Topic 7: Treatment of Abused and Traumatized Children and Adolescents {by 7/24}

There are two readings due this week covering Physical Abuse, Sexual Abuse, and Neglect: Mash and Barkley Chapters 9 and 10 (see specific page numbers).  Address the following two discussion points:  (1) Both readings address inclusion of parents in the therapeutic process, even if they are the perpetrators of the abuse.  Based on the readings and your clinical experience, what are your thoughts on including the parent-perpetrator in therapy?  Does it make a difference if the parent-perpetrator is a sexual abuser or physical abuser?  (2) What are some possible differences in conceptualizing and treating a neglected youth vs. an abused youth?  Your original post should be posted by the beginning of class 7/24.  Have your two replies no later than 7/26.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

Advertisements

42 Comments (+add yours?)

  1. Ashley
    Jul 20, 2014 @ 17:03:55

    1) After reading the outlined chapters, Mash and Barkley did not make working with the parents sound easy. For starters, they portrayed high dropout rates not only because the parents do not see themselves as an issue but also because the therapist and parents are at odds with one another causing higher dropout rates in regards to child abusers. The book suggests that if the father figure perpetrators go through abuse classification sessions reunification with the child can occur. Personally do not think children should be reunited with incestuous offends. However, I do think they should be apart of therapy – both abusive and sexual offenders for the victims sake. By facing this person and expressing what it was life or facing their fears might help the child to overcome current/future emotional and psychological difficulties. If the parent is a sexual abuser I think inclusion of the parent needs to be for the victims sake only. Not for the purposes of reunification because you cannot change someone sexual desires and it is setting the child up to be sexually abused again. In the circumstances of parental abuse, I think the parents should be involved for purposes of reunification. Parents can learn how to better handle their emotions and childrens behaviors that does away with the physical abuse. However, reunification should not be done without extensive therapy and follow ups.
    2) Some considerations when addressing neglected children over abused children is that parents might not have the resources to provide properly for their children (low SES, no jobs/low paying jobs, hold down several jobs so never home) thats why their children are not getting taken care of properly. Neglected children might present as withdrawn, trouble regulating emotions, feelings of worthlessness, difficulty trusting adults/others. Abused children might present with aggression, lying about abuse, on alert all the time, loss of sensitivity (empathy) towards others, poor social skills and adjustment and overall problems with self control. Children who are abused might require more therapy, regardless abuse, neglect and sexual abuse are all hard to treat.

    Reply

    • Taylor Tagg
      Jul 23, 2014 @ 22:03:10

      Ashley, I like your stance in regards to including parents in therapy with abused children. You brought up a very good point in regards to high dropout rates, which was something that I hadn’t fully considered in the context that you had. I really liked how you differentiated between the purpose of what parent involvement should be in therapy, particularly if they are the perpetrator. I had implied that the victim’s protection and risk of danger should be considered but I like the way you had put it in regards to whether or not the goal should be reunification. We also shared similar views of the issue of parent withdrawal due to stress as the basis of neglect.

      Reply

    • Melissa Symolon
      Jul 24, 2014 @ 00:21:49

      Ashley, I like how when you talk about neglect, you don’t just to conclusions that the parent is intentionally neglecting his/her child. I think many people would just to the assumption that the neglect is abuse, but your first thought was that the parent does not have the means to provide for their child even though they want to.

      Reply

    • Anthony Rofino
      Jul 24, 2014 @ 17:02:19

      Ashley, I like that you talk about how parents can be neglectful without actually being bad parents. Sometimes financial situations cause parents to be neglectful, but unfortunately, that’s the best they can do. That’s not to say that there shouldn’t be involvment in alternative agencies, such as DCF, but at least it acknowledges that the parent is trying

      Reply

  2. Taylor Tagg
    Jul 22, 2014 @ 18:22:07

    1) Both readings address inclusion of parents in the therapeutic process, even if they are the perpetrators of the abuse. Based on the readings and clinical experience, I have a couple different thoughts regarding the inclusion of parent-perpetrator abuse in therapy. I believe that if the parent or caregiver is nonrelated to the abuse, including them in therapy would most definitely be beneficial in that it allows the parents to become part of the experience and offer further support and emotional comfort to the child as they disclose. For example, in Trauma-Focused CBT, at one point in the therapy process, the child completes a narrative of the abuse and once the child feels comfortable reading through it, he then reads it to his mom and/or dad as a means of accepting what happened (for all involved). However, I feel completely different about parent inclusion in therapy when the parent is the perpetrator, particularly in the case of sexual abuse. According to Mash and Barkley (2006), a child’s parents or caregivers are the predominant perpetrators in all forms of child maltreatment. I think that in the case of physical abuse and neglect, including parents would be beneficial in focusing on increasing tolerance to child aversive behavior and expectations of normal behavior through cognitive restructuring, in addition to stress and anger management. By focusing on the family system and parent-child interactions, I believe that parent inclusion in treatment would lead to a decrease in abusive behavioral patterns. In the case of sexual abuse, including parent-perpetrators in the therapy process can essentially lead to an increase in PTSD symptomology due to the fear the child has for the parent. This can also be predictive of long-term depressive symptoms (Mash and Barkley, 2006). In my personal opinion, although I can see how clarification sessions can help with eliminating secrecy and accepting responsibility of the abuse may be beneficial for the parent and child, I just do not see how any sort of damage control could be done once this sort of experience arises in the familial context.

