Rape crisis counsellors' experiences of working with rape survivors in Cape Town

Includes bibliographical references (leaves 117-128).This exploratory qualitative study documents the clinical knowledges gained by Rape Crisis counsellors working with rape survivors in Cape Town. It includes a description of the demographic profile of their clients, the rape experiences that their clients report, the psychological difficulties that clients present with, the methods of treatment being offered by the Rape Crisis counsellors, and counsellors' experiences regarding the effectiveness and/or limitations of these interventions. The research is conducted from a phenomenological hermeneutic framework. A semi-structured interview was developed for the research and was administered to eight counsellors and three counselling co-ordinators across the three Rape Crisis centres in Cape Town. Data were analysed using grounded theory analysis techniques. The research found that for the survivors of rape presenting for treatment at Rape Crisis, the experience of childhood sexual assault (CSA) was common, and that many survivors have experienced multiple traumatisation, or experience multiple ongoing stressors in addition to dealing with the impact of rape or CSA. Participants reported that survivors experience similar patterns of post-rape symptomotology as described in international literature. Treatments offered by participants were guided by the principle of empowerment and closely resembled feminist counselling models. The majority of participants' counselling work focussed on the early stages of recovery from trauma described in the literature, namely establishing physical, community, interpersonal and emotional safety. Establishing physical safety required that participants draw on an extensive network of non-government and other organisations. Treatment also focused on helping survivors to talk about their traumatic experiences and facilitating their connection with others. Participants commonly reported experiencing vicarious traumatisation as a result of their work with clients. The most commonly reported barriers to treatment were clients' conditions of poverty and the limited amount of sessions participants are able to offer due to limited resources. Despite these, the participants reported observing positive change in many of their clients following treatment

Common pool resources: management for equitable and sustainable use

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Addressing childhood trauma in a developmental context

Publication of this article was funded by the Stellenbosch University Open Access Fund.The original publication is available at http://www.tandfonline.com/toc/rcmh20/current#.UfYgj6xL5nUWith the anticipated publication of the DSM-5 in May 2013, much reflection and work has been done on reviewing existing psychiatric nomenclature including, but not limited to the field of traumatic exposure. Traditionally, understanding of the psychiatric and psychological effects of trauma have been developed from studies with adults and then applied to trauma-exposed children with some modifications. While this is an important step to understanding the sequelae of trauma in children and adolescents, the adverse developmental effects of traumatic exposures on the rapidly evolving neurological, physical, social and psychological capacities of children calls for a developmentally sensitive framework for understanding, assessing and treating trauma-exposed children. The importance of early attachment relationships in infancy and childhood means that severely disrupted early caregiving relationships may have far-reaching and lifelong developmental consequences and can therefore be considered traumatic. Given the high rates of violence and trauma exposure of South African children and adolescents, the need for a developmentally based understanding of the effects of trauma on child and adolescent mental health becomes even more pronounced. In this paper, we draw on theoretical perspectives to provide a practical, clinically driven approach to the management of developmental trauma.Stellenbosch UniversityPublishers' versio

Clinical PerspectiveAddressing childhood trauma in a developmental context

With the anticipated publication of the DSM-5 in May 2013, much reflection and work has been done on reviewing existing psychiatric nomenclature including, but not limited to the field of traumatic exposure. Traditionally, understanding of the psychiatric and psychological effects of trauma have been developed from studies with adults and then applied to trauma-exposed children with some modifications. While this is an important step to understanding the sequelae of trauma in children and adolescents, the adverse developmental effects of traumatic exposures on the rapidly evolving neurological, physical, social and psychological capacities of children calls for a developmentally sensitive framework for understanding, assessing and treating trauma-exposed children. The importance of early attachment relationships in infancy and childhood means that severely disrupted early caregiving relationships may have far-reaching and lifelong developmental consequences and can therefore be considered traumatic. Given the high rates of violence and trauma exposure of South African children and adolescents, the need for a developmentally based understanding of the effects of trauma on child and adolescent mental health becomes even more pronounced. In this paper, we draw on theoretical perspectives to provide a practical, clinically driven approach to the management of developmental trauma.Journal of Child and Adolescent Mental Health 2013, 25(2): 105–11

A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders

Publication of this article was funded by the Stellenbosch University Open Access Fund.The original publication is available at http://www.biomedcentral.com/1471-244X/13/289CITATION: Gregorowski, C., Seedat, S. & Jordaan, G.P. 2013. A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders. BMC Psychiatry, 13:289, doi:10.1186/1471-244X-13-289.Introduction: Research has shown that eating disorder (ED) patients who abuse substances demonstrate worse ED symptomatology and poorer outcomes than those with EDs alone, including increased general medical complications and psychopathology, longer recovery times, poorer functional outcomes and higher relapse rates. This article provides a broad overview of the prevalence, aetiology, assessment and management of co-morbid EDs and substance use disorders (SUDs). Review: The co-occurrence of EDs and SUDs is high. The functional relationship between EDs and SUDs vary within and across ED subtypes, depends on the class of substance, and needs to be carefully assessed for each patient. Substances such as caffeine, tobacco, insulin, thyroid medications, stimulants or over the counter medications (laxatives, diuretics) may be used to aid weight loss and/or provide energy, and alcohol or psychoactive substances could be used for emotional regulation or as part of a pattern of impulsive behaviour. A key message conveyed in the current literature is the importance of screening and assessment for co-morbid SUDs and EDs in patients presenting with either disorder. There is a paucity of treatment studies on the management of co-occurring EDs and SUDs. Overall, the literature indicates that the ED and SUD should be addressed simultaneously using a multi-disciplinary approach. The need for medical stabilization, hospitalization or inpatient treatment needs to be assessed based on general medical and psychiatric considerations. Common features across therapeutic interventions include psycho-education about the aetiological commonalities, risks and sequelae of concurrent ED behaviours and substance abuse, dietary education and planning, cognitive challenging of eating disordered attitudes and beliefs, building of skills and coping mechanisms, addressing obstacles to improvement and the prevention of relapse. Emphasis should be placed on building a collaborative therapeutic relationship and avoiding power struggles. Cognitive behavioural therapy has been frequently used in the treatment of co-morbid EDs and SUDs, however there are no randomized controlled trials. More recently evidence has been found for the efficacy of dialectical behavioural therapy in reducing both ED and substance use behaviours. Conclusion: Future research would benefit from a meta-analysis of the current research in order to better understand the relationships between these two commonly co-occurring disorders.Stellenbosch UniversityPublishers' versio