The Contribution of Emotional Intelligence and Participation in Therapy as Resilience Resources to Couple and Work Interpersonal Relationships Among People Who Have Experienced Childhood Sexual Abuse

Background   

Childhood sexual abuse (CSA) is a widespread phenomenon and global problem that includes many types of abusive sexual acts perpetrated against children. A main area that can be harmed as a result of CSA is interpersonal relationships. In fact, in recent years, there has been a proliferation of studies indicating the difficulty of CSA survivors in creating good couple relationships. The work domain is another major domain in a person's adult life but, in contrast to the relatively extensive knowledge about the association between CSA and difficulties in couple relationships, the association between CSA and the quality of interpersonal relationships at work has hardly been explored. In the present study, interpersonal relationships at work were examined via three key components: perceived satisfaction from relationships at work, loneliness at work, and aggression at work.

In 2018, the ICD-11 identified a diagnosis of complex post-traumatic stress disorder (CPTSD) as distinct from post-traumatic stress disorder (PTSD). Preliminary studies have indicated that CSA survivors suffer from higher levels of CPTSD symptoms and are more likely to have a CPTSD diagnosis relative to other trauma survivors, but further research is needed to substantiate this claim. To date, almost no studies have investigated the differences in the quality of interpersonal relationships between people ascribed to the two diagnoses as formulated in the ICD-11.

Given the above, many studies have addressed the negative effects of CSA on survivors. At the same time, over the last few decades there has been growing recognition of the role that resilience resources can play in mitigating the impact of harm and enabling resilient functioning among CSA survivors. The current research relied on Hobfoll’s conservation of resources (COR) theory (Hobfoll, 1989), according to which the more resources people have, the more resilient they are in coping with stressful events. Childhood sexual abuse, the focus of this study, can lead to the loss of resources of all kinds throughout life. Among others, CSA depletes critical resources for creating beneficial interpersonal relationships. By contrast, obtaining resources leads to obtaining additional resources. As such, it is important to explore resources and their contribution to the resilience of CSA survivors’ interpersonal relationships. The resources that were thus explored in the current study were emotional intelligence and participation in therapy. Emotional intelligence (EI) represents an array of abilities (verbal and non-verbal) that allow a person to recognize, know, express, understand, and appreciate the emotions of oneself and others in order to manage one’s thoughts and behaviors effectively, in accordance with the requirements and pressures of the situation.  Although studies have shown that EI contributes to the quality of interpersonal relationships, this notion has not been examined among CSA survivors. Participation in therapy has been found to contribute to improving CSA survivors’ mental health, especially in terms of reducing PTSD symptoms.  However only a few studies have examined the contribution of participation in therapy to improving CSA survivors’ couple relationships and, to the best of our knowledge, the contribution of participation in therapy to the improvement of their relationships at work has not been examined at all. The association between the characteristics of therapy (i.e., type of therapy, duration of treatment, degree of trust in therapist, evaluation of the treatment results) and the nature of the survivors’ interpersonal relationships has also not been investigated to date.

Until the mid-1980s there was almost no public or research awareness of the phenomenon of sexual abuse among boys. Since then, studies have shown that sexual abuse has serious consequences for survivors of both genders. However, there is no consensus about similarities or differences in those consequences.

Childhood sexual abuse is a general term that describes a wide range of situations that may be considered abusive events. It is known that the characteristics of the CSA (age at the time of abuse, duration of the abuse, proximity to the offender, and degree of fear, helplessness, or horror at the time of the incident) may influence the negative psychological consequences for survivors in the future. However, the question of how CSA characteristics may affect survivors’ interpersonal relationships has hardly been explored.

Objectives

The first objective of the study was to examine the hypothesis that CSA contributes to a decrease in the quality of survivors' interpersonal relationships – both couple and work relationships – relative to people who have not experienced trauma, as well as relative to other trauma survivors.  The second objective was to test the hypothesis that CSA survivors are more likely to be diagnosed with CPTSD than those who have experienced other traumatic events and, even more so, than those who have not experienced traumatic events at all. In addition, we wished to test the hypothesis that the interpersonal relationships of people with CPTSD would be more troubled than those of people with PTSD. The third objective was to examine whether EI and participation in therapy contribute to improving CSA survivors’ couple and work relationships and can therefore be considered resilience resources for survivors' relationships. The fourth objective was to expand knowledge about gender similarities and differences in regard to the implications of CSA for survivors’ interpersonal relationships. The fifth objective was to examine the claim that CSA characteristics would contribute to the formation of PTSD symptoms and CPTSD symptoms, as well as both the couple and work relationships of CSA survivors.

Procedure

The study, a cross-sectional, quantitative study, was approved by the university's ethics committee. Participants comprised 296 men and women over the age of 18, who were in a couple relationship for over a year and who worked at the same workplace for over a year. Data were collected via online questionnaires that were posted on social media and forwarded by email to participants. Questionnaires were also handed out to patients in the sexual abuse treatment centers of Israel’s Ministry of Welfare and Social Affairs. On the basis of the analysis of the questionnaire regarding identification of previous traumatic events, three groups were created: 92 CSA survivors, 172 non-CSA trauma survivors, 32 who did not experience a traumatic event.

