Child abuse: Prognostic factors in therapy effectiveness

We have attempted to define the problem of child abuse by separating the abusers into two categories. Pattern abusers seem to be primarily a social issue in that the abuse is an outgrowth of the parental charge to control her/his child. However, another abuser is seen as a borderline or psychotic individual when the abuse is an outgrowth of a transferential distortion on the part of the parent. It was suggested that family therapy for the latter may be the preferential mode of intervention.     

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.     

Impacting Awareness of Child Abuse through a Performing Arts Project

A folk opera, AVE, explored issues of child abuse, sexual assault and violence through the character of Mary Magdelene. Using indigenous religious folklore images, Magdelene is befriended by Jesus's mother and healed of her childhood wound through a religious conversion. Six hundred secondary students attended three daytime performances and 486 returned a Likert‐scaled questionnaire. Results indicated most students perceived abuse as a personally relevant, real social problem, with felt relevance increasing with age. Significant trends supported initial expectations with an increase in community and personal awareness of child abuse/sexual assault and an increase in personal and community interest in helping others. Community risk factors contributing to denial of abuse were explored. More Hispanics responded positively to the sense of benefit. Findings suggest that performing arts can help increase awareness of child abuse as well as help stimulate personal and community interest in helping. This benefit increases with teacher discussion and age.     

The World of the Abused Child: A Phenomenological Report

ABSTRACT: A verbatim interview of one 21-year-old suicidal woman, who had a long history of abuse by her mother, is presented. Some theoretical issues concerning the scientific and clinical usefulness of phenomenological reports in the understanding of child abuse (and other aberrant behavior) are briefly discussed.     

The child's experience of Munchhausen syndrome by proxy

This paper examines the emotional impact of Munchhausen syndrome by proxy on a child aged 6 who had been poisoned by her mother. It describes her treatment in child psychotherapy over twenty months at the Cassel Hospital where the family worked towards her successful rehabilitation home. The work with her showed her experience of dangerous relationships in her family that left her distrustful of any new relationship, and doubtful of her capacity to be close without being destructive. Like her parents, she was terrified of facing the murderous feelings in the family, retreating into denial when life was too painful. The paper describes three phases of treatment: fear of separation and preoccupation with the trauma of poisoning, ambivalence about facing the destructiveness in the family and the move into more appropriate latency behaviour as she prepared to go home with her parents. It concludes with an overview of the impact of Munchhausen syndrome by proxy on the developing child, as shown in this treatment: the delay in emotional and cognitive development, the interference with the capacity to relate, the retreat into illness under stress, and the fear of permanent damage caused by the emotional and physical abuse.     

Understanding the “ghosts in the nursery” of pregnant women experiencing domestic violence: Prenatal maternal representations and histories of childhood maltreatment

Selma Fraiberg and colleagues (1975) conceptualized the “ghosts in the nursery” as experiences from a mother's past that influenced her ability to form a warm and attuned relationship with her child. Contemporary infant mental health interventions often ask the mother to reflect on her own history of attachment relationships to gain insight into as well as to strengthen her developing relationship with her child. This study investigated the association between a mother's history of childhood maltreatment (CM) and her subsequent prenatal maternal representation during the third trimester of pregnancy. Controlling for domestic violence (DV), distorted prenatal representations were associated with higher rates of self‐reported childhood physical neglect. In addition, DV moderated the relationship between representations and CM, such that women who were exposed to DV during pregnancy and had distorted prenatal representations were least likely to report childhood physical and sexual abuse. Implications are discussed in relation to infant mental health interventions which rely on a parent's ability to psychologically access and reflect on childhood histories to more sensitively parent her own child.     

Science, policy, and the protection of children

Child maltreatment is a particular concern for many researchers, practitioners, and policymakers. The articles in this Child Sexual Abuse: Science, Practice, and Policy Issues section, edited by Jeffrey Haugaard, address this issue from several perspectives. Haugaard articulates the difficulties of defining certain types of abuse and of researching ambiguous variables. Karen Saywitz and her coauthors provide an overview of current treatments for child sexual abuse victims. Recent national statistics on child maltreatment and federal efforts to address the problem are described by Olivia Golden. Tom DeLay highlights current problems in the child welfare system and the federal government's role in responding to them.     

Countertransference,enactment and sexual abuse

This paper examines the development of a therapeutic relationship with a sexually abused latency girl who, in the course of her two years of four times weekly psychotherapy, was placed in two different foster-homes. It is argued that the child's re-enactment of the abuse in the consulting room allowed her to move from a seductive relationship with the therapist to one characterized by basic trust. This was paralleled by her development of a capacity to think and to tolerate affect states. The use of an imaginary twin by the child and the use of powerful countertransference feelings in the therapist are seen as the main therapeutic tools in the treatment. The premature termination of the treatment – due to the therapist's departure – enabled the child to articulate for the first time her feelings, in the transference, about the trauma and the traumatizing agent. The child's progressing moves in the therapy are also presented.     

