|Healthcare Training Institute - Quality Education since 1979CE for Psychologist, Social Worker, Counselor, & MFT!!
Using the 'What If?' Exercise to Brainstorm about Potentially Dangerous Situations
Read content below or listen to audio.
Left click audio track to Listen; Right click to "Save..." mp3
In the last section, we discussed the effect of male
sexual abuse on sexual identity.
In this section, we will examine
the condition of rape trauma syndrome in boys and its two phases: acute and long
As you may already know, rape trauma syndrome is a form
of post-traumatic stress disorder and was first described in 1974 by Ann Burgess
and Dr. Larry Holstrom of Boston College. Initially, the condition is divided
into two phases: acute and long term.
Two Phases of Rape Trauma Syndrome
♦ #1 Characteristics
of the Acute Phase
Characteristics of the acute phase include extreme fear,
upheaval, physical trauma, skeletal muscle tension, gastrointestinal irritability,
genitourinary disturbance, and a range of emotional reactions and sensitivity.
These symptoms reflect the client's bodily reactions to a severe trauma.
age 14, had flashbacks of the repeated acts of sodomy, nightmares of suffocation and death, and marked detachment from his family and friends.He suffered weeks
of initial insomnia and fears of sleeping alone. Showering became an ordeal for
him as he feared someone behind the shower curtain attacking him. In order to
sleep, he had to lay on his side, lying prone or supine made him feel vulnerable
to another attack.
♦ Technique: What if?
was experiencing feelings of PTSD type powerlessness and uncertainty, I found
the "What If?" exercise beneficial. I asked Marshall to brainstorm about
potentially dangerous situations. I asked him to write down the situations on
index cards with each phrase starting with "What if
the situations that Marshall wrote down were:
-- "What if a teacher repeatedly
asked you to stay after school to help, and you felt weird about being alone with
-- "What if your older brother had friends over to the house when
your parents were not home, let them use alcohol or drugs, and joined them in
looking at magazine pictures of naked women?"
Then, I asked Marshall to
brainstorm ideas in which he handles the potentially dangerous situation and write
them down on index cards which he can keep and look at anytime he needs to.
of the solutions he included were:
# 1. Be alert, aware, and careful at all times.
# 2. Avoid dangerous situations.
# 3. If someone attempts to approach or abuse you,
you can do the following things:
-- Get away.
-- Yell, "Fire"
-- Tell the person you will tell.
-- Find an adult immediately and
ask for help; if the first adult does not respond, find another.
-- Pay attention
to how the person looks in case you are asked questions later.
Characteristics of the Long-Term Phase
The second phase of rape PTSD trauma
syndrome is the long-term phase. This stage is characterized by the client's attempts
to reorganize their lives after the period of severe upheaval. Most notably, the
impacted reactions include: increased motor activity, disturbing dreams and nightmares,
and "trauma-to-phobia" which, as you know, includes the fear of indoors
if the client was abused in bed, fear of outdoors if the client was abused outside
of his home, fear of being alone, fear of crowds, fear of people walking behind
him, and a fear of engaging in consensual sexual activity.
Jim, age 14, was going
through his long-term phase of his rape trauma syndrome. He stated, "I'm
afraid. I don't think I ever leave my house without feeling some fear. Even if
I try not to think about it, there's that feeling that I'm at risk, especially
at night. Nothing goes on around me that I'm not aware of. I have a hard time
even paying attention. I get distracted very easily because I'm always watching."
As you can see, Jim is hyper vigilant? Think of your hypervigilant client. Could
they be suffering from rape trauma syndrome?
To address Jim's feelings of fear, I found the "Problem
Solving" Therapy Strategy beneficial. By learning how to be responsible for
the problems that arise during his own life, Jim can begin to feel confident and
less anxious about his surroundings. I recommend doing this exercise over the
course of two sessions. In the first session, I explained to Jim the process for
solving problems and practicing steps involved.
Some of the steps included the
Step # 1. Define the problem as clearly and specifically as possible. Break
it down into its separate components or manageable pieces. What is happening right
Step # 2. Describe the resolution. What would you like to be happening?
Step # 3. Identify the factors that are contributing to the problem. What is keeping you
from creating the desired situation?
Step # 4. Brainstorm ways to overcome the barriers and turn the desired situation into reality.
Step # 5. Evaluate the ideas listed.
Choose one to try-something that might change the current situation into the desired
situation and something that you can actually do.
Step # 6. Figure out what you need
in order to act on your choice. Decide who or what can help you; then get the
Step # 7. Examine the potential consequences of your choice,
in terms of both positive and negative outcomes.
Step # 8. Rehearse the option you
Step # 9. Carry out the selected option.
Step # 10. Evaluate the outcome: How
have things changed? Has the problem been resolved? Have you created the desired
In the second session, I asked Jim to recall a problem
that he wished to solve. I then asked him to use the steps we had discussed previously
and to try and solve his problem. Jim related the following problem solving sequence:
stated, "First, I described my problem: every time I thought about taking
a shower or a bath, I got scared and started shaking. This is because my uncle
abused me while I was in the bathtub. I would like to feel safe and unafraid when
I want to clean myself. I think that I associate water with my abuse keeps me
from bathing. I thought of thinking of relaxing things before I take a shower;
repeating to myself that nothing can happen to me; having someone I trust sit
outside the bathroom door to make sure I have someone who will save me if something
"I decided to do a combination. For the first few days, I asked
my mom to sit outside the bathroom and talk to me soothingly. It worked, I felt
a lot better knowing that she was out there, caring about me and keeping somebody
bad from getting me. I also thought of relaxing things. Soon, I didn't need my
mom out there at all, and my relaxing thoughts like the beach or my favorite hero
movie was all I need. I feel like I am starting to solve the problem."
you can see, Jim has addressed one of his greatest emotional burdens by organizing
his thoughts. By giving himself a sense of order, Jim was better capable to deal
with his abuse.
In this section, we discussed the condition of
rape trauma syndrome in boy clients and its stages: acute and long-term.
the next section, we will examine the ways in which social pressures affect a sexually
abused boy's development: gender role identity, double standard, and age-disparate
What are examples of "trauma-to-phobia?" To select and enter your answer go to .