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TOPIC Toxic shame and the concomitant fear of
feeling are core issues needing to be addressed
during group therapy with adult survivors of
childhood sexual abuse.
PURPOSE. To increase awareness of the toxic shame
that survivors experience and to describe the
impact of group therapy based on a family
systems model.
SOURCE. The authors' clinical experiences.
CONCLUSIONS. Symptom management,
repatterning of cognitive distortions, and the
improvement of self-care strategies are identified
as crucial aspects of healing shame-based feelings
and behaviors. Group treatment offers members
the opportunity to cease reenacting family rules
and roles that create toxic shame.
Key words: Child abuse survivors, group
therapy, sexual child abuse, shame
Psychiatric clinical nurse specialists (CNSs), practicing in the arena of managed care, often are challenged to support and empower their clients in short-term, problem-solving endeavors. When dealing with crisis situations, the brief therapy perspective is advantageous. This model, however, is not the treatment of choice with women who were sexually abused as children (Courtois, 1988; Kepner,1995; Kaufman,1992).
The core issue of shame and the concomitant fear of feeling usually escape resolution in brief therapy (Kaufman, 1992). Nurse-therapists working with women in individual and group therapy offer survivors the opportunity to manage symptoms, repattern cognitive distortions, and improve self-care strategies.
Group treatment, using a family systems model, offers female adult survivors of childhood sexual abuse an opportunity to cease reenacting shame-based family rules and roles (Kreidler & Fluharty, 1994). The group becomes like a new family, promoting integration of new learning and allowing for reparation of shameful abuse experiences.
Shame
Shame as a concept is described frequently but seldom defined. Within early psychoanalytic theory, Freud's exploration of shame was limited by his focus on anxiety and guilt. He viewed shame as a social moderator opposing the pleasure principal. Shame was both reactive and inhibitive, relegated to the status of a defense mechanism (Broucek, 1991; Freud, 1905/1953). Other psychoanalysts have viewed the function of shame as promoting repression and blocking insight into one's own sexual dynamics (Kohut,1971; Wurmser,1981).
Erickson (1950) viewed shame as a negative ramification of the second stage of psychosocial development. He identified the critical task of early childhood as autonomy versus shame and doubt. Mahler (1968), Kohut (1971), and Thomas (1997) expanded on Erickson's...