couples impacted by trauma
are reviewed and critically analyzed to determine potential adaptability for couples
impacted by CSA. A proposed treatment combining findings from research on individual
CSA treatments and couples trauma treatments is presented.
Key Words: childhood sexual abuse, couples therapy, cognitive-behavioral therapy,
sexual trauma, cognitive-processing therapy, cognitive-behavioral couple therapy
ii
Acknowledgments
The long and challenging experience of completing my dissertation would not
have been possible without the wisdom, expertise, and support of many loved ones and
colleagues. I would like to express my sincere gratitude to those who have made my
journey possible. To Dr. Lisa Christiansen, my dissertation chair, thank you for all of
your knowledge, patience, and encouragement throughout this process. To Dr. Jon Frew,
you have been very influential in my development as a clinician, including being my
clinical supervisor in two separate years that have helped me tailor my personal style and
approach to therapy. To Dr. Phi Loan Le and Dr. Susana Salgado, the training and
encouragement each of you provided during my pre-doctoral internship have been
necessary to my development as a professional and will continue to stay with me
throughout my career. To Jerry and Susan Donovan, my parents, thank you for your
continued and unconditional love, support, and wisdom throughout all of my graduate
school training, as well as everything you have done to help me achieve a happy and
successful life. To Deirdre Silcott, thank you for all of your love and support that has
made completing this difficult task much easier. Finally, thanks to my friends, family,
and all others who have supported me throughout this process and throughout my life.

iii
TABLE OF CONTENTS
Page

ABSTRACT..................................................................................................................ii

ACKNOWLEDGMENTS...........................................................................................iii

INTRODUCTION AND SELECTED REVIEW OF THE LITERATURE .................1

Psychological Effects of Childhood Sexual Abuse...............................................1

Cognitive-Behavior Therapy for CSA...................................................................2

Relationship Problems and CSA............................................................................4

CBT Treatment for Couples...................................................................................6

Couples Therapy and CSA.....................................................................................8

Purpose of Review...............................................................................................10

METHOD....................................................................................................................11

LITERATURE REVIEW............................................................................................12

Individual Treatments for Trauma......................................................................12

Mind-body practices..................................................................................12

Eye-movement desensitization and reprocessing......................................14

Stress inoculation training..........................................................................20

Prolonged exposure....................................................................................23

Skills training in affect and interpersonal regulation.................................27

Cognitive restructuring..............................................................................32

Cognitive-processing therapy....................................................................39

Imagery rescripting....................................................................................44

Exposure, relaxation, and rescripting.........................................................47

Psychoeducation........................................................................................48
iv
Summary....................................................................................................50

Couples Treatments............................................................................................50

TBCT vs IBCT...........................................................................................50

Cognitive-behavioral couple therapy.........................................................53

Behavioral family therapy..........................................................................56

Rational emotive behavior therapy............................................................59

Mind-body practices..................................................................................62

Eye-movement desensitization and reprocessing......................................66

Stress inoculation training..........................................................................67

Summary....................................................................................................70

ADAPTATION CONSIDERATIONS........................................................................71

General Challenges.............................................................................................71

Gender.................................................................................................................73

Treatments and Interventions..............................................................................75

Mind-body practices..................................................................................75

Eye-movement desensitization and reprocessing......................................76

Stress inoculation training..........................................................................79

Prolonged exposure....................................................................................82

Skills training in affect and interpersonal regulation.................................87

Cognitive restructuring..............................................................................88

Cognitive-processing therapy....................................................................91

Imagery rescripting....................................................................................92

Exposure, relaxation, and rescripting.........................................................94
v
Traditional behavioral couples therapy......................................................95

Integrative behavioral couples therapy......................................................98

Cognitive-behavioral couple therapy.......................................................100

Proposed Treatment..........................................................................................101

DISCUSSION............................................................................................................110

Limitations and Future Research......................................................................113

Conclusion........................................................................................................114

REFERENCES..........................................................................................................116

APPENDIXES...........................................................................................................131

vi
Introduction and Selected Review of the Literature
Childhood sexual abuse (CSA) can create many difficulties throughout life, including
social, psychological, and relationship issues in adulthood (Beitchman et al., 1992; Colman, &
Spatz Widom, 2004; Fleming, Mullen, Sibthorpe, & Bammer, 1999). While cognitive-behavioral
therapy (CBT) has been found to be effective in treating individuals who have experienced CSA
(Cloitre, Koenen, Cohen, & Han, 2002; McDonagh et al., 2005), and CBT has also been
demonstrated to be effective in treating couples (Baucom, Shoham, Mueser, Daiuto, & Stickle,
1998; Dattilio, 2010), very few studies have examined the potential for CBT as an intervention
modality for couples in which one partner is a CSA survivor. Given that many of the common
issues that arise from CSA are likely to impact one’s relationships, it follows logically that such
issues may be most effectively treated in a couple’s therapy setting. This paper will explore the
utility of modifying existing CBT couples therapy interventions and CBT individual
interventions for CSA to create a CBT treatment modality for use in couples in which CSA has
impacted the relationship.
Psychological Effects of Childhood Sexual Abuse
Psychological disorders that are associated with CSA include depression, substance-use
disorders, eating disorders, and anxiety disorders, particularly posttraumatic stress disorder
(PTSD; Rodriguez, Ryan, Vande Kemp, & Foy, 1997). Other maladjustment issues that may
arise are low self-esteem (Romans, Martin, & Mullen, 1996), fear and shame (Beitchman et al.,
1992), suicidal ideation and attempts (Mullen, Anderson, Romans, & Herbison, 1993), increased
likelihood of physical and sexual abuse as an adult (Fromuth, 1986), and sexual dysfunctions
(Mullen, Martin, Anderson, Romans, & Herbison, 1994). The effects of CSA are particularly
1