When Compassion is Making It Worse: Social Dynamics of Tabooing Victims of Child Sexual Abuse

The paper explores the social dynamics of tabooing, using sexual abuse of children as an example. Some social categories are problematic to embrace, because they entail socially problematic category bound activities in an emotional context of guilt and shame. This theoretical paper shows how a victim of sexual abuse as a child may suffer from two separate offenses, a sexual and a social; one caused by actions of the offender, one caused by actions of intended helpers. By ascribing an identity of ‘incest victim’ or ‘victim of child sexual abuse’ to a person, the taboo act becomes linked to the person. This may be an inescapable ascribed identity for the person, leading her/him to be subject of both sexual and social offenses. As a consequence, potential ‘victims’ may have troubled affiliation with such identity casting, and may fight a future tabooed role by not reporting tabooed abusive actions, hence not receiving the help needed to recover.     

A Behavioral Treatment of Child Abuse:

The following case presents the behavioral analysis and treatment of abuse in an 18-year-old unmarried mother. Both her children were being abused. Treatment involved teaching child management techniques, thought-stopping, programming activities incompatible with abuse, and increasing the mother's sources of reinforcement. A foster home was also arranged for use in emergencies and types of behavior and levels of attainment expected from children at various ages were outlined. Combined instances of abuse decreased from 10 in the week prior to intervention to 0 by week nine and remained at this level for the rest of the 21 week treatment period. A follow-up 18 months later indicated no further occurence of abuse.     

The early appearance and intergenerational transmission of maternal traumatic experiences in the context of mother-infant interaction

The paper describes the case of a girl of 8 weeks, referred by her mother because of 'intolerable hysterical attacks' triggering maternal impulses of abuse. Maternal perception of her infant was distorted to the extent that the mother was re-experiencing encounters with her own intrusive and traumatizing mother in the face of her screaming child. She also perceived the infant's motor impulses as physical attacks on herself and expressed intense anxieties about her daughter's future aggressive potential. The infant was viewed by her mother as extraordinarily and dangerously greedy. Even neutral infantile vocalizations were perceived as manipulating and sadistic. She tried to ward off these anxieties by employing a rigid scheme of rules and obsessively controlling the father's and grandmother's interaction with the child. The mother feared being overwhelmed by the infant's needs if she were to yield to them in a flexible way. The mother's background of early neglect and trauma is described, in the light of recent literature about the early intergenerational transmission of traumatic experiences, in order to demonstrate possible treatment modalities and the need to consider both protective and risk factors.     

Forming a Consortium: A Design for Interagency Collaboration in the Delivery of Service Following the Disclosure of Incest

A central issue in the treatment of intrafamilial sexual abuse is the "secondary trauma" experienced by both the victimized child and her family when the wider system of regulatory and treatment agencies present redundant, incongruent, or conflicting perspectives and demands. This article describes an attempt to effect second-order change through formation of a consortium of regulatory and treatment agencies to develop a consistent and coordinated response to the disclosure of sexual abuse. Feminist, social constructionist, and organizational development ideas are used to develop principles of intersubjectivity, collaboration and a "both-and" stance, which have guided both the clinical and wider systems work.     

Aggression inhibition in high‐ and low‐risk subjects for child physical abuse: effects of a child's hostile intent and the presence of mitigating information

Exposure of an aggressor to the suffering of his/her victim generally inhibits subsequent attacks [e.g. Baron, 1971a] presumably because of an empathic process. Physically abusive parents and individuals at high risk for child physical abuse are thought to present a deficit in empathy [e.g. Milner, Halsey and Fultz, 1995]. The present research was designed to investigate whether high‐risk, compared to low‐risk, subjects for child physical abuse select more aggressive responses and aggress with more intensity toward a supposed child whose behavior is adequate, inadequate or ambiguous in the presence of the child's pain cues. A second objective was to explore whether high‐risk, compared to low‐risk, subjects for child physical abuse fail to adequately integrate mitigating information and, therefore, do not inhibit their aggressive behavior following the receipt of mitigating information before or during an inadequate child behavior. Participants were engaged in an experimental task that involved attempting to teach a child how to proceed accurately through a computer‐displayed maze and were given the opportunity to send positive (pleasant sounds and happy faces) and negative feedback (mad faces and unpleasant sounds) to the child. Two hundred and fifty undergraduate students participated in the experiment. A 2 × 5 factorial design based on two levels of the participant's risk status (high, low) and five conditions based on the child's behavior and the introduction of mitigating information was employed. As expected, low‐risk, compared to high‐risk, subjects showed less aggression when mitigating information was provided. Aggr. Behav. 32:1–15, 2006. © 2006 Wiley‐Liss, Inc.     

Applying a Family-Ecosystemic Model to Reunite a Family Separated Due to Child Abuse: A Case Study

Family reunification following the removal of a child due to child abuse is a challenging process. In this case study the authors demonstrate the success of a family-ecosystemic intervention for achieving the reintegration of an adolescent into her family following a court-imposed separation. The SET (Structural Ecosytems Therapy) model was used to: (1) repair family bonds, (2) build collaborations among the agencies involved in overseeing the child's welfare, and (3) build an alliance between the mother and agency personnel. This case study suggests that facilitating such collaborations can be helpful in the evaluation and follow-through of high risk cases.     

