HIV Treatment

According to Stebbing et al. (2008), "preclinical and cohort studies suggest that certain antidepressants are associated with a predisposition to cancer whereas others decrease the risk" (p. 2305). Additionally, "despite extensive data demonstrating that HIV infection and associated immunosuppression predisposes individuals to a wide range of cancers . . . (including non-AIDS-related malignancies . . .), no studies have specifically investigated the association between antidepressant use, length of antidepressant exposure, and the development of both AIDS-related and non-AIDS-related cancers in the highly active antiretroviral therapy (HAART) and pre-HAART eras" (p. 2306).

Stebbing and colleagues therefore set out "to assess whether different classes of antidepressants were associated with changes in cancer incidence in a population of HIV-1 infected individuals, based on duration of exposure" (p. 2305). The investigators found that, within a "cohort of 10,997 patients . . . attending a large HIV center during the pre-HAART and HAART eras, a total of 2,004 (18%) were prescribed antidepressants. . . . A total of 1,607 (15%) individuals were diagnosed with cancer. There were no significant associations between any class of antidepressant and any type of cancer . . . , in either the pre-HAART or HAART era" (p. 2305). Stebbing and colleagues conclude that "antidepressants, irrespective of their class, do not affect cancer risk in HIV-infected individuals" (p. 2305).



Neuropsychological Impairment

In a racially diverse sample of 93 children living with HIV, Hochhauser, Gaur, Marone, and Lewis (2008) "examined the impact of environmental risk factors on the cognitive decline normally observed with pediatric HIV disease progression" (p. 695). The investigators found that "immunosuppression was clearly associated with poorer cognitive outcome in the high-risk children" (p. 695); in other words, there was greater risk for HIV-associated cognitive decline among children living in highly stressful environments. Notably, "this relationship was not seen in those with lower levels of environmental risk" (p. 695). These findings have several implications, according to Hochhauser and colleagues:

First, while medication adherence has been shown to be worse in stressed or disorganized families . . . , it may also be most crucial for those children, as it is they whose neuropsychological functioning is at greatest risk from HIV neurotoxicity. Second, reducing environmental stressors may prove to be neuroprotective. This may be particularly important for patients for whom reducing immunosuppression . . . may be difficult or impossible. In these cases, perhaps their impact on cognitive functioning could be moderated by taking measures to reduce stress. Such interventions might include concrete actions to improve the child's home or family environment . . . or perhaps stress-reduction interventions like psychotherapy or massage therapy. (p. 696)
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Adherence to Treatment

Leserman, Ironson, O'Cleirigh, Fordiani, and Balbin (2008) "examine[d] demographic, health behavior and psychosocial correlates (e.g., stressful life events, depressive symptoms) of nonadherence" (p. 403) among 105 men and women residing in South Florida and taking antiretrovirals. Within this sample,

44.8% had missed a medication dose in the past 2 weeks, and 22.1% had missed their medication during the previous weekend. Those with three or more stressful life events in the previous 6 months were 2.5 to more than 3 times as likely to be nonadherent (in the past 2 weeks and previous weekend, respectively) compared to those without such events. Fully 86.7% of those with six or more stresses were nonadherent during the prior 2 weeks compared to 22.2% of those with no stressors. Although alcohol consumption, drug use, and symptoms of depression were related to nonadherence in the bivariate analyses, the effects of these predictors were reduced to nonsignificance by the stressful event measure. (p. 403)

Leserman and colleagues suggest that "having many stressful events may be a more robust correlate of nonadherence than depression. Persons who report more stressful events may have more chaotic lifestyles that may account for their missed medications. . . . These findings suggest that while interventions for depression may be useful, cognitive behavioral interventions that address stress and coping may have a greater impact on adherence to HIV medication" (p. 409).

Malta, Strathdee, Magnanini, and Bastos (2008) conducted a "systematic review of studies assessing adherence to HAART among HIV-positive drug users (DU[s]) and identif[ied] . . . factors associated with non-adherence to HIV treatment" (p. 1242). The investigators selected 41 peer-reviewed studies published between 1996 and 2007; these studies included

a total of 15,194 patients, the majority of whom were HIV-positive DU[s] (n = 11,628, 76.5%). Twenty-two studies assessed adherence using patient self-reports, eight used pharmacy records, three used electronic monitoring [i.e., Medication Event Monitoring Systems (MEMS) caps], six studies used a combination of patient self-report, clinical data and MEMS-caps, and two analyzed secondary data. Overall, active substance use was associated with poor adherence, as well as depression and low social support. Higher adherence was found in patients receiving care in structured settings (e.g.[,] directly observed therapy) and/or drug addiction treatment (especially substitution therapy). (p. 1242)

