Childhood sexual violence is a serious social problem, as every fifth girl is said to has been sexually abused, while the number of sexually abused boys is slightly lower. Sexual abuse can traumatize a child for a lifetime. Many studies show that sexual violence in childhood and adolescence is a major risk factor for psychological, emotional, cognitive, behavioral, physical and interpersonal problems, both in the short and long term. Many also show, that individuals who were victims of sexual violence in childhood have more problems than individuals who were not victims of sexual violence. In the doctoral dissertation, we therefore wanted to investigate the differences in difficulties between individuals who were sexually abused in childhood and individuals who were not, as well as to understand the profound experiences of victims of sexual abuse who joined group therapeutic treatment according to the Relational Family Therapy model.
The doctoral dissertation entitled A Client's Perception of Change in Group Treatment of Childhood Sexual Violence by the Relational Family Therapy is divided into a theoretical and an empirical part. In the theoretical part, we first described the phenomenon of sexual violence in childhood, focusing on the definitions of sexual abuse, on the prevalence of sexual abuse and on disclosure and treatment of sexual abuse. In the second chapter of the theoretical work, we presented the consequences of sexual violence in childhood by describing the factors that affect the outcomes of sexual violence, short-term and long-term consequences, behavioral responses of victims and the impact of trauma on the brain. We continued with selected aspects of sexual violence, namely: individual problems, aggression, self-control and emotional response. In the fourth part we presented a model of Relational Family Therapy in the context of sexual violence, and in the last chapter of the theoretical part, we discussed the broader aspect of understanding sexual abuse in the Bible, both in the New and Old Testament.
This was followed by the empirical part, which consists of quantitative and predominantly qualitative part. In the quantitative part, we were interested in the differences between individuals who were sexually abused in childhood and individuals who were not abused, in the following areas: individual problems and strengths, the expression of aggression, the ability to self-control, and the ability of emotional processing. The 707 participants voluntarily participated in the study, of which 61,39 % experienced a low, moderate, or severe form of sexual abuse, which is above the research average. By analyzing results of the questionnaires, we found that individuals who experienced sexual abuse in childhood, in comparison to individuals who did not, have statistically significantly more individual problems and less strength in the areas of expression of negative emotions, absence of inhibition of strong impulses, life functionality, and self-acceptance, but not in the areas of openness to self-expression, lack of self-understanding, substance abuse, and flexibility. Furthermore, the research results showed that individuals who experienced sexual abuse in childhood have a statistically significantly worse regulation of aggression, namely in all areas of aggression: physical and verbal aggression, anger, hostility, and general aggression level. We also found that individuals who have experienced sexual abuse in childhood, compared to individuals who have not, have a statistically significant lower capacity for self-control in the area of temper but not in areas of impulsivity, simplification, risky behavior, physical activity, and self-focus. Also, the results of the research in the field of emotional processing ability showed that individuals who experienced sexual abuse in childhood have a statistically significantly worse functionality of emotional processing in the area of emotional stability but not in the areas of the openness of expressing emotions, appraisal and use of emotions, overall level of emotional processing.
In the predominantly qualitative and partly quantitative part of the research, we were first interested in the contribution of Relational Family Therapy in reducing problems in victims of sexual abuse in childhood in the area of individual problems and strength, aggression, self-control and emotional processing. We were also interested in the client's experience of changes in therapy, i. e. the client's experiences of the course of the therapeutic process and the therapist's actions within the group treatment of sexual violence. Ten participants who had been sexually abused in childhood joined the research. The research result showed that after the process of group treatment according to the model of Relational Family Therapy, there was a statistically significant reduction of individual problems and helplessness in the areas of expression of negative affects, life functionality, misunderstanding of oneself and self-acceptance among victims of sexual abuse in childhood, while no statistically significant differences in the absence of impulse inhibition, openness to self-expression, flexibility and substance abuse, could be confirmed. Furthermore, we found that in victims of childhood sexual abuse after therapy, there was a statistically significant increase in the regulation of aggression in the areas: of anger, hostility, and general aggression level, as well as in the areas of physical aggression and verbal aggression. The research showed that victims of childhood sexual abuse after the group treatment process experienced a statistically significant increase in self-control in the area of temper but not in the areas of impulsivity, simplification, risky behavior, physical activity and self-focus. We also found that victims of childhood sexual abuse after the process of group therapy experienced a statistically significant improvement in emotional processing in the following areas: appraisal of emotions, emotional stability and emotional processing together, while there was no statistically significant improvement in the area of openness to expressing emotions. In the second part of the qualitative research, we were interested in the client's experience of change within the framework of group Relational Family Therapy and the client's experiences of the course of the therapeutic process and the therapist's actions. This can be classified into four main categories: client's changes, changes in the relationship with others, conditions during the therapy and characteristics of the therapist. The changes reported by the victims of sexual abuse during the therapeutic process related to the: area of emotions, evaluation of the abuse, self-compassion and better self-understanding, experiencing power, double awareness and the area of bodily responses. They also reported changes in their relationship with others, namely in the areas of delimitations, social network, partner relationships and family relationships. Furthermore, the conditions of the therapy related to the meaning and effect of the therapy, the possibility to speak, the feeling that you are not alone and belonging, trust, security, motivation, positive expectations, the structure and regularity of the meetings, and exposure to the group. The therapist's compassion, professionalism, and personality, as well as therapeutic phrases that helped, proved to be essential qualities of the therapist.
Relational Family Therapy has proven to be a safe space where an individual gets words for what happened to him, and through various mechanisms the trauma is also regulated and the victim regains hope for a normal life. Group therapy has also proved particularly important because of the feeling that people who have been traumatized by the trauma of sexual abuse know that they are no longer alone in this and that there is nothing wrong with them.
The conclusions of this study should be understood by taking into account the limitations, the first part mainly due to the non-representative sample, while the second part did not include a control group, and when processing sexual abuse, it is also necessary to take into account the individuality and diversity of each individual who faces the consequences of trauma in its own specific way.
The doctoral thesis is an important contribution to a better understanding of victims of sexual abuse and contributes to the development of Relational Family Therapy treatment of victims who have experienced the trauma of sexual abuse.
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