Counseling Abused Adolescents
Counseling Abused Adolescents
Course Description
CCEUS29 - Counseling Abused Adolescents [Click On Title To Go To Course Page] [Approved for 10 contact hours by The National Board For Certified Counselors - Provider #5936] - [$50.00 - NO OTHER COURSE FEES APPLY] Adolescents who have been abused, either recently or earlier in their lives possess some very unique set of needs from a counseling relationship. Making the problem even worse is the fact that these young people evoke fear and trepidation in adults and professionals. Information in this study is focused on demonstrating how to communicate more effectively with these young people who are suffering and have suffered from traumatic abuse at some point in their lives. Case studies are employed to illustrate some of the tangential behaviors of abused youth and point out avenues that my be pursued in overcoming blocks to counseling progress with these young people.
Course Directions
Click on the Course Directions page to read course procedures.
Course Textbook
Treating Abused Adolescents by Eliana Gil ISBN# 1572301155 $21.00 at from The Bookstore page .
ASCA Position Statement: The Professional School Counselor and Child Abuse And Neglect Prevention http://www.schoolcounselor.org/content.cfm?L1=1000&L2=8
Course Outcomes
As a result of the work in this course, the counselor will
learn the modern concept of adolescence from a demographic perspective.
discover some assumptions concerning the adolescent period.
understand some of the basic needs of adolescents.
understand some obstacles in the path of adolescent development.
be introduced to the prevalence of adolescent abuse.
know the types of adolescent abuse.
be familiar with the common reactions to adolescent abuse.
know the effects of child abuse on adolescents.
view a normal course of adolescent development.
understand the theories of adolescent development in regard to attachment, cognitive development, moral development, physical development, psychosexual development, and personality development.
discover how adolescent development fits into societal demands and development.
distinguish between current versus cumulative abuse in adolescence.
become aware of assessment considerations in working with abused adolescents.
become aware of the role of the family in adolescent abuse.
learn a set of treatment goals that may be useful in working with abuse adolescents.
learn some specific techniques and strategies in working with adolescent abuse.
learn strategies for dealing with denial.
understand the timing of cognitively processing trauma.
learn about structured processing of trauma and the steps to complete it.
learn the advantages of structured processing.
develop an understanding of the general principles of working with abused adolescents.
learn the value of indirect versus direct with with the client.
become aware of the various counseling modalities available for the abused adolescent.
Study Guide Questions
Define the term adolescence and discuss its political and social roots.
Outline at least two major assumptions about adolescents.
List some of the basic needs of adolescence.
What are some of the obstacles or barriers to adolescent development.
Cite some of the major statistics regarding adolescents and abuse.
List and describe six major types of adolescent abuse.
Describe some of the common reactions to adolescent abuse.
Outline some of the effects of childhood abuse on adolescents.
What are some of the milestones of normal adolescents?
What is attachment theory?
Discuss the course of normal cognitive development according to Piaget's theory.
Discuss the influence of Lawrence Kohlberg in understanding the moral development of the individual.
What is meant by adolescent identity formation?
What are the roles of societal demands and social maturity in the course of adolescent development?
Differentiate between current and cumulative abuse.
What is meant by acute abuse?
What is meant by chronic abuse?
What is the overriding goal of working with survivors of childhood abuse?
What role does denial play in working with adolescents that have been abused?
When is it important to process the abuse trauma in adolescents?
When is it important to process the abuse trauma in a structured way?
What is meant by cognitive reassessments?
What role does expansion of self-image and positive identity have with regard to abuse adolescents?
What is meant by an "orientation to personal safety?"
Describe the concepts of improvement, affiliation, and future orientation in regard to adolescent abuse.
What are the elements involved in structured processing of trauma?
List the steps in structured processing.
What are some of the advantages of structured processing of trauma?
Discuss the major principles of working with abuse adolescents.
Describe
the major treatment modalities in working with traumatized and abuse
adolescents.
Course Vocabulary
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child abuse |
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neglect |
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adolescence |
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identity crisis |
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maltreatment |
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medical neglect |
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deprivation of necessities |
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physical abuse |
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psychological maltreatment |
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sexual abuse |
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post traumatic stress disorder |
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attachment |
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cognitive development |
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moral development |
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physical development |
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personality development |
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identity formation |
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current abuse |
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acute abuse |
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cumulative abuse |
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chronic abuse |
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denial |
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cognitive reassessment |
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power struggles |
|
individual therapy |
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group therapy |
|
family therapy |
Supplementary Readings
Treating Adolescent
Survivors of Sexual Abuse
Child sexual abuse; it is not a topic
that makes people comfortable. Discussing child sexual abuse, in fact, remains
taboo even in this era of increasing openness about personal or family
difficulties. While most Americans can understand, although not condone, how
some forms of child abuse occur, it is almost impossible for them to consider
the idea of sexual abuse. This is particularly true when the abuser is a parent
or family member. Sexual abuse fuses those areas in which most people still
experience discomfort: sexuality, power, gender domination, and the horrific
exploitation of an innocent child. Sexual molestation, like so many forms of
abuse, wounds not only its victim: it cuts through families and communities,
destroying trust and the belief that some things simply do not happen in an
enlightened society. And yet they do. Almost 1 million children were identified
as victims of substantiated or indicated abuse or neglect in 1996, according to
the Office of Child Abuse and Neglect (formerly the National Center on Child
Abuse and Neglect), U.S. Department of Health and Human Services (DHHS). About
12 percent of these children were sexually abused. The figures, of course,
include only those incidents of abuse that were reported to, and investigated
by, child protection agencies.
Despite these numbers, the Nation lives
in denial. The results of this country's refusal to confront the sexual
molestation of children are staggering. These include gaps in services to young
survivors, little research into the effects of sexual abuse, inadequate
technical assistance on effective approaches to supporting youth who have been
sexually abused or intervening with their families, and few therapists trained
to provide appropriate services. The limited intervention and support typically
given to youth survivors is compounded by the fact that they must deal with
their trauma in a society that is reluctant to acknowledge that child sexual
abuse even occurs.
Denial is a costly tactic:
| The research shows that victims
often become victimizers. |
| Victims seek comfort in behaviors,
such as alcohol or drug abuse, that have consequences for the larger
community. |
| Severely wounded children sometimes grow up to be violently aggressive adults. |
Moreover, a Nation is judged by how it
cares for its most vulnerable populations, and to ignore the victimization of
children is unacceptable.
Talking About the Unthinkable
Twenty years ago, no one wanted to
admit that men beat their wives. Domestic violence was unthinkable, especially
in affluent neighborhoods. Today, people know that domestic violence occurs in
families across the spectrum of racial groups, and education and income levels.
Society's perception of, and response to, domestic violence was changed by
battered women's advocates who continued to talk about violence in the home,
even when those around them wished they would stop.
