Treating adult survivors of severe childhood abuse and neglect:
Further development of an integrative model

John Briere, Ph.D.
Department of Psychiatry and the Behavioral Sciences
Keck School of Medicine
University of Southern California

    This chapter outlines an integrated approach to the treatment of adults severely abused or neglected as children. The theory upon which it is based, referred to as the self-trauma model (e.g., Briere, 1992, 1996), incorporates aspects of trauma theory, as well as cognitive, behavioral, and self-psychology. Although this perspective is implicitly cognitive-behavioral, it also may be understood as an attempt to rework and reconceptualize psychodynamic therapy to encompass empirically-based principles as they relate to child abuse victims. The current chapter especially expands the cognitive components of self-trauma theory, based on newer ideas in the areas of suppressed or "deep" cognitive activation (e.g., Wegner & Smart, 1997), relational schema (e.g., Baldwin, Fehr, Keedian, Seidel, & Thompson, 1993), and the role of early attachment experiences on thoughts, feelings, and memories (e.g. Simpson & Rholes, 1998). As well, this analysis takes as its basis a growing awareness in cognitive-behavioral circles that implicit memories and processes are - at minimum -- as important as explicit ones, and that emotion is as important as cognition in understanding and treating anxiety-based disorders (Foa & Kozak, 1986; Samoilov & Goldfried, 2000; Westen, 2000) The implications of this model are presented in terms of the specific process, content, and goals of abuse-relevant psychotherapy.

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