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Introduction to Psychotherapy

The film “Precious” serves as a proof that in the contemporary society, sexual, psychological and physical violence against children and women are still prevalent. In most cases, the perpetrators are family members and intimates, such that culture prevents the victims from taking actions. The film “Precious” illuminates the individualized and complex nature of how women and young girls respond to sexual abuse. The plight of Precious, the main character, as a survivor serves as an explanation of the way sexually abused survivors experience chronic and severe mental symptoms. Effective treatment of sexual trauma, according to Goodyear-Brown (2012), depends on the availability of psychological and social resources and support, cultural and environmental conditions, assault characteristics and survivors’ attributes. This essay explores sexual trauma as the central theme in the film “Precious” and discusses clinical interventions of dealing with it to ensure recovery and safety among sexually traumatized survivors. 

Themes in the Film

The film encompasses series of issues such as cultural and racial stereotyping, sexual abuse, sexual trauma, sexuality, poverty and its images, dissociation, and resilience (Daniels, 2009). The central theme is the plight of the girl child regarding sexual trauma which originates from childhood. Cultural differences and ethnic stereotyping are some of the contributing factors to her psychological trauma on top of sexual abuse. The Sociocultural context in the film According to Goodyear-Brown (2012), any perpetrator of child sexual abuse usually takes advantage of the cultural and moral decay, which induces the fears to silence the victims. There is an instance in the film where Precious does not leave her home when her father rapes her, but instead, she acts like one of the star dancers. 

Sexual trauma victims free themselves from mental and psychological trauma in a variety of ways. An example is the case of Precious, who liberates herself from sexual abuse and violence trauma through resilience. Butler, O’Donovan, and Shaw (2009) describe resilience as an attribute that originates from within people’s innate beliefs that they have the capacity of surviving mental situations and disorders regardless of their severity. For Precious, resilience occur in the form of disassociation and developing series of personality and mental illnesses for filing away the painful experiences and encounters. The first disorder that is evident in the film is post-traumatic stress disorder (PTSD) which Zarb (2013) defines to be a type of mental condition which occurs as a result of an individual experiencing traumatic ordeals, terrifying events, and experiences which cause physical and psychological harms. According to Blinik and Hall (2014), dissociative identity disorder is a chronic and complex post-traumatic condition common in children, which occurs as a result of exposure to severe child abuse and maltreatment. Furthermore, Blinik and Hall (2014) suggest that it is perplexing to identify the manifestation of dissociative identity condition at childhood as its symptoms reveal themselves during adulthood. As Precious enters into adulthood, it is evident that the dissociative identity condition starts to affect her as she begins developing phobic anxiety and severe depression. 

Working with Sexual Trauma Clinically: Therapeutic Practice and Sexuality Theories

The systematic approaches of the practice to assist Precious is a subdivision of three models namely CBT model, psychodynamic psychotherapy, and supportive therapy. For the cognitive-behavioral treatment (CBT) model, the assistance for Precious will aim at recognizing her as the product and producer of her immediate environment. Hence the psychological support will have its core objective of changing Precious’ perception and behavior (Zarb, 2013). CBT model utilizes a series of theories such as social learning, behavioral and cognitive theories. The second systematic strategy is psychodynamic psychotherapy whose focus is on dealing with Precious’ interpersonal relationships, identifying possible defense mechanisms, examining her past ordeals, and restructuring ways in which she can avoid distressing emotions (Trippany, Kress, & Wilcoxon, 2004). An essential element of the psychodynamic psychotherapy model will be reducing Precious’ psychological tensions and personal conflicts and help her to traverse the unconsciousness to cognition for improved mental and psychological functioning. The purpose of supportive psychotherapy is assuring hope for the sexually traumatized individual, and reducing the feeling of isolation and increasing interpersonal learning. A preferable theory applicable in fortifying the practice is the cognitive theory, which will be applicable in Precious’ treatment for influencing her attitudes and the ways she feels about herself after the past sexual trauma (Kieffer, 2014). The cognitive theory operates using the assumption that people have the capacity of controlling their feelings. For the case of Precious, if the therapies can positively affect her cognition of feeling cheerful and having positive thoughts, there is a possibility of Precious feeling better and shedding negative thoughts (Hyde & DeLamater, 2017). The other principle of the cognitive theory is the belief that psychological pain occurs due to past traumatic experiences whose symptoms have not become realistic, but unpleasant thoughts, such as the feeling of approaching death, disturb the victims. 

Tthe case of Precious is also best approached with the aid of Self-trauma Model whose basis includes theories such as Trauma Theory, self-psychology and behavioral therapy as Yule (2013) propose them to be the essential psychological theories for dealing with the victims of child abuse. Working with sexually abused individuals like Precious using the cognitive and behavioral approaches is similar to applying the Psychodynamic Theory which involves practical principles which according to Meca, Alcázar, and Soler (2011), assist in solving child abuse trauma in ways such as changing the victims’ attachment to childhood dynamics. The second way by using cognitive behavioral therapy (CBT) to address the trauma clinically is through motivating the victims to develop coping strategies. 