Malta and colleagues conclude that, although HAART adherence was lower among DUs "than other populations – especially among users of stimulants, incarcerated DU[s,] and patients with psychiatric comorbidities – adherence to HAART among HIV-positive DU[s] can be achieved. Better adherence was identified among those engaged in comprehensive services providing HIV and addiction treatment with psychosocial support" (p. 1242). Moreover, "most papers [included in this review] suggest that the adherence to HAART among HIV-positive [DU]s can be similar to those found among other [people living with HIV/AIDS], once proper timing to initiate treatment is followed, comorbidities are properly managed and treated, psychosocial support is provided, and drug treatment, particularly substitution therapy, is instituted" (p. 1253).

Stress Management

In a departure from the traditional cognitive-behavioral approach to HIV-related stress management (research about which is coincidently and conveniently summarized in the Tool Box in the Summer 2008 issue of mental health AIDS), McCain et al. (2008) conducted a "randomized clinical trial . . . to test effects of three 10-week stress management approaches – cognitive-behavioral relaxation training (RLXN), 4 focused tai chi training (TCHI), 5 and spiritual growth groups (SPRT) 6 – in comparison to a wait-listed control group (CTRL) among 252 individuals with HIV infection" (p. 431). According to the investigators, the "purpose of the research was to determine whether the three 10-week stress management interventions would improve and sustain improvements 6 months later in the domains of psychosocial functioning, quality of life, and physical health among persons with varying stages of HIV infection. These three outcome domains, along with neuroendocrine and immune mediating variables, were measured by multiple indicators derived from the psychoneuroimmunology (PNI) paradigm" (p. 431). "Interventions were conducted with groups of 6-10 participants who met in suitably equipped conference rooms in an office setting for 90-min sessions weekly for 10 weeks. Participants who attended less than 8 of the 10 intervention sessions were deemed as having incomplete treatments and classified as withdrawn from the study" (p. 433).

McCain and colleagues found that, "in comparison to the CTRL group, both the RLXN and TCHI groups less frequently used emotion-focused coping strategies, and all three intervention groups had higher lymphocyte proliferative function. Generally, decreased emotion-focused coping can be considered an enhancement in coping strategies; however, there was no concurrent increase in problem-focused or appraisal-focused coping, making interpretation of this change more tenuous" (p. 437). Similarly, "the consistent finding of increased lymphocyte proliferation indicates the interventions were associated with enhancement in immune system functional status. . . . However, because there was no significant change in salivary cortisol, the mechanism of increased lymphocyte function is not clear. Ongoing assessment of cytokine activity or patterns of production may ultimately yield insight into other mechanisms involved in immune function changes" (pp. 437-438).

Despite these challenges in interpreting the study findings, McCain and colleagues contend that, in general,

study findings support use of the PNI-based model for stress management in individuals living with HIV infection. Despite modest effects of the interventions on psychosocial functioning in this sample, the robust finding of improved immune function with these stress management approaches has important clinical implications, particularly for persons with immune-mediated illnesses. . . . Findings of this study indicate that immune function and possibly coping and quality of life may be enhanced with cognitive-behavioral stress management, tai chi, and spirituality-based interventions. While further research is needed to examine specific effects of various stress management interventions and to expand the repertoire of alternative approaches that might be effective in enhancing adaptational outcomes, this study contributes to a growing body of well-designed research that generally lends support to the integration of stress management strategies into the standard care of individuals living with HIV infection. (p. 439)

Coping, Social Support, & Quality of Life

Murphy, Greenwell, Resell, Brecht, and Schuster (2008) "investigated current autonomy among early and middle adolescents affected by maternal HIV (N = 108), as well as examined longitudinally the children's responsibility taking when they were younger (age 6-11; N = 81) in response to their mother's illness and their current autonomy as early/middle adolescents" (p. 253). Within this sample of primarily low-income Latino and African American families residing in Los Angeles County, "children with greater attachment to their mothers had higher autonomy [when performing household-centered activities], and there was a trend for children who drink or use drugs alone to have lower autonomy. In analyses of management autonomy[, which encompasses activities performed outside the home], attachment to peers was associated with higher autonomy" (p. 253). In their longitudinal analysis of this cohort, Murphy and colleagues found that "those children who had taken on more responsibility for instrumental caretaking roles directly because of their mother's illness showed better autonomy development as early and middle age adolescents" (p. 253). Importantly, the investigators also found that autonomy was associated "with 'positive' characteristics such a mother-child bond and coping self-efficacy" (p. 271). Murphy and colleagues conclude that

