Group therapy with sexually abused boys: leadership, projective identification, and countertransference issues

Group therapy is an essential component of the treatment of sexually abused children. Since the painful effects associated with the abuse are often dissociated or acted out, the group leaders learn of the affective experience of the abuse through the process of projective identification. The leaders must be aware of this process, set limits on the abusive acting out in the group, and help moderate, label, and empathize with the affect. It is through this difficult process that the children have a chance to reintegrate and work through their abuse experiences so they no longer feel compelled to act them out through repetitive abusive relationships. Specific leadership, countertransference, and projective identification issues in group therapy with sexually abused boys are discussed.     

Abusive families and character formation

Family research studies confirm that abusive parents tend to be undifferentiated partners who compete with each other and with their children for attention and nurturance. More or less healthy parents make demands on children to counteract their own injured narcissism, but they do so largely without devaluation and the sadistic use of projective identification. Under sufficient stress abusive parents attack the child who fails to gratify their needs, thereby giving vent to longstanding frustrations and feelings of being threatened by the child's individuation and competency. The emotional atmosphere in such families facilitates ego deficits like those of the borderline personality as it molds the child's efforts to avoid anxiety. Devaluation, loss, and defenses against mourning partially account for depression and paranoid traits in abused youngsters. Early neglect and abuse exposes them to influential models who act out rage and primitive defenses. Some abused individuals project their rage and later become paranoid or antisocial, whereas others fragment or retain infantile defenses. The destructiveness of severe psychological abuse lies in the constriction of the experiencing self and healthy character development, together with the conditioning to repeat abusive relationships and to avoid intimacy. Achieving individuation under these circumstances entails overcoming the internalized abusive relationships and relinquishing the unconscious wish to be transformed from the abused into the abuser.     

No Man's Land?: The Role of Men Working with Sexually Abused Children

Most sexual abusers of children are men. It is argued that sexually abused children may be anxious about contacts with men, especially when these include discussions of sexuality or of their abusive experiences. The implications of this for the role of men working with sexually abused children are explored. It is suggested that disclosure interviews should not usually be carried out by men, but that men do have a role to play in the post-disclosure therapeutic process.     

Working with child sexual abuse: a systemic perspective on whether children need to tell their therapist details of the abuse for healing to take place

As clinicians working with children who have been sexually abused we have observed that many children choose not to give the therapist a detailed account of their abuse. ^{1 1}‘Children’ refers to children and adolescents.
Our hypothesis is that whether or not children tell their story to the therapist hinges upon several factors: whether they have been believed by their significant (non‐abusing) carer(s); their developmental stage; the therapeutic context; and whether they feel their therapist is available to hear the distressing details of the abuse. We explore this through two case studies and conclude that while children's ability to use therapy is affected by multiple factors – societal, cultural, personal, life histories and beliefs about the value of therapy – telling their therapist the details of their abusive experiences is not necessarily a part of effective therapy.     

An exploratory study assessing relations of demographic characteristics with police recruits' attitudes toward abuse of children and abusive parents

The purpose of this exploratory study was to assess the relationships of demographic characteristics with attitudes toward abusive parents and abused children in a convenience sample of 183 police recruits. Police academy training staff invited recruits to complete a questionnaire which contained three vignettes and a 36-item questionnaire that depicted child neglect, sexual abuse, physical abuse, and demographic information. Analysis of responses showed that African Americans and Latinos reported more negative attitudes of anger, disgust, sadness, and discomfort toward an abusive parent than the Euro-American group. Women reported more negative attitudes toward an abused child and also more positive attitudes of sympathy and caring toward an abused child. Results partially support previous research suggesting demographic characteristics influence report of attitudes toward abusive parents and abused children. These findings about the influence of demographic characteristics on positive and negative emotional reactions toward abusive parents and abused children add to the literature.     

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.     

Understanding expert testimony on child sexual abuse denial after New Jersey v. J.L.G.: Ground truth,disclosure suspicion bias,and disclosure substantiation bias

The New Jersey Supreme Court held in New Jersey v. J.L.G. (2018) that experts can no longer explain to juries why sexually abused children might deny abuse. The court was influenced by expert testimony that “methodologically superior” studies find lower rates of denial. Examining the studies in detail, we argue that the expert testimony was flawed due to three problems with using child disclosure studies to estimate the likelihood that abused children are reluctant to disclose abuse: the ground truth problem, disclosure suspicion bias, and disclosure substantiation bias. Research identifying groups of children whose abuse can be proven without reliance on disclosure reveals that denial of sexual abuse is common among abused children.     

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.     

