If you’re part of a couple, chances are you understand that at certain times, things can become difficult. Sometimes it’s because of circumstances outside of your realm of control, such as if one of you loses a job, a loved one passes away or something else happens that no one saw coming. However, there are also times when things slowly begin to decay between the two of you, whether one of those outside events intervenes and exacerbates things or not. Regardless, every couple goes through good times and bad, and it’s the difficult times that define whether or not a couple is going to make it together for the long haul. When two people love each other, they want to do everything possible to stay together, which is why so many of them go to counseling. 

However, this is a form of help that’s unfamiliar to many people, and to some there’s a stigma attached to it that gives them pause. That’s unfortunate, because this type of effort really helps people and it has saved countless couples over time. Quick Results Counseling has also helped many couples see their way through tough times and emerge on the other side happy together. Given this hesitation a lot of people experience, we’d like to offer some insight into what to expect from couples therapy. If you’re thinking you could use this type of help but you’re not sure what to expect, please read on and hopefully you’ll become more comfortable with what you may encounter.

One of the reasons that people may not know what to expect from couples therapy is that they have seen it depicted many times in Hollywood, and these depictions are rarely positive. Either couples therapy is panned in some way as a farce or it’s presented in a way that shows nasty, hurtful exchanges taking place for an hour at a time. This is unfortunate, but we need to remember that Hollywood is not a truth factory, but rather a storytelling factory. What you see in the media isn’t always meant to be accurate – it’s meant to be entertaining.

What you should expect from couples therapy is to not talk about assigning blame to either person for anything. What you have been saying is 100% true; what your partner is saying is also 100% true. However, both of you are having parallel conversations, and you are not speaking about the same things. These sessions will help you get across what you are trying to communicate at the core level, so your partner can hear you. Sessions are not about blame, fault, shame or guilt. Instead, it’s about figuring out what you truly meant, what caused those feelings, and how to avoid having these situations arise again. That can’t happen if all you do in couples therapy sessions is argue about who should be held accountable for what – it’s highly likely that failing to agree on that is a big part of what led you down this road in the first place. It’s time to get off of that road.

Every couple’s dynamic is built upon a foundation of truth, trust and the like, but even more important from a functionality standpoint, a couple depends on healthy and clear communication. If you and your partner argue often, take an internal look back at what led to it. Chances are you said something that your partner didn’t like or vice versa, and everything devolved quickly from there. What started as a pleasant or even a basic everyday conversation suddenly became a heated exchange. Did you ever look back on these disagreements and think, “How in the world did that happen?” If so, it’s likely because of a communication breakdown.

In terms of what to expect from couples therapy, especially when you work with Quick Results Consulting, you should expect to work hard on your communication approaches and practices with your partner. If your partner is constantly saying the same thing, then that is not the issue. The first 5 layers of the onion is merely surface talk. Do not fall for it. What they are really trying to say starts at the 18th - 28th layer.You just have to do this once. Then it is a plug-and-play situation, after that. This will likely involve education on how to have healthy arguments, how to come together and get to a win-win solution, and making up after the fight. You may utilize some role playing and scenario planning, especially if certain situations arise regularly that often lead to arguments. This will help you handle these situations more calmly and civilly in the future, and it could help avoid quite a few nasty arguments that leave both of you with hurt feelings.

If you’ve been in a relationship in the past that didn’t work out, it would surprise no one in the counseling field to find out that it was because one person was more committed to it than the other. For whatever reason, people sometimes think they are committed to a relationship when it turns out they are not, and they realize this when something else comes along. That same lack of symmetry of commitment when it comes to couples counseling will more often than not lead to a lack of success with this effort. (I need to edit this entire line)After all, if you both don’t want the same things, you’re not going to pursue common goals together. The fastest way to find out if you want the same things is to do 4 assessments, that will give us a 60-80 page report on the both of you, before you step into a therapist’s office. You may think that this person has commitment issues around marriage, or around having children, but the problem may actually be around their self-esteem. Being committed to solving the right problem is very important in couples therapy.  
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With regards to what to expect from couples therapy, you should at least discuss your desires with each other before taking this step. If you both have the same goal with regards to it, then that’s great and you should keep moving forward. If you do not, then it may be a sign that things were not meant to be, although you should still at least talk to a therapist about this before making that difficult decision.