"parentification" of young children with a mother with HIV/AIDS – that is, the young children taking on household responsibilities due to the mother's illness – may not negatively affect later autonomy development in these children. While it may indeed have other detrimental effects, such as more absence from school and school performance . . . , in at least this limited sample of children affected by HIV, higher responsibility taking as a result of maternal HIV/AIDS among young children was associated with later early/middle adolescent higher autonomy functioning. . . . Thus, even if they experienced some distress from parentification at an earlier age, it did not interfere with their long-term early and middle adolescent autonomous functioning. (p. 272)

Murphy and colleagues acknowledge that these findings require additional exploration with larger samples. Nevertheless, the investigators stress that if

HIV-positive mothers, due to their fatigue or illness, must rely on their young children at times to perform behaviors that most children their age do not typically perform, then it is critical that there be a strong focus on the mother developing or maintaining: (1) A high level of attachment and bond between herself and the child; and (2) strong support of the child to assist in the child developing strong coping self-efficacy. . . . [I]f a child does indeed have to sometimes function in a "parentified" role, then the data from this study indicate that children with a close attachment to their mother and who have good coping self-efficacy will have higher autonomy as they develop; these are both issues that can be worked on and improved in family therapy. (p. 272)

With a sample of 104 MSM averaging 50 years of age and living with HIV, Dutch investigators (Kraaij, van der Veek, et al., 2008) assessed relationships among "coping strategies, goal adjustment, and symptoms of depression and anxiety" (p. 395). The investigators found that "cognitive coping strategies had a stronger influence on well-being than . . . behavioral coping strategies: positive refocusing, positive reappraisal, putting into perspective, catastrophizing, and other-blame were all significantly related to symptoms of depression and anxiety. In addition, withdrawing effort and commitment from unattainable goals, and reengaging in alternative meaningful goals, in [the] case that preexisting goals can no longer be reached, seemed to be a fruitful way to cope with being HIV[-]positive" (p. 395). With regard to intervention, as Kraaij and colleagues see it, "the focus of treatment could be the content of thoughts and bringing about effective cognitive change, combined with working on goal adjustment. Various studies showed the positive effects of cognitive-behavioral oriented interventions . . . and coping effectiveness training . . . in improving psychological states in HIV-infected men. Future studies should be undertaken looking at the effectiveness of intervention programs focusing on cognitions and life goals" (p. 400).

In another study by this research group with the same sample of MSM (Kraaij, Garnefski, et al., 2008), the investigators found that greater

use of positive refocusing, refocus[ing] on planning, positive reappraisal, putting into perspective, and less use of other-blame, was related to higher levels of personal growth. . . . [P]ositive reappraisal appears to be the most powerful predictor of personal growth.

Another important predictor . . . was goal self-efficacy. Respondents who reported a higher belief in their ability to adjust their goals when important goals are obstructed by being HIV-positive, reported higher levels of personal growth. (p. 303)

As in the study described above (Kraajj, van der Veek, et al., 2008), Kraajj, Garnefski, and colleagues conclude that cognitive-behavioral oriented interventions and coping effectiveness training "could be offered to improve personal growth. The specific focus of treatment could be then the content of thoughts, combined with working on goal adjustment. Ingredients of treatment should be a combination of (positive) cognitive coping strategies and goal self-efficacy" (p. 303).

---- Compiled by Abraham Feingold, Psy.D.

--------------------

4 The structured RLXN training intervention "consisted of physical and mental relaxation skills training, with a focus on individualized combinations of relaxation techniques, as well as active coping strategies for stress management. Participants were expected to routinely practice relaxation techniques during and following the intervention, and daily practice frequency was recorded each week. Each participant was given a set of eight 30-min audiotapes specifically produced for use in this study" (p. 433).

5 A focused short form of TCHI "involving eight movements was developed for this study. The intervention sequence began with a focus on breathing and balance, both key elements in all tai chi exercises. The sequence of movements taught was focused on developing each individual's skills in balancing, focused breathing, gentle physical posturing and movement, and the active use of consciousness for relaxation. Training videotapes were provided to participants for weekly and ongoing practice of the techniques" (p. 434).

