Therapeutic Work with Sexually Abused Children
Publication Year: 2002
"It is refreshing to find child therapists ready to engage with sexually abused children by incorporating trauma theory and research, addressing child protection and seeing themselves as part of a team that includes the carers. The authors provide an overview of phases of treatment, theoretical considerations and essential skills. They emphasis the importance of relationship and explore its impact on the therapist. Their approach is creative and child-centered. Case vignettes, poems and exercises promote empathy with the child's perspective. There is a useful chapter on cultural issues and the needs of children in alternative care.... this is an excellent primer for the child's helping network" - COMMUNITY CARE Therapeutic Work with Sexually Abused Children is a creative and practical guide for professionals working directly with ...
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: The Dimensions of the Issues
- Defining the Problem of Child Sexual Abuse
- Being the Victim of Child Sexual Abuse
- The Need for More Research on the Effectiveness of Treatment and Outcomes
- The Challenge of Providing Therapy
- Chapter 2: The Therapist's Clinical Skills
- The Central Task of the Therapeutic Process: Acceptance and Integration of the Sexual Abuse Experience
- The Therapeutic Relationship
- Functions of the Therapist
- Chapter 3: Beginning Phases of Treatment
- Referral Source and Information
- Safety and Protection of the Child
- The Assessment Process
- Establishing the Therapeutic Relationship
- Obtaining a History of the Abuse
- The Child's Relationship with the Abuser and Disclosure
- Addressing the Child's Feelings of Guilt and Responsibility for the Abuse
- Chapter 4: The Therapist's Experience of Working with Abused Children
- Taking Care of Yourself (The Therapist)
- Emotional Demands and Countertransference
- Hypersensitivity to Child Sexual Abuse
- Countertransference Issues for the Therapist Who is a Survivor of Sexual Abuse
- Support for the Therapist
- Chapter 5: Children in Society, Cultural Considerations, and Alternative Care Provision
- Children in Society
- Sensitivity to Cultural Issues
- Special Considerations When Working with Children Placed in Substitute Care
- Chapter 6: Carer Involvement
- Initial Goals of Partnership and Liaison Work
- The Child's History
- The Child's Symptoms
- Assessment of Parenting Skills
- Typical Carer Responses
- Carer Functioning and Responsiveness
- The Therapist's Ongoing Relationship with the Carers
- The Social Worker's Role
- Chapter 7: Theoretical Considerations
- Identification of the Child's Development
- Piaget's Developmental Theory
- Erikson's Psychosocial Theory
- The Importance of Attachment and the Therapeutic Process
- Chapter 8: Common Symptomology
- Somatic Complaints and Bodily Concerns
- Sleep Disturbances
- Performance at School
- Fear/Anxiety and Feelings of Powerlessness
- Acting Out or Aggressive Behaviour
- Low Self-Esteem and Poor Sense of Self
- Chapter 9: Sexualized Behaviour, Substance Abuse, and Eating Disorders
- Sexualized Behaviour
- Use of Alcohol or Drugs
- Development of Eating Disorders
- Chapter 10: The Child's Coping Styles and Defence Mechanisms
- The Child Sexual Abuse Accommodation Syndrome
- Defence Mechanisms and Coping Styles
- The Diagnosis of Post Traumatic Stress Disorder (PTSD)
- The Role of Sexual Abuse in the Formulation of MPD and DID
- Chapter 11: Tools of the Therapeutic Process
- Is the Child Able to Verbalize Feelings about the Abuse?
- Techniques Used
- Why are Creative Methods Effective?
- Child-Centred Therapy
- Guidelines for Assessing and Observing the Child during Play
- Individual Therapy or Group Treatment?
- Chapter 12: Liaison with Agencies and Services: Professional Work within Child Protection Procedures and Courts
- Child Protection Procedures: A Brief Overview
- Legislation, Principles, and Codes of Practice
- Safeguarding Children
- Investigating Suspected ‘Significant Harm’: Collecting Possible ‘Evidence’
- The Child's View of the Process
- The Child as a Court Witness
- The Therapist's Roles in the Legal Setting
- Child Protection and Court Involvement: The Effects on the Child
- Formal Communication and Report Writing
- Chapter 13: The Grieving Process and the Termination of Therapy
- Losses and Grieving
- The Termination Phase of Treatment: Central Considerations and Tasks
- Evaluation of the Process
- Normalizing Regression and Boundaries
- The Loss of the Therapist
- The Final Session
© Randall Easton Wickham and Janet West 2002
First published 2002
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.
