10.2: Treatment for Child Abuse Survivors

Supportive Treatment for Child Abuse Survivors

It is normal for most people to want to help children who have experienced maltreatment. When children don’t receive services after being traumatized, research shows that they are at greater risk for being re-victimized. It is very important that society provides these children with the best possible treatment in supporting them. How do we best help them? There are many supportive treatments available... one type does not fit all. Within the confines of this text, we cannot fully explore all of the supportive treatments available; we will take a snapshot look at a few of the most prevalent and helpful.

Family-Centered Therapies

When trauma happens, it doesn't usually impact just one child... it impacts the entire family. Anyone who is a direct or indirect victim of the trauma should be able to access help in overcoming the trauma. This often includes the children and adults of a household (unless they were the perpetrator, and then sometimes they are included anyway if they will be reunified) and may include extended family members or friends. The more healthy support available, the better. The following information is a summary from an article by the Child Welfare Information Gateway, found at https://www.childwelfare.gov/pubPDFs/trauma.pdf.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a proven method that aids children, teenagers, and their caregivers in overcoming trauma-related challenges. This therapy effectively addresses negative emotions and behaviors stemming from various traumatic experiences, including child sexual abuse, domestic violence, traumatic loss, mass disasters, and multiple traumas. TF-CBT works by correcting harmful beliefs and perceptions related to these traumatic events. In a nurturing setting, children are encouraged to openly discuss their trauma and develop coping skills for everyday stress. Additionally, TF-CBT supports non-abusive parents in managing their own emotional distress and equips them with techniques to better assist their children.

Overview

After experiencing trauma, such as child maltreatment, children can face serious emotional, behavioral, and other challenges both immediately and in the long term. These challenges can include depression, substance abuse, PTSD symptoms (like intrusive memories, avoidance, emotional numbing, and hyperarousal), mood and anxiety disorders, suicide attempts, increased cortisol levels, and legal issues. They might also develop harmful beliefs and attributions, such as feeling powerless or believing they are to blame for the abuse.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a scientifically supported treatment designed to help children manage and reduce the negative impacts of trauma. This therapy aids in processing traumatic memories, resolving harmful thoughts and behaviors, and building effective coping and social skills. Additionally, TF-CBT involves a component for non-abusive parents or caregivers, helping them acquire skills in stress management, positive parenting, behavior management, and effective communication.

TF-CBT integrates principles from various therapeutic approaches:

• Cognitive Therapy: Focuses on altering unhelpful thinking patterns to change behavior.
• Behavioral Therapy: Aims to modify habitual emotional responses, like anger or fear, to non-threatening situations.
• Family Therapy: Looks at family interaction patterns to identify and resolve issues.
• Attachment Theory: Highlights the significance of the parent-child relationship.
• Developmental Neurobiology: Provides insights into how the brain develops during childhood.

TF-CBT is designed for children and adolescents aged 3 to 18 who have experienced at least one traumatic event, such as child maltreatment, community violence, or the traumatic loss of a loved one. Suitable candidates for this therapy include those who:

• Exhibit PTSD symptoms
• Experience high levels of depression, anxiety, shame, or other dysfunctional feelings, thoughts, or beliefs related to the trauma
• Display trauma-related behavioral issues, including age-inappropriate sexual behaviors

The therapy also involves non-offending parents or other caregivers in the supportive treatment process.

TF-CBT has shown effectiveness in various settings, such as clinical environments, foster care, schools, and in-home care. It works well with children and families from diverse cultural backgrounds and can address different types of trauma, including physical or sexual abuse, domestic violence, natural disasters, and traumatic grief. It is also effective for those who have experienced multiple types of trauma.

However, TF-CBT may not be suitable for all populations and might require adjustments for:

• Children and adolescents with primary issues of severe conduct problems (e.g., aggressive or destructive behaviors) or significant behavioral issues that predate the trauma. These individuals might benefit more from treatments focusing on these behaviors first.
• Children with extensive inappropriate or illegal substance use
• Children who are acutely suicidal
• Adolescents currently engaging in serious self-harming behaviors or other nonfatal self-harm actions

It is crucial to conduct thorough assessments to ensure that children and adolescents fit the profile for TF-CBT and can benefit from the intervention.