A program that integrates cognitive therapy with spiritual awareness and healing has proved beneficial to female survivors of childhood sexual abuse, significantly decreasing symptom scores in all patients in a small pilot study.
The 8-week program of manualized, individual sessions offers the kind of experience many abuse survivors never encounter though they may spend years in therapy—a way to explore how sexual abuse has shaped their spirituality and how that spirituality has shaped their mental and emotional health.
The link between spirituality and health has long been recognized, said Nichole Murray-Swank, Ph.D., who created the program. Just as positive spirituality is associated with better mental health, negative spirituality is associated with poorer mental health. Many abuse survivors carry extremely negative spiritual images; these very persistent thought patterns can impede healing, said Dr. Murray-Swank, a clinical psychologist at Loyola College in Maryland, Columbia.
At the core of these images is the survivor's belief that she is utterly worthless, irredeemably damaged, and undeserving of love or happiness, Dr. Murray-Swank said. These feelings form the basis of crippling shame, sexual dysfunction, poor body image, anger, and emotional isolation. They can also exacerbate depression and posttraumatic stress disorder.
Dr. Murray-Swank's pilot program, “Solace for the Soul: A Journey Towards Wholeness,” asks clients to work through these thoughts and images. The program is nondenominational, although it is theistic, she said in an interview. In Ohio, where the pilot study was conducted, most clients subscribed to a monotheistic, paternal image of God. But the program does not specify this image. “By 'theistic,' we mean that it describes a creative force, whether people understand that to be nature, or energy, or a deity,” Dr. Murray-Swank said.
Each session focuses on a specific aspect of spirituality and its relationship to childhood sexual abuse: feelings of abandonment by God and associated anger; connecting with the spiritual; letting go of shame; seeing the body as a beautiful creation; and seeing sexuality as a sacred, life-affirming way of connecting to others.
Dr. Murray-Swank's first group consisted of four adult women who had experienced long-standing sexual abuse—including penetration—by their father or stepfather, beginning in prepubescence. The women were referred from mental health agencies after they learned about the program and expressed an interest in joining. All of them had serious, chronic mental illness: one had bipolar disorder; one had borderline personality disorder and depression; and two had chronic, serious depression. All had severe PTSD.
The women filled out five questionnaires at baseline, after session 4, at the end of the intervention, and at 1 or 2 months' follow-up (Brief Symptom Inventory, Trauma Symptom Checklist-40, Brief Measure of Religious Coping, God Image Scale, and Religious Concepts Survey). They also kept daily symptom logs measuring psychological and spiritual distress, positive and negative coping, self-worth, sexual problems, trauma symptoms, and body image.
By the last measurement, all of the patients experienced decreases in the Brief Symptom Inventory, with the most symptomatic patient making the largest improvement (dropping from 80 to 15 on the scale). One patient dropped from 55 to 35, one from 45 to 34, and the last from 15 to almost 0. The largest improvements were seen in depression and anxiety symptoms.
Dr. Murray-Swank said the work was challenging to all the women. The most difficult sessions were those that concerned sexuality and body image. “When I asked them to write positive things about their body, some were unable to give even one answer.”
Some of the women experienced intermittent increases in their sexual symptom scores during the sessions. This wasn't a surprise, Dr. Murray-Swank said. “It's not fun doing these things. Healing is difficult, and it might even be more painful during the process.”
Additional research is ongoing and may find a permanent home, the Center for the Study of Spirituality, Trauma, Loss, and Violence to be located at Loyola College in Maryland and focus on the importance of spirituality in healing, clinical programs, and provide education and training.
While acknowledging that these brief interventions cannot completely heal survivors of sexual abuse, she does think they can be an important adjunct to other therapy.