ÇOCUK CİNSEL İSTİSMARINA PSİKODİNAMİK BAKIŞ AÇISI VE HEMŞİRELİK YAKLAŞIMI Gülseren KESKİN

Yıl 2005, Cilt: 21 Sayı: 2, 191 - 208, 01.01.2005

Gülseren Keskin Olcay Çam

Öz

Psikiyatri hemşiresi, travma sonucu acı çeken bireylerle sık sık karşı karşıya kalır. Psikiyatri hemşiresi mağdur ve geride kalanlara terapötik bakım vermede önemli bir role sahiptir. Bu gözden geçirme yazısında çocukluk çağı cinsel istismarı yaşamış bireylerde hemşirenin danışmanlık rolünü açıklamak amaçlanmaktadır. Bu gözden geçirme yazısında çocukluk çağı cinsel saldırısı son literatürlere dayanılarak değerlendirilmiş ve yaygınlığı, risk faktörleri, çocuk üzerindeki psikodinamik etkileri, terapötik girişimler yeni bulgulara dayanılarak özetlenmiştir. Cinsel istismar çocuklarda akut psikiyatrik semptomlara yol açabilmektedir, yetişkinlik döneminde istismarın tıbbi ve psikiyatrik spekturumda yer alabilen etkileri olabilmektedir. Terapist hemşirenin psikolojik desteği, travmaya uğramış çocuk için bütüncül bakım açısından önemlidir. Çocukluk çağı cinsel istismarında travmatik dinamiğin ve sonraki döneme yansıyan etkilerinin anlaşılması, çocuğun kendini açması ve girişimlerin planlanması sırasında terapist hemşireye yaklaşımda kolaylık sağlar. Cinsel travmanın pek çok psikopatolojik sonuçları vardır, fakat psikopatoloji üzerindeki etkisi, çocuğun psikodinamik yapısını bütünüyle bozmaz. Bununla birlikte psikodinamik yapıda iyileşmenin sağlanmasıyla birlikte cinsel istismarın psikopatolojisi azalma eğilimi göstermektedir

Anahtar Kelimeler

Travma, cinsel istismar, cinsel istismar girişimleri, psikodinamik

PSYCHODINAMIC ASPECTS OF CHILD SEXUAL ABUSE

Öz

Psychiatric nurses are confronted oftenly with individuals who are suffering from the consequences of trauma. Psychiatric nurses have a genuine role in offering therapeutic care to victims and survivors. The aim of this paper is to review the nurse's role in counselling survivors of child sexual abuse. In this review, we examine the most recent literature on child sexual assault, and summarize new findings regarding prevalence, risk factors, psychodinamic effect on child and therapeutıcs interventions. Sexual abuse is associated with acute psychiatric symptomatology in children, possible effects of abuse on health in adult life and may progress to a spectrum of psychiatric post-traumatic stress disorder and medical disorders in adults. Psychological support by Therapist nurse are important in comprehensive care of traumatized child. Understanding the traumagenic dynamics of childhood sexual abuse and its after effects provides direction for the nurse therapist during both the child's disclosure and intervention planning. Sexual trauma status was associated with most of the psychopathology outcomes, but its impact on psychopathology was largely unmoderated by child psychodinamic structure. In addition to this the increased well-being of the child’s psychodinamic structure was generally associated with lower psychopathology for sexual abuse sample