    2) Some possible differences in conceptualizing and treating a neglected youth vs. an abuse youth may be in regards to the level of stress in the family environment. In the case of abuse, stress can increase the probability of violence as a means of coping in order to essentially gain control over the stress. However, in the case of neglect, the level of stress in the household may be so high that parents may simply withdraw and isolate themselves from the child as a means of coping (Mash and Barkley, 2006). I believe another difference in regards to conceptualizing and treating neglected and physically abused youth depends on the family process and parent-child interactions, in addition to parent psychopathology, whereas in conceptualizing and treating sexually abused youth depends on who the perpetrator is, and the attempt of figuring out the mindset of why such an act was committed and if it will be committed again following clarification in treatment. One similarity between the conceptualization and treatment of neglected and abuse youth, however, may be in regards to the assessment and identification of the danger and risk to the child, in addition to the upmost protection for the child.

    Reply

    • Robin Horsefield
      Jul 24, 2014 @ 16:44:14

      Taylor, I appreciate how strongly you feel about not including the parent-perpetrator in therapy when the abuse was sexual in nature. I myself went back and forth between being instinctively opposed to understanding how some components of therapy may be useful. I agree that the close proximity of the perpetrator in therapy could be dangerously detrimental to the child’s progress and feelings of safety. Including the parent-perpetrator could damage the “safe environment” perception of therapy and bring the child back to square one.

      Reply

  3. Sarah Chelio
    Jul 23, 2014 @ 16:17:02

    1) The issue of parent-perpetrator inclusion in therapy is a difficult one to make. I believe that the specific details of the case must be taken into careful consideration when making this call. All semester long we have been learning about the benefits and necessities of including parents in therapy. I believe that if the parent is not the cause of the abuse a child underwent they would certainly benefit from being included in therapy. Abuse is a tough thing for any parent to address with their children, and therapy would give them the skills to d so appropriately. They can provide a great deal of support to the child and understand where their troublesome behaviors are coming from. In cases where he parent is the perpetrator, however, more clinical judgment must be used. I think the severity as well as the nature of the abuse should be looked at. I believe that children who were physically abused by a parent would benefit from confronting the situations in a therapeutic setting. The parent cant receive education and the child can have a chance to speak about his feelings in a safe environment. In sexual abuse cases, however, I would be against including the perpetrator. I think that this might be too overwhelming for the child. In any case, I believe the therapist should use clinical judgment to only include the parent if it is best for the child, and would not cause risk or harm.

    2) The readings discuss both neglected and abused youth. There are several differences in the way one would conceptualize and treat each. Parents who abuse their children often present differently than those who neglect. They can be more angry and violent, while neglectful parents can appear withdrawn. Although both of these unhealthy parenting types are often a result of stress, they differ in how the parent responds. They are both difficult to treat and therapy should balance both child and parent intervention needs.

    Reply

    • Ashley
      Jul 23, 2014 @ 16:59:13

      Sarah, just to bounce off of what Nafi pointed out, I was wondering how you would handle a parent that was not the perpetrator of the abuse but did not believe their child? I agree, the case specifics need to be taken into careful consideration when including the parent in the therapy but are parents who dont believe their child just as difficult to work with and would you feel comfortable giving the parent custody knowing they did not support their own child?

      Reply

      • Juliana Eells
        Jul 26, 2014 @ 15:38:51

        Ashley, I had some ideas in response to your question…. I think if a parent did not believe their child I would try to work with the parent individually to figure out why they don’t believe the child and also to explain how not being supportive of their child could be really detrimental in coping with what happened to them. Hopefully I could get the parents to understand the situation better or to at least be supportive even if they weren’t sure that the child was telling the truth. I would be very disappointed and concerned about a lack of support if a parent refused to believe their child’s allegations. Unfortunately, I don’t think that simply not believing the child would allow DCF to remove them from their parents’ custody. However, if a parent did not believe their child’s allegations, and therefore continued to expose them to the perpetrators, that would putting the child at risk for further abuse and I would not feel comfortable with allowing the child to remain in that situation.

        Reply

  4. nafi
    Jul 23, 2014 @ 16:23:44

    This week’s reading were tough as I began thinking about what my actions would be if a child told me his/her parents were being abusive. Working with children, this can be a hard area to address as empathy towards children comes so easily. Including parents in the treatment I believe is hard enough as some parent may not want to believe their child. For example, a female child reporting her mother’s boyfriend has been sexually abusing her or even that her father has been abusing her. With so many autobiographies and films on this area, I assume that sometimes parents may not believe their child. At that moment where do I go as the therapist in being possibly the only support for that child? Working in therapy I think it does make a difference if the child is being physically or sexually abused. Although both forms of abuse can be as equally traumatizing for a child, with physical abuse the parent can learn skills for better managing his/her own emotions. Physical abuse can sometime be the only way that an individual learns to get a point across and although inappropriate, if parents can learn more effective strategies to interacting with their children, change can be prompted. On the other hand, with sexual abuse that would be something I would give the child total control over whether or not he/she wants the parent (s) to partake in session. Moments like these can either assist in further building client-therapist rapport or can damage the relationship that has been built.

