Child Abuse Detection, Reporting and Treatment > Chapter 11- Part B - Interpersonal Issues

Chapter 11: Part B - Interpersonal Issues

INTERPERSONAL ISSUES

A range of interpersonal issues must be dealt with in therapy. In this section the issues of identification with the aggressor, victimizing behaviors, intimacy, and betrayal are discussed.

Identification With the Aggressor

Theorists note that one way of dealing with and combating the experience of being a helpless victim is to become the powerful victimizer.169 170 171 172 A child often imitates another person who the child feels is strong and powerful; for many abused children this “someone” is the abuser. Unfortunately, the abusive adult did not teach the child appropriate problem-solving skills or methods for negotiating to fulfill needs and desires. In cases of sexual abuse, the child has learned inappropriate ways to satisfy the need for intimacy, control, and power. A child learns that intrusive and controlling behaviors are the norm and uses these behaviors for management of stress and anxiety, problem solving, and social and intimate interactions. The therapist must address loss, responsibility for the abuse, affiliation, and power and control in therapy sessions with the child.

The therapist can:
  • Help the child identify the positive and negative behaviors that the child experienced with the perpetrator. The positive experience may generate a feeling of loss in the child. The child may need to mourn for what is missing in his/her life once the abuse has been disclosed. The therapist can express this loss for the child, and thus, give the child permission to acknowledge the experience. It is important for the therapist to identify the positive behaviors, attributes, or skills that the child has learned from the perpetrator.
  • Focus on the abusive behavior rather than on the perpetrator. This helps the child feel more comfortable talking about what happened. Telling the child that the perpetrator’s behavior is wrong is far more effective than telling the child that the perpetrator is “bad.” When a child hears that a parent or someone they cared about is “bad,” the child often thinks that he/she needs to protect or justify his/her relationship and may protest and minimize the abuse. Expressing anger at the perpetrator often elicits the child’s loyalty and generates defensiveness from the child.
  • Connect the child with appropriate adult role models in the community. This helps the child learn that he/she can benefit from a relationship without suffering abuse. This also facilitates and supports a shift in loyalty from the perpetrator to more available and appropriate role models.
  • Help the child’s caregivers address issues of role reversal, boundaries, and setting limits. If the perpetrator was the disciplinarian in the family, and the nonabusive parent turns to the child to assume this role, the parent needs to know that the child is neither an appropriate role model nor has the skills for disciplining siblings. In these cases, the parent needs support and skills assume a disciplinary role and relieve the child of these responsibilities. Clearly defined limits on interacting with siblings and other children need to be stipulated.
  • Educate parents about warning signals that indicate that the child is having difficulties managing anxiety, powerlessness, or anger. These warning signals include displaying intrusive and controlling behavior toward siblings, peers, and younger children; hurting or victimizing peers or younger children; and demonstrating aggressive or sexual acting out.


Victimizing Behaviors

A child who uses secrets, threats, intimidation, force, or weapons to secure access to a vulnerable child needs to be evaluated for unresolved issues related to physical or sexual abuse and protected from acting out his/her inappropriate behavior. Numerous articles have been written addressing the “abuse-reactive” child, adolescent, or juvenile perpetrator as well as aggressive or antisocial behavior.173 174 175 176 Developing empathy, a perspective on his/her own victimization, behavior management, and relapse prevention techniques, facilitate managing this behavior. Family therapy can provide a structure in which to develop and implement these skills.

In dealing with victimizing behaviors, therapists should address issues related to mastery and control, impulse control, and aggressive behavior.

[QN.No.17.In dealing with victimizing behaviors, therapists should address issues related to :]


Intimacy

Intimacy, the need and ability to feel close to a responsive and willing (age-appropriate) partner and be able to share one’s most personal thoughts, feelings, and behaviors, can be affected by abuse and neglect. An abused child is shaped, in part, by his/her age-inappropriate knowledge of sexual behavior and violent interaction, his/her experience of the perpetrator’s abuse of power and trust in a relationship, and his/her awareness of the impact and effects of emotional and physical manipulation. These experiences have an effect on the child’s ability to interact in an appropriate and responsible manner and can interfere with the establishment of positive, supportive relationships.177

