Counseling Abused Children by Nicole Pepitone Janet Wiseman

Child Abuse/Neglect To Effectively help a victim Of Child Abuse You must connect the pieces of the puzzle.

Child Abuse/Neglect Children go to school with MORE than books in their Backpacks

Child Abuse/Neglect l l l 4 of 5 children from violent homes have witnessed extreme violence. 3 to 5 children in each classroom may be witnessing violence in their homes. Violent relationships begin when teens are about 15 and starting to have serious relationships.

Child Abuse/Neglect l Children who witness abuse between the adults in their homes become secondary victims. Research shows that, even if a child is not abused, witnessing violence is much like being an actual victim. Child care providers should be trained to recognize secondary victims, too.

Mediators in Effects of Child Abuse l Age of Child at Time of Abuse – the younger the child the more vulnerable they are to damage because “uncontrollable terrifying experiences may have their most profound effect when the central nervous system and cognitive functions have not yet fully matured, leading to a global impairment”

Mediators in Effects of Child Abuse l Chronicity – the more chronic the abuse the greater the impact. The more abuse occurs over a period of time the child’s sense of vulnerability and helplessness can increase which leaves the child with greater opportunity to refine and utilize defense mechanisms, which can become problematic later in life.

Mediators in Effects of Child Abuse l Severity – severe physical abuse can cause physical impairments, developmental delays, and brain damage. Neglect can cause failure to thrive. l Relationship to Offender – the closer the relationship between the offender and the victim the greater the resultant trauma.

Mediators in Effects of Child Abuse l Level of Threats – the use of threats, including nonverbal threats, can produce fears and generalized anxiety in victims of child abuse. l Sex of the Victim – male victims show longrange serious problems and greater psychopathology.

Mediators in Effects of Child Abuse The emotional climate of the child’s family– patterns of intergenerational abuse, inappropriate parenting skills and child rearing practices, isolation from support systems, social incompetence, emotional distress, inaccurate perceptions/high expectations of child, incohesive and inflexible.

Mediators in Effects of Child Abuse l The child’s mental and emotional health – if child’s health is good prior to abuse then child has a better chance of resisting the damaging effects. l Level of Cognitive Development – the higher the level of cognitive development the better protected they are, psychologically.

Mediators in Effects of Child Abuse l The guilt the child feels – the more guilt a child abuse victim feels the greater the impact of the abuse. l Parental responses to the child’s victimization – an unsupportive or overreactive response of the parent can result in greater trauma.

Abuse and Neglect l l l The dynamics of abuse and neglect differ in regards to parental attention. Abuse results in the victim receiving attention from the parents/caregiver, even if the attention is harsh and damaging. Neglect results in the victim receiving no attention at all from the parents/caregivers.

Symptomatic Behaviors l l l l SEXUAL ABUSE – fear and anxiety depression anger and hostility difficulties in school running away or delinquency inappropriate sexualized behavior

Symptomatic Behaviors l l l l l NEGLECT – deprivation – detachment repression of feelings developmental delays impaired ability to empathize with violence delinquency decrease in general intellectual ability, due to the lack of cognitive stimulation

Symptomatic Behaviors l l l l l Emotional Abuse – feelings of being unloved/unwanted anxiety, aggression, hostility anxious attachment to parents self-destructive behavior tendency to act as caretaker to parents fear or distrust negative view of the world feelings of inferiority, withdrawal

Symptomatic Behaviors l l l l PHYSICAL ABUSE – withdrawal / opposition hypervigilance / compulsivity impaired capacity to enjoy life defensive in anticipation of danger learned helplessness lack of object permanence preoccupation with behavior of others

Counseling Victims of Child Abuse l When counseling victims of child abuse/neglect the clinician should provide opportunities for self-exploration, adaptation, and some new functional behaviors. Clinician should resist the urge to overgratify or overstimulate the child and overattention and compliments should be curtailed.

Disclosure l l Response received by disclosure is linked to levels of self-esteem and functioning as adults Take action to stop the abuse Elicit support from nonoffending family member Help children to resolve internal conflicts of being victims

Treatment Objectives Decrease/eliminate responsibility l Decrease isolation l Improve verbal expression l Increase self worth/esteem l Develop coping skills l

Four Phases of Therapy l Intake l Beginning Phase l Middle or Processing Phase l Termination Phase

Intake Phase Determine the child’s need for therapy based on symptoms of abuse l Learning as much as possible about the presenting problems and the severity l Taking a history l Developing a treatment plan l

Beginning Phase l l Focuses on establishing trust and rapport Establish a relationship based on the child’s interests and needs Guide child into understanding and awareness Helpful if therapist is familiar with music, movies, and activities of various age groups

Middle Phase l l l Identify how the child has been affected by the abuse Identify ways to cope productively with his/her symptoms Address and explore memories, sensations, thoughts and feelings, and beliefs

Termination Phase l l l Integration and utilization of child’s new thoughts, feelings, and perceptions of him/herself Transfer skills acquired in therapy to other areas of his/her life Child may show ambivalence about attachment, dependency, and autonomy

Treatment Modalities l l l Play therapy Art therapy Journaling Individual therapy Group therapy Family therapy

References l l l l Gil, E. (1991). The Healing Power of Play Working with Abused Children. Hubbard House, Inc. (2004). Domestic Violence Advocacy Training. Johnson, S. L. (2004). Therapist’s Guide to Clinical Intervention. San Diego: Academic Press. Urquiza, A. J. & Winn, C. (1994). Treatment for Abused and Neglected Children. Department of Health and Human Services: Administration of Children, Youth, and Families. www. playtherapy. org www. arttherapy. org Childswork. com- plays, art, catalogue of references

Resources l l l Journal of Child Sexual Abuse Child Maltreatment Child Abuse and Neglect U. S. Advisory Board on Child Abuse and Neglect Child Abuse Hotline 1 -800 -96 -ABUSE