Current Treatment Strategies for Sexually Abused Children

SUMMARY

Given the disturbingly high prevalence of child sexual abuse, the expertise of medical and mental health professionals in treating child sexual abuse victims is essential. Relevant issues in treating these children include the mindfulness of developmental considerations, incorporation of a multi-modal therapeutic evaluation approach, clarification of treatment goals, appropriate use of and integration of various treatment modalities, and effective treatment termination. This article provides an introduction aid overview of treatment of sexually abused children of all ages, from preschoolers to adolescents, with special emphasis on the importance of developmentally linked evaluation and treatment strategies. Treatment is discussed in terms of goals, stages from evaluation to termination, and formats and modalities including individual psychotherapy, family psychotherapy, group psychotherapy and hypnotherapy, to provide a comprehensive overview of current treatment strategies for sexually abused children.     

Questioning Children Who May Have Been Sexually Abused

Summary

This article derives from an Open Forum on Leading Questions sponsored by the American Professional Society on the Abuse of Children. It represents the thoughts of participants in the Open Forum, and the article attempts to integrate analogue research that relates to questioning children about past events into questioning practice with children who may have been sexually abused. It proposes a continuum of questions that includes four categories: most preferred, preferred, less preferred, and least preferred.     

Expectancies for Sexually Abused Children: Evidence of Perceiver Bias

We investigated perceiver bias in relation to children labeled as sexually abused. Building on recent research indicating that adults perceive children with such a label as having more behavioral problems and lower achievement, we replicated and expanded upon an earlier study. We tested undergraduate students (N = 699), who judged a six-year old child's aggressive behavior in vignettes that varied on severity of the aggressive behavior, child gender, and family history (sexually abused, mother dying of cancer, normal). Perceiver bias was related to family history label for internalizing behavior problems and competence issues and child gender for internalizing behavior problems and externalizing behavior problems. Implications for educators and practitioners are discussed as well as routes for future research.     

Making of Victim a Patient: Sexually Abused Children and the Consequences of Unprofessional Help

The disclosure of sexual abuse by a child not only disturbs the mental peace of the family members but influences their attitudes towards the victim as well. This article explores how the diverse types of attitudes of the family members towards the victim and un-fulfillment of role expectation of a victim from his/her family members make him/her a patient. An attempt has also been made to analyse how the reluctance of parents to take any professional help impedes the recovery of the child along with the strategy a child adopts to cope with this traumatic event of his/her life. The child wants love and support from his/her close relatives, besides expecting protection from them. In such circumstances even a little negligence from any of the family members or their unsupportive and unpractical attitudes towards the victim, makes him/her a silent sufferer. A sense of helplessness develops in her/him and later on this sense of helplessness makes him/her a patient of depression.     

Multimethod Assessment of Depression in Sexually Abused Girls

This study measured depression in sexually abused Black girls using the Children's Depression Inventory (Kovacs & A. T. Beck, 1977), the Internalization scale of the Child Behavior Checklist (Achenbach & Edelbrock, 1983), and the Rorschach Depression Index (Exner, 1986). There were no significant correlations between these self-report, behavior observation (by parental report), and projective measures. The abused subjects had high scores on the behavior observation and Rorschach scales. Consistent with past research, negative results were obtained with the self-report instrument. We suggest that the low scores on self-report measures of distress produced by sexually abused children may be the result of guardedness or defensiveness rather than a genuinely low level of dysphoria in this population. There were no significant relations between abuse characteristics and scores on the depression measures. Scores on Rorschach measures of organizational activity (Zf) and available coping resources (EA) were generally positively related to depression within the abuse group and negatively related to depression within the control group.     

Exploration of Recovery Trajectories in Sexually Abused Adolescents

Abstract

This study documents recovery status and symptom changes in a one-year follow-up of sexually abused adolescent girls in child protection services in the province of Québec, Canada. Sixteen French-speaking participants completed questionnaires assessing symptoms, types of maltreatment endured, and services received and were interviewed using the Multidimensional Trauma Recovery and Resiliency Interview (MTRR-I), which was in turn rated by interviewers using the companion rating scale, the MTRR. Analyses of one-year follow-up data revealed statistically significant changes towards better functioning on multiple domains and less symptomatology for a majority of the girls interviewed. The recovery status of a minority of research participants seems to have worsened in the interval. The discussion considers these findings and addresses relevancy of the MTRR measures in cases of sexually abused adolescents.     

Pathways to Adolescent Substance Use Among Sexually Abused Girls

This study examined the link between childhood sexual abuse and adolescent substance use among girls, and evaluated depressive self-concept and behavioral under-control (BUC) as pathways to substance use for sexually abused girls. Participants (n = 150) were drawn from a longitudinal study of the impact of domestic violence on the lives of women and children. Structural equation modeling revealed that girls childhood sexual abuse was associated prospectively with their later substance use. This relationship persisted when age, co-occurring forms of child abuse (physical, exposure to domestic violence), childhood depression and aggression, family income, maternal substance use, and parenting practices were controlled. Behavioral under-control mediated the relationship between childhood sexual abuse and later substance use, but depressive self-concept did not. Implications, limitations, and directions for future research are discussed.     