To help the child with issues related to intimacy, the therapist can:
  • Work to increase the child’s investment in age-appropriate activities and relationships.
  • Help the child increase his/her comfort with interactions such as talking, listening, and sharing.;
  • Support and encourage the child for interacting with others and developing close, reciprocal, personal relationships. Initially, the therapeutic relationship is a model for responsive, appropriate, and caring interaction. Help the child identify the qualities in the therapeutic relationship that can be expected or transferred to other relationships.
  • Help the child manage his/her anxiety about connecting with others.
  • Clarify and interpret positive and negative behaviors that support or interfere with developing meaningful relationships.
  • Offer nurturance and support as the child invests his/her time and energy into meaningful relationships.
  • Offer hope and guidance if the child feels rejected or loses an important friendship.
  • Acknowledge the adolescent’s excitement and fascination with intimate relations. This is a natural part of the adolescent experience, and willingness to talk with the therapist about these feelings can indicate the establishment of trust in the therapeutic relationship.
  • Discuss sexual concerns, questions, behaviors, health protection, and birth control.
  • Interpret the adolescent’s sexual behavior in light of his/her history of maltreatment as well as in terms of normative issues (e.g., universal adolescent concerns about sexuality).
  • Clarify the possible intentions, meanings, and consequences of the adolescent’s behavior. Many adolescents welcome hearing that they can wait to have sexual relations until they are married or until they are absolutely certain that they are choosing to do so because they want to rather than to prove that they are unaffected by the abuse.


Betrayal

Betrayal occurs when a child realizes that what he/she understood to be real and acceptable turns out to be painful and emotionally damaging. When a trusted adult acts out his/her anger in a physically assaultive manner or uses the child for sexual and emotional needs, the child’s expectation that adults will provide for his/her care and protection is violated.178 A child who recognizes that he/she has been hurt or abused by an adult often has feelings of confusion and vulnerability. This can be profoundly negative and disruptive to the child’s world view.179 Betrayal by a physically or sexually assaultive parent may lead to disillusionment, distrust of others, hostility, and anger.180

To help the child deal with feelings of betrayal, the therapist can:
  • Help the child express his/her feelings about the abuse or neglect.
  • Identify and talk about the adults who should have protected the child. Address issues of abandonment and feelings of rejection. Often, children are more negatively affected by abuse when they believe other people knew and took no action to protect them.
  • Increase the child’s ability to recognize hurtful and abusive situations. Instill the idea that children need help and have a right to protection. Help the child feel comfortable asking for and eliciting help from adults.
  • Help the child identify similarities between the abusive experiences and his/her expectations regarding how adults will respond to children. This awareness can be related to the child’s interaction with and expectations for the therapist, peers, and other adults in his/her life.

INTRAPERSONAL ISSUES

The effects of child sexual abuse and physical abuse can be understood as a combination of classically conditioned responses to traumatic stress and socially learned behavioral and cognitive responses to the abuse experiences.181 182 Two main themes dominate the generation of symptoms—affective responses characterized by anxiety and behavior patterns that are the result of social learning processes. Treatment that is directed at altering the conditioned and the socially acquired responses to victimization will alleviate initial symptoms and reduce the likelihood of long-term or more serious disruptions in development.

Fear

Fear is generated when an external event threatens a child’s safety or well-being. A child who expresses fear of the perpetrator, fear of retaliation, fear for his/her own safety, or fear of reoccurrence needs to be protected to the best of the professional’s ability. Mandated reporting laws and emergency response and placement out-ofhome (if the child’s safety cannot be ensured in the home) can provide some protection for the child. Any current safety or protection issues that may be frightening the child warrant immediate assessment.


Trauma

Trauma occurs when the child is unable to manage the overwhelming affective reactions generated by the abuse.183 184 185 186 When a child becomes overwhelmed by his/her sensations, thoughts, or feelings about the abuse, the child is unable to make sense of this experience. The child continues to feel as if he/she is still in danger and repeatedly reenacts the abusive experience and continues to relive the event as if it were still occurring. The child’s ability to feel safe and secure is impaired. He/she needs to develop strategies that enable him/her to feel that he/she can survive the experience. Sometimes, a child will behave in such a way that elicits reactions from others that resemble the abusive event. The child creates situations that replicate the abuse in an attempt to master overwhelming feelings and gain the sense that he/she has some control over the experience.