Anahtar Kelimeler

Trauma, sexual abuse, sexual abuse interventions, psychodynamic nursing aproach

Kaynakça

• Alexander PC, Anderson CL, Brand B et all (1998). Adult attachment and long-term effects in survivors of incest. Child Abuse & Neglect. 22(1): 45–61.
• Anderson CL, Alexander PC (1996). The relationship between attachment and dissociation in adult survivors of incest. Psychiatry. 59(3):240-54.
• Arıkan D, Yaman S, Çelebioğlu A (1999). Çocuk istismarı ve ihmali konusunda hemşirelerin bilgileri. VII. Ulusal Hemşirelik Kongresi.22-24 Haziran, Erzurum.
• Bal S, Van Oost P, Bourdeaudhuij ID(2003). Avoidant coping as a mediator between self-reported sexual abuse and stress-related symptoms in adolescents. Child Abuse & Neglect. 27(8):883-897.
• Barker-Collo SL, Melnyk WT, McDonald-Miszczak L (2000). A cognitive-behavioral model of post-traumatic stress for sexually abused females. Journal of Interpersonal Violence. 15 (4):375–392.
• Berlin LJ, Dodge KA (2004) Invited Commentary .Relations among relationships. Child Abuse & Neglect . 28(11):1127-1132.
• Berliner L, Conte L (1990). The process of victimization: The victims’ perspective. Child Abuse & Neglect. 14: 29–40.
• Bowlby J (1977). The making and breaking of affectional bonds. British Journal of Psychiatry. 130 :201–210.
• Briere J (1992). Methodological issues in the study of sexual abuse effects. J Consult Clin Psychol. Apr; 60(2):196-203.
• Brodsky B.S, Malone K.M., Ellis S.P (1997). Characteristics of borderline personality disorder associated with suicidal behavior. American Journal of Psychiatry 154 (12): 1715–1719.
• Celano M, Hazzard A, Campbell SK, Lang CB. Attribution retraining with sexually abused children: review of techniques. Child Maltreat. 2002 Feb; 7(1):65-76.
• Cupoli JM, Sewell JM.(1988). One thousand fifty-nine children with a chief complaint of sexual abuse. Child Abuse & Neglect.12 (2): 151–162.
• Davis J L, Petretic-Jackson P A (2000). The impact of child sexual abuse on adult interpersonal functioning. A review and synthesis of the empirical literature. Aggression and Violent Behavior. 5(3): 291-328.
• DiLillo D (2001). Interpersonal functioning among women reporting a history of childhood sexual abuse, empirical findings and methodological issues. Clinical Psychology. Jun; 21(4):553-76.
• Eckenrode J, Rowe E, Laird M et all (1995). Mobility as a mediator of the effects of child maltreatment on academic performance. Child Dev. Aug; 66(4):1130-42.
• Edwards JJ, Alexander PC (1992). The contribution of family background to the long- term adjustment of women sexually abused as children. Journal of Interpersonal Violence. 7(3):306–320.
• Elliot AJ, Peterson LW (1993). Maternal sexual abuse of male child ren. When to suspect and how to uncover it. Postgrad Med. Jul; 94(1):169-72.
• Finkelhor D (1994). Sex abuse and sexual health in children: current dilemmas for the pediatrician. Schweiz Med Wochenschr. 27; 124(51-52):2320-30.
• Finkelhor D, Browne A (1985). The traumatic impact of child sexual abuse: a conceptualization. Am J Orthopsychiatry. Oct; 55(4):530-41.
• Fontanella D, Harrington SJ, Zuravin SJ (2000). Gender differences in the characteristics and outcomes of sexually abused preschoolers. Journal of Child Sexual Abuse. 9(2):21–40.
• Friedrich WN, Fisher J, Dittner C et all (2001). Child Sexual Behavior Inventory: Normative, psychiatric and sexual abuse comparisons. Child Maltreatment. Feb; 6(1):37-49.
• Glod C (1993). Long-term consequences of childhood physical and sexual abuse. Archives of Psychiatric Nursing. 7(3): 163-173.
• Gorey KM, Leslie DR (1997). The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement biases. Child Abuse Negl. Apr; 21(4):391-8.
• Hoff LA, Ross M (1995). Violence content in nursing curricula: strategic issues and implementation. J Adv Nurs. 21(1):137-42.