Ultimately, what to expect from couples therapy will also depend on whom you work with to get through those tough times. If you choose to work with Quick Results Counseling, then you can expect to go through a thorough assessment before you begin along with a progression through defined, tangible stages that help you achieve your common goals in the end. We’ve been helping couples all over the Bay Area for years, and we hope that you’ll reach out to us if you’re having problems. Most of our couples are able to graduate from therapy within 12 - 24 sessions. Your relationship does not have many issues; it has one. The one issue sips into many areas and creates many problems. We do not have to solve all the problems. At Quick Results Counseling, we help you find and solve the issue. You will then be given the tools and skills to solve your own problems, and will really not need a therapist after that. If this sounds like something you would like, we look forward to working with you so you can both live the happy life together that you deserve.

Updated April 19, 2021

Part 2
In part 1, I defined child sexual abuse and the types of child sexual abuse. In this blog, I think it will help to know the reasons behind why a person will commit this act on a child. In this blog, I will examine the etiology of CSA by examining different theories on why people do this to children. I will also be analyzing the acts done to a victim, etiology and maintenance of such acts, by the perpetrators.

If you are into research, the first part of EACH theory below will give the scientific information. The second part (BLACK text) I lay it out in a simpler, easy to understand language. 

​Etiology of CSA
The cause of CSA is multifaceted, and provides an understanding, and motivation behind CSA perpetration.  

Psychodynamic Theory.  This theory states that the human psyche is composed of the id, the ego, and the superego (Freud, 1923).  The id functions under the pleasure principle and requires instant gratification of the urges (Freud, 1923).  In the human psyche, the ego is the conscious part.  The job of the ego is to mediate between the id and the external environment (Freud, 1923).  Freud referred to the superego as the conscience. 

Psychodynamic theory explains sexual deviance as an expression of the unresolved conflicts experienced during any stage of development (Schwartz, 1995).  These unresolved problems bring fixations or hindrances. The consequence is the distortion of a sexual object or a sexual aim (Schwartz, 1995).  Fulfillment of the primal desires of the id and the moral authority of the superego causes a constant struggle (Freud, 1923).  Sexual perpetrators lack a strong superego and become overwhelmed by their primal id (Holmes & Holmes, 2002).

Attachment Theory.  It is an innate need for humans to establish strong emotional bonds with others (Tallon, 2013).  Parenting styles foster appropriate social skills in children and facilitate balanced development (Tallon, 2013).  [R1] Individuals act out as a result of their loneliness and isolation, as a result of experiencing loss or emotional distress (Tallon, 2013).  

Armstrong’s (2016) research showed that attachment deficits in childhood led to adults who have intimacy issues later in life. Some of the challenges adults with poor childhood attachment faced were being afraid of intimacy and fearful of attachment in romantic relationships, looking at self in a negative view in relationships and challenges around feeling autonomy in relationships (Armstrong, 2016).

A study by Marshall (1989) showed similar correlation demonstrated that male perpetrators of CSA had attachment deficits, undeveloped social skills and lacked the self-confidence, necessary to form effective intimate relationships.  Such deficits lead to frustration, causing these individuals to seek intimacy with underaged partners (Tallon, 2013).  Tallon (2013), cited Ward et al.’s (1999) position that sexual offenders who have had a preoccupied insecure attachment style with their parents, will characteristically offend by “courting” a child and treat the child as a “lover.”

