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Treatment Models: Identifying Therapeutic Approaches
Many models, therapeutic approaches and techniques are used by health professionals who work with survivors of child abuse. Clients present for treatment at different stages of recovery, with varying symptoms, medical histories, coping strategies and levels of functionality. Many approaches are integrative or eclectic and demonstrate responses to individual client needs during the recovery process (Henderson, 2006).
'Medical model' and 'Misdiagnosis'
The medical model is almost universally criticised by therapists working with survivors of childhood abuse. Whilst all modalities have their critics, the medical model has been highlighted here because it is the dominant model utilised by clinicians working in mental health settings, particularly for depression and anxiety disorders (Henderson, 2006). The medical model is inclined to support the theory that abuse memories are fantasies, and treat symptoms, such as depression, with medication (Henderson, 2006). The medical model holds a 'disease' perspective whereby psychological disorders are viewed as diseases. These diseases are then not viewed as being related to interpersonal experiences such as childhood abuse (Saakvitne et al., 2000). Within the medical model, survivor clients are categorised according to their symptoms, which are many and varied, without attention to the meaning, function and causes of these symptoms.
The National Inquiry into the Human Rights of People with Mental Illness in 1993 found that "some professionals place an over-reliance on symptomatology and purely medical models to the exclusion of psycho-social and environmental factors in diagnosing psychiatric disorders in women". It was recommended that "treatment, counselling and rehabilitation of women who have suffered violence and abuse should address the situation directly and attempt to protect women from further harm" (Australian Human Right Commission, 1993, chapter 19).
The medical model focuses on symptoms and diagnoses while viewing behaviour outside of a context. Diagnoses are drawn from the behavioural elements of a disorder, without consideration as to the aetiology of these behaviours (e.g. to cope with the trauma). Diagnosis highlights what is wrong with a person and pathologises while ignoring adaptations, coping mechanisms, and elements of resilience (Saakvitne et al., 2000). The focus is 'there is something wrong with this person' rather than 'something wrong happened to this person'. The medical discourses that categorise abuse experiences as pathology, and the survivor or 'victim' as damaged, are disabling; and render survivors powerless in their capacity to reclaim and reshape their identity after such toxic human interactions (van Loon & Kralik, 2005a).
Personality disorders
Although most survivors report symptoms consistent with PTSD or complex PTSD, the diagnosis more typically assigned to survivors is of a personality disorder (see Herman, 1992). A personality disorder is a pervasive and enduring disruption of the ability of a person to function normally (Millon, 1991; cited in Walker, 1994). However, the question of what is 'normal' within the mental health context is the subject of much debate.
The diagnosis of borderline personality disorder (BPD) is not unusual for women with symptoms resulting from childhood or adult violence or trauma (see Sansone, Sansone, & Wiederman, 1995). A diagnosis of BPD for survivors has traditionally implied likely failure to recover (Candib, 1995). Candib (1995) argues that the label of BPD is stigmatising and ignores the link between abuse, trauma and a survivor's response. She argues that this diagnosis may result not only in an inappropriate or fragmented approach to treatment, but to broader ramifications such as losing custody of children or inability to secure health insurance.
Personality disorder diagnoses can result in inadequate and even harmful treatment for abuse survivors. Survivors attest that the symptom-focused, diagnosis-based, therapist-as-authority figure framework that guides many health providers often harms survivors of childhood abuse (Harper et al., 2007; O'Brien, Henderson, & Bateman, 2007). The power structure of the medical model recreates a situation of dependence associated with danger, pain and betrayal for survivors of childhood abuse (Linehan, 1993a).
A study by Harper et al. (2007) found that the quality of survivors' relationships with their therapists was negatively impacted when participants perceived that their therapists viewed them as 'mentally ill', rather than as suffering the effects of repeated traumatic experiences (Harper et al., 2007). The fear participants held that they would be perceived as needing psychiatric hospitalization inhibited their ability to share their thoughts and feelings (Harper et al., 2007).
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