• Kendall K, Tackett K (2002). The health effects of child abuse: four pathways by which abuse can influence health. Child Abuse Negl. Jun; 26(6-7):715-29.
• Lazarus RS (1993). Coping theory and research: Past, present, and future. Psychosomatic Medicine . May-Jun; 55(3):234-47.
• Lewin L (1995). Interviewing the young child sexual abuse victim. J Psychosoc Nurs Ment Health Serv. Jul; 33(7):5-10.
• Martin G (1996). Reported family dynamics, sexual abuse, and suicidal behaviors in community adolescents. Archives of Suicide Research. 2(3): 183–195.
• McCarthy G, Taylor A(1999).Avoidant/ambivalent attachment style as a mediator between abusive childhood experiences and adult relationship difficulties. Journal of Child Psychology and Psychiatry. Mar; 40(3):465-77.
• Mullen PE, Martin JL, Anderson JC et all(1994). The effect of child sexual abuse on social, interpersonal and sexual function in adult life. Br J Psychiatry. Jul; 165(2):35-47.
• Muram D (2003). The medical evaluation of sexually abused children. Journal of Pediatric and Adolescent Gynecology. 16 (1): 5–14.
• Nair P, Schuler ME, Black MM. et all (2003). Cumulative environmental risk in substance abusing women: early intervention, parenting stress, child abuse potential and child development. Child Abuse & Neglect. 27(9): 997-1017.
• Ornduff SR, Kelsey RM, O'Leary KD. Childhood physical abuse, personality, and adult relationship violence: a model of vulnerability to victimization. Am J Orthopsychiatry. 2001 Jul; 71(3):322-31.
• Ornstein A (1981). Self-pathology in childhood: developmental and clinical considerations. Psychiatr Clin North Am. Dec; 4(3):435-53.
• Peleikis D, Mykletunb A, Dahlaand A(2004). The relative influence of childhood sexual abuse and other family background risk factors on adult adversities in female outpatients treated for anxiety disorders and depression. Child Abuse & Neglect . 28(1):61-76.
• Peters DF(2001). Examining child sexual abuse evaluations: the types of information affecting expert judgment. Child Abuse Negl. Jan;25(1):149-78.
• Reid B, Long A (2002). Suspected child abuse: Communicating with a child and her mother .Journal of Pediatric Nursing.17(3): 229-235.
• Roberts S(2000).Primary Health Care of Survivors of Childhood Sexual Abuse: How Can Psychiatric Nurses Be Helpful?. Journal of the American Psychiatric Nurses Association. 6(6):191-195.
• Sigmon ST, Greene MP, Rohan KJ et all (1996). Coping and adjustment in male and female survivors of childhood sexual abuse. Journal of Child Sexual Abuse. 5(3):57–76.
• So-kum Tang C, Davis C(1996). Child abuse in Hong Kong revisited after 15 years: Characteristics of victims and abusers. Child Abuse & Neglect.20(1):1213-1218.
• Steel J, Sanna L, Hammond B et all (2004). Psychological sequelae of childhood sexual abuse: abuse-related characteristics, coping strategies, and attributional style. Child Abuse & Neglect. 28(7): 785-801.
• Tajima AE (2000). The relative importance of wife abuse as a risk factor for violence against children. Child Abuse & Neglect. November; 24(11): 1383-1398.
• Tardif M, AuclairN, Carpentier J (2005). Sexual abuse perpetrated by adult and juvenile females: an ultimate attempt to resolve a conflict associated with maternal identity . Child Abuse & Neglect, Volume 29(2): 153-167.
• Uysal A, Erefe İ (1999). Çocuk İstismarı Ve İhmalinin Belirti Ve Rsiklerini Tanılamada Hemşire Ve Ebelerin Bilgi Düzeylerinin Saptanması. VII. Ulusal Hemşirelik Kongresi. 22-24 Haziran. Erzurum.
• Vahip I (2002). Evdeki Şiddet ve Gelişimsel Boyutu: Farklı Bir Açıdan Bakış 13(4): 312-319.
• Westerlund E (1992). Women's Sexuality after Childhood Incest. New York (N.Y.): W.W. Norton and Company, Inc. 241 p.
• Wyszynski ME (2000).Screening women for family violence in the maternal child healthcare setting. Clin Excell Nurse Pract. Mar; 4(2):76-82.
• Yates A (1982). Legal issues in psychological abuse of children. Clin Pediatr (Phila). Oct; 21(10):587-90.