    Some possible considerations when addressing issues of neglect verses abuse may be the availability of resources. In some cases, parents may need to leave children at home due to working several jobs to make ends meet and not being able to find a babysitter. It does not make the act alright but therapist will want to assess the home life the social supports or lack of that the client and his/her family has. Likewise, when addressing abuse, consider assessing the home life as well and also the severity of the abuse. As mentioned. Abuse can be very traumatizing for most if not all youth and some may require more intense therapy than others. Working in the field I have seen some client’s well into adulthood expressing readiness to address their childhood abuse and describing the trauma has impacted their lives over the years. I believe it is important to offer services to youth so they know that they do not have to continue suffering from nightmares that their abuser will come into their bedroom. Sometimes peace of mind is the best thing that we can help our client’s achieve at the conclusion of therapy, this applies even with children.

    Reply

    • Ashley
      Jul 23, 2014 @ 16:55:57

      Nafi, I thought your answer for question one was very insightful. I had not considered my own feelings when addressing a child who reports abuse. It also made me think how I would feel if a parent did not believe their child (as you pointed out). More than just being the only childs support — how could the parent not believe their child!! This brought up a great point that part of treating children is our (or the therapists in general) feelings towards a particular case/child. How do you treat a child that is abused and no one believes them just a client?

      Reply

    • Anthony Rofino
      Jul 24, 2014 @ 17:05:26

      Nafi,
      The approach you took with sexual abuse and children was a very good point. I do think it is important to leave it up to the child about their comfort level having their parent involved. However, if the child has not yet told their parent about the situation, that is definitely something we as therapists might have to speak to the parent about.

      Reply

    • Sarah Chelio
      Jul 25, 2014 @ 17:03:20

      Nafi, I enjoyed our points on physical vs. sexual abuse. I agree that, although both are forms of trauma, they should be treated differently in therapy. I think that it is the child that is the client, therefore everything that is done should be in their best interest. It seems as if facing a parent-perpetrator would be more difficult for a child if the abuse was sexual, even in a safe environment. Overall I find this to be an extremely difficult and sensitive issue in which the details of the case are necessary before making a decision on inclusion.

      Reply

  5. Becca Boisvert
    Jul 23, 2014 @ 17:20:04

    1) When considering a physically abused child, given that it has been determined that current risk of re-offense is low and the child will ultimately remain with his/her parents, Mash & Barkley strongly advocate for parental involvement in the therapeutic process, even if the child has been placed in a temporary foster home. The rationale for this is that the parents are the underlying foundation of the family, and any change that occurs in therapy must include the parent, otherwise it is unresolved as an issue. In other words although there may be issues that originate with the child (health, temperament etc.) that cause stress, the parents are the driving force behind the abuse, and no therapeutic gains can be made without parental interventions as well. In fact, depending on the age of the child (infants and toddlers), therapeutic interventions may be prioritized completely with the parents due to the understanding that the abuse is stemmed from the parent’s response to developmental behaviors, such as crying, or attention seeking. Older children and adolescents are more likely to be included in treatment interventions because it is perceived that the older the child gets, the more likely they are to be involved and even facilitate family violence. With regards to treatment, Mash & Barkley have found that various cognitive and behavioral interventions are effective for families of abused children. However, treatment application should vary from case to case, and should maintain a sensitivity to the family’s capabilities (ex. Low cognitive abilities, willingness of the parents to engage, etc.).
    Unlike children who have been physically abused, children who have been sexually abused are not encouraged to maintain and strengthen relationships in which a parent is the perpetrator of the abuse without prior treatment beforehand. Instead, the child is first provided with adequate therapeutic interventions that meet their specific needs, and then provided with the opportunity to have access to his/her perpetrator, given that the perpetrator has also completed the required therapy and have met the necessary steps for reunification.
    In my opinion, I believe that the determination as to whether or not to include the parent-perpetrator in therapy should be a joint decision made by the child and the therapist once a good therapeutic relationship has been established. Oftentimes, the non-perpetrating parent will influence the child into recanting, or prematurely reuniting with the offender because they are concerned with being in trouble, or further allegations. By observing the non-offending parent/child interactions paired with a trusting rapport with the child, the therapist should be able to determine if the child is ready to begin to include the perpetrator in therapy or not.
    2) Children who have been neglected present with significantly different symptomatic behavior patterns than those who have been abused. According to Mash & Barkley, typical behavior of neglected children is socially avoidant, isolated, non-trusting, and not affectionate. In addition, neglected children may also develop cognitive delays in functioning. Based on these frequently seen behaviors, it is recommended that a combination of social skills and educational interventions are used with children who have been neglected. On the other hand, children who have been abused are more likely to experience emotional dysregulation, aggressive tendencies, anger issues, social deficiencies, and cognitive impairment. Treatment for children who are victims of abuse includes socioemotional regulation, anger management, social skills training, and educational interventions.