A child also offers symbolic representation of abusive experiences through his/her play, art work, dreams, and fantasy reconstruction. The child’s art work may include actual information about the assault or representations of his/her sense of powerlessness. Play and fantasy reconstructions often include wishful or magical thinking, themes of anger, violence, and rescue fantasies.

In many ways, trauma is an open-ended experience that the child needs to address in order to gain understanding and closure. Trauma resolution comes about when there is sufficient processing for the information to be stored. That is, the event is remembered, the attendant feelings are neutralized, and control of the anxiety generated by the event is achieved. When a traumatic event is not resolved and remains either in active memory or defended by a cognitive mechanism, the diagnosis of PTSD is generally used.

[QN.No.18.Trauma is an open-ended experience that the child needs to address in order to gain understanding and closure.]

To help the child work through the trauma, the therapist can:
  • Help the child recall the details of the traumatic event.
  • Help the child identify the sensations, thoughts, feelings, and beliefs generated by the experience.
  • Help the child make the connection between what occurred during the abuse and how the child is feeling currently.
  • Use interventions that provide a sense of completion and closure to the experience.
  • Use techniques such as relaxation exercises and cognitive completion to help the child manage overwhelming experiences.187 188 189


Anxiety

Anxiety is created when a child anticipates that a frightening or dangerous experience will reoccur. Sometimes, a child will remain in a state of anticipation, hyperalertness, or fearfulness when no immediate danger is present. In these cases, the child has often moved from the specific abuse experience to more generalized anxieties of circumstances or situations reminiscent of the abuse. Because anxiety is experienced as an intensely unpleasant state, the anxious individual is motivated to engage in responses to reduce or eliminate the anxiety. These coping responses may be behavioral; for example, avoidance of situations or persons associated with the anxious feelings. These responses may be cognitive; for example, compulsive or ritualized behavior that are attempts to render the anxiety-producing cues inert.190

To help children work through the anxiety they experience, the therapist can:
  • Provide support and encouragement for addressing a difficult task.
  • Help the child relate the details of the abuse in a relaxed and matter-of-fact way.
  • Encourage discussion about various aspects of the abuse experience. With a young child, play therapy can incorporate elements of desensitization, graduated exposure, modeling, and assertiveness training. The play interaction can be structured in a number of different ways, such as using puppets, dolls, art work, or story telling. The process is facilitated by gently encouraging and directing reenactment and discussion about various aspects of the abuse experience. This kind of desensitization is characterized by the gradual, imaginal presentation of a hierarchy of feared situations paired with relaxation and safety.191

    A more direct approach is often useful with an older child.192 Graduated exposure and alleviation of emotional distress can be encouraged by helping the child talk about the abuse in therapeutic situations that are safe and supportive. Through a process of talking about abuse-related material in a regular and matter-of-fact way, the memories eventually lose the capacity to elicit arousal.
  • Monitor the child’s ability to talk about anxiety-inducing experiences. Berliner and Wheeler note that sensitivity and clinical judgment are required in determining at what rate to proceed in eliciting this material.193 The child should not be forced prematurely to recall or talk about the abuse because the therapist and the therapeutic environment may become simply an aversive reminder of the abuse.
  • Identify the source of the child’s anxiety. This usually requires eliciting specific information from the child about the content of his/her intrusive memories, dreams, or nightmares or identifying cues that evoke anxiety responses.194
  • Initiate and model methods of managing difficult experience. Appropriate methods of managing anxiety, such as asking for help, talking about feelings, and expressing strong emotions need to be modeled by the therapist.
  • Reinforce the child’s attempts at effective coping responses.


Depression

Many of the methods developed to alleviate depression in children and adolescents are also useful for abused and neglected children.195 In depression, one of the most important areas that needs to be addressed is repressed or pent-up feelings. Therefore, the therapist can:
  • Identify the child’s capacity and willingness to experience and express his/her feelings. For example, does the child have an adequate vocabulary? How did the parents/caregivers react when the child expressed his/her feelings or opinions? Does the child feel secure in expressing his/her feelings about the abusive experience?
  • Facilitate awareness and identification of feelings.
  • Acknowledge and encourage the expression of feelings. Support the child’s utilization of various media including poetry, song, dramatic play, art, and written expression to express his/her feelings.