Today, that education process must
continue. Violence in the home includes sexual violence. And just as with
domestic violence, the effects are intergenerational. Clearly, preventing the
sexual abuse of future generations by treating the victims of today should be a
priority. A key strategy for doing so is to implement a youth development
approach that ensures services and opportunities for all youth, that builds on
young people's strengths, and that provides support for youth whose
developmental process has been delayed by abuse and neglect. Young people who
have been sexually abused, especially by a trusted adult, suffer damage to
almost every aspect of their personal development: sexual, physical, emotional,
and spiritual.
Child Sexual Abuse: The Impact
on Adolescent Development
Our culture demands that children
mature from an egocentric to a sociocentric focus. They are expected to
participate in school, become involved in the community, and develop
relationships outside their families. This is a challenging process even for the
average young person; living with abuse makes the process incredibly difficult.
During adolescence, youth are growing and changing in a range of ways that are
affected by sexual abuse:
| Physiological change: How tall they
are or how much they weigh becomes a source of concern to young people
during adolescence, particularly as they compare themselves with their
peers. That comparison may produce feelings of anxiety or contribute to
dampening their self-esteem. For youth who have experienced abuse or
criticism by their parents, teasing about their looks may reinforce their
perception that they are not valued. |
| Emotional development: Young people
in abusive situations must redirect their energy from emotional development
to survival. When they are forced to focus on avoiding the violent or sexual
advances of an adult caretaker, they do not make the same developmental
progress as children who receive unconditional love, support, and guidance. |
| Cognitive change: Young people
develop their cognitive thinking ability, which means that they will
reexperience and reframe abuse that occurred to them earlier, particularly
if it began when they were young. |
| Moral and spiritual development:
During adolescence, youth begin to question the meaning of life and
specifically to think about the larger world, the role they play in it, and
the options and opportunities available to them. |
| Sexual development: For some young people, it is during adolescence that the real consequences of being sexually abused occur. When a child of 3 or 4 years of age is sexually abused, it is not a sexual event in the way adults may think. It is physically hurtful, confusing, and alarming, but they do not have a context for defining the abuse. When those children turn 12 or 13, they cognitively reassess the abuse as they begin to learn about or experience sexual feelings. |
While all young people's development is
affected by both internal and external factors, each youth experiences growing
up differently. For youth who are abused, however, that process is negatively
affected, resulting in certain reactions or behaviors.
The Abused Adolescent
While there is no clear profile of a
sexually abused child, the research indicates that there are symptoms that
present frequently in young survivors. These include the following:
| Anxiety/numbing: Young people who
have been sexually abused often exhibit the polarity of anxiety/numbing
behaviors. These youth are hypervigilant, scanning the environment for
threats to their safety; conversely they have learned to shut down their
feelings.
The chronicity of the abuse plays a
part in the level of anxiety experienced by child victims. Youth who have
been assaulted through most of their developmental phases have learned to
maintain a defensive posture to protect themselves. They have learned the
most debilitating lesson of child abuse: people who love you hurt you. For
these children, the expression of caring is presumed to be followed by harm
or danger. At the end of 4 months of therapy,
6-year-old "Katie," for example, brought a paddle to her
therapist. When the therapist asked about the paddle, Katie said, "It
is for you to hit me with." When the therapist asked why Katie thought
she wanted to hit her, the child replied, "Well you like me, don't
you?" The sad reality is that children seek out behaviors with which they are familiar. In some instances, children do so to master or take control of situations, thereby reducing their anxiety about what might happen next. |
| Hypersensitivity: Young people
growing up in violent or abusive environments tend to be hypersensitive to
their surroundings. They flinch at sudden noises and are hyperaroused or
overstimulated easily. They may experience acute fear in some situations and
typically "stay on alert," which requires energy and takes a
tremendous toll on their physical and mental well-being. They tend to carry
a lot of tension in their bodies, so they may not move as fluidly as other
children. Many of these youth present somatic concerns, such as always
having headaches or stomach pains. Again, the chronicity of the abuse is an important factor in the degree to which young people develop hypersensitivity. If the abuse is an isolated incident, the child is better able to regroup. When the assault is frequent or long term, the child does not have respite to reorganize or stabilize and must develop highly refined defense mechanisms. |
| Depression: Even the youngest
children who have been abused exhibit characteristics of depression. They
may have a flat affect, not make eye contact, or not laugh. There are many
manifestations of depression, including self-mutilation, substance abuse,
and eating or sleeping disorders.
The foster parents of a 9-year-old
boy reported that he would cut himself and watch the blood run down his arm.
A therapist asked what he said to himself when he watched the blood, and the
youth replied, "It's red." She asked what he expected to see, and
he replied, "guck." Through further questioning, the therapist
learned that the boy expected guck to come out of his arm like the bionic
man on television. This boy thought of himself as a robot, which is a strong defense mechanism against being hurt. When he saw the blood, he actually felt better because he could say, "I'm a real human being." For the next 3 weeks, he would be more interactive, responsive, and happy because he had verified his own existence. |
| Alcohol or drug use: While some
young people may experiment with drugs or alcohol as a rite of passage,
youth who were or are abused use substances to numb their feelings. The alcoholism of one 6-year-old
child was discovered when her preschool reported unusual behaviors to her
foster family. The child was given a medical examination, through which the
doctors determined that she had been sexually abused. She was referred to a therapist who
used play therapy. The child would pick the play therapy rag doll up and
roll its head back and forth, put one foot in front of the other, as if the
doll were walking, and then make it fall. She repeated the sequence 14
times. After watching this behavior, the therapist wondered if the child was acting out the behavior of someone who had been drinking. The therapist brought in a small bottle of liquor, the type you get on an airplane, and waved the open bottle under the child's nose, asking if she had ever smelled the odor before. The child grabbed the bottle and tried to drink its contents. Through further questioning, the therapist learned that the child kept a bottle of vodka she had smuggled from her home to the foster residence inside the zipper pouch of a stuffed animal. It turned out that the child's father had given her alcohol in a bottle so that she would relax and go to sleep while he sexually molested her. The child learned that when she drank, she could go to sleep and have the experience of not being "present" while the abuse occurred. |
| Problem sexual behaviors: Children
who were sexually abused may become involved in sexual acting-out behaviors,
particularly when they reach adolescence, a time of increasing biological
urges and exposure to sexual education. Under normal conditions, sexual
behavior develops gradually over time, with youth showing curiosity and then
experimenting with themselves and others. When children are sexually abused,
however, they are prematurely exposed to material they do not understand and
cannot make sense of. Moreover, children become
conditioned to respond to certain things. In many instances, adults who
interact sexually with children may reward them before or after the event.