    Reply

    • Taylor Tagg
      Jul 23, 2014 @ 22:23:11

      Becca, I agree with your viewpoint in regards to the determination of parent-perpetrator involvement in therapy. It should definitely be a joint decision between the child and the therapist. That way the child voices his or her opinion and feels included, and comfortable, in such a critical and potentially further traumatic decision (initially), and the therapist, based on what he or she knows about the incident and own professional knowledge and judgment, will make a sound decision, as well. If the parent is the perpetrator, I believe that they should be excluded from the initial agreement terms of inclusion in therapy, as the goals should be geared for the best interest and safety of the child. I also thought you did a good job distinguishing between severity of symptoms in children who have been neglected versus children who have been sexually abused. Treatment of children who have been sexually abused would most likely be more intense, therefore, than that of neglect.

      Reply

  6. Sara Grzejszczak
    Jul 23, 2014 @ 22:46:14

    I feel that parents should be included in therapy so they can get psychoeducation with what is going on with their child. Many times parents are having difficulty with their parenting for many reasons and maybe even having trouble with accepting that their significant other or another child of theirs is the perpetrator. I also feel that by having parents be included in the therapeutic process, the therapist would be able to help parents learn about different resources to help alleviate some of the burdens that they face. Especially with parent trainings, in order to help better manage their children and finding supports in the community that can be used by the parents when they need help with their children and with childcare. I also feel, though, that this would be extremely difficult if the child’s mother does not believe the child and sides with the perpetrator or knows that the abuse was happening and did not help and is passive about the situation. By having a mother who is not willing to acknowledge or refuses to believe that the abuse happened the ability of the therapist to help the child through this situation would be more difficult because the child does not have a support system to fall back on. In this case, much more work would need to be done individually with the child and the mother before she could be included in therapy sessions with the child.
    I think it does make a difference if the parent-perpetrator is a sexual-abuser or a physical abuser. While both perpetrators should have therapy I feel that it should be situational as to whether or not they should be included. Some children may feel victimized again seeing their abuser, especially if the abuse was for an extended amount of time and the child has had serious complications due to the abuse, no matter what type of abuse it was. Children may also be traumatized and seeing their abuser in therapy, though it is a safe place with other people to protect them, may cause the child to traumatized again. I feel that a lot of work would have to be done, no matter what kind of abuse happened, and the child would have to be extremely comfortable and okay with the idea of facing their abuser.
    Some possible differences in conceptualizing and treating neglected versus abused youths would be in terms of the parents’ ability. Many times neglected parents do not have the funds or other resources to properly care for their child, i.e. food, clothing, shelter, money for bills, while parents that abuse their children do not know how to handle frustration and anger in certain situations. By helping the parents find the appropriate resources that they need or by teaching parents how to more appropriately handle their anger and set boundaries and handle their child’s behavior, the living situation for the child will in turn become better. Treating the child and the child’s symptoms is also a large factor. Children who are neglected often present as withdrawn and unable to regulate their emotions while children who are abused present with a lot of aggression and have problems with their self-control. By helping both the parents and the child equally in therapy the best results will be gained.

    Reply

    • Paige Hartmann
      Jul 24, 2014 @ 11:28:25

      Sara, you make a valid point regarding working with a child when the parent does not believe the child about the past abuse or sides with the perpetrator. This type of situation can make treatment much more challenging, since the child is lacking support from the parent. How would you handle this type of situation in treatment?

      Reply

    • Rebekah Kiely
      Jul 25, 2014 @ 12:06:55

      Sara,
      I like the acknowledgement you made about potential lack of support from a parental figure being a major challenge in therapy. You also mention that a lot of work would need to be done individually before integrating the parent in therapy with the child because of this. When an abusive situation occurs within a family the way you mentioned, I feel family conflict is inevitable in one way or another. However, I wonder about the possibility that the parent in question (or the family as a whole) could even become resentful of the child due to such an accusation. I find myself struggling how to overcome such a situation effectively.

      Reply

  7. Melissa Symolon
    Jul 24, 2014 @ 00:32:55

    1. I think I generally agree with everyone else’s answers to this question. I think a parent who is a physical abuser can be included in therapy eventually. I think the child has to be ready to face that parent first and when the child is ready the parent can be introduced. Before that happens, I think the parent should also already going to therapy to learn to deal with their anger and any other emotions and should also be learning parenting skills as well.
    I also think that sexual abusers should not be included in therapy for the intent to be reunited with the child. If the child wants to confront the parent after receiving therapy and learning proper coping skills, that is probably okay. I would never be comfortable sending a child back into a home with a parent who sexually abused them.

    2. Neglected children tend to be more socially withdrawn, don’t feel like they’re important, and not in touch with their emotions. Abused children are typically more aggressive and have trouble with adjustment. Both types of children would require extensive therapy. I think social skills training would be important for both. I also think since neglected children may not have grown up getting opportunities to express their emotions they will need help with identifying and expressing themselves, whereas abused children may need more help toward controlling and regulating their emotions.

