Personal qualities of therapists who individuals disclose abuse to

[ceruleania]

Hey all-

This may be best focused for trauma researchers/clinicians. Does anyone know of work about the personal qualities/attributes of therapists and clinicians who children are more likely to disclose abuse, and more specifically sexual abuse, to?

I would guess greater empathy, warmness, perceptions of them being "loving" and unconditional, but haven't been able to find any actual work..

Anything would be of help!

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[smalltownpsych]

Hey all-

This may be best focused for trauma researchers/clinicians. Does anyone know of work about the personal qualities/attributes of therapists and clinicians who children are more likely to disclose abuse, and more specifically sexual abuse, to?

I would guess greater empathy, warmness, perceptions of them being "loving" and unconditional, but haven't been able to find any actual work..

Anything would be of help!

Sounds like a great idea for some research. I have always been told that i am very approachable and people trust me to be non-judgemental. These ineffable qualities are probably one reason that I have been the recipient of a greater degree of disclosures than the average clinician. There might be a little research existing along the lines of self-disclosure from therapists about personal abuse and the role that plays in victims groups and such.

 

[CheetahGirl]

Have exhausted your searches for psychotherapy research and play therapy with 'personality characteristics,' 'child abuse' and 'child maltreatment' ? I supposed most of the literature looks at the personality characteristics of children and families. And it does sound like a great research idea.

In child psychopathology and when working with children who were abused, we were given articles that informed our treatment (most of what we did was play therapy for ages 4-12, with older kids, you still play board games, draw, etc.), so I know they are out there but I can't put my hands on them right now. I'll respond later if I do.

 

[deleted343839]

In the adult literature there are data to suggest that clients are more likely to disclose sexual abuse to female therapists. But yeah, there isn't a lot out there. Probably what little is out there is concentrated in the forensic literature. But to look at it from a different angle you could reach back a couple of decades to the "recovered memories" literature and see what you find!

 

[thewesternsky]

From experience, my guess is that the best predictor of whether clients disclose abuse is whether the therapist asks about it.

There may be other factors that play a role (e.g., therapist gender, warmth, etc.)--But I'd guess that everything after that explains a relatively small portion of the variance.

 

[50MinuteHour]

Interesting question. Perhaps another interesting question would be what enables clients to self-disclose abuse? Someone else said that therapist qualities may account for small variance in trauma disclosure, and I think they may have a point. I think this because some clients are eager to share, others are quite anxious or paranoid about discussing the abuse, and the list could go on and on... despite what qualities the therapist exhibits. The majority of therapists establish themselves with a basic presence of being there to help, and this in and of itself encourages disclosure. The reason why some clients disclose and some don't then, while certainly can be and are influenced by therapist variables, I suspect may have more to do with their own personality structure.

 

[CheetahGirl]

The reason why some clients disclose and some don't then, while certainly can be and are influenced by therapist variables, I suspect may have more to do with their own personality structure.

There are so many confounding variables there that I don't think it would be measurable at the level where you could see adequate effect. Sure, you could do some self-reports to corroborate with substantiated reports of abuse cases, but the trauma literature clearly states that underreporting is generally a limitation in studies that measure childhood abuse, family violence, domestic violence, etc.

I like the idea...OP, I'll try to see if I can locate those articles because I feel like someone has done some sort of psychotherapy research about therapist characteristics with this population. It would be useful research that could inform clinicians about how they could be more present, empathic and open to hearing horror stories... because that is what it often is for the survivor of abuse.

 

[cara susanna]

I know that college women are more likely to disclose to friends and family than to a professional.

 

[ceruleania]

Hey all! Amazing replies.

I was going along the lines of what cara susanna mentioned- but with kids. I read somewhere that child/adolescent survivors of CSA often delay disclosure, as adolescents 42%~ disclose to a friend only, and abyssmal rates to professionals (somewhere between 3-13%, 8.3% in epidemiological work, if I'm remembering correct). My real question is with the rates so low of overall disclosure, what is leading that 8.3%/ small portion to disclose? What on the therapeutic end can further foster a safe environment for disclosure (beyond open dialogue about abuse)? A more general idea of: what do therapists themselves bring to the table?

One idea I had is Rotenberg's idea of emotional trust (i.e., belief that an individual will respect personal disclosures, be caring/empathic).

 

[AcronymAllergy]

Hey all! Amazing replies.

I was going along the lines of what cara susanna mentioned- but with kids. I read somewhere that child/adolescent survivors of CSA often delay disclosure, as adolescents 42%~ disclose to a friend only, and abyssmal rates to professionals (somewhere between 3-13%, 8.3% in epidemiological work, if I'm remembering correct). My real question is with the rates so low of overall disclosure, what is leading that 8.3%/ small portion to disclose? What on the therapeutic end can further foster a safe environment for disclosure (beyond open dialogue about abuse)? A more general idea of: what do therapists themselves bring to the table?

One idea I had is Rotenberg's idea of emotional trust (i.e., belief that an individual will respect personal disclosures, be caring/empathic).