Lack of Expression of Feelings

The lack of verbal expression is a characteristic of an abused and neglected child. There are several reasons why the child says little about how he/she feels including the following:
  • The child may not know how to express his/her feelings.
  • The child may not have the language or verbal skills to express his/her feelings. For example, one 6-year-old girl who was both physically abused and neglected referred to her home as a “crying place.”
  • The child may be unsure of his/her own ability (or others’ abilities) to tolerate and manage a display of feelings. The child may be unwilling to acknowledge or display his/her pain, fear, or sadness.
  • The child may have a limited range of feelings or limited awareness of his/her feelings.
  • The child may not feel or think that his/his feelings are “safe.”

To help the child express his/her feelings, the therapist can:
  • Educate the child about feelings. Teach the four groups of feelings—mad, sad, scared, and happy.
  • Model and demonstrate appropriate expression of a wide range of feelings. For example, the therapist can model anger or sadness about the child’s statement that no one responded when he/she was hurt. The therapist can reaffirm to the child the message, “I am here to help you now. I want to make sure you are safe and you get help when you need it.” The therapist can model pleasure as the child demonstrates new skills and abilities.
  • Support the child’s attempts to manage his/her feelings about the abuse. Some children will not allow themselves to remember or reexperience the pain involved in the assault. This ability to ignore, dissociate, or not have feelings about the experience has been a useful survival technique. The child will not surrender this survival technique until he/she feels that he/she is absolutely safe from abuse.
  • Routinely explore safety issues with the child.
  • Make the distinction between how the child felt when the abuse occurred and how the child feels currently. Remind the child that he/she is able to manage better now that he/she is bigger, older, or in a safe place. This assurance helps the child recall the experience of being hurt and still remain connected to the present where he/she is more capable of asking for help and receiving protection.


Guilt, Blame, and Responsibility

An abused or neglected child has a very difficult time placing responsibility for the abuse where it belongs—with the perpetrator. It is often a constant struggle for the abused child to determine who is responsible for the abuse and to understand who is the victim and who is the aggressor.196 It is more likely that the child will internalize responsibility and blame him/herself for the perpetrator’s abusive behavior. The following are some of the reasons why a child might blame him/herself for the abuse:
  • The perpetrator may have said things to make the child feel responsible for the abusive behavior.
  • The perpetrator may have cultivated a special relationship with the child and offered special rewards or privileges for the child’s cooperation or silence (particularly in cases of sexual abuse). The child may feel guilty and blame him/herself for enjoying the special treatment, especially if it interfered with seeking help quickly.
  • The abused child may have experienced some covert power and feel guilty about using the secret to manipulate the perpetrator or other family members.
  • The child may think his/her behavior provoked the abusive behavior. The behavior of a physically abused child is often provocative. The child may interact with parents in ways that elicit the parents’ attention, even if that attention is negative and hurtful.
  • The child may feel guilty about what happened after the abuse was disclosed, especially if the family has financial problems or is experiencing shame, sadness, anger, or loss from the removal of the perpetrator.197 198
  • The child may feel guilty if he/she experienced any physical pleasure from the abuse or acted out similar behaviors with peers or younger siblings. Assuring the child that he/she is “not to blame” for the abuse is not enough to convince the child that the abuse was not his/her fault.
To help the child work through guilt, blame, and feeling responsible, the therapist can:
  • Discuss the child’s relationship with the offender.
  • Increase the child’s understanding of why this kind of behavior is so hurtful to children.
  • Educate the child about adult responsibilities (i.e., caring for and protecting children, knowing right from wrong, and using the child’s body and mind appropriately—that is, to not hurt or trick the child) and why adults are assumed more responsible (e.g., they know more, they are more mature, they have more options, they are bigger, they control resources).199 The child needs to know that the perpetrator is an adult and knows the difference between right and wrong. Often, the child understands the concept of right and wrong when he/she is reminded that the perpetrator asked him/her to keep a secret or hide the injuries from physical abuse.
  • Explain the concept of consent to the child (i.e., when a person is afraid or doesn’t understand what he/she is agreeing to or how to say “no,” then the agreement is unfair).
  • Help the child explore the reasons why he/she kept the abuse a secret, and why the child finally decided to disclose the abuse. The child needs to recognize that there were reasons why he/she was unable or unwilling to disclose the abuse and that these reasons do not make the child responsible for the abusive behavior.