    Reply

    • Sarah Chelio
      Jul 25, 2014 @ 17:09:49

      Melissa, I fully agree with your points on sexual abuse. I do not think it is appropriate for a parent who sexual abused a child in the past should be reunited with them. For children trying to process the traumatic event and move on, a confrontation might be beneficial. I think that is important, as you mentioned, to provide them with the skills necessary to do this. Otherwise, bringing them into therapy can actually be damaging. The counselor should properly assess the child’s readiness before including them.

      Reply

  8. Paige Hartmann
    Jul 24, 2014 @ 09:37:58

    I think that including the parent-perpetrator within therapy with a child requires substantial clinical judgment from the clinician. If the parent was not involved in the abuse, I think it is necessary to include them within treatment for the parent to understand and know how to support their child. Depending on the severity of the physical abuse, I would include the parent within treatment since the child would have a safe environment to discuss their feelings. However, if the parent was the perpetrator of sexual abuse to a child, I would not include them within the child’s treatment. This would be too overwhelming for the child to face at a young age and I don’t believe it would be beneficial to the child’s situation.

    When working with neglected or abused youth, it is important to recognize how these children present differently. A child who was abused will often present as aggressive, have issues with anger, as well as deficits in their social functioning. However, a child who was neglected will appear socially withdrawn, lack trust, and appear to be non-affectionate. It is important to be aware of these differences when treating a youth who is either neglected or abused, as it will impact the treatment methods used by the clinician.

    Reply

  9. Julianna Aguilar
    Jul 24, 2014 @ 10:03:53

    Although each case has unique and important considerations (e.g., age of the child, whether reunification or remaining together is a goal, etc.), I do think that, if possible, the parent-perpetrator should be included in therapy in physical abuse cases. Mash and Barkley (2006) note that child maltreatment cases are unique and involve investigating unusual experiences within these parent-child relationships. This argument can be difficult to digest being that our natural inclinations would be to shy away from any theory than even slightly places blame on the child. (e.g., saying they are a factor in these “unusual” relationships). It took me a while to accept the fact that, though the child is absolutely not to be blamed for the parent-perpetrator actions, the child is now, inevitably, part of this dysfunctional parent-child relationship that may be best treated together (e.g., role-playing more effective problem solving in therapy). More specifically, careful consideration should be given to whether the parent-perpetrator is a sexual or physical abuser. Though physical abusers and their children may benefit from being in therapy together, even greater precaution should be taken with sexual abusers. Mash and Barkley (2006) note that occasionally supervised and structured access to the parent-perpetrator may be beneficial to the child, as well as a possible abuse clarification session in which the parent, child, and therapist or social worker meet in order for the parent to apologize to the child and for the child to say whatever he or she would like to the parent. However, it is important to assess each individual situation in order to determine if the child is ready to see his or her parent (e.g., child could be suffering from mental health issues associated with the abuse) and if the parent is ready to apologize to the child appropriately, among other factors.

    Some possible differences to consider when conceptualizing and treating neglected versus abused children are potential parental skill deficits or available resources as well issues with emotion regulation. For example, parents who neglect their children, physically or emotionally, may do so as a result of a lack of resources (e.g., money to buy food and clothing, etc.) as well as skill deficits (e.g., overestimating their child’s ability to maintain their own level of physical safety, a lack of understanding about the importance of giving their child affection, etc.). If the neglect is a result of these deficits, effective interventions may include helping parents gain access to appropriate resources in order to care for their child, as well as providing psychoeducation about child development and the level of care that needs to be provided given their child’s developmental level. Physical abuse, on the other hand, may be better understood as a parent’s difficulty managing his or her emotions. For example, Mash and Barkley (2006) argue that a parent’s escalation from punishment to abuse is linked to issues with emotion regulation and aggression inhibition. These issues can lead to increased frustration to interactions with their child over time, as well as incorrectly attributing their anger to their child (e.g., frustrated with a co-worker but attribute that frustration to the child), for example. In this case, the parent would likely benefit from CBT addressing issues related to emotion regulation and aggression, for example.

    Reply

    • Paige Hartmann
      Jul 24, 2014 @ 11:36:59

      Julianna, I liked your discussion about considering parental skills deficits and available resources when treating a child who was either neglected or abused. It is important to work with the parent on improving their parental skills as well as identifying if a lack of resources has contributed to the parental neglect of a child.

      Reply

  10. Robin Horsefield
    Jul 24, 2014 @ 11:45:45

    Honestly, I am not sure how I feel about the inclusion of parent-perpetrators. My first impression is that I am really uncomfortable with this interaction. When I thought about it more, I can begin to understand slightly because they are the child’s parent, but they also violated this relationship. I would imagine that the child’s wishes would be the first factor in the decision to include the parent-perpetrator. I would also hope that the severity of the abuse or situation would be taken into consideration before considering a joint session. I do not see the nature of the abuse as making much difference, although parents who inflict abuse at a very low level I would categorize differently. I see severe physical abuse and sexual abuse as being on par with one another. Both have the potential to (and usually succeed) cause traumatic responses that permeate for the rest of the child’s life.
    Neglect and abused can sometimes mean the same thing, but more often than not, they are very different. Neglect implies that the parents or guardians ignored or withheld certain basic needs of a child. Abuse implies that the parents or guardians have played a direct role in the infliction of pain on the child. Both have the potential to influence the child to internalize their discomfort. These children have probably been blamed for everything from birth, so treatment should emphasize that they are not to blame for the interference of government agencies. These children also should be made to understand that they are not to blame for their past, current or future maltreatment. Treatment for a neglected youth should take into consideration the current living state of the parents. There is a difference between parents who choose to withhold food or safety and parents who do not have the resources to support or feed their family. The latter parents deserve some compassion and assistance to try to bring them to a better state. Another difference between treating abused vs neglected youths is that abused youths need an emphasis on building a healthy support system. Research has shown that abuse usually happens at the hands of a known family or friend and therefore the child must establish who is safe to trust during treatment.

