Psychological resilience of childhood sexual abuse survivors: A group psychotherapy outcome study
This investigation used archival data from 112 adult female survivors of child sexual abuse (CSA) who participated in a randomized controlled trial of group psychotherapy at Stanford University. Based upon attachment theory premises, the reflective functioning rating system (Fonagy, Target, Steele, & Steele, 1998) was applied to Trauma Interviews. These interviews were administered to women who were assigned to trauma-focused group psychotherapy or a waitlist condition, at baseline and six months' follow-up. The results of the primary research hypotheses were not supported, indicating that the reflective function (RF) ratings of women in the trauma-focused treatment condition were not significantly different from women who were assigned to the waitlist condition at six-month follow-up. In addition, significant associations were not found between RF ratings and reported overall interpersonal problems, the age of first CSA episode, number of CSA episodes, or abuse involving a parental perpetrator.
While RF ratings were not found to be associated with CSA involving penetration, a post-hoc linear mixed model analysis revealed a significant difference in RF ratings from baseline to 12-months for women, depending on whether their CSA involved penetration, regardless of the condition to which women were assigned. Women who reported CSA without penetration were more likely to show improvements in RF ratings over time compared to women who reported CSA involving penetration, regardless of treatment assignment.
An exploratory post-hoc analysis also indicated that the age of first CSA episode may be an important factor to consider in understanding improvements in RF ratings for treatment-seeking adult female survivors of CSA. However, these results were contrary to expectation and should be interpreted with caution. Women who reported their first CSA episode at an earlier age were more likely to improve their RF ratings from baseline to 12-month interviews if they were in the trauma-focused condition, while women who reported their first CSA episode occurring at an older age showed greater improvements in RF ratings from baseline to 12-months if they were in the waitlist condition.