[QN.No.19.To help the child work through guilt, blame, and feeling responsible, the therapist can: ]

Secrecy itself is a choice.200 The child may choose to keep the abuse a secret for a number of reasons. Perhaps the child did not think anyone would understand. Perhaps he/she made the decision not to tell because he/she thought that his/her family would be angry with the child, or perhaps the child did not tell because he/she believed that the abuse was his/her fault. The perpetrator may have threatened to harm the child or his/her family members or pets. Some children attempt to avoid the abuse rather than tell someone.

Whatever reasons the child had for keeping the secret, they imply that the child made a decision based on information that was available, whether that information was accurate or inaccurate. This means the child was capable of discriminating between options and deciding what to do. It is this decision-making capacity that needs to be maximized. Implicit in this experience is that the child needs to learn that he/she has choices and feels that he/she can make decisions to care for him/herself.201

Therefore, the therapist should enforce this behavior as follows:
  • Help the child understand that certain kinds of behavior contribute to his/her vulnerability. Be sure that the child understands that his/her behavior does not make him/her responsible for the perpetrator’s decision to abuse. However, the child’s behavior can result in a situation that leaves him/her vulnerable to exploitation or abuse. Berliner and Wheeler note two examples.202 The child who believes she caused her molestation by asking her father where babies come from requires reassurance that her father’s literal demonstration was a result of his disturbed thinking and behavior and that her conduct was completely normal. On the other hand, the child who has repeatedly returned to the neighbor’s home, knowing of the possibility of molestation, or who has sought extra privileges in exchange for compliance with abuse can be gently helped to acknowledge that a choice was made. This child needs to understand why, at the time, it seemed the better or only alternative, and how this decision put the child in a vulnerable position.
  • Educate the child about the prevalence of abuse in our society. A child who realizes that abuse does happen to other children seems to experience less self-blame than a child who feels that abuse is extremely rare.203
  • Affirm the child’s sense of power, rather than his/her status as victim.
  • Educate the child in an age-appropriate manner about the physical nature of sexual response to explain the presence of physical pleasure (if applicable) and address feelings of guilt.


Loss and Grief

Loss and grief are major issues for an abused and neglected child. Grief can result from the loss of an important relationship (e.g., older brother, baby-sitter), from a legally mandated separation from the abuser (e.g., grandparent) or from an irrevocable change in the view of the person or role (e.g., “It’s like I don’t really have a dad”).204 The child may need to mourn the abuse and the subsequent loss of personal integrity.205

A very young child who is separated from his/her primary caregiver for a period of time may respond in three progressive stages described by Bowlby:206
  • protest,
  • despair, and
  • detachment.
The abused and neglected children often experiences grief and mourning and moves through stages similar to those identified by Kubler-Ross:207
  • denial,
  • anger,
  • bargaining or ambivalence,
  • depression,
  • acceptance, and
  • hope for the future.

[QN.No.20.The abused and neglected children often experiences grief and mourning and moves through stages similar to those identified by Kubler-Ross:]

A child who has experienced a disruption in his/her usual living arrangements or needs to adjust to a major change in his/her environment, needs to focus his/her energy on adapting and figuring out what is expected of him/her and what he/she can expect of others. Major changes in the child’s immediate family or circumstances interfere with the necessary mourning process.208 The child needs to adjust to new conditions and become familiar with his/her surroundings, new relationships, and behavioral expectations before he/she will have the energy to address the deeper work of mourning the loss of an important relative or membership in the family.209

To help the older child work through loss, the therapist can:
  • Talk with the child about any changes, including his/her adjustment to a new home or life without the perpetrator. Often, the child does not realize that he/she is in the middle of a major upheaval. The child benefits from hearing that change is a major challenge for most people.
  • Explain that everyone needs some time to adjust to major changes. This gives the child permission to be accepted and understand him/herself and to express his/her difficulties adapting to the specific changes in his/her life.
  • Prepare the child for the possibility that he/she may feel some powerful, perhaps confusing, feelings. It may confuse the child to miss the perpetrator and long to see or meet with the perpetrator. The child may report that he/she thinks about the perpetrator or an unavailable family member all the time. He/she may frequent places where he/she might “accidentally” run into the perpetrator or unavailable family member. This puts the child in a vulnerable position. He/she may be at risk for further abuse or could be emotionally hurt by the adult’s inappropriate response to the attempted contact. This type of behavior needs to be monitored and restricted when possible.
  • Help the child express powerful feelings of sadness, loss, and anger. These feelings need to be expressed and dealt with repeatedly throughout the course of therapy.
  • Give the child permission to acknowledge his/her sadness and loss. Sometimes, a child may feel uncomfortable expressing sadness for someone who hurt or molested him/her. This is a natural ambivalence; the child needs permission to care about and long for connection or membership in a family.
  • Help the child recognize the positive qualities or interactions with the perpetrator. Help the child express love, disappointment, hurt, and hope that the perpetrator will be able to change his/her behavior. Help the child express anger about the behavior or fear of the reoccurrence of abuse.
  • Explain to the child the changes the perpetrator or other family members need to make in order for visitation or reunification to occur. The child needs to be informed of family expectations and aware of possible decisions regarding placement and reunification.
  • Let the child come to his/her own realizations about his/her relationship with the perpetrator or other family members. It is usually better to let the child conclude at his/her own pace and ability that contact or reunification may not take place. If the perpetrator or other family members demonstrate that they are unable or unwilling to meet the child’s needs appropriately, the therapist can then support and commiserate with the child.


