Child Sexual Abuse : Treatment, Part 7

by Child Welfare Information Gateway

(Page 11 of 11)

With some offenders, particularly those with cognitive limitations and difficulty being introspective, the clinician merely teaches the offender to anticipate, identify, and avoid risky situations. Thus, the offender may be instructed that he cannot assist at summer camp anymore or he cannot be left alone with his daughter.

With other offenders, the clinician helps him understand the chain of events, often seemingly unrelated to the sexual abuse, that precedes the victimization. This might include a series of procedures, such as the grooming process an offender may employ in the seduction of his victim, or acts such as getting upset with his wife and getting drunk after she goes to bed as a prelude to going into the daughter's room to molest her. The therapist then teaches the offender to interrupt the chain of events rather early while he still has control of his behavior. Thus, the pedophile is instructed to avoid driving by playgrounds, and the offender whose abuse is precipitated by drunkenness is instructed to abstain completely. If he has a serious substance abuse problem, he is sent to a substance abuse treatment program, either before treatment of his sexually abusive behavior is begun or in conjunction with sexual abuse treatment.

The relapse prevention plan is usually written out, and the offender carries it with him so he can refer to it when he thinks he is in a high-risk situation.

Interventions with the family mentioned earlier, such as not allowing the offender to be alone with the child or to discipline her, are meant to prevent him from being in high-risk situations. Moreover, there are numerous other ways the family and others can be involved in helping the offender prevent a relapse. Because most offenders experience more than one deficit leading to propensity to act, interventions that focus both on his taking responsibility and on relapse prevention are advised.

Other dysfunctional behaviors and problems. The offender may experience many other problems, and often these are contributing factors to the sexual abuse. Examples might be violent behavior, problems with the law, poor parenting skills, marital discord, poor social skills, low self-esteem, lack of education, and unemployment.

These are appropriate foci of treatment, and indeed it may be necessary to treat them because they increase the risk for future sexual abuse. Nevertheless, it is crucial that the clinician not allow him/herself to become sidetracked into only dealing with these other problems. Distraction can occur more easily than one might think if the offender refuses to admit to the sexual abuse or is reluctant to focus on it in treatment, yet is more than willing to work on his other problems. This pitfall is usually avoided if group therapy, which forces the offender to deal with his abuse, is a major component of the intervention and/or if there are several therapists involved in the case.

Conclusion

Impressive progress has been achieved in the child sexual abuse field in the last 10 years. Advances have been made in identification, investigation, intervention, and treatment. Sexual abuse cases, perhaps even more than other types of maltreatment, require multidisciplinary, multiagency collaboration in order for professionals to effectively act in the victim's and family's best interest. Many communities have developed guidelines and protocols for handling these cases.

Yet there is still much work to be done. More progress has been made in the identification and investigation of sexual abuse than in treatment, and resources tend to go into these efforts rather than into preventing and ameliorating the problem. There is a startling paucity of treatment outcome studies. Consequently case management decisions and decisions about what techniques to use in treatment are made by clinicians without empirically tested guidelines.

Moreover, despite the progress in identification, many cases still go undetected. Further, our investigative techniques do not guarantee all victimized children will disclose, and many cases are still inadequately investigated. Moreover, in too many instances children's disclosures are met with skepticism, and the conscientious work of professionals acting on their behalf is challenged.

Although in part professional shortcomings relate to the fact that our abilities to address sexual abuse are still developing, they are largely the result of lack of adequate resources. Caseloads for child protection staff and foster care workers are too large; their training is inadequate; and because of the stresses of the job, their turnover rates are unacceptably high. There are too few trained clinicians who can provide treatment to families and individuals involved in sexual abuse, and when skilled professionals are available, there are often insufficient funds to pay for the necessary treatment. Finally, the funding for research to help us better understand sexual abuse and how to address it is in very short supply.

Nevertheless, professionals in the field of child sexual abuse continue to strive to educate the public and other professionals about this problem and its pervasive effects. Despite the shortage of resources, there is leadership at the Federal and State levels that has played a fundamental role in the substantial progress that has been made. The willingness of adults with prominent roles in the community to identify themselves as former victims and survivors of sexual abuse has added immeasurably to the credibility of child victims and has inspired professionals to continue their work.

About the Author

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Formerly the National Clearinghouse on Child Abuse and Neglect Information and the National Adoption Information Clearinghouse, Child Welfare Information Gateway provides access to information and resources to help protect children and strengthen families. A service of the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.