6 "The SPRT . . . intervention was designed to facilitate personal exploration of spirituality and to enhance exploration of the spiritual self and awareness of the meaning and expression of spirituality. Each session was designed to explore an aspect of spirituality and included the intellectual process of knowing or apprehending spirituality; the experiential component of interconnecting one's spirit with self, others, nature, God, or a higher power; and an appreciation of the multisensory experience of spirituality. The process of weekly journal entries facilitated increased awareness and the integration of spirituality into daily life" (p. 434).

Human Sexuality Online Course

Human Sexuality Online Course
Human Sexuality CEUS
Human Sexuality Continuing Education
Interns and License Renewal
Full text Click hereHuman Sexuality
(10 hours/units)
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.

1. Define the different study/research areas of human sexuality.
2. Increase familiarity with concepts related to the psychology of sex
3. Identify and evaluate clinical perspectives related to sexual activity and lifestyles.
4. Explore the impact religious belief systems on sex.
5. Learn specific laws related to sex and sexual crimes.
6. Identify the causes and symptoms of STDs
7. Increase familiarity with sexual disorders
Table of Contents:
1. Definition
2. Psychology and Sex
3. Sexual Activity and Lifestyles
4. Religion and Sex
5. The Law and Sex
6. Sexually Transmitted Diseases
7. Masters and Johnson
8. Sexual Disorders
9. References

1. Definition
Human sexuality can be defined as the manner in which people experience and express themselves as sexual beings. There are many facets in the study of human sexuality including:
• Biological
• Emotional
• Physical
• Sociological
• Philosophical
(Ellen Ross, Rayna Rapp Sex and Society: A Research Note from Social History and Anthropology Comparative Studies in Society and History).
From a biological perspective, sexuality is defined as “the reproductive mechanism as well as the basic biological drive that exists in all species and can encompass sexual intercourse and sexual contact in all its forms”. There are also emotional or physical perspectives of sexuality, which refers to the “bond that exists between individuals, which may be expressed through profound feelings or emotions, and which may be manifested in physical or medical concerns about the physiological or even psychological aspects of sexual behavior”. Sociologically, it includes the cultural, political, and legal aspects of sexual behavior. Philosophically, it emphasizes the moral, ethical, theological, spiritual or religious aspects of sexual behavior (Ellen Ross, Rayna Rapp Sex and Society: A Research Note from Social History and Anthropology Comparative Studies in Society and History).

Continuing Education CEUS for MFT, LCSW, and LPC License Renewal

AGING AND LONG TERM CARE(10 Hours/units)
© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.

Aging and LTC Courses

1. Define aging and long term care
2. Become familiar with relevant demographic information.
3. Obtain information that includes but is not limited to, the biological, social, and psychological aspects of aging.4. Learn the psychological impact of aging
5. Describe the relationship between aging and culture
6. Distinguish between long term and alternative types of care7. Identify and access relevant resources

Table of Contents:
1. Definitions
2. Demographic Information
3. Biological Aging
4. Aging and Culture5. Long Term Care
6. Psychological Considerations
7. Elder and Dependent Adult Abuse Reporting8. Resources
9. References

Spousal and Partner Abuse CEUs

© 2009 by Aspira Continuing Education. All rights reserved. No part of this material may be transmitted or reproduced in any form, or by any means, mechanical or electronic without written permission of Aspira Continuing Education.

1. Learn definition and distinguish between types of abuse
2. Become familiar with relevant facts and statistics
3. Identify spousal/partner abuse symptoms
4. Evaluate the effects of spousal/ partner abuse5. Identify same gender abuse dynamics
6. Become familiar with relevant cultural factors
7. Learn the national domestic violence applicable laws
8. Become familiar with resources and referrals

Table of Contents:
1. Definitions and Types of Abuse
2. Facts and Statistics
3. Symptoms and Effects
4. Domestic Violence and the Law
5. Evaluation, Intervention and Treatment
6. Resources and Referrals
7. References

