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Therapy for Children and Teens Who were Sexually Abused

by Sheri_Oz

How do professionals help children and teenagers heal from the sexual abuse? What are the therapy approaches most commonly applied with young people and their parents?

Because the field of psychotherapy for sex trauma victims is still developing there is no one proven best way to work with children and teens. Some clinics offer only individual therapy while others offer a combination of individual and group formats.

Research has shown that cognitive-behavioural therapy seems best suited to treat phobias (extreme fears that cause avoidant behaviours) and depression as well as one-time traumatic events. When the abuse continued over a long period of time, it is best to use a variety of therapeutic tools.

The more classic form of talk therapy, called dynamic psychotherapy, is not effective in the treatment of children or adolescents who were abused.

For many children and teenagers, art therapy, movement therapy, sand therapy, zootherapy (use of animals in treatment), or other interesting forms of therapy can help them get over the negative effects of the abuse.

All these terms will be discussed below.

Cognitive-Behavioral Therapy (CBT).  Generally a brief approach to therapy which seeks to change the thought patterns that lead to problematic behaviors using specific tasks and homework assignments.  Often used to help with depression and phobias. There are many different techniques that are part of CBT. This is the most researched type of therapy and there are methods that have been proven to help with different kinds of trauma.

Dynamic Psychotherapy.  Also called: Psychodynamic Therapy.  In this form of therapy the relationship between the therapist and the client is the most significant tool for healing. Clients need to raise topics they want to talk about in each session and for trauma victims/survivors this is particularly difficult - they tend to need more guidance from the therapist than dynamic therapists are used to providing. There are dynamic therapists who have experience working with trauma survivors and therefore they do adapt their way of working to these clients.

Art Therapy. In this form of therapy, the therapist and client communicate through drawing, sculpture and other artistic forms. It allows victims/survivors of trauma to work through their experiences without necessarily having to talk about them.

Movement or Dance Therapy. Victims/survivors of sexual trauma suffer from extreme levels of stress that affect they way they feel in their bodies. That affects sleep patterns, eating habits, aches and pains in various parts of the body and general health. By focusing on movement in therapy, the stress can be released and healing promoted.

Sand Therapy.  This is a form of play therapy whereby the client places figurines in a sand box and works through problems by organizing and re-organizing the figurines. These figurines represent different people in the child's life or different aspects of himself or herself.

Zootherapy. Animals can form healing relationships with children and adolescents. Clients feel safer telling the animals about their problems than telling adults. The animals are specially trained to calm children, and to play with them in a therapeutic manner.

What is Healing about Therapy?

While some young people find relief from the traumatic events by telling a professional therapist what happened during the abuse, others are not helped by this.The therapist must be able to tell the difference and lead each client along his or her unique path to recovery.

Most children and teenagers want to do well in school, want to be loved by their parents, and want to have friends. If therapy aims to help them accomplish these goals, many do not find it necessary to relate details of the abuse. They will have gained sufficient self-confidence to be able to function well in their lives. This makes them less vulnerable to subsequent exploitations.

Sometimes the most important help we give to children and to teenagers is the help we give their parents in learning more effective parenting skills. 

It is  important to understand that recovery for young people often occurs in stages such that at each new developmental stage, the person will have to digest what happened to them over again. That is because as children grow they are able to understand other aspects of the traumatic event and their needs change. For example, a five-year-old child cannot understand sexual abuse in the way a fifteen-year-old will. For this same reason, adults may need to return to therapy even if they felt as children that they healed from what was done to them.

Popular Tools for Healing from Trauma that Can be Used with Children and Teens

These are not therapy approaches, but rather, tools that can be applied by therapists working from a variety of therapy of schools of therapy. They are well regarded within the trauma therapist community.

EMDR

Eye Movement Desensitization and Reprocessing: Originally consisted of clients moving their eyes from side to side as they talk in order to access both sides of the brain simultaneously, the thinking side and the feeling side. Now the therapist may use earphones to provide auditory stimulation, tapping on the knees or hand-held gentle vibrators to provide tactile stimulation instead of eye movements. There are specific adaptations that have been developed specifically for children and teenagers. When used properly, this is a very effective means of therapy for many people.

SE

Somatic Experiencing:  This set of tools is based upon the fact that traumatic stress remains locked inside our bodies and we can heal by recognizing the impact of trauma on our bodies and allowing the stress to be expressed safely in the therapy room, thereby releasing ourselves from it. This knowledge is applied in work with children in a gentle and subtle way while they are playing, doing artwork, etc.

Research on Therapy Tools for Healing from Traumatic Events

There are several tools for trauma resolution. Some have been scientifically tested to explore how effective they may be and others have not. While it may give greater confidence to therapists, and perhaps to parents as well, to know that academic research has shown a particular method to be helpful, it is important to remember a few facts:

1

When research shows that a form of therapy is helpful it shows that it may be helpful for a certain percentage of the people studied - that may be 50%, 70% or even only 40%. That means that for many people even a "proven" tool is not going to help everyone.
2

Studies of effectiveness take place under conditions very different from what happens in most therapy in private and public clinics. Therefore, if the research shows the technique is effective in 6, 12 or 20 sessions, in real life, the technique may be applied very differently and it may take much longer to feel the results.
3

There may be drop-outs from studies, people who do not complete the therapy programme being studied. Researchers do not tell us about these people - was the therapy too hard? did it seem inappropriate to the client? what happened to them after they left the programme?