Even When You Win You Lose: Targeted Parents' Perceptions of Their Attorneys

The author attempts to deal with three important issues in relation to child sex abuse allegations. These are (1) some potential signs in the behavior of children who might have suffered sexual abuse; (2) how an evaluation of an allegedly sex abused child can be carried out; (3) the possible long term affects on a child who has suffered from being sexually abused. The complexity of drawing the right conclusions are considered when there are false positives due to the overlap of evidence between sexually abused and non abused children.     

Child molestations by homosexual foster parents: Illinois, 1997--2002

Do those who engage in homosexuality disproportionately sexually abuse foster or adoptive children as reported by child protective services? Illinois child services reported sexual abuse for 1997 through 2002. 270 parents committed "substantiated" sexual offenses against foster or subsidized adoptive children: 67 (69%) of 97 of these mother and 148 (86%) of 173 of these father perpetrators sexually abused girls; 30 (31%) of the mothers and 25 (14%) of the father perpetrators sexually abused boys, i.e., 92 (34%) of the perpetrators homosexually abused their charges. Of these parents 15 both physically and sexually abused charges: daughters by 8 of the mothers and 4 of the fathers, sons by 3 of the mothers, i.e., same-sex perpetrators were involved in 53%. Thus, homosexual practitioners were proportionately more apt to abuse foster or adoptive children sexually.     

The Development,Process, and Evaluation of Group Psychotherapy With Sexually Abused Preschool Girls

The development, process, and evolution of group psychotherapy specifically designed for sexually abused preschool aged females is presented. Utilization of male and female cotherapists, group structure, individual and family dynamics, the role of children's mothers in treatment, and process of treatment are examined. Issues regarding countertransference phenomena, cotherapy relations, in-depth involvement of the children's mothers, and specifics related to structuring of a time-limited group are beyond the initial intent and scope of this paper, and are not discussed here.

The cotherapists conclude that group psychotherapy for children of this age group is both clearly valuable and highly indicated as an adjunct treatment modality. In future group psychotherapy with sexually abused preschool aged children, based upon clinical experience and evaluation, the cotherapists advocate a time-limited approach whereby each session would focus upon specific issues as illustrated in Table 1, and include structured and purposeful involvement of the girls' caretakers.     

Sexual and Physical Abuse Among Adolescent Girls with Disruptive Behavior Problems

We examined the prevalence and age of onset of physical and sexual abuse in a clinic-referred sample of adolescent girls, as well as differences in diagnoses and symptoms among abused and non-abused girls. Forty-nine girls (aged 13–17 years) with disruptive behavior were interviewed along with their primary caretaker. Data were gathered through both a structured interview with the girl and her parent, as well as self and parent-report questionnaires. Findings indicated that the prevalence of Conduct Disorder (CD) and Major Depression were higher for abused girls. Somatoform Pain Disorder was significantly less likely for physically abused girls, compared to girls who were both physically and sexually abused. Of CD symptoms, truancy was twice as high for the physically and sexually abused group, compared to the prevalence for non-abused girls. Internalizing symptoms were also highest for the dual abuse group. Onset graphs show that the onset of sexual abuse usually occurred at an earlier age than the onset of physical abuse. Abused girls showed an earlier age of onset of CD symptoms. Results indicated that the experience of combined types of abuse is associated with a poorer psychiatric prognosis.     

False recognition in women reporting recovered memories of sexual abuse

False recognition—the mistaken belief that one has previously encountered a novel item—was examined in four groups of subjects: women reporting recovered memories of childhood sexual abuse, women who believe that they were sexually abused as children but who cannot recall this abuse (the "repressed" group), women who were sexually abused as children and always remembered the abuse, and women with no history of childhood sexual abuse. Subjects were administered a Deese/Roediger-McDermott paradigm. The results suggest that the recovered-memory group was more prone to false recognition than the other groups. In addition, women reporting recovered and repressed memories showed greater reduction in false recognition across study trials than did other subjects, perhaps reflecting strategic changes in performance.     

Strengths and Limitations of Forensic Child Sexual Abuse Interviews with Anatomical Dolls: An Empirical Review

A comprehensive review of the use of anatomical dolls reveals three areas of research: (1) normative studies (with no known history of sexual abuse) of children's interactions with anatomical dolls; (2) comparative studies of children suspected of being victims of sexual abuse, and those believed not to be; and (3) the role anatomical dolls play in the identification of a child who has been sexually abused. The results of empirical studies in each area are mixed and inconsistent. However, there is general clinical support for the use of the anatomical doll as a demonstration aid during forensic interviewing with children over 3 years of age.     