According to Gorman (2013), another clinical approach of treating sexual trauma using the self-trauma model is the application of self-psychology whose working principle is changing the cognitive recognition of the victims’ comprehension of others and themselves. According to Courtois and Ford (2016), self-trauma model utilizes relational theories and research in cognitive behaviors in addressing interpersonal, behavioral, emotional and cognitive impacts of childhood violence and abuse. On the other hand, Meca, Alcázar, and Soler (2011) advocate for the application of Psychodynamic Theory as an element of self-trauma model and a theory that focuses on victims’ self-capacities and impart skills for tolerance against stress and depression. In McCann and Pearlman’s (2010) research, the findings revealed that most of the victims of childhood sexual violence and abuse who remain untreated for a long time use extra energy and time involving themselves in drug addiction, dissociation, and externalization as ways of trying to cope up with post-traumatic distress. Therefore, the research best explains the reason behind Precious’ development of post-traumatic disorders and dissociative identity disorder (DID). 

Another essential model for dealing with her condition should follow the Constructivist Self Development Theory (CSDT) which McCann and Pearlman (2010) outline its principles to involve the childhood abuse developing at later stages of human developments and solution through interjecting people’s abilities for identifying and regulating their feelings. Furthermore, Kieffer (2014) proposes the application of Somatic Trauma Therapy which works through understanding victims’ body and brain processes in recalling and internally perpetuating traumatic events. The psychologists operating using the theory assist clients in learning ways of regulating pain resulting from the trauma.  Precious can also undergo Survivor Therapy in her course of treatment. Meca, Alcázar, and Soler (2011) recommends the application of Survivor Therapy in dealing with post-trauma stress by emphasizing on victims’ strengths regardless of the injuries (Courtois & Ford, 2016). The trauma treatment approach agrees with sexuality theory by emphasizing on gender-based effects of the sexual trauma hence considering the economic, cultural and sociopolitical context of women’s plight. Clinically assisting Precious through the application of Survivor Therapy in building her strengths to cope up with the trauma.

Ethical Dilemmas

The professional moral dilemma arises from the therapeutic relationship between the patients and psychotherapists, and the common difficulties that occur when dealing with sexually abused and traumatized clients like Precious are confidentiality and dual role dilemmas (Vyskocilova & Prasko, 2013). First, dual function among psychotherapists presents a type of dilemma that links psychotherapists’ beneficence responsibilities towards their patients which conflict with their obligations towards knowledge continuation, other healthcare professionals, third parties and the society. Confidentiality presents the second form of a dilemma in the psychotherapy field (Vyskocilova & Prasko, 2013). The dilemma is such that while the psychotherapists should ensure confidentiality for their clients, there are significant levels of engagement with other individuals allowed in psychotherapy unit leading to exchange of psychotherapy notes. Differentiating between legal rights and confidentiality further complicate the dilemma regarding when, why and how to break them. There is shallow understanding for the reasons behind legal rights among many psychotherapists.  

Ethical Considerations

As the therapists work with individuals like Precious experiencing childhood sexual abuse trauma, there are series of ethical considerations that are necessary. The two leading moral concepts that are fundamental in dealing with sexually violated victims are autonomy and consent (IACP, 2015). First, attending to them should be on a voluntary basis following their will to seek the psychological intervention of the issues facing them. Traumatic patients like Precious have a common feature that they all do not have emotional and mental control of their action, words and the body. It is necessary to ensure that the counseling the therapists should not drive the counseling session and instead should observe, foster, maintain, and respect patients’ autonomy (Trippany, Kress, & Wilcoxon, 2004). Secondly, sexually traumatized patients such as those whose conditions resembles Precious should have consent regarding the whole therapeutic process. The consent should entail when and what they want to share about their childhood abuse and sexual violence with the psychologists. It is also inclusive of the speed that they feel should be applicable in exploring their past experiences. Patients should be given liberty to share or conceal the contents that they feel that are embarrassing such as the previous sexual scenes and bodily harms. Furthermore, it is ethically recommended to give traumatized patients prior knowledge about all the types of treatments together with associated benefits and impending risks. 

IACP 2015 Code of Ethics and Practice offers psychotherapies and counselors a useful framework for accountability and standard ethical practice (IACP, 2015). Interacting and dealing with patients with childhood abuse memories and sexual trauma requires a careful consideration of all the underpinning principles of IACP such as autonomy. It entails giving respect and adhering to patients’ freedom to choose a particular treatment plan with an individual practitioner. The second IACP principle is beneficence which is a type of commitment among the psychotherapies to respect the well-being and welfare of their clients. The third IACP policy is non-maleficence which entails a particular calling and duty among the counseling team to restrain from causing more harm to the already distressed patients. The fourth IACP element is justice which enforces the consideration of fairness and honesty in all the psychotherapy procedures for all clients. Lastly, IACP advocate for professional psychotherapy services to all patients and it is the obligation of counselors and psychology therapists to offer an efficient care. The IACP’s principles have the purpose of shaping and informing the professional core values such as integrity, competence, professional responsibility and respecting dignity and rights of clients (IACP, 2015). 