Seidman et al. (1994) conducted two studies aimed at examining intimacy problems and loneliness among sex offenders.  Seidman’s research demonstrated that these offenders had significant deficiencies in social skills, which prevented them from accurately perceiving social cues, created challenges in determining appropriate behaviors (Seidman, 1994).  Their lack of skills hindered their ability to attain intimacy (Tallon, 2013).  The rapists and non-familial child molesters in the sample group appeared to be the most deficient in intimacy (Tallon, 2013).

Cognitive Behavioral Theory.  Abel et al. (1984) postulated that cognitive distortions or distorted thinking patterns that allow the sex offenders to remove guilt, shame, and responsibility for inappropriate actions[R2] .  Tallon’s  (2013) research examined how sex offenders reduced feelings of guilt and shame through rationalization, excuses, and justifications (Tallon, 2013).  Such cognitive defenses allow offenders to validate their behaviors (Tallon, 2013).

Hanson et al. (1994) labeled sexual entitlement as a cognitive distortion, derived from narcissistic attitudes of offenders who sought to fulfill their desires.  Hanson’s research demonstrated that sex offenders had a tendency to misread social cues and were unable to identify emotions such as anger or fear in their victims.  Rapists and child molesters perceived their victims as having initiated sexual contact and saw their victims’ actions as sexually provocative (Hanson, 1994).  Child molesters misread cues from children that they knew well since children are naturally affectionate towards adults whom they know well (Hanson, 1994).  For example, a child sitting on an adult’s lapis perceived it as initiating sexual contact (Hanson, 1994).  Child sex offenders perceived any sexual curiosity as a child’s desire to learn about sex.  The offender then takes it upon himself to teach the child, via sexual experiences (Hanson, 1994).  Such misreading of cues reinforces offenders’ narcissistic beliefs and detract from the ability to feel empathy for victims (Nisha, 2014).

Biological Theory.  Biological theorists postulate that physiological factors, such as hormone levels and chromosomal makeup, affect the sexually offending behavior (Berlin, 1983; Marshall & Barbaree, 1990).  This theory shows the relationship correlation between high testosterone levels and aggression and the role of androgen and androgen-releasing hormones citation.  

Androgens are male sex hormones that promote sexual arousal, orgasm, and ejaculation, as well as regulate sexuality, aggression, cognition, emotion, and personality (Winder, 2014). Child sex offenders show abnormal hormonal and androgenic levels in the brain (Nisha, 2014).

Behavioral Theory.  Laws and Marshall (1990) stated that deviant sexual preferences and cognitions are acquired through the same mechanisms by which others learn more conventionally accepted modes of sexual expressions.  

The model explains that maladaptive behavior can result from a combination of processes that are intrinsically orderly, and normal in origin (Laws & Marshall, 1990).

Integrated Theory.  Finkelhor (1984) integrated various theories to explain the etiology and continuance of CSA via four underlying factors: emotional congruence, sexual arousal, blockage, and disinhibition.  Emotional congruence is the relationship between the adult abuser’s emotional needs and the child’s characteristics (Finkelhor, 1984).  

If an abuser’s self-perception is child-like, he prefers to relate to other children (Finkelhor, 1984).  If the abuser has low self-esteem or sense of efficacy, he is more comfortable in relating to a minor for power and control (Finkelhor, 1984). 

Integrated theory explains that when sexual arousal is a factor, a molested child grows up to find other children arousing, and this arousal causes them to sexually abuse as an adult perpetrator (Finkelhor 1984).  Alternatively, if the perpetrator of the molested child modeled victimization, the molested child will grow up to find children more stimating, if the child acts like a victim (Finkelhor, 1984).

Blockage happens when the abuser is unable to have his sexual and emotional needs met in a healthy adult relationship (Finkelhor, 1984).

 Psychoanalytical theory describes such blockage as an abuser’s intense conflict about his mother via the “castration anxiety” that hinders relations with adult women (Finkelhor, 1984).  
By contrast, attachment theory explains blockage as a failure to develop skills and self-confidence in nurturing intimate relations with adults (Finkelhor, 1984).