Results

The study’s findings indicated that CSA survivors’ couple relationship satisfaction was significantly lower than that of other trauma survivors, and of participants who did not experience any traumatic events. Regarding the quality of interpersonal relationships at work, it was found that among trauma survivors (both CSA and other traumas), aggression at work was greater than among participants who had not experienced any traumatic events. No difference was found between the three groups in terms of perceived satisfaction from relationships at work or levels of loneliness at work. Regarding gender, no differences were found between male and female CSA survivors in any of the above qualities of couple and work relationships.

It was found that CSA survivors had significantly higher levels of PTSD and CPTSD symptoms relative to participants from the other two groups. In addition, CSA survivors were diagnosed to a statistically significant degree as suffering more from CPTSD compared to participants who experienced other traumatic events. A significant association was found between PTSD and CPTSD symptom levels and interpersonal relationships, so that the higher the level of symptoms, the lower the satisfaction with the couple relationship, the lower the perceived satisfaction from relationships at work, and the higher the levels of aggression and loneliness at work. When participants who met the criteria for a PTSD versus CPTSD diagnosis were examined, no differences were found between participants ascribed to the two diagnoses regarding the quality of the couple relationship or relationships at work, apart from the findings showing that high levels of CPTSD symptoms, beyond PTSD symptoms, contributed significantly to loneliness at work.         

An examination of EI’s contribution as a resilience resource to CSA survivors’ interpersonal relationships revealed that the higher the EI, the higher the satisfaction from the couple relationship, the higher the perceived satisfaction from relationships at work, and the lower the levels of loneliness and aggression at work. This finding held true both for the whole sample and for the CSA survivor group alone. Likewise, it was found that the higher participants perceived their partners' EI, the higher their satisfaction with the couple relationship.

An examination of the contribution of therapy as a resilience resource to CSA survivors’ interpersonal relationships revealed no association between participation in therapy and either couple or work relationships. It should be emphasized that the findings related to participation in therapy should be viewed with caution, as the CSA survivor group who did not participate in therapy was very small. As a result, it is hard to determine from the present study’s findings the extent to which participation in therapy contributed to survivors’ interpersonal relationship satisfaction, and further research is thus needed on this front. An examination of the characteristics of the therapy revealed that trust in the therapist was associated with higher couple relationship satisfaction and perceived satisfaction from relationships at work. No association was found between the other therapy characteristics and the quality of CSA survivors’ interpersonal relationships.

In terms of CSA characteristics, the current study revealed that the lower the age at the time of the abuse and the longer the duration of the abuse, the higher the levels of PTSD and CPTSD symptoms; the greater the sense of being horrified at the time of the CSA, the higher the level of PTSD symptoms; and the longer the duration of the CSA, the greater the level of aggression at work. In the regression analysis, the only association that remained significant was the association between sense of being horrified at the time of the abuse and an increase in the PTSD symptom level. No association was found between CSA characteristics and satisfaction with the couple relationship, perceived satisfaction from relationships at work, or loneliness at work.

Discussion and conclusions

 The current study increases the knowledge regarding the association between CSA and decreased couple relationship satisfaction and also addresses the gap in the literature regarding the quality of CSA survivors' relationships at work. In contrast to couple relationship satisfaction, the study’s findings indicate that CSA survivors do not differ significantly from others in terms of the quality of their relationships at work. The significant association between PTSD symptom level and a decrease in the quality of work relationships may suggest that symptom level makes a greater contribution to the quality of work relationships than does type of trauma. The current study also adds important information about the lack of significant gender differences in the quality of CSA survivors’ interpersonal relationships. The study’s findings also reinforce the relatively new theoretical perception according to which CSA survivors are more likely to suffer from CPTSD than are other trauma survivors. In addition, a novel finding of the current study is that the higher the CPTSD symptom level, in addition to the higher PTSD symptom level, the lower the quality of couple and work relationships. Another novel aspect of the present study is that EI and participation in therapy, as resilience resources, were investigated for the first time in terms of CSA survivors’ relationship quality. Emotional intelligence was found to contribute to the quality of both couple and work relationships of CSA survivors, and thus can be considered a resilience resource for their interpersonal relationships. The fact that among the components of therapy trust in the therapist was found to be associated with high satisfaction from couple and work relationships indicates the importance of the issue of trust in the treatment of CSA survivors.         

The findings of the study have important practical implications. Strengthening the theoretical understanding that CSA may result in the formation of CPTSD could lead to the construction of appropriate intervention programs. In addition, the fact that a connection was found in this study between the level of EI and the quality of survivors’ interpersonal relationships may allow for an integration of techniques meant to increase EI in intervention programs designed for this population.  As EI was found in this study to contribute similarly to both male and female CSA survivors’ interpersonal relationships, it seems clear that intervention programs for both genders need to be built. Conducting research in the context of the workplace raises awareness of the importance of CSA survivors’ work relationships, and calls attention to the fact that this issue should be prioritized both in research and therapy.

The limitations of the research and ideas for further research are formulated in the last chapter.