Self-Control and Child Abuse Potential in Mothers with an Abuse History and Their Preschool Children

We examined whether physically and sexually abused mothers display lower levels of self-control, whether this explains their higher tendency to abuse their own children, and if this results in lower levels of self-control among their children. In a cross-sectional study, 40 abused and 47 matched, non-abused mothers completed validated self-control and child abuse potential questionnaires. Their preschool children (2.3–3.7 years) were tested for self-control with the effortful control battery and delay of gratification test. Relationships and mediations were tested using stepwise regression analyses and bootstrap mediation tests, while controlling for potential confounders. Mothers with a history of abuse had a significantly higher potential to abuse their children (p < .001) and lower levels of self-control (p < .05) compared to non-abused mothers. Maternal self-control predicted child abuse potential (p < .001) while controlling for maternal history of abuse, revealing that self-control partially mediated the relation between past abuse and current abuse potential. Next, child abuse potential was found to be a borderline significant predictor of child self-control (p = .05) on the delay of gratification task but not on the effortful control battery. We did not discover a correlation between child self-control and maternal self-control. These findings suggest that self-control may be a potentially important mechanism in the intergenerational cycle of child abuse. Further investigation on the topic is needed to confirm this hypothesis, for example through investigating the impact of parental self-control training on abusive parenting and children’s self-control development. Improved child self-control measures or focusing on older children is expected to address the key limitations of the current study.     

Multidimensional Self-Perception of Sexually Abused Girls: Factor Models and Differences Between Sexual Abuse and Comparison Groups

This study investigated the multiple dimensions of self-perception in a sample of sexually abused and nonabused comparison girls (n = 140), with particular attention to self-perception in the scholastic, social, athletic, physical (appearance), and behavioral conduct domains. First, this study examined whether the five dimensions of self-perception were psychologically discrete. Second, the relationships between the self-perception factors and childhood sexual abuse were investigated using structural equation modeling. The results supported the multidimensionality of self-perception and suggested the presence of two distinct second-order self-perception factors: academic- and social-self. While the sexually abused girls indicated less positive perception for the academic-self than the comparison group, the two groups did not differ regarding the social-self. The findings highlight the importance of a multidimensional approach to self-perception in assessing and treating sexually abused children.     

Immediate and delayed suggestibility among suspected child victims of sexual abuse

Children suspected of being victims of sexual abuse are often interviewed by police, but little is known about the effects of sexual abuse on their suggestibility. The aim of this paper was to investigate differences in ‘immediate’ and ‘delayed’ suggestibility between children being investigated as suspected victims of sexual abuse and other children and to compare the suggestibility scores of children allegedly abused by a family member versus a person from outside the family. The participants were 180 children aged between 7 and 16 years, who had been subdivided into ‘victim’ and ‘control’ groups; each group being comprised of 90 children and matched for IQ. All children completed the Gudjonsson Suggestibility Scale (GSS 2) and a non-verbal IQ test. The children in the victim group scores significantly higher on Shift and Yield 2 than the control group, after controlling for memory capacity. Children abused by a family member coped significantly worse with interrogative pressure (high Shift) than those abused by a non-family member. Immediate suggestibility showed much stronger effects than delayed suggestibility. The findings suggest that sexually abused children are very vulnerable during questioning where there is interrogative pressure and those abused by a family member are even more vulnerable.     

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.     

Psychodynamic group therapy for male survivors of sexual abuse

The group therapy literature on male sexual abuse is very preliminary and concerned solely with short-term support models. This paper describes a long-term psychodynamic therapy group for male survivors that has been running successfully in a clinic setting for almost three years. This combined group and individual treatment approach presupposes the selection of men who are capable of using group process to explore basic personality and relationship problems. With sexually abused men, certain treatment issues are paramount. These concern the safety of group boundaries, power and control, facilitating intimacy, handling shame and guilt, and the effects of trauma. Special attention is given to the gender-related dynamics and conflicts that occur in a group of male survivors with a male leader.     

Resolving the trauma organized system of sexual abuse by confronting the abuser: A focal family therapy approach with a woman who was a childhood victim of sexual abuse

The longer-term emotional and interpersonal effects of sexual abuse in childhood are reviewed and approaches to treatment discussed. The notion of a 'trauma organized system' to account for the long-standing effects of abuse is described. A major potential issue in creating therapeutic change is confronting the abuser, and a case is described where a woman brought her family for therapy when it was feared that the father, who had abused her in childhood, might abuse his grandchildren. A focal family therapy approach was used: this takes into account the traumatic nature of abusive events and their long-term organizing effects on individual and family functioning. The process of therapeutic work is described, including the resolution of traumatic effects by confronting the abusive act.