Disinhibition refers to factors that help abusers overcome any reservations regarding abuse of a child.  Cognitive-behavioral theorists explain that disinhibition may occur through cognitive distortions and/or personality factors.  Additionally, substance abuse or stress may assist the abuser in lowering of inhibitions (Finkelhor, 1984).

Family Systems Theory.  This theory postulates that CSA occurs within the context of parental dysfunction, characterized by patriarchal or unavailable parenting styles, parental rejection, and high levels of parental psychopathology (Zinzow 2010).  Krugman (1987) discussed triangulation across generations as the basic pattern in CSA.  

When adults cannot manage conflict and tension independently, they take it out on children (Krugman, 1987).  Role reversal elevates the child into the parental hierarchy for stabilization.  The child becomes a surrogate parent or a surrogate wife, in father-daughter incest (Krugman, 1987, p.139).  Since CSA is often perpetrated by a known and trusted individual, poor parenting sets the stage for abuse to occur.  Unavailable parents may not monitor their children or respond appropriately once sexual abuse has occurred (Zinzow 2010, Vogeltanz et al., 1999).

Understanding Child Sexual Abuse
To many people, child sexual abuse is the result of an extreme environment shrouded by normalcy. Due to their youth, victims of child abuse are typically powerless, especially if the abuse is happening at home or in a trusted setting like at school or while in the care of a trusted adult or family member. 

Understanding child sexual abuse isn't about explaining the evil behavior; it’s about giving us a chance to understand the circumstances surrounding the sexual abuse, how it happened, and how we can prevent it in the future. 

With these pieces, we can learn more about how to protect our society's most vulnerable population—children—from predatory behavior and situations. To understand this, it's important to know that child sexual abuse is rarely the result of one cause, and usually several factors play a role in an abuser’s behavior, as explained below.

Sexual Desires
While sexual desires do often play a role in sexual abuse, such desires are, by themselves, typically not enough to cause child sexual abuse. For someone to act on those desires, there's typically more going on, such as a need to control and feel powerful, a need to realize or act out difficult emotions, a need for status in the eyes of others, or a need for more general intimacy or closeness. This explains why most child abusers’ sexual desires are not limited to children, though children are often targeted because they're more vulnerable and less likely to speak up or challenge the abuser.

Delusional Thoughts
Some abusers have delusional thoughts that convince them that abuse is normal. These thoughts can make the abuser believe that s/he is more important than the victim, that abuse isn't harmful, and/or that the child deserved or consented to the abuse somehow. These delusional thoughts help the abuser weave a narrative of being right or justified in their behaviors due to the circumstances, which enables the abuser to continue to engage in the abusive behavior.

Psychological Issues
Not surprisingly, child abusers often have deep psychological issues that drive their behavior. Some examples of psychological issues that might influence a child abuser’s behavior are:  problems controlling their emotions, a preoccupation with sex, or a lack of empathy that prevents them from understanding the toll of their actions. Such psychological problems often prevent abusers from abiding by basic social rules.

Difficult Life Experiences
Previous life experiences of a child abuser—especially traumatic experiences—frequently lead directly to the sexual desires, delusional thoughts, and/or psychological issues that govern the abuser’s behavior. In fact, abusers were/are often victims of abuse themselves, whether it’s emotional abuse, physical abuse, or sexual abuse. These past experiences can make an abuser think that such abusive behavior is normal, and when s/he is unable to manage his/her thoughts or emotions, s/he might act out in such behaviors.

Societal Influences
While abusers most often take their cues from internal forces such as distorted thoughts and emotions, external forces such as societal influences also play a role in how abusers’ behavior. 

For example, in our society, there are many examples of objectification of young girls that abusers use to justify their actions. These examples are found throughout our culture, including our music, movies, and advertisements.

Similarly, mainstream media imagery often promotes the idea that power can be sexy. As a result, aggression and dominance are often viewed as a big part of sexual relationships, leading to displays of coercion or persuasion, especially in porn and other sexualized forms of entertainment.