The children are conditioned to believe that if they engage in certain
behaviors they will be rewarded. This is pure learning theory: children
repeat acts for which they receive positive reinforcement. A judge who was doubting the sexual
abuse of a 3-year-old child called everyone into his chambers and hoisted
the young girl on his lap so that he could interview her. The moment he
placed her on his lap, she reached under his robe and began fondling his
genitals. She clearly had been conditioned to believe that when a man sits
her on his lap, he expects this type of behavior. The judge quickly reversed
his opinion and went forward with the case of sexual abuse. Some children who were sexually abused also may become sexually provocative, dressing and talking in a manner that puts them at risk of further sexual exploitation. Others merge sexual behavior and aggression and become the victimizers of other children. |
| Aggression: Eventually, most abused
children get angry and some begin to act aggressively, typically with
smaller children. This is the victim-victimizer dynamic; abused children
learn that the bigger, stronger person hurts or takes advantage of the
smaller, weaker person. Youth who have been victimized are conditioned to
believe that when two people interact, one of them will be hurt. At each
interaction with others, they may wonder who will be hurt this time. Some
children adopt the victim role; others become the victimizers. In either
case, they simply are playing out the roles that they have been conditioned
to believe people play during interactions with others. The research would indicate that boys tend to adopt the role of aggressor more often than girls. They have a harder time tolerating the role of victim, which is in stark contrast to the cultural definition of masculinity. Girls tend to adopt the role of victim more often, which could be linked to the traditional social view of women as the weaker gender. Yet neither pattern holds true in all cases. Some boys take on the victim role; some girls become aggressive. |
Obviously, these behaviors and
reactions are learned. Young people who have survived sexual abuse can just as
easily learn more positive behaviors if communities choose to provide them with
appropriate interventions and support. They need support in both working through
the trauma and addressing the developmental stages they may have missed because
of the abuse. This includes the critical step of developing an identity separate
from their family or caretaker.
Identity Formation in
Adolescence
Forming an identity is a major
developmental issue during adolescence. This process of individuation, however,
is one that begins when children are very young and crystallizes in adolescence.
For positive identity formation to occur in any human being, some basic things
have to be attained, including the following:
| Expressions of love: Children have
to feel that somebody cares about them. |
| Feelings of significance: Children
must feel that they are significant or important to someone. |
| A sense of virtue: Children must
have a belief in their innate, inner goodness. |
| A sense of belonging: Children must
feel connected to a family that provides them with a sense of stable
belonging. |
| Mastery and control: Children must experience feelings of mastery and personal power and control. |
All of these variables are severely
compromised by child abuse and neglect. Abused children's sense of self and
their future has been badly damaged. They may have learned that negative
attention is better than no attention, and they act accordingly. Unfortunately,
their behaviors, which result directly from the abuse, often lead significant
people in their lives to react in ways that reinforce this negative self-image.
This further damages young people's sense of virtue and feeling of being loved.
To deal with these overwhelmingly
negative feelings, some children develop an affect disorder, which results from
a person compartmentalizing information about an abusive event separately from
their feelings. They will describe an abusive event in great detail without
emotion, as if it were happening to someone else. This dissociation is a defense
mechanism that helps people block reality, especially when it is painful.
Children who are being sexually abused use dissociation to separate from their
own experiences. They talk about floating above their bodies or sitting on top
of a lamp watching what happened.
This process enables a young person not
to feel the pain associated with actually being present during the abusive
event. Unfortunately, dissociation also creates a problem with a child's sense
of identity and interrupts their sense of being anchored in reality.
Children who have an identity problem
or no sense of who they are may, for example, develop an insecure attachment
disorder. Therapists experience this with young people who ask to see them every
day or to come live with them. These young people do not feel real unless they
are in another person's presence. Or they fear that the person they are with now
will go away and not come back, leading to feelings of abandonment and despair.
When children are not allowed to
develop an identity, they may appear as if they are presenting a "false
self." These youth simply may not have a good sense of self to present to
the world. When with other groups of people, especially other youth with strong
personalities, abused children may easily retreat into themselves or mimic those
they are around. Helping young people go back through the developmental stages
and rebuild a sense of self is critical to their overall emotional well-being.
Treating the Sexually Abused
Adolescent
Therapists have identified three stages
to working with survivors of childhood abuse: (1) establishing the young
person's safety, both in their home situation and with the therapist; (2)
processing traumatic material; and (3) fostering social reconnection.
One of a therapist's most important
tasks is to ensure that a child is living in a safe environment with a central,
supportive, caring adult. Often, young people who have been abused or neglected
experience incredible mobility in their lives as they move from one placement to
the next. These youth begin to doubt that any adult will be with them for very
long. A sense of security and safety in one place, therefore, is very important
to the therapeutic process.
Once the child is in a safe
environment, the therapist can begin to develop a relationship with the child.
Through that relationship, the therapist can begin to help the child understand
why it is important to process what happened to them. Most abused adolescents
want a sense of control over their lives. Therapists can show youth how, by
working through their earlier experience, they can eliminate some of their
negative feelings and the resulting behaviors. Through that process, youth can
develop a sense of control over their behavior.
When a young person is ready, the
therapist can help them begin affiliating with others and developing the ability
to trust and have relationships with other people, both adults and peers. Often
at this stage, a therapist will place a youth in group therapy.
Time and consistency of care are key
factors in all three stages of therapy, but especially in stage 1. By the time
an adolescent receives the help they deserve, they may have been sexually or
otherwise abused over a period of time. They have built up an array of defenses
to protect themselves, and making contact with them may be difficult. To
establish the trust of an abused child, a therapist needs to build a
relationship with that child, which takes time. Therapists need that time to
demonstrate that they are trustworthy, by action as well as words.
In some communities, the new managed
care systems are threatening this process by covering the costs of only
short-term therapy. The trust of a severely abused child simply cannot be
established in six to eight sessions. Under those circumstances, experts caution
that therapists should work only on phase 1, or the establishment of the child's
safety. It is inappropriate to encourage a child to talk about traumatic abuse
if that child is not in a position to receive ongoing therapeutic support.
In such situations, a therapist must
simply advocate for children's safe placement and help them to develop coping
strategies, teach them about available resources, and suggest behavioral
alternatives that may positively affect their interactions with others. A
therapist also might help children understand that their behavioral problems may
be related to something they learned or experienced a long time ago.
