Running head: GROUP THERAPY ABUSED CHILDREN 1Lenia SmithGroup Therapy for Sexually Abused ChildrenArgosy UniversityAugust 2013
2GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENAbstractSexual abuse is one of the most perplexing and confusing problems facing families. Those thatshould be protecting their children are either the perpetrator or oblivious to the fact that theirchild is being sexually abused. So what should be done? The number of families affected bysexual abuse is heart breaking. According to the American Association for Marriage and FamilyTherapy, 2012, 1 out of 4 girls and 1 out of 5 boys are sexually abused by the time they are 18years of age. Child abuse occurs at every socioeconomic level, across ethnic and cultural lines,within all religions and at all levels of education (Swan, 1998).Treatment of child sexual abuse isa complex process; however, research suggests that group therapy for abused children iseffective however the impact of group therapy for sexually abused children requires moreresearch; therefore, this paper will further explore the research on sexual abuse among children,the signs and symptoms of sexually abused children, the nature of therapy with children whohave been sexually abused, the aspects a counselor should consider when working with sexuallyabused children and most importantly the benefits of group therapy for those who have sufferedfrom sexual abuse.
3GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENGroup Therapy for Sexually Abused ChildrenNo one really wants to talk about it. No one wants to hear about; in fact, many pretend as if itdoesn‘t exists- even if it is taking place in their very own home. They wear blinders when it isvery clear what is going on. Most people do not want to believe that it is usually a close relativeor a close friend, but the truth is loved ones can destroy and interrupt homes to the point that it isunbearable and those who do know it exists pretends it does not and only hope it will stopeventually and as a result, the victim suffers faces their demons alone and for eternity. A readermay ask, ―What is this author talking about?‖ What is she hinting to?‖ The answer is child sexualabuse. The American Association for Marriage and Family Therapy (2012) gives a cleardefinition of sexual abuse. It describes sexual abuse asany sexual contact between an adult and achild defined as touching with the intention of sexually arousing the child; for example, kissing,or fondling in a sexual or prolonged manner, oral genital contact, sexual intercourse or manualstimulation. Furthermore, any behavior that is intended to stimulate the child sexually, or tosexually stimulate the abuser through the use of the child, including showing the child eroticmaterials like pornographic films or magazines, taking still shots of the child in a sexual manneror talking sexually to the child (American Association for Marriage and Family Therapy, 2012).Sexual abuse is one of the most perplexing and confusing problems facing families.Those that should be protecting their children are either the perpetrator or oblivious to the factthat their child is being sexually abused. So what should be done? The number of familiesaffected by sexual abuse is heart breaking. According to the American Association for Marriageand Family Therapy, 2012, 1 out of 4 girls and 1 out of 5 boys are sexually abused by the timethey are 18 years of age. Child abuse occurs at every socioeconomic level, across ethnic andcultural lines, within all religions and at all levels of education (Swan, 1998). Furthermore, the
4GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENoverwhelming majority of these children are abused by someone they know; for example; aspreviously mentioned, a family member, a close friend, a member of clergy, or a youth leader.Overall, it is typically someone they know and trust (Swan, 1998). Most would agree that childsexual abuse is a painful and traumatic event that has torn families apart. However, therapy forfamilies who have been impacted by sexual abuse can help them heal from the pain and find thepieces to help them re-build their lives and most importantly, help them create coping skills toassure no further abuse will ever happen in their families again, and hopefully for generations tocome (Swan, 1998).Treatment of child sexual abuse is a complex process; however, research suggests thatgroup therapy for abused children is effective however the impact of group therapy for sexuallyabused children requires more research; therefore, this paper will further explore the research onsexual abuse among children, the signs and symptoms of sexually abused children, the nature oftherapy with children who have been sexually abused, the aspects a counselor should considerwhen working with sexually abused children and most importantly the benefits of group therapyfor those who have suffered from sexual abuse.Sexual Abuse among Children:According to the American Academy of Child and Adolescent Psychiatry (2011), childabuse has been reported up to 80, 000 times per year, but the numbers of unreported instancesare far greater because the children are afraid to tell what happened. Many may question, who isvulnerable to child sexual abuse? All children are vulnerable to sexual abuse but there are somerisk factors that make some children more vulnerable than others; for example, the age of thechild, the socioeconomic status of the child, and the relationship to the offender. The most
5GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENvulnerable age for a victim is preschool children (Brenna, 2006). Preschoolers are more in needof supervision, especially when dealing with daily activities such as bathing and changingclothes; these activities open the door to sexual abuse by the caregivers, relatives, babysitters,and other individuals who come into contact with these children.Low socioeconomic status isanother factor that contributes to the vulnerability of children (American humane association,2002). In other words, low socioeconomic status is correlated with other variables such as singleparenthood, lower education, parental stress and depression, and marital conflict.Lastly, therelationship the child has to the offender also plays a role in the vulnerability of a child(Ramono&Rayleen, 1996). Abuse usually occurs over a long period of time and there is a closerelationship between the victim and the offender (Ramano&Rayleen, 1996). Moreover, theperpetrator usually targets their victim for months and ―grooms‖ the victim to gain their trust. Aspreviously mentioned, the victim is typically victimized by someone they know and trust andunfortunately because of the nature of their relationship, this prohibits the child from speakingout. In some cases, sexual abuse is routine and expected from the child. In other words, the childis unaware that he or she is being abused because of the trust they have in the abuser.A child five years or older who knows and cares for the abuser becomes trapped betweenaffection or loyalty for the person and If the child tries to break away from the sexualrelationship, the abuser may threaten the child with violence or loss of love. When sexual abuseoccurs within the family, the child may fear the anger of the other family members, or be afraidthe family will break up if the secret is told (Child abuse prevention, 2010).No child ispsychologically prepared to cope with repeated sexual stimulation. Even a two or three year old,who does not understand the damage that is being inflicted upon them, will develop problemsresulting from the inability to cope with the overstimulation (Brenna, 2006).
6GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENNancy Swan (1998) states, ―A child who is the victim of prolonged sexual abuse usuallydevelops low self-esteem, a feeling of worthlessness and an abnormal or distorted view of sex.The child may become withdrawn and mistrustful of adults, and can become also becomesuicidal. She further states ―Some children who have been sexually abused have difficultyrelating to others except on sexual terms. Some sexually abused children become child abusersor prostitutes, or have other serious problems when they reach adulthood (Swan, 1998)‖.Signs and Symptoms of Sexually Abused Children:Child abuse is more than bruises and broken bones. While physical abuse might be themost visible, other types of abuse, like sexual abuser can also leave deep, lasting scars.Thinkingof what the signs and symptoms of sexual abuse may look like can be a little difficult;especiallysince the presence of a single sign does not prove sexual abuse is occurring in a family.However, the United States Department of Health and Human Services (2007) lists the followingsigns that can be strong indications that sexual abuse is occurring, or has occurred, for instance;if the child shows a sudden change in behavior or school performance, or has learning problems,for example concentrating that cannot be attributed to specific physical or psychological causes.Another sign is if he or she lacks adult supervision, is overly compliant, passive, or withdrawn,comes to school or other activities early, stays late, and does not want to go home (U.S.Department of Health and Human Services, 2007). Further signs of sexual abuse to consider areif the child has a difficulty walking or sitting,suddenly refuses to change for gym or to participatein physical activities, reports nightmares or bedwetting, experiences a sudden change in appetite,demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior, becomes pregnant
7GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENor contracts a venereal disease, particularly if under age 14, runs away orreports sexual abuse bya parent or another adult caregiver. Furthermore, other possibilities to consider is if the parent orcaregiver is unduly protective of the child or severely limits the childs contact with otherchildren, especially of the opposite sex, is secretive and isolated, and or is jealous or controllingwith family members (U.S. Department of Health and Human Services, 2001). Aside from thephysical damage that sexual abuse can cause, the emotional component is powerful and far-reaching. Sexually abused children are tormented by shame and guilt. They may feel that theyare responsible for the abuse or somehow brought it upon themselves. This can lead to self-loathing and sexual problems as they grow older—often either excessive promiscuity or aninability to have intimate relations.All types of child abuse and neglect leave lasting scars. Someof these scars might be physical, but emotional scarring has long lasting effects throughout life,damaging a child‘s sense of self, ability to have healthy relationships, and ability to function athome, at work and at school.Furthermore, psychological effects of child sexual abuse includehigher rates of depression, anxiety, eating disorders, substance abuse disorders, post-traumaticstress disorder, self-mutilation and suicide (American Academy of Child and AdolescentPsychiatry, 2004) The magnitude of these effects ranges from mild to severe to life-threateningwhich requires immediate counseling intervention. If the child goes untreated he or she may havea myriad of problems that could not be reversed. A survey conducted by Benjamin Sounders andhis colleagues found that children who were victims of physical sexual abuse were more likelythan non-victims to meet the DSM IV diagnostic criteria for a major depressive episode,agoraphobia, obsessive compulsive disorder, social phobia and or sexual disorders (Sounders,2000). Moreover, the long-term emotional and psychological damage of sexual abuse can bedevastating to any child which is why intensive therapy such as group therapy is warranted.
8GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENThe Nature of Group Therapy amongst Sexually Abused Children:Before discussing the nature of group therapy for sexually abused children, this paperwill briefly discuss the nature of group therapy alone. Group therapy is a counseling group thatis usually comprised of 6-8 people who meet face to face with 1 or 2 trained facilitators and talkabout what is concerning them most (Roeb, D. 1998). Members listen to each other and openlyprovide each other feedback. These interactions give members; in this case, sexually abusedchildren, an opportunity to increase understanding, try out new ways of being with others andlearn more about the ways they interact. The content of group sessions is confidential; membersagree not to identify other members or their concerns outside of group (Roeb, D. 1998). In thecase of sexually abused children; before entering into group therapy, the child must acknowledgetheir painful experience and accept it as something traumatic that has happened to them(Wickham, West, 2002 p. 8). Further, if the abuse is not acknowledged and accepted, the childwill invest tremendous energy in minimizing, suppressing, repressing, and attempting to forgettheir traumatic experience in order to manage and or cope with and defend the trauma(Wickham, West, 2002 p.8). Although the child‘s defenses provides a means to survive and copewith the trauma, they gradually need to be replaced with more adaptive ways of coping andfunctioning and group therapy is one way a child can begin his or her healing process.The courage to face the reality of childhood sexual assault as a society has led toincreased awareness of the problem and skill in identifying its presence. Grotsky, Camerer,&Damiano (2000) indicate over the past two decades, the demand for therapy for sexuallyabused children has increased dramatically and in order to meet the growing needs of thevulnerably populated children and families the authors and other clinicians have looked towardthe group therapy model for its therapeutic effectiveness and economy (Grotsky, et al, 2000).
9GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENYolom (2005) effectively defines group therapy in which he stated ―Group therapy methods haveproven to be so useful in so many clinical settings that no longer is it correct to speak of ―grouptherapy‖, instead, we must refer to the group therapies‖ (Yalom, 2005, p.486). In other words,―the group therapies‖ not only offers the advantages of helping those who are less fortunate at alower cost, it is believed to be an effective form of treatment for the cognitive, affective, andbehavioral symptoms associated with children who have been sexually abused (Grotsky, et al,2007). Furthermore, Grotsky, et al (2007) also mentioned that group work with sexually abusedchildren is not only effective, it is highly rewarding.What the Counselor Should Expect/Consider:Corey and Corey (2010) mentions the main goals of a group for abused children is to foster atherapeutic relationship in which children who have been abused feel safe enough to risk trustingother children and another adult and in the case of group counseling, ―other adults‖. The group isdesigned to establish a safe environment, empower children, and enhance their sense of self(Corey, Corey 2010 p. 314). Before the group is established, the counselor (group leader) shouldcomplete a screening. The screening is crucial when counseling children who have been abused,and good timing is essential in choosing group members (Corey, Corey, 2010). Further, thechildren must be ready and willing to interact with other children. Corey and Corey (2010)indicates group counseling is contradicted if the abuse happened recently, if the abuse is stilltraumatizing to the child, if the child has serious psychiatric disturbances such as suicidalideations, self-mutilation, or severe mood or thought disturbances, or if the child was abused bymore than one person at a time (Corey, Corey, 2010 p. 319). Children who have been abuseddeserve opportunities to express their feelings and reactions in a safe and constructiveenvironment. Group should provide an environment which children are able to break down the
10GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENbarriers of isolation, express their inner most struggles, clarify misplaced blame, and generallyfeel more comfortable about interacting with others. The authors suggest this is where healinghappens with children who have been affected by abuse (Corey, Corey, 2010 p. 319). Wickhamand West (2002) states consistency in the behavior of the therapists is equivalent to safety and aprerequisite to successful treatment. Consistency is established by elements such as always beingon time, being reliable, being unconditionally accepting and responsive to the child,remembering what the child says, the therapist doing what they say they will do, achievingcontinuity from one session to the next, being calm and acting in the child‘s best interest(Wickham, West 2002). Moving forward, some aspects a counselor should consider and look forwhen in group therapy for sexually abused children is group members may assume theproblematic roles which may be dysfunctional which may be dysfunctional for them and for thegroup; for example, being a scapegoat, the victim, the distracter, the monopolizer, the criticalmember, the non-contributor, the disrupter, the martyr, the joker and the needy member. A childmay identify with a certain role, or the group may unconsciously place the role on anothermember but it is up to the counselor on how he or she will handle this.Benefits of Group Therapy for Sexually Abused Children:In studies comparing group psychotherapy to individual therapy, group therapy has beenshown to be as effective and sometimes even more effective (Flores, 2007). Further, one of thebenefits of being in a group is realizing that although people have many different issues andvaried ways of coping, there are basic struggles that many people share that are intrinsic to beinghuman. This simple but powerful concept helps to reduce a person‘s sense of isolation andaloneness. When it comes to the group process, Wickham and West 2002 state the following:
11GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENWhen the group has successfully sorted out some of the issues of power andcontrol, it is freed to develop trust, cohesion, and a degree of intimacy, the groupbegins to be important to the members, relationships matter, and emotionalinvestment in ‗Our group‘ develops. Groups emerges (p.140).Wickham and West gave a wonderful example of what the group process is designed tobe. In the case of abused children, many defenses, when left in place, are maladaptive and resultin dysfunctional behavior as the child matures (Wickham, West, 2002). They also interfere withthe child‘s processing and resolution of developmental tasks, which is a necessary part of theirpsychological and emotional evolution. The exploration and process of the trauma in grouptherapy is necessary because becoming aware of and experiencing the effective and cognitiveaspects of the trauma helps to lessen dissociative tendencies. Uncovering and exploringmisconceptions about the trauma prevents false beliefs from being repressed (Wickham, West,2002). Moreover, the returning to the trauma and processing feelings, cognitions, and beliefsrelated to the experience would help in making the trauma less powerful and overwhelming. Thetherapist and its members can help to contain and soothe one another to strengthen each other‘scapacity to provide these functions for themselves (Wickham, West, 2002).Yalom (2005) indicates that a child can benefit from hearing about the experiences ofother children. Group members may provide examples of how other children have reacted to andcoped with abuse and subsequently realize that they are not alone. As a result, the child gainsnew insight and he or she gains a new array of coping mechanisms. Furthermore, children havethe opportunity to observe different stages of the healing process and this can encourage them toanticipate what the future may hold for them. In the group a child may develop friendships, feelaccepted and supported by their peers who increases their esteem and efficacy levels (Wickham,West 2002).
12GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENAs previously mentioned,individuals in group therapy improve not only from theinterventions of the therapist, but also from observing others in the group and receiving feedbackfrom group members. This writer will further elaborate on the benefits of group therapy as awhole. According to the University of North Carolina Ashville‘s Counseling Center, the groupformat, while not providing the one-on-one attention of individual formats, has severaladvantages; for example, participation in the group. The person can control, and are ultimatelyresponsible for, what, and how much they reveal to the group. The more the person becomesinvolved, the more they are likely to benefit. Many people are helped by listening to others andthinking about how what others are saying might apply to them. Importantly, group therapy isoften more enriching for some than individual therapy (University of North Carolina, 2013). Inthe case of children, the child will not feel like a ―special case‖ if they are in a group settingbecause it would be revealed that others share similar experiences.A person can benefit from thegroup even during sessions when they say little but listen carefully to others. In the groupenvironment, others serve as ―mirrors‖ in which others can see themselves in others, thusimplementing change (University of North Carolina, 2013). Group members may bring up issuesthat strike a chord amongst other members, which the others may not have been aware of; inessence, some cognitive change may occur (Grotsky, et al, 2000). A natural process or enhancedacceptance of self and others occurs as one learns to relate more honestly and directly with othersin the group. The group provides an opportunity for personal experimentation - it is a safe placeto risk enough to learn about themselves and others like them (University of North Carolina,2013).The University of North Carolina‘s Counseling Center (2013) also mentioned the firsttask is to establish an atmosphere of safety and respect; the group leaders are to help the group
13GROUP THERAPY FOR SEXUALLY ABUSED CHILDRENdevelop an environment conducive to doing the work of personal growth. An important benefitof group therapy is the opportunity to receive feedback from others in a supportive environment.The leaders will help members to give positive feedback. Taking a closer look at group therapyvs. individual therapy, many counseling professionals would agree that groups are often the mosteffective method to treat depression and anxiety and in the case of treating sexually abusedchildren who suffer from depression, also suffer from anxiety can be treated using cognitivebehavior therapy (Simmerman, 2007). Cognitive–behavior therapy (CBT) is a psychologicaltreatment approach that can be delivered not only on a one-to-one basis but also to groups(Grotsky, et al, 2000). Lastly,it is common for individuals, especially children to experiencesome discomfort over the idea of talking in group initially. This initial anxiety is quite normal asmost individuals have never been exposed to a group therapy environment and don‘t know whatto expect. Within a few sessions members often get comfortable enough to interact in the group(University of North Carolina, 2013).Conclusion:According to Yalom (2005), the child constructs an individual inner world that can bereconstructed through interactions with others and although some counselors report animmediate response to group therapy, they should not be deterred by the lack of immediateresponse with sexually abused children. Children who have experienced trauma such as sexualabuse have a very difficult time trusting others because of what they have endured. Therefore, itis very important for the counselor to be mindful and most importantly readily available for theirhealing process to begin.References
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