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.     

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.     

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.     

Objective Evaluation of the Process and Effects of Analytic Group Psychotherapy with Adolescent Girls

This article, written from a relational perspective, describes a shift that is taking place in the thinking of many psychodynamically oriented psychotherapists regarding the practice of therapy and the implications it has for group therapists. The shift, from one-person to two-person and multiperson theory, has particular importance for group leaders since it recommends making the subjective involvement of the therapist in the interactional field of the group much more a part of the treatment process. Theory and research on the use of countertransference, noninterpretive interventions, humor, and spontaneity by the leader are reviewed and vignettes are presented to illustrate the application of these ideas. Guidelines regarding the application of such ideas in group therapy are also discussed.     

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 affects 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.     

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.     

The Fear of Turning into Dust: Notes on a Group for Sexually Abused Women

For 10 years, I have been responsible for a group for adults who were sexually abused during childhood. In this brief paper, I will analyze one aspect of the particular kind of identification that exists between a child and an abusing adult, using Bion's concept of valency and Kaes' theories of unconscious alliances and pacts, in an attempt to further qualify Ferenczi's concept of identification with the aggressor. I will then show how the group encourages the process of disidentification with the aggressor.     

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.     

Social Memory of Preschool Girls and Boys

In two experiments, 40 female and 40 male preschoolers attending a day-care center were shown photographs of children attending the center, and were asked either to name each pictured child (recall condition) or to point to the picture of the child as the experimenter said the child's name (recognition condition). In both experiments, girls and boys did not differ significantly in the number of correct identifications on either the recall or recognition tasks. The results do not support Feldstein's (1976) conclusion that preschool girls show better social memory than preschool boys.     

Ethnicity, Culture, and Group Psychotherapy

Ethnicity and culture have great therapeutic import in the practice of group psychotherapy, especially given the increasing diversity of the population of North America, and this issue has not received appropriate recognition in the literature. In this paper these terms are defined, and the literature is reviewed. Ethnicity, culture, and psychopathology are discussed, focusing on treatment issues including transference, countertransference, resistance, group cohesion, group process, and multi-ethnic groups. The group therapist must be knowledgeable about ethnic and cultural issues in the lives of the group members in order to promote group cohesion and therapeutic effectiveness. The recognition and exploration of ethnic/cultural differences enhances the work of the group. Recommendations for treatment are discussed.     

Shame, Women, and Group Psychotherapy

This paper addresses gender-related experiences of shame, focusing on the shame-prone woman. Specifically the varied manifest behaviors, dynamics, and defenses commonly observed in shame-prone women are described. It is recommended that the addition of group therapy to individual treatment, once the client is ready, can expedite progress for these patients, as they are more able to integrate previously disowned and shamed aspects of themselves. A number of potential problems when working with these patients in group are identified and explored.     

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.     

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.     

Psychotherapy Process Measure Research and the Evaluation of Psychotherapy Orientation: A Narrative Analysis

This article discusses the need for a systematic method that enables researchers to evaluate integrative therapy approaches using a range of therapy process measures. The Narrative System Process Coding (NPCS; Angus, Hardtke, & Levitt, 1996) is proposed as such a method, and is applied with the Experiencing Scale (Klein, Mathieu, Gendlin, & Keisler, 1970) and the Levels of Client Perceptual Processing (LCPP; Toukmanian, 1986) to three brief good outcome integrative therapy modalities to illustrate this need. The study found higher Experiencing Scale scores to be most strongly related to an experiential approach to therapy and to the NPCS internal narrative processes. Higher LCPP scores were most strongly related to the NPCS reflexive narrative process and to a perceptual-processing approach. The discussion initiates a discourse on the importance of explicating process measures' origins when comparing different therapy approaches in order to allow for the meaningful consolidation of process research findings.     

The Influence of Retention,Turnover, and Alliance on Process and Outcomes in Rolling Group Psychotherapy for Cocaine Disorder

A longitudinal repeated measures design was used to investigate the influence of treatment retention, and membership turnover on individual outcomes, and the relationship between individual-level and group-level therapeutic alliance in rolling group psychotherapy for individuals with cocaine abuse disorder. Eighteen patients were studied; data were collected prior to therapy and then monthly for 24 months. Patient outcomes and process were assessed. Improvements in symptoms and psychological functioning were associated with retention in psychotherapy. Membership turnover had a negative influence on symptoms. Development of an individual alliance was affected by the development of group-level therapeutic alliance, but not by time spent in therapy.