General Principles for Working
With Youth Who Have Been Sexually Abused
Helping youth explore past abuse is
specialized work, requiring significant education, training, and expertise. The
following key principles provide guidance for those working with youth who have
been sexually abused:
| Remain neutral in your early
interactions with abused children: When some youth sense that a therapist or
other professional is paying attention to or trying to help them, they may
withdraw because the circumstances feel risky to them. The very nature of
counseling or therapy, which involves personal contact with another human
being and focused, positive attention, can produce stress and anxiety for
children who have been sexually abused. Youth who have been sexually abused
also may associate nice behavior with seduction. In the past, people were
nice to them when they wanted something. They may wonder what therapists or
other adults expect from them in return for their help. |
| Assist youth in understanding that
they are not to blame: Typically, left to their own resources, children make
incorrect assumptions about why they were abused or neglected. When 100
youth in San Francisco were asked why they were in the foster care system,
98 of them said, "Because I am bad." And young people's behavior
often reflects how they feel about themselves. If they think they are bad,
they may act in ways that perpetuate that image. |
| Be nonjudgmental: Youth do not
respond well to adults who want to tell them what to do or who are
constantly critical. |
| Catch youth doing something good:
Focus on telling young people what they are doing that is good. When they
make a thoughtful decision and stick to it, for example, congratulate them
on following through. |
| Help them view their feelings
without judgment: Feelings are not good or bad, they are just feelings. Help
young people understand that it is all right to feel angry, and help them to
learn to express their anger in ways that are healthy for themselves and
others. |
| Think of your interactions with
youth as "invitations" for them to do or say as much or as little
as they choose: Youth need to learn to make choices about how they will
participate, or not, in different situations. Offering youth options gives
them a chance to practice making choices in a safe environment. If a young
person does not complete an assignment, for example, consider talking with
him or her about what the assignment might have looked like if they had
finished it. Or, discuss what might have been the biggest problem in
completing the task. Through this process, you might accomplish more than if
you focus on the young person's failure to complete the task. |
| Avoid power struggles with young
people: It generally is nonproductive to spend time arguing a point with an
adolescent. Move on to other discussions that might prove more useful. Keep
in mind that if a young person is feeling defensive, they are not feeling
safe. |
| Remember that abused adolescents
have a reason to be defensive: If you are hit enough, emotionally or
physically, you learn to stand ready to protect yourself or even to ward off
attacks by attacking first. Young people who have been abused need time and
a trusted relationship to feel safe. |
| Understand how easy it is for abused
children to be further victimized: Without question, once abused, children
become more vulnerable to further victimization. It is not just the abuse
that leaves them exposed to exploitation; it is the concomitant loss of
love, nurturing, and feelings of being safe and valued. Often adult
predators provide, at least at first, the very things missing from an abused
child's history: time, attention, caring, and a sense of belonging. |
| Be aware that some behaviors provide
youth with a sense of control: When children are treated well, nurtured,
loved, and accepted, they learn to expect that treatment from others. When
children are abused, they similarly expect others will abuse them. These
children may engage in aggressive behavior as a defense mechanism; their
behavior is a means of taking control of a situation they anticipate will
occur anyway. When you work with youth to stop behaviors that place them at
risk, it is important to be aware that those behaviors may be the only
current means they have for mastery and control. |
| Help educate others that young people are never responsible for their abuse: Often, people suggest that adolescents should have told someone or fought back. The expectation is that adolescents should be able to protect themselves. It is important to remember that many young people have long histories of abuse, which makes them vulnerable; they are not "normal" (nonabused) adolescents suddenly confronted with dangerous circumstances. Moreover, it is critical to remember that children are relating to their parents, the people they love and need most in the world. When asked, "Who is bad, you or your Mom and Dad?" children will always choose themselves. Children need to protect the idealized image of their parents; those are the people they long for. |
Working with youth who have been
sexually abused obviously requires special skills and expertise. For that
reason, most youth agencies develop strong working relationships with therapists
who are experienced in working with youth who have been sexually abused. In
selecting a therapist, youth agencies should look for well-trained professionals
who understand and apply the above-mentioned principles. They also should look
for therapists who do the following:
| Use therapeutic approaches other
than talk therapy: Direct talk therapy generally is not the most effective
approach with adolescents. Well-trained therapists will use art or play
therapy in working with abused youth. They also might discuss news clippings
or watch a video and let youth comment on another young person's situation.
It may be easier for youth to talk about another person as a means of
sharing how they feel. Moreover, helping young people develop empathy for
others often can be the first step in developing self-empathy. |
| Help youth change behaviors that
cause negative reactions in others: Therapists examine a child's behavior,
describe it, and then try to determine why the child is acting in this
manner. A 12-year-old girl, for example, who threw temper tantrums explained
that she felt quiet inside when the tantrum was over. She said she felt calm
because "everything inside had come out." This child had been
beaten whenever she showed any emotion, so she had learned to keep her
feelings bottled up inside. Every now and then, however, she had to let those feelings go. Until she entered therapy, the child had never been taught how to live with and manage real feelings; the result was tension, control, and then loss of control. Her therapist worked with her, using a tea kettle as a metaphor. They jointly developed a plan for the young woman to begin to let her "steam" out in ways that would not cause concern among the people around her or allow the kettle to "blow its lid." Through the process, the young girl learned affect tolerance: the ability to feel, absorb, and express her feelings appropriately. |
| Appreciate that children sustain
injuries differently: Some young people are more resilient than others. A
therapist needs to assess how well the young person has survived the abuse,
what they think about themselves, and how they manage to reach out to
others. Through this process, it is important to help the youth build a
history of accomplishment by emphasizing the young person's strengths and
successes. |
| Help youth process traumatic
material: Young people need support to deal with what happened to them,
discharge their feelings, and develop a sense of mastery about that process.
