Treating Sexual Trauma Survivors

"Sandra"
Sandra, a 28-year-old female, seeks counseling for issues of depression. After three sessions, she reports that she was sexually abused from ages 4 to 9 by an uncle, after which she experienced two date/acquaintance rapes her senior year in high school. Sandra states that she told her mother, who accused her of making up stories and demanded she not say another word. She also reported an older female cousin had "played doctor" with her on several occasions, including examining her private parts with a "tube" and checking her tonsils with her tongue.

Sandra states she spent most of her time drunk from ages 18-22 and slept with at least 70 men during this time period. She reports she would pick up these men at bars with the intent of engaging in sexual activity, often not even knowing their names. She states she often thought of suicide during this time period, although only had one real attempt in which she tried to drive her car into a lake, but blew out a tire before reaching the water.

Sandra states she has very few friends and no longer talks with her anyone in her family. She reports not being able to keep a boyfriend and believes that the few friends she does have talk about her behind her back.

Sandra reports not drinking for the last few years and is determined not to drink again due to her raising her 2-year-old child. She states she wants to be a good mother. The father is out of the picture and Sandra is raising the child on her own.

a. What two interventions might be used to help Sandra deal with these effects?
b. Explain any cultural, ethical, and legal issues related to Sandra's treatment.
c. Explain what might be different in the effects of the trauma and the interventions you might select if Sandra had been a male.