1. Definitions and Types of Abuse

Domestic violence and emotional abuse is characterized by physically and/or psychologically dominating behaviors used by a perpetrator to control the victim. Partners may be married or unmarried; heterosexual, or homosexual; living together, separated or dating. Domestic violence occurs in all cultures; people of all races, ethnicities, religions, sexes and classes can be perpetrators of domestic violence. Domestic violence is also known as domestic abuse, spousal abuse, or intimate partner violence. Domestic violence is perpetrated by both men and women. Domestic abuse is any form of abuse that occurs between and among persons related by affection, kinship, or trust. It can occur with youth, adults or elders of all ages and walks of life. The perpetrator often will use fear and intimidation as a method of control. The perpetrator may also threaten to use or may actually use physical violence. Domestic abuse that includes physical violence is called domestic violence. Domestic abuse is intentionally trying to control another person. The abuser intentionally uses verbal, nonverbal, or physical methods to gain control over the other person. Domestic abuse includes:
• Physical abuse
• Sexual abuse or sexual assault
• Verbal abuse
• Emotional Abuse
• Financial abuse
• Neglect
• Ritual abuse
• Spiritual abuse
• Criminal harassment
• Stalking, and Cyber stalking(Stark, E., A. Flitcraft, 1996. Women at Risk: Domestic Violence and Women's Health. Sage).
There are many considerations in evaluating abuse including:
• Mode: physical, psychological, sexual and/or social.
• Frequency: on/off, occasional and chronic.
• Severity: in terms of both psychological or physical harm and the need for treatment.
• Transitory or permanent injury: mild, moderate, severe and up to homicide.
An area of the domestic violence field that is often overlooked is passive abuse leading to violence. Passive abuse is covert, subtle and veiled. This includes victimization, procrastination, forgetfulness, ambiguity, neglect, spiritual and intellectual abuse.
Increased recognition of domestic violence began during the women's movement. Awareness regarding domestic violence varies among different countries. Only about a third of cases of domestic violence are actually reported in the United States and the United Kingdom. According to the Centers for Disease Control, domestic violence is a serious, preventable public health problem affecting more than 32 million Americans, or more than 10% of the U.S. population.
There is increasing awareness and advocacy for men victimized by women. In a report on violence related injuries by the US Department of justice (USDOJ August 1997) hospital emergency room visits related to domestic violence revealed that physically abused men represent just under one-sixth of the total patients admitted to hospital reporting domestic violence as the cause of their injuries. The report reveals that significantly more men than women did not disclose the identity of their attacker. This is likely due to shame, stigma, and embarrassment associated with men victimized by women.
According to a July 2000 Centers for Disease Control Report, data from the Bureau of Justice, National Crime Victimization Survey consistently show that women are at significantly greater risk of intimate partner violence than are men. In May, 2007, researchers with the Centers for Disease Control reported on rates of self-reported violence among intimate partners using data from a 2001 study. In the study, almost one-quarter of participants reported some violence in their relationships. Half of these involved one-sided ("non-reciprocal") attacks and half involved both assaults and counter assaults ("reciprocal violence"). Women reported committing one-sided attacks more than twice as often as men (70% versus 29%). In all cases of intimate partner violence, women were more likely to be injured than men, but 25% of men in relationships with two-sided violence reported injury
compared to 20% of women reporting injury in relationships with one-sided violence. Women were more likely to be injured in non-reciprocal violence.

Physical Abuse

Physical abuse is characterized by aggressive behavior that may result in the victim sustaining injury. Physical abuse attacks are used by the perpetrator to control the victim. The abuse is rarely a single incident and typically forms identifiable patterns that may repeat more and more quickly, and which may become increasingly violent.

Physical abuse can include:
• assault with a weapon
• biting, pinching
• burning
• choking
• kicking, pushing, throwing or shaking
• slapping, hitting, tripping, grabbing or punching
• tying down or otherwise restraining or confining
• homicide
Sexual Abuse and Assault
Sexual abuse and assault includes any non-consensual sexual activity ranging from harassment, unwanted sexual touching, to rape. Sexual harassment is characterized by ridiculing another person to try to limit their sexuality or reproductive choices, while sexual exploitation could involve forcing someone to participate in pornographic film-making. Examples of sexual abuse include fondling of genitals, penetration, incest, rape, sodomy, indecent exposure, forced prostitution, forced production of pornographic materials (
Verbal/ Emotional/ Psychological Abuse
Abbott, Pamela and Emma Williamson, 1999.. "Women, Health and Domestic Violence". Journal of Gender Studies).
Domestic violence is not only physical and sexual violence but also psychological. Psychological violence can be defined as intense and repetitive degradation, creating isolation, and controlling the actions or behaviors of the spouse through intimidation or manipulation to the detriment of the individual. Emotional and psychological abuse sometimes involves tactics to undermine an individual's self-confidence and sense of self-worth, such as yelling, mocking, insulting, threatening, using abusive language, humiliating, harassing and degrading. It can also include deprivation of emotional care, and isolating the individual being targeted (Five Year State Master Plan for the Prevention of and Service for Domestic Violence." Utah State Department of Human Services, January 1994).