Unless this happens, images similar to those associated with the abusive
event may trigger a posttraumatic stress reaction. A youth may blow up or go
into trancelike behavior for no apparent reason. This is an indication that
they have unresolved traumatic material and they need help in processing
that material in a structured way that creates feelings of empowerment. |
| Work with youth to assimilate the
information and feelings associated with their prior abuse: By processing
traumatic material, therapists can help youth talk about the event and feel
the associated feelings at the same time. |
| Recognize that while abuse and
neglect have the potential to be traumatic, not every abused child is
traumatized: Traumatized children are a subset of abused children. Factors
that distinguish the two groups tend to include the child's relationship to
the abuser, age at the onset of abuse, and biology, and the chronicity and
severity of the abuse. All abused children are hurt and exploited, but,
depending on a broad set of variables, some children continue to live in the
climate of the trauma. |
| Help youth learn how to manage their
feelings in settings in which it would not be appropriate to act upon them:
Some youth need to learn affect regulation, which is the ability to control
feelings in certain situations. Adults, for example, who had a fight with a
spouse prior to making a presentation at work are able to refocus
themselves. They are able to control the feelings they are experiencing as a
result of the fight while they make the presentation. |
| Work with youth to develop impulse
control: Children growing up with abusive parents did not have impulse
control modeled for them. Many abusive parents think and act at the same
time; when they are angry, they strike their children. Nonabusive parents
also get angry at their children; they simply have the impulse control not
to act on every thought. Children who grew up with abusive parents may need
to learn that thoughts and action can be distant on the time spectrum. They
need help in determining how to go through a series of steps to make
decisions about what they will do in response to their thoughts. |
| Accept that all children are different: Some children act out in ways that continue the climate of trauma through behavioral reenactments that keep the victim dynamic present in their life. Others want to talk constantly about the abuse and will do so even with strangers. Still other youth refuse to talk about the abuse; they say it is over and they do not want to deal with it. A good therapist will develop a plan for working with a young person on the basis of that child's behavior, presenting problems, personality, and coping style. |
Selecting a Therapist
Selecting and developing a relationship
with a therapist to whom to refer young survivors is a critical job for youth
service agency staff. The following steps can help youth agency staff choose the
right therapist for youth who have been sexually abused:
| Talk with referral sources,
especially law enforcement or child protective services personnel, to find
out about local therapists, their approach to working with youth, and their
track record in helping young people who have been abused. |
| Check with other youth agencies who
have worked with therapists. |
| Call the American Professional
Society on the Abuse of Children for referral to the organization's local
chapter, which can identify therapists in your area. |
| Ask for referrals from the local
chapter of an association of mental health professionals (for example, the
American Psychiatric Association or the American Psychological Association). |
| Interview the therapist, asking the
following questions:
|
Once youth agencies have narrowed the
field of candidate therapists through the initial screening and interview
process, administrators might invite the top candidates to conduct a
presentation to agency staff on working with abused children. They can use the
time to observe the therapist's knowledge, style, and willingness to discuss
issues and/or differences of opinion with agency staff.
For more information on working with
young survivors of sexual abuse, please refer to the reading list.
Reading
List on Adolescent Sexual Abuse
Adolescent Art Therapy. Author:
D.G. Linesch. 1988. Available from Brunner/Mazel, Inc., 19 Union Square West,
New York, NY 10003; (800) 825-3089; fax (212) 242-6339.
Child Sexual Abuse:
Intervention and Treatment Issues. Author: K.C. Faller. 1993. Available
from the National Clearinghouse on Child Abuse and Neglect Information, P.O. Box
1182, Washington, D.C. 20013; (800) 394-3366; fax (703) 385-3206.
Child Sexual Abuse: Selected
Projects. (Report.) Authors: E. Hollenberg and C. Ragan. 1991.
Available from the National Clearinghouse on Child Abuse and Neglect
Information, P.O. Box 1182, Washington, D.C. 20013; (800) 394-3366; fax (703)
385-3206.
Developmentally Based
Psychotherapy. Author: S. Greenspan. 1997. Available from Jason Aronson
Publishers, 230 Livingston Street, Northvale, NJ 07647; (201) 767-4093; fax
(201) 767-4330.
The Evolving Self. Author:
R. Kegan. 1982. Available from the Harvard University Press, 79 Garden Street,
Cambridge, MA 02138; (617) 495-2600.
The Future of Children: Sexual
Abuse of Children. Author: Center for the Future of Children. 1994.
Available from the Center for the Future of Children, 300 Second Street, Suite
102, Los Angeles, CA 94022; (415) 948-3696.
Handbook of Child and
Adolescent Sexual Problems. Editor: G.A. Rekers. 1995. Available from
Lexington Books, Macmillan, Inc., 866 Third Avenue, New York, NY 10022; (212)
702-2000.
How Long Does It Hurt? Authors:
C.L. Mather and K. Debye. 1994. Available from Jossey-Bass, Inc., Publishers,
350 Sansome Street, San Francisco, CA 92104; (415) 433-1740.
A Judicial Primer on Child
Sexual Abuse. Editors: J. Bulkley and C. Sandt. 1994. Available from
the American Bar Association Center on Children and the Law, 1800 M Street,
N.W., Washington, D.C. 20036; (202) 331-2670; fax (202) 331-2225.
The Me Nobody Knows: A Guide
for Teen Survivors. Authors: B. Bean and S. Bennett. 1993. Available
from Lexington Books, Macmillan, Inc., 866 Third Avenue, New York, NY 10022;
(212) 702-2000.
Psychotherapy With Sexually
Abused Boys: An Integrated Approach. Author: W.N. Friedrich. 1995.
Available from Sage Publications, Inc., 2455 Teller Road, Thousand Oaks, CA
91320; (805) 499-0721; E-mail: <order@sagepub.com>.
Responding to Sexual Abuse of
Children with Disabilities: Prevention, Investigation and Treatment. Authors:
J.J. Plucker, K. S. Keeney, and J.F. Atallo. 1993. Available from the National
Clearinghouse on Child Abuse and Neglect Information, P.O. Box 1182, Washington,
D.C. 20013; (800) 394-3366; fax (703) 385-3206.
Switching Channels: A
Cognitive-Behavioral Workbook for Adolescents. Authors: R.D. Friedburg,
C. Mason, and M.D. Fidaleo. 1992. Available from Psychological Assessment
Resources Inc., P.O. Box 998, Odessa, FL 33556; (800) 331-TEST; fax (800)
737-9329.
Trauma and Recovery. Author:
J. Herman. 1992. Available from Basic Books, 105 East 53rd Street, New York, NY
10022; (212) 207-7574.
Treating Abused Adolescents. Author:
E. Gil. 1997. Available from Guilford Publications, Inc., 72 Spring Street, 4th
Floor, New York, NY 10012; (800) 365-7006.
Treating Victims of Child
Sexual Abuse. Editor: J. Briere. 1992. Available from Jossey-Bass,
Inc., Publishers, 350 Sansome Street, San Francisco, CA 94104; (415) 433-1740.
The Victimization of Children:
A Developmental Perspective. Author: D. Finkelhor. 1995. In American
Journal of Orthopsychiatry, Vol. 65, No. 2: pp. 177-193.
The Exchange is produced by Johnson, Bassin & Shaw, Inc., under a contract to manage the National Clearinghouse on Families & Youth (NCFY). NCFY is the Family and Youth Services Bureau's (FYSB's) central resource on youth and family issues. For more information, please call or write:
National Clearinghouse
on Families & Youth
P.O. Box 13505
Silver Spring, MD 20911-3505
(301) 608-8098
Fax: (301) 608-8721
================================================================================================
Just the Facts: Sexual Abuse and the Chemically DependentWhat is Incest?
Incest is defined as sexual activity between blood relatives. Incest violates the child's trust in parents and other family members. Because most children are taught from an early age that the family provides love, trust and security, incest is devastating.
What is Sexual Abuse?
