The sexually abused child in the foster setting
Current researchers believe the majority of children entering the foster system have been traumatized physically and emotionally and now require care the foster system was not originally created address[1]. Additionally, foster children are reported to have “three to seven times as many acute and chronic health conditions, developmental delays and emotional adjustment problems” as their non-foster peers[2]. The care provided in foster care is of critical importance, as research emphasizes the remaking of an attachment based relationship, such as the foster parent-child relationship, is the focal emotional need during the foster experience[3]. When a child has been sexually abused, the care required is of paramount importance, however, a careful and comprehensive assessment of the child is required as childhood sexual abuse affects different children completely differently, displaying a range of symptoms or lack thereof[4]. Cicchetti and Toth[5] emphasize the individual differences that abuse has on individuals is most often based on the child’s level of functioning at the time of the sexual abuse, such that the sexual abuse and/or other forms of concurrent child abuse will be interpreted by one child differently from another. As the child matures, the abuse will also carry different meanings, therefore Cicchetti and Toth[6] tell us that [foster] caregivers must readily adapt to the changing issues the child is dealing with and manner in which he/she relates.
This essay will present a brief case study followed by an examination of the foster parent skills, qualities and understanding needed to engage in a relationship with a child who has been sexually abused, critically reflecting on actions taken with the child.
For purposes of this paper, the child discussed is an adolescent who suffered repeated sexual abuse in an intra-familial setting. Issues relating specifically to infants, preschool or younger children victimized by sexual abuse and placed in a foster care setting are considered beyond the current scope of this essay. Additionally, issues pertaining to the legalities implicit in a childhood sexual abuse case, abuse by an extra-familial individual or issues pertaining to abduction and violence perpetrated upon a child in conjunction with sexual abuse are considered beyond the scope of this essay.
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Case study
J is a 14-year-old female who was repeatedly sexually abused by her step-father from the age of five years. J’s mother was an alcoholic and unable to hold a job. J’s step-father threatened that he’d kill her mother and J if she told anyone. J remained silent for the first eight years, displaying a variety of emotional and physical problem that doctors and school officials put off to developmental disturbances. When J finally told her mother when she was 13 years-old, her mother said it was because J was such a pretty girl and to just go along with it because after all, he provided for them all and they’d be on the street otherwise. When J was called to the principal’s office for disruptive and aggressive behaviour towards a boy who made sexual advances to her in the hallway, J finally told her principal what was going on at home and family service and police officials were called in. J was removed from the home and placed in foster care.
J was 15 by the time she was placed in this writer’s foster care. J exhibited many of the common mannerisms common to adolescent females victimized by intra-familial sexual abuse including adopting sexually promiscuous and extremely flirtatious behaviour with other males, engaging in self-injurious behaviour such as cutting coupled with distancing herself from trusting authority figures. Also noted by this writer were J’s frequent depressive episodes and affect. It was important to note, consistent with current research, that the British child welfare authority over two-thirds met current diagnostic criteria for at least one or more psychiatric disorders[7], emphasizing that older individuals in foster care have a higher rate of lifetime and past year psychiatric disorders, frequently onset prior to the initiation of the foster situation.
Fostering J
Consistent with research by Yancey[8] an appropriate combination of mentoring and role-modelling for J was an integral part of her fostering. Role modelling does not necessarily necessitate personal interaction, whereas mentoring also includes deliberate support, guidance and an effort to help shape the adolescent, as in the case of J where she had not developed the appropriate skills with which to weather difficult periods in her life or make sense of what had happened to her in real world terms[9] and examine the skills, qualities and understanding needed to engage in a relationship with that child.
J’s brain anatomy was modified by the repetitive abuse, accounting for much of her depression and other personality disorders[10] through the L-HPA axis impact[11]. Explaining this to J in terms she would understand was difficult as she was not overtly trusting of authority or parental figures; the information only seemed to fuel her rage at her role of helpless victim and further emphasize her own role in the abuse process rather than appropriate placement of blame externally on her step-father. Similarly, research highlights the persistence of depression and other emotional areas of dysfunction up to and extending beyond five years following childhood sexual abuse[12]. Given the goal of foster placement as the reunification of the family unit[13] occasional visitation with J’s mother caused greater depressive episodes and more dramatic episodes of self-injurious behaviour, which is consistent with the literature stating further abuser contact within five years can be used to predict higher levels of depression in the abused child[14].
Significant mentoring with J focused on building her sense of self-esteem and orienting her towards healing her own inner hurt child, mothering it in ways that were not provided to her in her critical early childhood years. For example, it was important to help J search for solutions and focus on how to overcome her current issues and for her to admit problems exist with her normal day to day actions. Rather than nurture her child’s mind questioning “why” did this happen to me, this writer had to stress that she is responsible for her own thoughts, feelings and behaviour at this point in her life and as it moves forward, that she can construct her own destiny, especially since she is within years of adulthood[15]. It was difficult explaining that her sexually aggressive behaviour was not considered normal, but an affect of her abuse[16] as she continued to seek the physical intimacy with a male as an expression of their love for her rather than simply sexual gratification[17], still replaying her step-father’s verbal expressions of his love for her, how attractive she was, etc.