    Reply

    • Juliana Eells
      Jul 26, 2014 @ 15:53:53

      Robin, I definitely tend to feel discomfort when thinking about including parent-perpetrators in therapy as well. In Mash & Barkley they discussed how in terms of physical abuse and neglect, it often occurs as the result of many factors increasing stress in the home as well as deficits in either parenting skills or resources. They pointed out how perpetrators of abuse and neglect are generally on a continuum, rather than categorically “abusers” or “non-abusers”. I had not realized this previously and this does give me a bit more hope in terms of including some parent-perpetrators of physical abuse in hopes of correcting the situation. However, I also agree that severe physical abuse and sexual abuse are likely more traumatic and including parent-perpetrators in those cases should be done more carefully, if at all. I also feel that sexual abusers are not simply a result of contextual factors that cause stress or a deficit in skills, and therefore it may not be possible to correct these behaviors in the perpetrator, so there is less reason to include them in therapy.

      Reply

  11. Rebekah Kiely
    Jul 24, 2014 @ 11:59:35

    When it comes to including the parent-perpetrator I think it depends entirely on the risk that the child is being placed in as well as how genuine and motivated said parent is about changing. If the parent does truly want to change, I feel this will be extremely beneficial for both the parent and child, whether the parent is able to keep custody of the child or not. These experiences become ingrained into the child’s identity, and despite the negative impact of abuse and neglect by including a parent motivated to change in therapy, I can see how this would foster the development of a stronger identity. Though I also think deciding to include the parent will also depend on the therapist: As therapists we need to have empathy for our clients, but having empathy for someone who abused a child may be a challenge for some.
    When it comes to differences between treating a neglected child vs. an abused child, trauma symptoms may be a bigger issue for abused children. Although being neglected can essentially be seen as a trauma, an abused child will be more likely to have specific stressors that need to be a focus of treatment. In other words, treatment of an abused youth may also includes some type of exposure or other developmentally appropriate technique for dealing with the triggers of the trauma experience.

    Reply

    • Melysa Faria
      Jul 26, 2014 @ 21:39:10

      Rebekah,
      I agree with your point that the child’s safety comes first when deciding whether a parent perpetrator should be involved in the child’s treatment. I also think it was a good point to consider how dedicated the parent really is to changing and decreasing the abusive patterns that have occurred in the past. A parent that is not dedicated to making change will show no progress in therapy and this may cause further damage in the child’s life. Therapy should be beneficial for the child, the parent, and the child parent relationship.

      Reply

  12. Juliana Eells
    Jul 24, 2014 @ 14:05:25

    In the case of physical abuse, I think the parents should be included in therapy in most cases, particularly if reunification is the goal. In fact, most treatment for abuse and neglect focuses on the parent, working to change the parent’s thoughts and behaviors and teaching them better parenting skills. Of course, children may develop their own emotional or behavioral problems as a result, so they may need therapy as well. Once the parents have progressed to the point that they can be safe with their children, they should be involved in treatment with the child as well to work on parent-child interactions. In the case of sexual abuse, I think it can be different. While physical abuse is often a result of contextual factors and maladaptive parenting techniques, sexual abuse is a much more complex psychological problem that cannot be fixed with simple parent training. I think that it is less likely that including a parent perpetrator in therapy following sexual abuse would be beneficial for the child and could be re-traumatizing.

    One major difference in conceptualizing and treating abused vs. neglected youth might be the types of behaviors that need intervention. For example, child who have been abused are more likely to be aggressive and neglected youth are more likely to be withdraw and have difficulties with emotional understanding and social skills. So treating abused and neglected children may require significantly different interventions based on the different types of behaviors that result from these experiences.

    Reply

    • Melysa Faria
      Jul 26, 2014 @ 21:30:02

      Juliana,

      I like the way you described the difference between physical and sexual abide. Physical abuse can be intervened with through parent training, however in the case of sexual abuse it is a much deeper problem psychologically that is happening for the parent. Sexual abuse can cause damage to a parent-child relationship and permanently damage the child’s psychological functioning. Exposing the child to any type of continual contact with their sexual abuser can often cause more harm than good.