Sexual activity between a child and anyone outside of the family constitutes sexual abuse. Children today are often socialized to believe that strangers cannot be trusted; sexual abuse confirms this belief. As a result of the sexual abuse, children often become suspicious and believe that all strangers want to coerce them into sexual activities.
Understanding Incest and Sexual Abuse
Both sexual abuse and incest are traumatic. Incest and sexual abuse can be overt or covert. Overt abuse involves physical contact for sexual purposes. This includes invasive touching of sexual body parts, oral and anal sexual activity, and sexual intercourse. Covert incest and sexual abuse involves seemingly accidental touching, comments that have sexual connotations, and exposure to sexual activity or pornography.
Signs of covert abuse include rigid rules concerning the types of clothing that may be worn by family members and discouraging association with people outside the family.
Incidence of Abuse
One of every three girls and 1 of every 10 boys are victims of incest and/or sexual abuse. Incest and sexual abuse are more prevalent among chemically dependent adolescents. The incidence of incest and sexual abuse among adolescents who are in chemical-dependency treatment is estimated to be two to three times higher than for adolescents in general.
Alcohol and other drug use by parents and other adult caretakers is common in homes where incest and sexual abuse occur. As many as three to four million children may be victims of incest living in alcoholic homes.
A Violation of Boundaries
Incest and sexual abuse violate a person's physical, emotional and sexual boundaries. A boundary in this sense is the point at which a one feels comfortable with physical contact, emotional closeness or sexual contact.
PHYSICAL BOUNDARIES
Violations of physical boundaries make children feel that the control of their bodies is in the hands of the abuser. They feel they have no control over their own bodies. Sexually abused children often lack the ability to identify themselves as individuals who are separate from their abusers.
EMOTIONAL BOUNDARIES
Emotional boundary violations occur when abusers seek out children to fulfill emotional needs that have not been fulfilled in their adult relationships. Victims of sexual abuse are taught by their abusers what they should feel and how they should think. Sexually abused children block out their own emotions and are unable to think and feel at a normal developmental level.
SEXUAL BOUNDARIES
Sexual boundary violations create confusion for children. Despite the fact that the experience may be frightening or painful, the sexual contact may also create pleasurable feelings for the child. Children whose physical contact, behavior, and communication needs are met through sexual activity may have a hard time distinguishing between appropriate and inappropriate ways of fulfilling these needs.
Characteristics of the Affected Family
Incest and sexual abuse are multigenerational problems. Often, perpetrators are victims of abuse themselves. Families affected by incest and sexual abuse often exhibit problems with boundaries and communication. Families may be enmeshed to the point that expressions of emotional and sexual needs are inappropriately transferred from the adult to the child.
Abusive families often cut themselves off from the outside world as much as possible to prevent discovery of their inappropriate sexual activity. Frequently a parent or other adult caretaker is absent from the home or otherwise unavailable when the sexual abuse takes place. Even when other family members are abused or know of the abuse, they rarely communicate among themselves or with people outside the family for fear of the trouble disclosure may cause. Abusers may give gifts or use threats and violence to prevent the children from telling about the abuse; others may tell the abused child that he/she won't be believed if he/she tells.
MALE ABUSERS
Fathers and other adult male caretakers are the most frequent perpetrators of sexual abuse. Father-daughter incest is the most prevalent. Abusive fathers or male caretakers are often domineering figures in the family, controlling much of what family members say or do. Wives and other female caretakers often dependent on the abusing male because they lack education, jobs, friends or relatives are more likely to side with the spouse or boyfriend and blame the child. They are also more likely to ignore the occurrence of the abuse if they have a close relationship with the adult male or if they feel that they or their children are in danger of physical violence.
Male abusers cite problems in their adult relationships as the reason for engaging in sexual activities with a child. Some men turn to children for fulfillment of their sexual needs when extended illness or sexual dysfunction affects their mate's ability to provide affection or sexual gratification. In some cases the female partner may know about the abuse but choose to ignore it to keep the family together.
FEMALE ABUSERS
Women engage in incest and sexual abuse less frequently than men. Society often labels sexual activity perpetrated by women as affectionate or appropriate. As primary caretakers, women generally have greater physical contact because they bathe and diaper young children. Women who engage in sexual activity with young boys are seen as seductive; a man is likely to be labeled a molester by society.
Effects of Sexual Abuse
Incest and sexual abuse are extremely disruptive to the development of a child. The effects of abuse are more severe when the child is victimized at an early age. The child who is not old enough to understand that sexual abuse is wrong becomes vulnerable to sexual exploitation by others later in life.
Sexually abused adolescents often suffer from low self-esteem. The sexual abuse has led them to believe that they are not worthy individuals. They frequently have feelings of disgust toward themselves and their bodies.
FEMALE VICTIMS
Female victims of incest and sexual abuse are likely to blame themselves for the abuse and question their own behaviors. Females are more likely than males to feel guilty about the abuse and to feel powerless. Adolescent girls often experience problems in interpersonal relationships and have a fear of intimacy. They may become emotionally withdrawn. They are also more likely to engage in prostitution and other promiscuous activities.
MALE VICTIMS
Adolescent boys sexually abused by men may struggle with the issue of homosexuality <~>or have difficulty determining their sexual preference. Because of the stigma associated with homosexuality the adolescent male is usually hesitant to report the abuse. Most adolescent males are socialized to keep their feelings and problems to themselves. This contributes to the under-reporting of sexual abuse in this population. Society fosters the belief that males are invulnerable and therefore must be willing participants in abusive sexual activities. The pleasurable feelings that may accompany the abuse cause confusion in the adolescent.
Adolescent boys are likely to identify with the aggressive aspects of their abuse and may either seek out similar sexual relationships or avoid intimate relationships altogether. Abused adolescent males may fear sexual activity or may feel that all sexual activity should be abusive.
Chemical Dependence and Sexual Abuse
Adolescent victims of incest and sexual abuse often turn to alcohol and other drugs as a means of dealing with their traumatic experiences. Sexually abused adolescents are more likely to use sedatives, stimulants and hallucinogens. They are also more likely to begin using alcohol and other drugs at an earlier age. The longer the duration of abuse and the more frequently it has occurred, the greater the need for alcohol and other drugs.
Signs of Sexual Abuse
Sexually abused adolescents often shy away from physical contact and touching because they fear that touching will lead to sexual activity. Sexual promiscuity is another sign of sexual abuse or incest. Abused adolescents often engage in sexual activities with numerous partners or exhibit bizarre sexual behaviors. Abused adolescents may also sexually abuse other children.
Personality problems can be signs of abuse. The adolescent may have excessive mood swings and may appear anxious or depressed. Sexually abused adolescents are often distrustful of others and may exhibit paranoid behavior or hide weapons for protection
Sexually abused adolescents may use various coping methods to deal with abuse. Substance abuse, bulimia or chronic illness may be symptomatic of an adolescent who is trying to suppress feelings related to abuse and to deal with the physical changes, sexuality and relationships with peers and family that are characteristic of adolescence. The invasion of sexual boundaries causes the adolescent to repress overwhelming feelings and emotions surrounding the abuse, which has been termed post-traumatic stress disorder (PTSD). This disorder may be characterized by sleep disturbances, flashbacks, depression or inappropriate expressions of anger. Severe post-traumatic stress disorder may require extensive therapeutic services.
Other signs of sexual abuse or incest
include:
| Sexually acting out |
| Compulsive eating or dieting |
| Suicide attempts |
| Nightmares related to abusive situations |
| Self-punishment or destructive behaviors |
| Fear of intimacy or closeness to others |
| Physiological problems (gynecological, abdominal, etc.) |
| Excessive anger or physical outbursts |
| Perfectionism |
Intervention
Incest and sexual abuse are forms of child abuse. Counselors have a legal responsibility to report the abuse to the appropriate authorities. Adolescents often feel responsible for the stress incurred by the family following disclosure; they may become angry and feel betrayed by the reporting counselor. They may alter the facts of the abuse or deny that it occurred in an attempt to protect parents, caretakers and other family members.
Counselors must work to regain the adolescent's trust and begin to work on issues related to the abuse. The adolescent needs to gain an understanding of the sexual abuse and learn to express feelings about the abuse, the abuser and other family members. Exploring feelings related to the abuse may help the abused adolescent determine the underlying causes of alcohol and other drug use or other self-defeating behaviors.
Beginning Treatment
The adolescent must deal with his/her chemical dependency before dealing with sexual abuse issues. If the chemical dependency is not sufficiently under control, the adolescent may return to abusing alcohol and other drugs; this may facilitate further sexual abuse.
Most chemically dependent adolescents affected by sexual abuse or incest can be treated effectively within the chemical dependency treatment setting. Clinicians must be familiar with the signs of sexual abuse or incest in chemically dependent adolescents and the implications for intervention and treatment. An adolescent in treatment may give out only small bits of information on his/her sexual history to test the comfort level. More personal information is gradually disclosed. Talking about the abuse usually makes adolescents feel uncomfortable; they will often become disruptive, violent or withdrawn following disclosure of information.
Factors Influencing Adolescent-Specific Treatment
Counselors must be aware of any personal biases or areas in their own lives that may create difficulties in treating sexually abused adolescents. It may be uncomfortable to discuss sexual issues with a client, especially one of the opposite sex. Counselors who have experienced abuse in their own lives may find that treating adolescents for similar abuse can be difficult. Counselors can become so involved in issues related to their own abuse that they lose focus on treating the adolescent as a different situation.
Adolescents must be sober for a while before the treatment of problems related to sexual abuse begins. It is important for counselors to set firm boundaries with the adolescents. Therapy sessions, homework assignments and other activities should adhere to scheduled time allotments. Extending deadlines or therapy sessions breaks down the structure that the adolescent needs in his/her life. Adolescents should be encouraged to discuss thoughts and feelings related to their abuse. They should not be pressured into disclosing information in group settings. The counselor must provide the adolescent with a secure environment to help him/her feel as comfortable as possible when discussing the abuse and other related problems.
Dealing with Shame
Shame is the strongest emotion that a sexually abused adolescent experiences. Feelings of shame are intensified by disclosure of the abuse and by the subsequent problems encountered. The abused child must come to understand that the abuse was not his/her fault and that through disclosure of the abuse, the entire family can eventually learn to function in healthy ways. Pregnancy resulting from sexual abuse and incest is very damaging and requires more extensive therapeutic efforts to resolve problems and issues further complicated by the pregnancy.
Chemical dependency counselors can help the adolescent develop a sense of worth and the ability to interact appropriately with others. Counselors can help adolescents develop a means of coping with the abuse and redefining reality. This helps the adolescent view the abuse as separate from him/herself and to develop a sense of identity and individuality.
Within the context of the family, counselors should work on building problem-solving skills to help family members communicate effectively and establish appropriate boundaries and roles. Involving the abuser in family therapy is not recommended unless the abuser has admitted the problem and is not a threat to the child or other family members. Parents or other adult caretakers should be encouraged to attend counseling to resolve problems in their relationships.
Conclusion
Most chemically dependent adolescents affected by sexual abuse or incest can be effectively treated within the chemical dependency treatment setting. It is important that counselors have a sufficient understanding of the signs and symptoms of sexual abuse and the implications for intervention and treatment.
Recovery from incest and sexual abuse is a lifelong process. Aftercare services for abused adolescents are often a necessity. Counselors should establish appropriate networking and referral sources for adolescents following the completion of chemical dependency treatment.
Funded through the Governor's Drug-Free Communities Program, Title V funding from the Drug-Free Schools and Communities Act of 1986.
Primary And Secondary Prevention
Mental health professionals may be involved in primary and secondary prevention depending on their interests and expertise. Primary prevention is directed toward preventing a problem from ever occurring. Broad-based public awareness, media campaigns, and school-based prevention programs are examples of effective means of educating the public about health and social concerns. Secondary prevention is targeted at a specific high-risk subpopulation or group. Examples include home visitor programs for mothers of newborns identified at the hospital as being "at risk."
Tertiary Intervention
The primary focus of mental health professionals' training is tertiary intervention through the provision of therapeutic services to clients with a psychological problem that impairs their day-to-day functioning and relationships with others. In the field of child abuse and neglect, this involves working with both child victims and parents who abuse or neglect their children. Therapeutic interventions with children are directed toward preventing the harmful effects of child maltreatment. Therapeutic interventions with abusive parents are directed toward preventing recidivism through education, developing problem-solving skills, providing cognitive and behaviorally oriented counseling to prevent maltreatment, helping parents identify when they are at risk of abusing or neglecting their children, and teaching parents how to obtain support and resources to prevent abuse and neglect. The following roles briefly describe the activities in which clinicians are involved as a result of providing tertiary intervention or therapeutic intervention with clients.
Evaluation And Treatment
The primary role of mental health professionals in cases of child abuse and neglect is evaluation and treatment of children, nonoffending parents, abusive or neglecting parents, and/or the family as a unit. Mental health professionals often specialize by working either with children, adolescents, or adults and by working with victims or offenders. Professionals with expertise in working with adults typically limit their practice to adults. Child and adolescent therapists, however, must also be knowledgeable about how to work with parents and families.
Treatment begins by developing a therapeutic relationship, evaluating the overall functioning of the client, and planning treatment goals and intervention strategies based on the initial and ongoing assessment of client needs. Services for children and their families may be limited to crisis intervention and referral, brief therapy (10 to 12 weeks), or long-term therapy. Treatment modalities vary and may include individual and group therapy for children and parents, family therapy, and marital therapy. Group therapy may include victims grouped by type of victimization, age, gender, or sibling group; or parents grouped by their role as offending or nonoffending adults.