Self-Worth, Self-Esteem, Self-Efficacy

Self-worth, self-esteem, and self-efficacy are all affected by abuse and neglect. Many abused or neglected children feel that they are unworthy of attention, protection, or nurturing. They have a limited understanding of their value as human beings and often feel inadequate and ineffective in their interaction with people. Low selfworth and low self-esteem often contribute to a pattern of interaction with peers and in relationships that increases the possibility of revictimization.

To help the child improve his/her self worth, the therapist can:
  • Address issues related to mastery and control.
  • Help the child develop self-image based on competence and realistic expectations of performance. This helps the child feel effective and hopeful about attempting new behaviors. Some children may see themselves as capable and adequate to the tasks of protecting and caring for themselves. Younger maltreated children can have an inflated self-image.210 Though inaccurate, this inflated selfimage may represent active defense mechanisms and a need for physical competence and control.
  • Give the child permission to acknowledge his/her wishful thinking or difficulties without losing esteem.
  • Teach the child that he/she has the right to be protected and cared for appropriately and that he/she does not need to be victimized to be loved.211
  • Educate the child about the intricacies of social skills and educational tasks. The child may need support and information about appropriate behaviors. The child may need tutoring or may have to make up a grade in school because his/her fear, stress, or anxiety interfered with his/her ability to learn new educational skills.


Stigmatization/Damaged Goods

Children often experience intense concern about physical and emotional impairment resulting from abuse. The child may feel physically damaged, dirty, ruined, or no longer whole or perfect.212 The child may feel that others can tell that there is something wrong with the child or that he/she is somehow different from other children. Victims may behave in ways that result in their bodies becoming damaged or dirty. The child may fail to bathe; have poor hygiene; or dress in sloppy, dirty, or unattractive clothes. The child may develop eating disorders such as overeating or undereating in an attempt to make him/herself less attractive to abuse and to feel that he/she has some control over his/her body.

To help the child deal with this concern, the therapist can:
  • Talk to the child about what it is like to feel vulnerable or powerless.
  • Help the child figure out what it would take to feel safe and strong. Sometimes, the child can identify activities (e.g., karate or self-defense classes) that can counteract the feelings of being damaged by the abuse. The therapist may need to suggest activities that help the child feel empowered and protected. Team sports and activities that build on current skills and interests are helpful.
  • Develop therapeutic interactions that help the child to feel good about his/her participation in therapy. The goal is to develop a series of tasks that helps the child feel competent. The therapist can speak positively about the child’s ability to explore issues in therapy, noting how difficult that can be and how strong someone needs to be to remember and talk about the abuse.
  • Emphasize the positive aspects of the child’s abilities and behavior. The therapist can identify the child’s interests and strengths and build on these factors so that satisfying interactions and esteemenhancing activities are developed and expanded.
  • Support and encourage new interests and strengths so that they become a progressively larger part of the child’s life while the memories of the abuse diminish in importance. This is a change in the child’s identity from an abused child to a child who is capable and involved in positive activities.


Learned Helplessness

All children need to feel that they have some control over their behavior and what happens to them. When this sense of control is diminished from repeated abusive experiences, the child may lose the interest, energy, and drive to protect him/herself. A child who feels powerless may believe that there is nothing that he/she can do to counteract the abuse. The child may learn to submerge his/her true feelings, distrust his/her own perceptions, and deny his/her own reality. An abused and neglected child will often demonstrate fear, confusion, passivity, pessimism, hopelessness, and an inability to protect him/herself.