      Reply

  13. Jane Jenkins
    Jul 24, 2014 @ 14:27:01

    1) My initial thoughts about including the parent-perpetrator in therapy are a strongly biased “no”, but Mash & Barkley make some good points about the child needing the process to happen. It is easier to imagine a physically abusive parent as one who may be operating within maladaptive schemas. These can be restructured and modified. However, a sexual abuser, to me, has a deeper seated disturbance that will take much more work to modify, if the behavior can be modified. I do understand the child’s need to continue to interact with the parent, though. Interaction with the abusive parent can help the child assess the relationship with the person, and it allows them to maintain a relationship with the person in a safe environment.
    2) Possible differences in conceptualizing and treating neglected youth vs. abused youth would be in the severity of the abuse and how it affects the child over time. For example, Mash & Barkley talk about abuse and neglect on a continuum, with the most harmful treatment on one end and the most beneficial treatment on the other end. If the continuum is considered, abused children would have the same problem list as neglected children, but the expression of the problems may be much more pronounced. It seems as though neglected children need to add and develop adaptive processes as part of their treatment, whereas abused children not only need those things, but also need help to reverse the damage of the harsh treatment they have experienced.

    Reply

    • Julianna Aguilar
      Jul 24, 2014 @ 14:50:32

      Jane, I like how you pointed out how our biases immediately play into our decision-making. I, too, was initially very strongly biased toward excluding all abusive parents from therapy with their child due to my initial reaction to protect the child by keeping him or her away from the parent. However, as you pointed out, Mash and Barkley (2006) present valid arguments about the importance of including the child and parent in therapy together (e.g., providing a safe environment for interaction, learning problem-solving within the relationship, etc.). It is always difficult to accept a particular theory or intervention that may go against our initial instinct, but reviewing the literature on the topic and assessing each individual client will help us make the most informed and appropriate decisions for that particular case.

      Reply

    • Robin Horsefield
      Jul 24, 2014 @ 16:55:50

      Jane, I like your discussion of the continuum of maltreatment. I conceptualized this to include the idea that higher levels of neglect would be close on the continuum to lower levels of abuse. This is not to say that neglect is not as harmful, but sometimes there are mitigating circumstances with the parents’ situations. I would also comment that I think children who have histories of neglect may still need treatment to deal with those past experiences. This may also relate back to the continuum concept and support the idea that serious neglect may need those extra services.

      Reply

    • Larrisa Palmer
      Jul 25, 2014 @ 16:41:35

      Jane, I was also shocked when I read our readings. I thought that it would be an absolute no to include perpetrators of child abuse in therapy. I also think that something we will have to put aside our own biases and work from an objective standpoint, which is always in the best interest of the child.

      Reply

  14. Larrisa Palmer
    Jul 24, 2014 @ 14:40:48

    (1). The inclusion of parents in therapy is profoundly important for treatment to be effective. Over the course of treatment a child’s behavior will likely to change which will inevitably affect the rest of the child’s family. It may seem difficult at times for a therapist to accept a perpetrator with unconditional positive regards, but it important to act in the best interest of the child at all times, which may involve the inclusion of that parent. It was mentioned in our readings that, a parent may have schemas that permit him or her to use violence as a means of interpersonal control. And as such, therapy would be a place where that parent could be educated, and given the necessary skills to appropriately take care of his or her child. Every situation will be different, some parent-perpetrator will be more appropriate to be included in treatment as a result of the type of abuse committed, and the severity. The inclusion of that parent can re-traumatize the child and as much it should be done on child’s timing. Both sexual and physical abuse have very lasting negative effects on a child and as such I would not say that one is more than the other.

    (2) Neglected children may become socially avoidant, lack empathy and may have difficulties dealing with challenging task in comparison to children who have been abused. Abused children may experience marked delays in self-control, are aggressive and hostile toward their peers and authority figures. Treatment for these children should focus on providing a safe environment, social skills training, pyschoeducation, and parental training.

    Reply

    • Angela Vizzo
      Jul 26, 2014 @ 12:01:38

      Larissa, I agree with your thoughts on including the parent-perpetrators in therapy. One of the hardest things I believe I would deal with is separating my own feelings as a therapist from the situation, as I would have strong negative feelings towards a parent who mistreated their children. However, as you mention it is important to remember to act in the best interest of the child and set one’s own feelings aside.

      Reply

  15. Anthony Rofino
    Jul 24, 2014 @ 14:41:46

    1) Based on the readings, it is a very difficult call to have abusive parents involved in the session. As it has been abundently clear throughout the course, parent involvement in treatment is paramount for effective therapy. However, in the case where the parents are the primary cause of the issue, it can be triggering to have the parent involved in the session. Also, parents may not want to engage in therapeutic interventions, believing that what they are doing is right or justified. This leads to a very high drop out rate from parents who are abusive. I believe the trick when working with this difficulty is to handle the situation with kid gloves. It is best to adress the situation slowly and delicately to not offend the parents, but establish where the problem lies.

    2) While both types of therapy are difficult, neglectful parents will most likely present as more withdrawn from sessions and helping, while abusive parents can be more agressive and defensive of their parenting. Neglectful parents may also be neglectful due to lower income, which can decrease frequency of therapeutic sessions due to financial reasons.Parenting involvment may be more difficult with abusive parents, who may not feel like they are doing anything wrong. I would assume working with a neglectful parent may be a bit easeier because, as previously stated, it may be due to financial issues.