The frequency and length of treatment are often determined by financial considerations such as health insurance, grant or contract funding for the treatment program, or whether the client is eligible for participation in the State's Victims of Crime Program. Every State has a Victims of Crime Program under which crime victims' expenses for medical and psychological services can be reimbursed by applying to the program and meeting eligibility criteria. (See Appendix A for a listing of State Victims of Crime programs.)
Evaluation and treatment are reviewed in this manual's sections entitled "Mental Health Evaluations" and "Mental Health Treatment Issues and Models." The traditional therapeutic role expands when working with child abuse and neglect cases to include that of an advocate, information and referral source, educator, consultant, and member of a multidisciplinary team.
Advocate
An advocate enables clients to become aware of their needs; receive competent intervention and decisionmaking by social services, criminal justice, and mental health personnel; and receive fair and equitable treatment. The number of cases, the many variables associated with child abuse and neglect cases, and the complexity of the system designed to serve children and families create the need for client advocacy. Individual client advocacy involves providing referrals, emotional support, assistance, and sometimes accompanying clients to other agencies to enable clients to obtain resources, services, and fair treatment.
Mental health professionals may also be involved in program advocacy or public awareness activities to promote improved or expanded services, increase funding for services, provide greater access for clients to services, develop new approaches to prevention and intervention, or prevent the elimination or reduction of services. Advocacy may also take the form of promoting new or revised laws, State regulations, or social policies. This type of change is most often accomplished through analysis of existing problems and/or research to establish a basis for proposing change. These proposals can be initiated by individuals but are most often brought about through coalitions and associations of professionals from single or multiple disciplines.
Source of Information And Referrals
Clients and their families may have needs that cannot be met through traditional therapy. These clients may need referrals to parenting classes, parent aide programs, homemaker services, alcohol and drug treatment programs, self-help groups, battered women shelters, rape crisis centers, medical and legal services, tutoring services, victim/witness programs, offender treatment programs, and services for children with special needs such as hearing or vision problems or learning or developmental disabilities. Some communities have service directories; otherwise, it is useful to develop a local referral list.
Educator
The role of educator is performed on several levels. Part of psychotherapy involves education of the client regarding family and interpersonal dynamics; abuse and neglect dynamics; psychological and behavioral signs of abuse and neglect; information regarding child abuse investigation procedures; and Juvenile, Family, or Criminal Court proceedings.
Mental health professionals are also involved in the education and training of professionals from their own as well as other disciplines such as medicine, law enforcement, prosecution, and the judiciary. Mental health professionals may also be involved in public education through the media, community meetings, and forums.
Preparing Clients To Testify In Court
Children and adults experience anxiety about testifying in court. Part of the victimwitness advocates' role is to prepare clients to testify in court. In communities without such services or in situations not handled by advocates, other professionals such as therapists, police officers, or CPS social workers may provide support. Anxiety and ambivalence about testifying can be reduced by familiarizing the client with court procedures; the courtroom setting; and the roles of the judge, prosecutor, defense attorney, bailiff, and court reporter.
Consultant To County Or State Departments Of Social Services
County and State Departments of Social Services make referrals to mental health professionals for assessments and treatment most often at one of three points during intervention in the child protection system. The first point is during the CPS investigation but prior to the adjudication or dispositional hearing. The purpose of this referral may be to obtain a psychological evaluation of the child to assess the mental health status of the child as a result of the abuse or neglect, or to obtain a psychological evaluation of the parent to assess the capability or nature and extent of the disabilities of the parent. These assessments are used to develop case plans and to support the agency recommendations regarding the disposition of the case.
The second point in time may occur after the adjudication or dispositional hearing when the family is ordered to participate in court-ordered protective supervision or the child is removed from his/her family and placed in foster care. The purpose of the referral may be to request an assessment of the child because of behavior that raises concern, provide psychological treatment for the child and/or parent, or evaluate the effects of multiple failed foster placements.
The third point in time may occur after the parent has failed to comply with family reunification efforts or is assessed to be incapable of parenting the child, and the decision is made to proceed with termination of parental rights. Children may be referred for psychological assessment and treatment for preadoptive therapy or conjoint therapy with adoptive parents.
Expert Witness
Mental health professionals may be called to render an opinion or testify as an expert witness in Juvenile, Family, or Criminal Court. The purpose of the Juvenile or Family Court adjudication hearing is to determine whether the child needs protection through court-ordered supervision of the family or whether the child must be removed from the home for a period of time to establish conditions for parental action for family reunification. The mental health professional may be asked to testify either to provide support for social service agency recommendations in the case or, if the professional has been working with the parent, support the parent's objectives. This is usually not a jury trial but a hearing conducted by a judge. Mental health professionals are also called to serve as expert witnesses in criminal trials for the prosecution or the defense, if felony offenses are charged.
Expert witnesses have the following responsibilities:
| to provide objective testimony
whether one is testifying for the prosecution or the defense; |
| to be a scholar in the field or
related fields, and be familiar with or have contributed to the literature
in that field; |
| to be an active or recently active
investigator in the field, if testifying on research matters, or be an
active or recently active clinician in the field, if testifying on clinical
matters; |
| to consider the role of expert
witness as a minimal part of professional activity and not as a profession
(in other words, the main activities of an expert witness should be those of
scholar, clinician, teacher, or investigator in the field of expertise); |
| to be aware of the legal and ethical
impact of the testimony, and the importance and potential consequences of
the testimony to the people involved in the case; |
| to be aware of the basic elements of
the law and the legal procedures with which the expert will be involved; |
| to understand that it is the
expert's job to provide information and/or render an opinion, not to win or
lose the case, and, therefore, avoid becoming consumed with the adversarial
atmosphere of the legal process; and |
| to obtain all the facts from the attorneys and clients(s) to avoid being surprised by damaging information later in the legal process.7 |
CHILD ABUSE - THE HIDDEN BRUISES
The statistics on physical child abuse are alarming. It is estimated hundreds of thousands of children are physically abused each year by a parent or close relative. Thousands die. For those who survive, the emotional trauma remains long after the external bruises have healed. Communities and the courts recognize that these emotional "hidden bruises" can be treated. Early recognition and treatment is important to minimize the long term effect of physical abuse.
Children who have been abused may display:
| a poor self image |
| sexual acting out |
| inability to trust or love others |
| aggressive, disruptive, and sometimes illegal behavior |
| anger and rage |
| self destructive or self abusive behavior, suicidal thoughts |
| passive or withdrawn behavior |
| fear of entering into new relationships or activities |
| anxiety and fears |