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British Library Cataloguing in Publication data
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ISBN 0 7619 6968 3
ISBN 0 7619 6969 1 (pbk)
Library of Congress Control Number: 2001135324
Typeset by SIVA Math Setters, Chennai, India
Printed and bound in Great Britain by Athenaeum Press, Gateshead
This book is dedicated to all children who have been sexually abused.[Page vi]
The authors wish to thank Alison Poyner, Senior Commissioning Editor, and Louise Wise, Editorial Assistant at Sage Publications for their contributions and support in writing this book. We are indebted to Pat Walton, University of Leicester, for her assistance in writing Chapter 12.
Randall Easton Wickham would like to thank the following: both her brother, Michael Easton and her sister, Kelly Easton for their intelligence, sensitivity and unfailing senses of humour, and to thank them for always being there when she has truly needed them; her children Celia and Katie, for their affection, spirit and patience with her while she worked on this manuscript; Phyllis Spinal-Robinson, LCSW, for friendship, supervision and co-authorship of the workbooks for sexually abused children and adolescents written in the US; her previous colleagues on the sexual abuse team and staff at Des Plaines Valley Community Centre in Chicago; most notably the following: Phyllis Spinal-Robinson, Avis Shapiro, LCSW, a highly skilled clinician; Beth Forte, LCSW, who supervised her on her first sexual abuse case; the teaching staff at SSA at the University of Chicago where she received her MA in Social Work; her co-author, Janet, for her unfailing sense of humour, dedication, hard work and fortitude; and lastly, and most importantly, all the children and families she has had the opportunity to work with, who have taught her so much. Thank you.
We also wish to acknowledge the following publications:
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders. Washington, DC.: American Psychiatric Association for permission to quote from DSM IV and defence mechanisms.
Sharp, S. and Cowie, H. (1998) Counselling and Supporting Children in Distress. London: Sage for permission to quote Table 2.1, p. 28.
Spinal-Robinson, P. and Easton Wickham, R. (1992) Cartwheels. A Workbook for Children Who Have Been Sexually Abused. Notre Dame, Indiana: Jalice, for permission to quote some of the Worksheets.
Spinal-Robinson, P. and Easton Wickham, R. (1992) Cartwheels. Therapist's Guide. Notre Dame, Indiana: Jalice, for permission to quote clinical material regarding feelings of responsibility for the abuse, p. 4.
Please note that the text is based on an integrative approach to treatment including the following orientations: psychodynamic, person-centred, self-psychology and cognitive. We also advocate a psycho-educational approach.
[Page xii]Please also note that the words ‘carer’ and ‘parent’ are used interchangeably in our text. We have varied gender pronouns in order to reinforce the reader's awareness that both girls and boys are sexually abused, and that there are male and female therapists. Within England and Wales, the person with overall case-management responsibility for the sexually abused child who is receiving therapy may be a social worker, a child protection officer, or some other designated worker. Only rarely is the therapist also the child's identified worker.
A final poem written by a survivor of childhood sexual abuse; a poem written at the end of treatment:
(To my abuser)
In my thoughts and dreams,
you do not exist.
I have banished you.
Ashes to ashes,
dust to dust.
I am the one
who moves on.
Besieged and defeated,
you can no longer
linger in the shadows.
(For my therapist)
In this room,
you have guided me,
I am the
Appendix 1: Answers to the Exercise on Coping Styles and Defence Mechanisms (Chapter 10)[Page 179]
- Acting out
- Denial and minimization
- Dissociation (symptoms of depression)
- Passive aggression/displacement of anger
Appendix 2: Worksheets (see Chapter 11)[Page 180]Feelings in Your Body
[Page 181]People often feel emotions in their bodies. Can you show where you have feelings in your body? You can use different colours for different feelings and colour them in.[Page 182]Ways to Cope
Things to do when I'm feeling afraid or overwhelmed:[Page 183]Write a Letter
Write to the person who abused you. Say whatever you feel like saying:[Page 184]Draw a Picture of Yourself or Write Some Words Describing Yourself
before the abuse
after the abuse
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