    Reply

    • Julianna Aguilar
      Jul 24, 2014 @ 14:58:39

      Anthony, I like that you pointed out the possibility of abusive or neglectful parents not wanting to participate in therapy. It can be easy to assume that, as therapists, we would be providing a privilege to these parents by allowing them to participate in therapy with their child, and they should be grateful for that opportunity (in an ideal world). However, as you mentioned, many parents may not wish to participate in therapy due to not taking responsibility for their actions, among other reasons. In those situations, it is especially important to evaluate the individual case in order to determine whether having the parent in therapy would be in any way beneficial to the child, or if that situation would only cause further damage to the parent-child relationship and the child’s overall well-being in general (e.g., causing the child to feel that the abuse was his or her fault).

      Reply

    • Angela Vizzo
      Jul 26, 2014 @ 11:58:24

      Anthony, I agree the issue of having parent-perpetrators of abuse invloved in therapy is a very tricky subject. One of the hardest things to deal with, as you point out, is dealing with a parent who does not believe they are doing anything wrong and trying to get them to see reason and develop better parenting techniques, I’d imagine.

      Reply

  16. Melysa Faria
    Jul 24, 2014 @ 14:42:13

    1) Based on the readings and my own clinical experience, I feel that including a parent-perpetrator in therapy really depends on the situation and timing. Having a family session with a child who is being reunified with his or her parents after the parents used physical punishments can be beneficial to teach the parents alternative methods of discipline. On the other hand, if the parent sexually abused his or her child, the situation is very different. Involving this parent in therapy with the child could cause further distress and psychological harm. Not every parent knows how to discipline their child appropriately, however every parent does know they should not be sexually abusing their child. It is also important to keep in mind the child’s current psychological state. If a child was just removed from the home for physical abuse by a parent and struggling with PTSD, having the parent come into a session with their child would do more harm than good. However, if the abuse took place months or years in the past and the child has worked through some of the issues, he or she may feel ready to further resolve past issues by including the parent-perpetrator in therapy.

    2) Neglected children often present with more internalizing behaviors and have difficulty with socializing and regulating emotions since they are not presented with the opportunities to learn these skills. Abused children often present with more externalizing behaviors such as aggression and difficulty controlling impulses and emotions, which can often be learned behaviors from parent’s aggressive and impulsive actions. It is important to determine the reason for neglect of youth; if the reasoning is financial difficulty, it would be necessary to help the family in locating resources to decrease neglect the child may be facing. It is also important to remember that abuse is much easier to see and report with evidence than neglect; this could complicate the process of helping the child get the needed supports when neglect is reported. Children that are neglected benefit from social skills training and emotion regulation skills training; children that have been abused benefit most from emotion regulation skills training and behavioral modification interventions. Neglected children and abused children could find benefits in family sessions as well depending on the severity of the abuse or neglect and the current structure of the family (i.e. do parents still have custody or visitation).

    Reply

    • Rebekah Kiely
      Jul 25, 2014 @ 12:08:17

      Melysa,
      I like the point you made about including the parent-perpetrator in treatment for cases in significant periods of time have passed and the child feels ready. I also believe that inclusion of the parent-perpetrator in treatment may depend greatly on the perspective of the child being treated. Recently, I read some research about resilience on maltreated children and it asserted that resolution of the past abuse had a strong impact on their perception of the future. I can see how some older children especially, would feel the need to face their abuser again in a therapeutic context to make greater sense of the experience and gain a more optimistic look of the future.

      Reply

  17. Angela Vizzo
    Jul 24, 2014 @ 14:51:13

    The issue of including parents who are perpetrators of abuse towards their children in therapy is a tricky subject. I would definitely have to say that each case is different and should be regarded based on those specific circumstances. However, in general if the child remains in the custody of the parent-perpetrator then including them in therapy is necessary. By doing this it allows work to be done on the parent’s parenting skills and hopefully to implement more effective, nonabusive parenting techniques. This is key in physical abuse situations because, as Mash & Barkley point out, physical abuse is usually a result of parent-child conflict. In the case of sexual abuse, however, an issue within the parent is generally the case. I would be very reluctant to put a child back in a home where sexual abuse occurred, even if the parent is receiving therapy.

    In the cases of abuse and neglect, Mash and Barkley point out that child behavioral problems often overshadow the problems within the home. In general, abused children present with more violent tendencies and aggressive behaviors, as well as hypervigilance and fearfulness. These children have also been taught by their parents to not report abuse for fear of retaliation. Because of this it is important to allow the parent a cooling off period with the therapist before taking the child home. In the case of children of neglect, they can present with running away, delinquency, and disruptive behaviors. It is also important to assess these children for developmental impairments, such as attention or language deficits, and difficulty with emotional understanding and treat these things if present.

    Reply

    • Larrisa Palmer
      Jul 25, 2014 @ 16:22:04

      Angela, I do agree with you that including the parent-perpetrators in therapy can be a tricky subject and that each case is different. I believe that some parents can be rehabilitated through the use of psychoeducation, and skills training. I also feel that I would be more open to include a parent who physical abused his or her child, than a parent who sexually abuse his or her child.

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Adam M. Volungis, PhD, LMHC

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 43 other followers

%d bloggers like this: