Return to index of Proceedings XX, click here.

SHORT-TERM EVALUATION AND TREATMENT OF
SEXUALLY ABUSED CHILDREN

Emily T. Knight, Ph.D. and Bracley C. Stolbach, M.A.

La Rabida Children's Hospital and Research Center

Chicago, Illinois

This presentation outlines the crisis intervention paradigm used at our hospital to treat child victims of sexual abuse. Children enter the hospital system for multidisciplinary evaluation soon after an allegation that sexual abuse has occurred is made. When appropriate, short-term, event-specific psychotherapy is recommended. Treatment lasts ten sessions and is intended to restore the child to his/her pre-crisis level of functioning by helping him/her to integrate the experience both cognitively and emotionally. Treatment serves several functions including: the reduction and prevention of chronic trauma symptoms; developing and understanding of the meaning of the abusive event(s); helping family members express their feelings about the sexual abuse openly, and, exploring methods for coping and getting support.

This intervention is generally most effective with younger children whose abuse did not involve violence, who were victims of one-time extrafamilial abuse, or who have not sustained chronic or severe physical and emotional injuries. In many cases, such as those involving on-going incest, threats of violence, or multiple forms of abuse, long-term treatment is required. A positive therapy experience during the crisis intervention phase may set the stage for successful on-going treatment by educating the family about and destigmatizing both the process of psychotherapy and the subject of sexual abuse. At the end of the ten sessions, a referral for further treatment may be made.

We use a modified play therapy approach with an active therapist who is alert to bringing the topic of abuse into the session and helping the child to work through and gain mastery over its effects. Drawing, writing, storytelling, and role playing may be used. Interpretations are kept to a minimum. Instead, discussion of the incident and the questions raised by it evolves mutually between the therapist and child. In some sessions, parent figures may participate actively in this process. Ideally, at the end of the ten sessions, a child has begun the process of integrating his or her feelings about the abuse, has developed ways of managing symptoms and affective responses, and has some of his/her shattered trust in others restored.

This presentation will have three components:

1. Discussion of theoretical issues and treatment rationale.

2. Session-by-session goals of treatment.

3. Presentation of two cases providing examples of the techniques used and the emotional issues involved in the treatment.

Return to index of Proceedings XX, click here.