Financial/Economic Abuse

Financial abuse occurs when one individual attempts to take total or partial control of another's finances, inheritance or employment income. It may include denying access to one's own financial records and knowledge about personal investments, income or debt, or preventing a partner from engaging in activities that would lead to financial independence.

Financial or economic abuse includes:
• withholding economic resources such as money or credit cards
• stealing from or defrauding a partner of money or assets
• exploiting the partner's resources for personal gain
• withholding physical resources such as food, clothes, necessary medications, or shelter from a partner
• preventing a partner from working or choosing an occupation
Ritual Abuse
Ritual abuse is defined as a combination of severe physical, sexual, psychological and spiritual abuses used systematically and in combination with symbols, ceremonies and/or group activities that have a religious, magical or supernatural connotation. Victims are terrorized into silence by repetitive torture and abuse over time and indoctrinated into the beliefs and practices of the cult or group. Ritual abuse may also be linked to Satanism or devil worship.
Spiritual Abuse
Spiritual abuse may include:
• using the partner's religious or spiritual beliefs to manipulate them
• preventing the partner from practicing their religious or spiritual beliefs
• ridiculing the other person's religious or spiritual beliefs
• forcing the children to be reared in a faith that the partner has not agreed to
Spiritual and religious abuse is also abuse done in the name of, brought on by, or attributed to a belief system of the abuser, or abuse from a religious leader. This can include Priests, Ministers, cult members, family members, or anyone abusing in the name of a deity or perceived deity. Spiritual or religious abuse can find its way into every religion and belief system that exists. It may encompass many other forms of abuse, especially physical, sexual, emotional, psychological and financial (Warshaw, C. (1993). "Limitations of the Medical Model in the Care of Battered Women". in Bart, P., E. Moran. Violence Against Women: The Bloody Footprints. Sage).

Harassment, Stalking and Cyberstalking

Stalking is harassment of or threatening another person, especially in a manner that physically or emotionally disturbs them. Stalking of an intimate partner can occur place during the relationship, with intense monitoring of the partner's activities, or it can take place after a partner or spouse has left the relationship. The stalker may be trying to get their partner back, or they may wish to harm their partner as punishment for their departure. Regardless of the motive, the victim fears for their safety. Stalking may occur at or near the victim's home, near or in their workplace, on the way to any destination, or on the internet (cyberstalking). Stalking can be on the phone, in person, or online. Stalkers sometimes do not reveal themselves, or they may just “show up” unexpectedly. Stalking is often unpredictable and dangerous. Stalkers may utilize threatening tactics including:
• “showing up” wherever the victim is located
• repeated phone calls (often hanging up)
• following the victim
• watching the victim from a hiding place
• sending the victim unwanted packages/gifts/letters
• monitoring the victim's phone calls
• monitoring the victim’s mail or internet use
• sifting through the victim's garbage
• contacting the victim's friends, family, co-workers, or neighbors to obtain information about the victim
• damaging the victim's property
• threatening to hurt the victim or the victim’s family, friends or pets
Cyberstalking is defined as utilizing the internet with the intention to harass and/or stalk another person. Cyberstalking is deliberate and persistent in nature. It may be an additional form of harassment, or the only method the perpetrator employs. The cyber stalker’s communication may be disturbing and inappropriate. Often, the more the victim protests or responds, the more rewarding the cyberstalker experiences the stalking. The best way to respond to a cyberstalker is not to respond. Cyberstalking may graduate to physical stalking, aggression, and violence.
Battering relationships are often characterized by cyclical phases, sometimes referred to as The Cycle of Violence. A period of peace and calm is followed by escalating tension. A woman might feel as though she were walking on eggshells. Minor incidents may occur that the woman tries to minimize or deny, sometimes by taking the blame. When the tension becomes unmanageable, aggression occurs. The victim may be kicked, thrown against a wall, raped, threatened at gun or knife point, slapped, punched or subjected to any of the endless mental and physical abuses that batterers use to intimidate and control their partners.

CEUS Continuing Education for LMFT, LCSW, and LPC Licenses in many states including California

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