To help the child deal with this concern, the therapist can:
  • Talk to the child about what it is like to feel vulnerable or powerless.
  • Help the child figure out what it would take to feel safe and strong. Sometimes, the child can identify activities (e.g., karate or self-defense classes) that can counteract the feelings of being damaged by the abuse. The therapist may need to suggest activities that help the child feel empowered and protected. Team sports and activities that build on current skills and interests are helpful.
  • Develop therapeutic interactions that help the child to feel good about his/her participation in therapy. The goal is to develop a series of tasks that helps the child feel competent. The therapist can speak positively about the child’s ability to explore issues in therapy, noting how difficult that can be and how strong someone needs to be to remember and talk about the abuse.
  • Emphasize the positive aspects of the child’s abilities and behavior. The therapist can identify the child’s interests and strengths and build on these factors so that satisfying interactions and esteemenhancing activities are developed and expanded.
  • Support and encourage new interests and strengths so that they become a progressively larger part of the child’s life while the memories of the abuse diminish in importance. This is a change in the child’s identity from an abused child to a child who is capable and involved in positive activities.


Learned Helplessness

All children need to feel that they have some control over their behavior and what happens to them. When this sense of control is diminished from repeated abusive experiences, the child may lose the interest, energy, and drive to protect him/herself. A child who feels powerless may believe that there is nothing that he/she can do to counteract the abuse. The child may learn to submerge his/her true feelings, distrust his/her own perceptions, and deny his/her own reality. An abused and neglected child will often demonstrate fear, confusion, passivity, pessimism, hopelessness, and an inability to protect him/herself.

To help the child work through learned helplessness, the therapist can:
  • Demonstrate care and concern for the child’s welfare. In therapy, children need to experience adults who are willing to pay attention to their behavior and help them communicate their needs and wishes. The therapist needs to take special notice of the child. He/she needs to see and comment on how the child looks as well as how the child is behaving in the therapeutic relationship. The therapist should note the child’s changes and accomplishments within and between sessions. Paying attention gives the child a model and permission to also pay attention.
  • Screen for any victimization that the child is unaware of or unable to report. Ask the child about his/her day and activities, including the child’s interactions with friends and other people in the neighborhood. The child may indicate that he/she is being rejected, bullied, or victimized.
  • Teach the child the kinds of behaviors that are considered hurtful or inappropriate and help the child identify these behaviors and talk about them. The child also learns that the therapist is there to help and will respond with respect, concern, and take action on the information. As the child gradually learns that he/she is important, valuable, and worthy of protection, he/she may be more willing to seek help or, when needed, protect him/herself.
  • Take steps to ensure the child’s safety. This may include asking the parents or caretakers to implement more supervision, contacting teachers or school officials if the child is being teased or bullied on school grounds, and reporting any inappropriate or abusive touching to proper authorities.
  • Emphasize that the child deserves to be safe and protected. The therapist can thread this theme throughout the session and remind the child when the session is over to tell someone if he/she needs help.
  • Teach the child assertiveness, communication, and problem-solving skills. Generally, these skills have minimal use until the child has a frame of reference that allows him/her to understand the importance of standing up for one’s safety and well-being. This positive frame of reference is based on increased self-esteem and self-worth.
By asking the child if he/she has any questions and reinforcing those questions with positive experiences, the therapist teaches the child to think about and ask for information. It takes courage to ask questions, especially if the child fears retaliation or humiliation. Permission to make mistakes also helps the child feel comfortable as he/she learns to make productive decisions. The therapist can set up role-playing situations and help the child practice asking for what he/she needs.213 The therapist can model problem-solving skills and teach the child how to think about situations and problems. When the child asks questions, the therapist can state, “Let’s figure it out,” and take the child through the steps for problem solving and decision making. Learning how to determine adequate and appropriate responses when requests are denied and developing alternative ways to achieve goals are also helpful. For example, an adolescent who feels she is not dressed adequately compared to her peers may benefit from wardrobe planning, learning to sew, or the joys of thrift store shopping.
 
Child Abuse Detection, Reporting and Treatment > Chapter 11- Part B - Interpersonal Issues
Page Last Modified On: September 7, 2014, 11:18 PM