 

For these reasons, while research is important, it only can give the therapist partial answers. Therapists, especially sex trauma therapists, need a great deal of experience to know which clients will likely benefit from a particular tool and when and how to use them.

 

The Most Scientifically Studied Approach to Trauma Therapy with Children and Teens

Trauma-Focused Cognitive Behavioural Therapy

Cohen, Deblinger and Mannarino, developed the most researched approach to trauma therapy for children and teenagers. It is a short-term process that includes relaxation exercises, telling the story of the abuse, explanations for victims and their parents on sexual abuse and its effects, parent guidance and parent-child sessions. I was critical of their one-size-fits-all approach and now am happy to see that they have begun to explore the multifaceted and complex issues that face sex abuse victims/survivors and their families.

Their most recent study explores the relative importance of the various aspects of therapy and they show what many therapists have known for a long time - that the most important part of therapy for many children after being safe from abuse is not telling the story of the abuse, but rather learning important coping skills for functioning better in school and among peers.

They were able to show that different therapy approaches are necessary for different symptomatic presentations of children of different ages and they promise future studies will provide more answers to clinicians who seek to provide the best therapy possible to each individual client.

Their latest article:

Deblinger, E., Mannarino, A.P., Cohen, J.A., Runyon, M.K. & Steer, R.A. (2011). Trauma-focused cognitive behavioral therapy for children: Impact of the trauma narrative and treatment length. Depression and Anxiety, 28, 67-75. 

Written by a survivor of incest, this book details a clear and easily-followed path that can help young people heal from sexual abuse trauma. Parents going through this book with their children may find it helps strengthen their relationship and builds the child's shattered ability to trust.

Therapists may find it a helpful accompaniment to the therapeutic process.

Family Therapy in Cases of Sexual Abuse

Family therapy can take different forms. The therapist may see all the family together, may work with the parents only, or may alternate between seeing members individually or in pairs and in larger groups.  The purpose of family therapy is to help family members communicate more effectively and develop healthier and more satisfying interactions.

An important part of family therapy when there has been child abuse is parenting education and parenting skills development.

When the abuser is a member of the nuclear family, it is more likely that family members will be seen individually until they are ready to acknowledge the abuse, the abuser takes responsibility and the nonabusive parent knows how to help the children in light of the abuse having gone on unstopped.

Siblings need special attention in order to help them vent their feelings. Their feelings toward the abuser, the nonabusive parent/s and the victim/s will be complex and cause a great deal of confusion. 

Family reunification aims to enable parents to provide a safe and healthy environment in which to continue raising their children.

What do parents need after learning that a child of theirs was sexually abused?

  Display results
Parents need all of these. Given the abuser's manipulations and threats, the child may successfully hide the fact of the abuse from the nonabusive parent/s, who will explore their own behaviour if others support them and don't put them on the defensive.

All My Articles on the Internet
Here you can find the growing list of articles I publish in various places around the Web. It includes all topics and you will see that the list of sex abuse articles will grow faster than the others.

Sheri Oz, Expert in the Field of Childhood Sexual Trauma

I have been working almost exclusively in this for over 25 years. In 1999, I established the first multidisciplinary clinic in the country (Israel) treating children, teenagers and adults who were sexually abused and their families. We did couples therapy when one or both partners were survivors of abuse and offered parental guidance when a child or youth was abused or was found to have sexually acted out against another minor. I directed the clinic until 2010, when I turned my energies toward establishing a two-year specialist training programme for therapists who want to work in this area.

I have presented at international conferences in Israel and abroad. My first book on therapy for adults survivors and their therapists was published in 2006 and I have published numerous professional papers in English and Hebrew.

One of my current goals is to share all that I have learned over my career - for survivors, their loved ones and professionals working with them.

I will answer questions, personal and professional, and make articles around the questions asked so that others can benefit as well.

Sheri_Oz, on 01/18/2012
 
Thank you! Would you like to post a comment now?
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Are you optimistic that victims and survivors can heal if given support and appropriate therapy?


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Sheri_Oz on 01/21/2012

Thanks for your feedback. It is important to me. You are so right, Graceonline, that in adulthood the recovery markers cycle in decades or half-decades rather than in years.

katiem2 on 01/18/2012

What an amazing article, a great work. Thank you for reaching out, the numbers of people suffering through this painful reality is tremendous. Glad to have found your helpful resources for those who were sexually abused. Katie

graceonline on 01/18/2012

I know it for a fact. One of the most important facets of this article is this: "Recovery ... occurs in stages such that at each new developmental stage, the person will have to digest what happened to them over again." For people whom I know to have suffered childhood sexual abuse, this remains true even throughout adulthood, though the recovery markers may be separated by decades rather than by years.

Excellent article. You have provided a good service. Thank you.


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