Integrating Group Cognitive Behavioural, Art Psychotherapy for women following childhood sexual abuse

ABSTRACT

Background

Despite the prevalence of childhood sexual abuse, and the number of adults referred to secondary mental services with symptoms of mental distress or disorder who report such a history, there is little in the way of specific recommendations for treatment approaches.

Aims

We wanted to consider the effectiveness of a combined Cognitive Behavioural Therapy (CBT) and Art Psychotherapy (ApT)* group therapy model (GCB-ApT) for women with experience of childhood sexual abuse.

Methods

GCB-ApT was delivered to seven groups of female survivors of childhood sexual abuse (n = 41) in community mental health team settings, using a standardised model. There were 32 participants who completed the group, and full data is available for 30 participants. Each group was facilitated by two female therapists – a clinical psychologist and an art psychotherapist. The study was registered with the employing Trust (BSMHFT) as a retrospective evaluation of validated clinical outcome measures routinely administered pre – and post-intervention.

Results

Results showed significant post-intervention improvement in the domains of global distress, depression and self-esteem.

Conclusions

Results were promising, although numbers were small.

Implications for practice/policy/future research

Results suggested that group provision using the GCB-ApT model could be a helpful addition to clinical interventions provided for women who have experienced childhood sexual abuse. Further research is recommended.

*Some texts referenced may use ‘art therapy’ rather than ‘art psychotherapy’. The abbreviation ApT is used for either throughout.

Plain-language summary

We looked at how we could provide specific ways to help those women referred to Psychological Services who had experienced childhood sexual abuse. There weren’t many suggestions from previous research that gave us a confident idea about what specific approach works best.

We found evidence that Cognitive Behavioural Therapy and Art Psychotherapy can be useful, and we wanted to combine them in a group setting to see how helpful this was.

Cognitive Behavioural Therapy looks at how our thoughts might affect our behaviours and feelings, while Art Psychotherapy uses and explores image-making as a way of helping with distressing experiences and emotions.

We organised seven groups with a total of forty-one women. Two therapists (one specialist in each therapy) led each group, held over twenty sessions.

There were three parts to the group: firstly we covered coping strategies, then we looked in more detail at each person's account of what they had been through. Finally, we supported women to review what had happened for them in the group and to plan for after it had ended.

Each week we began by looking at a topic or theme relevant to this group (e.g. flashbacks) through information giving and discussion. The theme provided a starting point for using the art materials, followed by group members being invited to share the images they had made and how that had felt, and to explore any thoughts and feelings that arose in the group in response.

We gave each woman three questionnaires to complete at the beginning and the end of the groups, and compared the results. These showed that there had been improvements in mood, self-esteem and psychological well-being.

There are limitations with these results, partly because the numbers are small. However, they suggest that more research would be worthwhile.

KEYWORDS:

• Childhood sexual abuse
• art psychotherapy
• cognitive behavioural therapy
• combined group model

Acknowledgments

We would like to thank Debbie Williams, Consultant Clinical Psychologist, Dr Nina Ahuja, Clinical Psychologist, Jane Scheuer, Art Psychotherapist, Laura Chaisty, Art Psychotherapist and Analytical Psychotherapist, and Dr Ann-Marie Munday, Clinical Psychologist. Also Professor Alan Meaden, Consultant Clinical Psychologist, Dr Nazreen Fazal-Short, Consultant Clinical Psychologist, Camilla Matthews, Art Psychotherapist, Sally Baldwin, Psychotherapist, and Dr Alex Copello, Consultant Clinical Psychologist, for their advice and help.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Notes on contributors

Rosemary Carter

Dr Rosemary Carter (she/her) Consultant Psychological Professions Lead for Integrated Community Care and Recovery Services (ICCR) Birmingham and Solihull Mental Health Foundation Trust. This includes secondary care, assertive outreach, steps 2 recovery, rough sleepers, personality disorder services and children and young people’s services. She is a Clinical Consultant and has also trained as an accredited Cognitive Behavioural Psychotherapist and Cognitive Analytic Therapy Practitioner and Supervisor. She has worked in inner city adult mental health services in NHS for 28 years with a particular interest in supporting women who have experienced childhood sexual trauma; additionally, she has a particular interest in dissociative identity disorder (DID) with an aim to see an effective treatment pathway for DID in NHS settings. Previously, she lived and worked for several years in Hong Kong, working with St Stephen’s Society, supporting people who were recovering from substance misuse in the Chinese community; and then working with her husband to develop an English-speaking rehabilitation programme. This involved liaising and travelling to support organisations involved in rehabilitation in New Zealand, North East India and the Philippines. Email: [email protected].

Sarah Wigington

Sarah Wigington was Lead Art Psychotherapist for Birmingham and Solihull Mental Health Trust until her retirement in 2016. She has worked extensively in adult mental health community and inpatient services as a clinician, supervisor and manager, as well as in education, an eating disorder service and private practice. She has always had a particular interest in women's health issues, and ways in which these have not been adequately addressed, since working in gynaecology as a general nurse in her earlier life. She values the richness of cross-professional/practice working - whether in the clinical setting, education (she is also a qualified art teacher), or alongside other artists as part of community art and well-being initiatives. She has written for publication and exhibits her own art. This is her first research article. Email: [email protected].

Barry O-Mahony

Barry O’Mahony BSc, MRes, studied his undergraduate in Psychology at The Open University where he developed a keen interest in mental health and clinical interventions. He subsequently went on to complete an MRes in Clinical Psychology at the University of Birmingham. His research interests include psychosis, the effects of bullying, and childhood trauma. He worked on placement in the West Hub CMHTs as a research assistant providing assistance with analysing data and interpreting results. Email: [email protected].

Rebekah Coates

Rebekah Coates completed her MSci in Psychology and Psychological Practice at the University of Birmingham in 2017. After her degree, she was awarded an internship and spent three months in China working as a research assistant on a project for children's physical health. She has worked as an Assistant Psychologist in inpatient hospitals for adults with Learning Disabilities, Memory Assessment Services and Younger People with Dementia services. She currently works in the paediatric neuropsychology team at Leeds Children's Hospital and aspires to complete the doctorate course to become a clinical psychologist. Email: [email protected].

Sally Crisp

Sally Crisp (she/her) completed her BSc in Psychology at Aston University in 2019. Following graduation, she started working as an Assistant Psychologist in a group therapies team (The OAKS: ICCR Group Therapies Programme) based in Solihull. In 2022, she began working as a Clinical Associate in Psychology Apprentice, studying with the University of Exeter, alongside The OAKS: ICCR Group Therapies Programme and Solihull Psychological Services. Email: [email protected].