Another outside factor that contributes to abusers’ behaviors is the reluctance of victims to report the abuse. Due to their youth and fragility, children are often unable or unwilling to report the abuse. Therefore, child abuse cases are under-reported, and we hear of only a portion of such cases, which makes child abuse seem very rare. Consequently, when child abuse victims step forward, their claims are sometimes treated with skepticism, particularly if the abuse occurred a long time ago and/or continued over a long period of time. Abusers who are aware of children’s reluctance to report the abuse often act with impunity or apathy.

Get help at Quick Results Counseling
If you, a family member, a friend, or other loved one has been the victim of child sexual abuse, we can help. Our experienced team of counselors has successfully helped numerous children work through the devastating effects of child sexual abuse. Here at Quick Results Counseling, we believe that a multi-faceted and tailored approach to solving issues is essential to providing mental health services. Instead of weekly check-ins, we help you build the tools to address and overcome challenging obstacles once and for all. Contact us to see how we can help you.

In part 3 I will be discussing how common is CSA in the U.S. by providing data compiled by federal agencies. I will also be analyzing data on the gender of the victims in the U.S. and in other countries. 

Everyone has trauma; ranging from a BIG "T" trauma to little "t" trauma. 

As a psychologist who specializes in trauma in mental health, my job is to bring an end to the pain and suffering that patients feel. This should not span over months and years. You have been carrying it around with you for years. The treatment does not have to last for years though. It can be done in as little as 10 day intensive treatment, or over 12 - 24 weekly sessions. 

In the next few weeks, I will be writing a series of articles on trauma and how trauma treatment happens in the sessions. My writing will be supported with research, so you can see the basis of my reasoning, and clinical intervention. I am writing these as it is important for the general public to have access to this information, and for people to have the awareness about trauma.

I will be writing in bite sizes, so you can digest it. 

I will demonstrate the basis for treatment for a client diagnosed with MDD (major depressive disorder) and GAD (generalized anxiety disorder), and treated with EMDR (eye movement desensitization reprocessing).  I will begin by discussing the different theories regarding how her adverse experiences contributed to her symptoms and discuss the prevalence of child sexual abuse (CSA).

In the following weeks, I will be discussing the following;
1. thorough research of CSA, taking into account the neurobiology, and interpersonal and intrapersonal impacts.
2. discussing the psychopathology.
3. how the impact of CSA contributed to depression and anxiety
4. explain my diagnosis of MDD and GAD, rather than of PTSD.  
5. present information on EMDR treatment,
6. explaining the theory around EMDR in trauma processing
7. why I chose the modified protocol application for this clincial case
8. discuss the research supporting the use of EMDR treatment with CSA clients diagnosed with co-morbid MDD and GAD.

PART 1

Child Sexual Abuse
The World Health Organization (WHO) defined CSA as “the involvement of a child or an adolescent in sexual activity that he or she does not fully comprehend and is unable to give informed consent to, or for which the child or adolescent is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society (WHO, 2017, pg vii)."

CSA includes incest by a family member or close relative (WHO, 2017).  Incest involves the perpetrator’s intent to satisfy personal needs, and includes seeking power over the child (WHO, 2017).  Adolescents may also experience sexual abuse at the hands of their peers, including in the context of dating or intimate relationships (WHO, 2017).

The WHO (2017) distinguished three types of sexual abuse;
The first, “non-contact sexual abuse” which includes threats, verbal sexual harassment, sexual solicitation, indecent exposure, and exposing a child to pornography.
The second, “contact sexual abuse,” involves sexual intercourse, sexual assault, and rape (WHO, 2017).
The third, is also known as “contact sexual abuse,” however, this definition excludes sexual intercourse, and involves acts such as inappropriate touching, fondling, and kissing (WHO, 2017).  A majority of CSA cases involve manipulation, such as psychological, emotional or material abuses (WHO, 2017).

Now that you know the definition, and the types of CSA, in my next blog post, I will be writing about why the perpetrators commit such an act.