“Clinical practice should be driven by theory and research findings. However, the treatment of abused children is often atheoretical and consists of a variety of generic treatment techniques. In addition, research into treatment efficacy with abused children only now is emerging”.
(Friedrich, 1990, p.104) The team places great importance on viewing sexually abused children and young people as a heterogenic group with correspondingly diverse treatment needs: “It is important to recognise both the common and the idiosyncratic aspects of each case and approach treatment accordingly” (Chaffin, et al., 1996, p.126). The team therefore places great emphasis on holistic assessment, which allows for the development of individual treatment plans. A wide range of treatment techniques are drawn on. However, theoretical considerations which have greatly informed the team’s practice falls into three main categories: those which improve our knowledge of the traumatic nature of abuse and its manifestations; child development and issues arising as a result of disruptions to a normal process; and theories relating to family functioning. McLeer, et al., (1990) and Finkelhor (1986) have lent much to an understanding of the traumatic nature of abuse, the former with regard to the Post-Traumatic Stress Disorder (PTSD) model, the latter in their presentation of the Traumagenic Factors model. With regard to developmental issues, areas to be considered are cognitive development, social development, psychosexual development, age at onset of abuse and sex differences. This has been well documented in the work of Friedrich (1990). It is also within the context of developmental considerations (social development) that insights into attachment theory should be given appropriate attention (Bowlby, 1973).
The concept of attachment is a central element in all modern theories of child treatment (Ainsworth, 1989). The application of attachment theory to the act of abuse and the response of significant others to disclosure of abuse necessitates examining family functioning. Since the sexual abuse of children is not a random occurrence, but something which occurs within a family context, the importance of the quality of family functioning must not be overlooked. The team places great emphasis on a family system approach to provide an overall framework for understanding and draws on specific techniques and skills from family therapy when dealing with child sexual abuse. We believe strongly in taking account of family functioning to ensure a more encompassing and complete picture of both family and individual dysfuctions in the present moment.
Applying theory to practice shapes one of the central planks in our assessment of the impact which sexual abuse has on children and their families. Our focus falls on family functioning prior to disclosure of abuse, the child’s initial response and coping resources, parents/carers initial response and coping resources, the impact which other agencies will have had on the situation and the response/attitudes of the wider community.
Assessment involves review and evaluation of the following:
Background information provided by referring agency.
This is presented in the form of general referral details and reports – case conferences, comprehensive assessment, court, etc. Information is sought on circumstances surrounding disclosure, the investigation, reaction of parents and significant others to disclosure, also the reaction of professionals and the wider community to the child’s disclosures.
Reports by other professionals.
Education, health and psychological reports form an important part of the assessment. Details of other counselling services provided are also be sought. Information shared by parents/carers and other family members. This aspect of assessment will have implications for recovery given the central role of parents in the therapeutic process.
What the child shares.
Each aspect of assessment is extremely important, but the child’s account of his/her experiences, abusive and non-abusive, takes on a greater significance given that the primary focus of our intervention is with him/her. In working with the child we must always remember to work at their developmental level, which is not always consistent with their chronological age. Assessment is not a one-off exercise which precedes the offer of a service but a process which continues throughout the period of therapeutic intervention. At the point at which a referral is accepted by the team, it is allocated to a key-worker and co-worker who acts in a consultative role. The two workers plan for each session and the keyworker carries out the direct intervention with the child or family. Following each session the key-worker and co-worker meet to debrief and plan ahead.
A team approach is seen as crucial to the therapeutic process and weekly team discussions are held to assess, plan and review work with the children and families. The team uses a variety of tools and approaches to gather information. One example of an assessment tool used in helping to establish the traumatic symptoms the child is suffering is a Measuring Scale and Checklist taken from Spinal Robinson and Easton Wickham (1993). Through these worksheets children identify their trauma symptoms, which enables the team to establish what area of work needs to be carried out. Consideration is given to the importance of allowing the child a sense of control over what he/she wishes to discuss and as such allows him/her choice about which area of work they wish to address first.
Ainsworth (1989). cited in J., Briere, L. Berliner, J. Bulkley, C. Jenny, T. Reid (eds) (1996). The APSAC Handbook On Child Maltreatment. London: Sage Publications.
Bowlby, J. (1973).
Attachment and Loss. Volume 2: Separation, Anxiety and Anger.
London: Hogarth Press.
Chaffin, M. (1996). cited in J., Briere, L. Berliner, J. Bulkley, C. Jenny, T. Reid (eds) (1996). The APSAC Handbook On Child Maltreatment. London: Sage Publications.
Finkelhor, D. (1986). A Sourcebook in Child Sexual Abuse. Beverly Hills: Sage Publications.
Friedrich, W. N. (1990). Psychotherapy of Sexually Abused Children and Their Families. New York: W.W. Norton. Cited in J., Briere, L. Berliner, J. Bulkley, C. Jenny, T. Reid (eds) (1996). The APSAC Handbook On Child Maltreatment. London: Sage Publications.
McLeer, et al., (1990). Post-traumatic Stress Disorder in Sexually Abused Children. Journal of American Academy of Child and Adolescent Psychiatry, 27 p. 650-654.
Robinson, S. and Wickham, E. (1993). High Tops. A Workbook for Teens who Have Been Sexually Abused.
O’Doherty, T., McLaughlin, S., O’Leary, D., O’Neill. D.& Tierney, C. (2002)) Recovery work with child victims of sexual abuse: A framework for intervention. Child Care in Practice, Vol.7 No.1, pp.78-88