Competencies and Decision Making

For effective decision-making and offering effective therapeutic services for assisting Precious and any other individual with trauma-related disorders, it is essential that clinicians portray competence in skills and knowledge about sexuality, gender inclusion and sexual dysfunction and concerns that are commonplace in the plight of women (ARHP, 2010). Therefore, competencies are essential for reducing the communication gap and weakness in managing sexual dysfunction and female sexuality. In the film, it is evident that Precious was not reluctant to share her past experiences. Competency in medical and psychological therapy knowledge is important for understanding the heterogeneity existing in sexuality and sexual response, and thus it is necessary to use multifactorial sexuality models to explore and respond to patients’ queries. It is also important to enhance competencies in understanding psychosocial issues relating to sexuality (Barret, 2013). Sexuality and the related factors such as gender and sexual abuse do not occur in vacuums but rather exist as the products of sociocultural factors, stress, fatigue and relationship in women’s lives. It is essential to comprehend the sociocultural context of the patient where sexual abuse and traumatic experiences occur for accurate diagnosis.  Other clinical competencies that are critical to effective decision-making include communication, clinical management, and diagnostic skills. 

Conclusion

Sexual trauma poses significant threats to the well-being and health of victims like Precious. It is evident from the case of Precious that sexual abuse and childhood violence increase the risks of developing series of psychological health issues such as post-traumatic stress disorder (PTSD) and dissociative identity disorder (DID). Therapy for assisting such individuals should aid in preventing negative assessments of past experiences, problem exaggerations, distortion, and misconceptions. Therefore, the clinical ways of dealing with Precious’ traumatic experiences include re-experiencing her physiological distress, emotions, and intrusive thoughts. There should also be persuasion to avoid all the stimuli and thoughts that remind sexually abused individuals of their previous traumatic events. The last strategy is cognitive, emotional and biological arousal, which can include counseling on how to live another life after the traumatic events.

References

ARHP. (2010). Clinician Competencies for Sexual Health. Retrieved from Association of Reproductive Health Professionals: http://www.arhp.org/publications-and-resources/clinical-fact-sheets/shf-competencies

Barret, M. S. (2013). Ethical Issues and Decision-Making in Treatment of Trauma. Philadelphia: University of Pennsylvania. Retrieved from http://dhss.delaware.gov/dsamh/files/si2013_ethicalissuesandtrauma.pdf

Blinik, Y., & Hall. (2014). Principles and Practice of Sex Therapy. New York: The Guilford Press.

Butler, C., O’Donovan, A., & E.Shaw. (2009). Sex, Sexuality and Therapeutic Practice. East Sussex, UK: Routledge.

Courtois, C., & Ford, J. (2016). Treatment of complex trauma: a sequenced, relationship-based approach. New York: Guilford Press.

Daniels, L. (Director). (2009). Precious [Motion Picture].

Goodyear-Brown, P. (2012). Handbook of child sexual abuse: identification, assessment, and treatment. Hoboken, New Jersey: Wiley and Sons.

Gorman, K. (2013). Clinical Models of Treatment for Trauma Experiences and Symptoms specific to Sexual Abuse and Sexual Assault. Alberta: Association of Alberta Sexual Assault Services.

Hyde, J., & DeLamater, J. (2017). Chapter 2: Theoretical Perspectives on Sexuality. In Understanding Human Sexuality, 13th Edition. New York: McGraw-Hill.

IACP. (2015). Introduction to Code of Ethics and Practice. New York: IACP. Retrieved from http://www.iacp.ie/files/UserFiles/News-Links/Draft-Revision-of-IACP-Code-of-Ethics-Nov-2015.pdf

Kieffer, C. C. (2014). Mutuality, Recognition, and the Self: Psychoanalytic Reflections. London: Karnac Books.

McCann, I. L., & Pearlman, L. A. (2010). Constructivist Self-Development Theory: A Theoretical Framework for Assessing and Treating Traumatized College Students. Journal of American Health, 40(4):189-196.

Meca, J., Alcázar, A. I., & Soler, C. L. (2011). The psychological treatment of sexual abuse in children and adolescents: A meta-analysis. International Journal of Clinical and Health Psychology, 11(1):67-93.

Trippany, R., Kress, V., & Wilcoxon, A. (2004). Preventing Vicarious Trauma: What Counselors Should Know When Working With Trauma Survivors. Journal of Counseling and Development, 82(1):30-42.

Vyskocilova, J., & Prasko, J. (2013). Ethical Questions and Dilemmas in Psychotherapy. Act Nerv Super Rediviva, 15(2):1-11.

Yule, W. (2013). Post-traumatic stress disorders: concepts and therapy. New York: Wiley.

Zarb, J. (2013). Developmental cognitive behavioral therapy with adults. Hoboken, NJ: Taylor and Francis.

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