The abused child as parent: Perception of self and other

Although not all abused children grow up to be abusive parents, it is well known that people who were severely mistreated by their parents as compared to those who were not are at higher risk for mistreating their children. It has also been shown that abusive parents often have unrealistic expectations for their children—expectations based on distorted perceptions of their children's needs, feelings, and abilities. In this paper, we examine the utility of new methods developed in social psychology to study: (1) the impact of abuse on the structure and content of interpersonal and self-perception and (2) the interrelationships among an abused mother's social and self-perception, the quality of her interactions with her child, and the child's development. Case studies will be presented to illustrate how these new methods reflect risk for abuse as predicted independently by clinicians treating the cases.     

Sequelae of child sexual abuse: a child and parent assessment

We present a case example of a 9-year-old, biracial girl and her mother. We integrate data collected from rating scales (e.g., Child Behavior Checklist; Achenbach & Rescorla, 2001), a free response measure (Thematic Apperception Test; Murray, 1943), and a direct observation measure (Parent-Child Interaction Assessment-II; Holigrocki, Kaminski, & Frieswyk, 1999, 2002) and reveal how a child sexual abuse victim's internal representations and symptoms manifest in both an interpersonal context and in the realm of play. We discuss assessment findings regarding how they provide for an idiographic understanding of the child.     

Child Abuse and Adolescent Parenting

Abstract

Adolescent parents are commonly identified as an at-risk group in the child abuse literature. However, theoretical models specific to the area of child abuse and adolescent parenting are not well developed. This essay reviews established theories on child abuse, abusive parenting, and adolescent parenting to synthesize a proposed child abuse and adolescent parenting model. An ecological perspective is used to organize the theoretical model. The components of this model are supported by existing research on child abuse and adolescent parenting. The new synthesized model on child abuse and adolescent parenting should be viewed as an informed way to organize and conduct future research in this area. Further theory development on child abuse and adolescent parenting should be encouraged.     

The challenge of defining child sexual abuse

Although child sexual abuse has been a concern for many researchers, therapists, and advocates for the past 3 decades, several fundamental issues regarding child sexual abuse remain unresolved. In particular, the term child sexual abuse has never been unequivocally defined. The lack of a commonly accepted definition of child sexual abuse continues to inhibit research, treatment, and advocacy efforts. Early researchers used broad and inclusive definitions of child sexual abuse--definitions that often continue to be used today. The consequences of these definitions are discussed, and strategies for developing other definitions of child sexual abuse are suggested.     

Ordinary physical punishment: is it harmful? Comment on Gershoff (2002)

E. T. Gershoff (2002) reviewed processes that might mediate and contexts that might moderate the associations between corporal punishment (CP) and child behaviors and provided an account of the methodological weaknesses of the research reviewed in her meta-analyses. In this examination of Gershoff, the authors argue that the biases and confounds in the meta-analyses further limit any causal inferences that can be drawn concerning the detrimental "effects" of CP on associated child behaviors. The authors suggest that undesirable child outcomes are associated with CP because the construct marks inept harsh parenting and conclude that although the harmful effects of physical abuse and other extreme punishments are clear, a blanket injunction against spanking is not justified by the evidence presented by Gershoff.     

Parenting contributors to early emerging problem behaviour in children of mothers in methadone maintenance treatment

This study explored whether variations in parenting provided by mothers with substance‐abuse disorders are related to behaviour problems in their young children and whether specific parenting practices are associated with specific types of behaviour problems. Mother‐reported and observational assessments were used to examine contributions of parenting behaviour and home environment to internalizing and externalizing behaviour problems in 150 preschool children of mothers receiving methadone‐maintenance treatment for heroin addiction. In multivariate analyses, mother‐reported child externalizing behaviour was related to greater maternal harshness and to mother history of illicit drug use during pregnancy but not other features of substance use and treatment history. Observer‐coded child internalizing behaviour was related to less maternal sensitivity and less provision of learning activities in the home. Additionally, mother report of her own psychopathology symptoms was related to mother‐reported, but not observer‐coded, child internalizing and externalizing problems. Findings suggest that women in substance abuse treatment should receive parenting interventions and that interventions should focus on increasing maternal sensitivity, reducing harshness, and providing children with cognitively stimulating environments. Findings also suggest that the need for attention to ongoing mental health problems of women in substance abuse treatment—both for their own well‐being and the well‐being of their children.

Highlights

• This study explored whether variations in parenting provided by mothers with substance‐abuse disorders are related to behavior problems in their young children.
• Maternal harshness was related to child externalizing behavior, low sensitivity, and low provision of learning opportunities to child internalizing problems.
• Findings suggest that women in substance abuse treatment should be provided access to parenting interventions.