Getting at what thewesternsky mentioned, I wonder if perhaps a large chunk of it is that many professionals simply don't ask. Or if they do ask, do so in a "lip service" sort of way while going through a laundry list of yes/no type questions (e.g., "Have you been sad more days than not for the past 2 weeks? Have you had recent thoughts of seriously wanting to hurt or kill yourself or someone else? Have you ever experienced any form of abuse or neglect?" etc.).

I believe there may also be data to indicate that many victims of abuse may not regularly/frequently seek out mental health care, particularly soon after the trauma(s), for a variety of reasons. It's one of the impetuses behind the VA pushing to have primary care providers ask about military sexual trauma, since many more folks will see their PCP than a psychologist/psychiatrist/social worker.

 

[ceruleania]

Getting at what thewesternsky mentioned, I wonder if perhaps a large chunk of it is that many professionals simply don't ask. Or if they do ask, do so in a "lip service" sort of way while going through a laundry list of yes/no type questions (e.g., "Have you been sad more days than not for the past 2 weeks? Have you had recent thoughts of seriously wanting to hurt or kill yourself or someone else? Have you ever experienced any form of abuse or neglect?" etc.).

I believe there may also be data to indicate that many victims of abuse may not regularly/frequently seek out mental health care, particularly soon after the trauma(s), for a variety of reasons. It's one of the impetuses behind the VA pushing to have primary care providers ask about military sexual trauma, since many more folks will see their PCP than a psychologist/psychiatrist/social worker.

Very true- I think the way professionals approach/ extent of their rapport and relationship with the patient has a huge impact..

Some interesting finds:
- https://www.nspcc.org.uk/globalasse...eports/no-one-noticed-no-one-heard-report.pdf
- Denov (2007): study about the impact of professionals' responses to disclosures on mental health outcomes of the patient

http://www.sciencedirect.com/science/article/pii/S0145213402005094

 

[psych844]

I would think that most of the hesitation to disclose would be not wanting to get the perp in trouble (as the abuser is often a family member or someone close)...or in some cases relying on the perp at the time. (for food, shelter, etc)

 

[cara susanna]

I would think that most of the hesitation to disclose would be not wanting to get the perp in trouble (as the abuser is often a family member or someone close)...or in some cases relying on the perp at the time. (for food, shelter, etc)

That's part of it. For adult women, it's usually shame, not wanting to get the perpetrator in trouble, and/or being unsure if the incident was actually sexual assault.

 

[Ollie123]

Somewhat of a tangent, but there is some extremely interesting work coming out on "unintended consequences" of domestic violence and abuse reporting laws. At least in some regions, there is growing recognition of the problem, increased effort to encourage reporting to authorities and a greater likelihood of action being taken against the perpetrators (restraining orders, etc.). However, social services and funding have lagged behind. The result seems to be a growing number of people who feel "revictimized" by the system itself and regret making the report. Individuals might lose access to shelter or financial resources (e.g. if they lived with the perpetrator and everything was in the perpetrator's name, the perpetrator may have been providing childcare (for better or worse...) or financial resources to which they no longer have access).

Major problems that don't have easy solutions. I'm hoping it encourages significant expansion of social services systems for victims (though I have my doubts). Seeing this play out during my forensic work last year really highlighted to me how messed up the current system is and how complex the decision to report abuse can be...

 

[futureapppsy2]

I would think that most of the hesitation to disclose would be not wanting to get the perp in trouble (as the abuser is often a family member or someone close)...or in some cases relying on the perp at the time. (for food, shelter, etc)

This is HUGE problem when it comes to people with disabilities who are being abused. One of my favorite studies on the issue is titled "Bring me my scooter so that I can leave you," which pretty much sums it up. Another problem is that a lot of people with disabilities report fearing loss of their freedom if they report abuse, as society has used the experience of abuse--in the not-distant past and probably the present, although less efficiently--to justify that it isn't "safe" for people with disabilities to live in the community (holy victim-blaming).

 

[starsinnight]

I would look up studies on the "common factors" model for therapy disclosure with children. I would think that feeling comfortable to disclose at all to a therapist is driven by the same necessary factors, not necessarily for trauma. I work with trauma patients (children and adults) and see that they either feel comfortable to disclose (in general), or they don't. I don't know if it is so much that they disclose about the abuse or just disclose in general. Children are generally either initially trusting of you or not, in my opinion.

So if you can't find any specific literature on what you are looking, I'd go broader and examine the therapists' qualities that allow for child disclosure in therapy, as a whole. Then go from there.

 

[starsinnight]

This is HUGE problem when it comes to people with disabilities who are being abused. One of my favorite studies on the issue is titled "Bring me my scooter so that I can leave you," which pretty much sums it up. Another problem is that a lot of people with disabilities report fearing loss of their freedom if they report abuse, as society has used the experience of abuse--in the not-distant past and probably the present, although less efficiently--to justify that it isn't "safe" for people with disabilities to live in the community (holy victim-blaming).

This can be said for adults too with PTSD. I think it has more to do with the nervous system response and hypervigilence because even if they are far away from the threat of danger, something in them typically holds them back from trusting and disclosing. So there's this whole additional confounding variable, besides just the therapist qualities but the hypervigilence of the individual.