Rorschach Assessment of Psychological Functioning in Sexually Abused Girls

We measured psychological functioning in a group of 79 Black females between the ages of 5 and 16 and a comparison group of nonabused girls using the Rorschach. In addition to Exner's (1985) Comprehensive System, the Elizur (1949) Rorschach Content Test Scale (RCT), the Mutuality of Autonomy Scale (MOA; Urist, 1977, Urist & Shill, 1982), and the Barrier and Penetration Scales (Fisher & Cleveland, 1968) were used. Sexually abused girls were found to show more disturbed thinking, to experience a higher level of stress relative to their adaptive abilities, to describe human relationships more negatively, and to show more preoccupation with sexuality than the comparison group. The distress experienced by the victimized children was more related to internal mediating variables then to abuse characteristics. Sexually abused girls who are cognitively and emotionally active also experienced high levels of distress compared to abused girls who are psychologically constricted.     

Equine Facilitated Therapy with Children and Adolescents Who Have Been Sexually Abused: A Program Evaluation Study

Child sexual abuse (CSA) is a social problem that often inflicts long lasting psychological trauma and leads to psychopathology, behavioural problems and re-victimization. Treating young people who are presenting with the detrimental effects of CSA is often difficult because these effects off-set efforts at establishing a therapeutic bond. Animals have been found to facilitate the development of the therapeutic alliance between client and practitioner and therapies utilizing horses have the added bonus of empowering clients. This study aimed to evaluate an Equine Facilitated Program (EFT) run by Phoenix House, a sexual assault referral centre in Queensland, Australia. Participants were six boys and nine girls (aged 8–11 years) and 15 adolescent girls (aged 12–17 years). All participants provided several measures of data designed to establish levels of psychological distress at three points in time. That is, Time 1—intake into the service; Time 2—following approximately 6 weeks of in-clinic counselling and pre-EFT; and Time 3 post-EFT (9–10 week duration). Significant improvements in functioning were found between Time 2 and Time 3 assessment across all psychometric measures and for both age groups. No, or non-significant, improvements were found between Time 1 and Time 2 assessments. Overall the results show that EFT proved an effective therapeutic approach for the children and adolescents referred to the service. Of particular note was the finding that efficacy was similar across gender, age and Indigenous/non-Indigenous status. Implications of this and suggestions for further research are discussed.     

Me and My Shadow: Therapy with Sexually Abused Pre-Adolescents

The purpose of this paper is to describe the use of solution focused techniques with preadolescent children who have been sexually abused and to present a therapeutic model that: 1) represents a blending of traditional psychological theoretical ideas with the more recent solution focused techniques; 2) presents a unique time-limited group format for assisting children to come to know and like their authentic selves; and 3) provides the therapist with the opportunity to expand his or her roles. In this model, the path from false self to authentic self is conceptualized as an interplay among abuse events, family relationships, and other life contexts.     

Group Treatment of Sexually Abused Adolescent Girls: A Review of Outcome Studies

Abstract

This paper considers factors that make children “at risk” for postdivorce maladjustment. The risk factors include (a) demographic variables of sex, age and socioeconomic status; (b) predivorce family functioning; (c) postdivorce relationship with the ex-spouse; (d) postdivorce parentchild interaction; and (e) social support systems. Treatment programs incorporating these factors are briefly described. Recommendations are provided for the clinician and researcher.     

Perceptions of Juvenile Offenders Who Were Abused as Children

Should a history of child abuse be taken into consideration when a juvenile offender is punished? Although some research shows that child abuse is used as a mitigating factor for juvenile offenders (i.e., elicits less punitive sentences), surveys of juvenile court officials reveal that it is considered an aggravating factor. Specifically, in controlled mock jury studies in which child abuse is experimentally manipulated, child abuse elicits less punitive sentences. In contrast, child abuse elicits more punitive sentences in a nonexperimentally controlled environment—the juvenile justice system. This article provides a comprehensive literature review to explain these conflicting bodies of research by considering factors that naturally covary with childhood abuse: chaotic family environment, mental health problems, behavioral problems, and school problems.     

Counselor Trainees' Self-Statement Responses to Sexually and Physically Abused Clients,and Client Role Conflict

Because sexual abuse issues present a threat to counselor trainees, the authors predicted that trainees who expected to counsel a sexually abused client would respond with an increase in anxiety and negative self-statements. A total of 63 female trainees were assessed after viewing a videotape of a client reporting sexual abuse, physical abuse, or role conflict. Results indicated that, counter to predictions, the trainees who expected to counsel the sexually abused client increased their positive self-statements. Schwartz's (1986) States-of-Mind model was applied to the self-statement ratios, and, according to the model, trainees were unrealistically optimistic with respect to their counseling.     

A Group of Sexually Abused Adolescents' Perceptions of their Future Life-Roles: An Exploratory Study

Sexual abuse of adolescents can have detrimental effects on their perceptions of their different future life-roles. We investigated such perceptions of students with a history of sexual abuse (n=163) as well as typically developing others (n=237). Participants completed the Life-role Inventory of the then called Human Sciences Research Council (Langley, 1990). Between-group comparisons were carried out. Adolescents with a history of sexual abuse reported negative perceptions of themselves fulfilling some of their roles in the future, being committed to these roles and attaching value to them, compared to typically developing others.