Given J’s level of problems with attachment relationships, it was instrumental working with her coming from the transactional analysis framework emphasizing relations needs both current and in the archaic ego, emphasizing J’s need for security and protection experienced within a relationship[18].
One of the most difficult issues relative to providing care for J was to nurture her commitment to positive change, as considered a fundamental principle of transactional analysis based integrative therapy[19] as J demonstrated oppositional and defiant behaviours on a regular basis.
J’s continual behaviour issues emphasized the need for working with her as a role model and mentor rather than being directly confrontational with her regarding her dysfunctional behaviour or inappropriate thinking. This emphasized keeping control of J’s life in her hands, considered by research as critical for survivors of sexual abuse[20]. Research demonstrates that combining therapy in the foster setting can reduce stress for the child and caregiver, increase the development of positive attachment relationships and corresponds with an increase in positive behavioural change[21].
While the interaction with J was a positive, albeit difficult one, upon reflection, however, one major change would have been to mutually establish J’s goals for growth into an integrated and intact adult. This would have helped establish a foundation and framework for working together.
Bibliography
Alfaro, Jose, Fein, Edith, Fine, Paul, Halfon, Neal, Irwin, Martin, Nickman, Steven, Pilowsky, Daniel K., Rosenfeld, Alvin A., Saletsky, Ronald, Simms, Mark D. & Thorpe, Marilyn. Foster Care: An Update. Journal of the American Academy of Child and Adolescent Psychiatry, 1997.
Auslander, Wendy F., McMillen, J. Curtis, Munson, Michelle R., Ollie, Marcia T., Scott, Lionel D., Spitznagel, Edward L. & Zima, Bonnie, T. Prevalence of Psychiatric Disorders Among Older Youths in the Foster Care System. Journal of the Academy of Child and Adolescent Psychiatry, 2005.
Baird, Frank. A Narrative Context for Conversations with Adult Survivors of Childhood Sexual Abuse. Progress – Family Systems Research and Therapy, 1996.
Black, James E., Haight, Wendy L. & Kagle, Jill Doner. Understanding and Supporting Parent-Child Relationships during Foster Care Visits: Attachment theory and Research. Social Work, 2003.
Chamberlain, Patricia, Fisher, Philip A., Gunnar, Megan R. & Reid, John B. Preventive Intervention for Maltreated Children: Impact on Children’s Behaviour, Neuroendocrine Activity, and Foster Parent Functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 2000.
Cicchetti, Diane & Toth, Sheree L. A Developmental Psychopathology Perspective on Child Abuse and Neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 1995.
Erskine, Richard G. A Gestalt Therapy Approach to Shame and Self-Righteousness: Theory and Methods. The British Gestalt Journal, 1995.
Green, Arthur H. Child Sexual Abuse: Immediate and Long-Term Effects and Intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 1993.
Oates, R. Kim, O’Toole, Brian L., Swanston, Heather & Tebbutt, Jennifer. Five Years after Child Sexual Abuse: Persisting Dysfunction and Problems of Prediction. Journal of the Academy of Child and Adolescent Psychiatry, 1997.
O’Reilly-Knapp, Marye & Erskine, Richard G. Core Concepts of an Integrative Transactional Analysis. Transactional Journal, 2003.
Temple, Susannah. Transactional Analysis Philosophy, Principles and Practice. Temple Index of Functional Fluency, 2006. Retrieved from: http://www.functionalfluency.com/articles_resources/Philosophy_Principles_Practice.pdf Cited 10 September 2007.
Yancey, Antoinette, K. Building Positive Self-Image in Adolescents in Foster Care. Adolescence, 1998.
Footnotes
[1] J. Alfaro, E. Fein, P. Fine, N. Halfon, M. Irwin, S. Nickman, D. J. Pilowsky, A. A. Rosenfeld, R. Saletzky, M. D. Sims & M. Thorpe, Foster Care: AN Update, Journal of the Academy of Child and Adolescent Psychiatry.
[4] A. H. Green. Child Sexual Abuse: Immediate and Long-Term Effects and Intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 1993.
[5] D. Cicchetti & S. L. Toth. A developmental psychopathology perspective on child abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 1995.
[7] W. F. Auslander, J. C. McMillen, M. R. Munson, M. T. Ollie, L. D. Scott, E. L. Spitznagel & B. T. Zima. Prevalence of Psychiatric Disorders among Older Youths in the Foster Care System. Journal of the American Academy of Child and Adolescent Psychiatry.
[8] A. K. Yancey. Building Positive Self-Image in Adolescents in Foster Care. Adolescence, 1998.
[10] J. E. Black, W. L. Haight & J. D. Kagle. Understanding and Supporting Parent-Child Relationships during Foster Care Visits: Attachment Theory and Research. Social Work, 2003.
[11] P. Chamberlain, P. A. Fisher, M. R. Gunnar & J. B. Reid. Preventive Intervention for Maltreated Preschool Children: Impact on Children’s Behavior, Neuroendocrine Activity, and Foster Parent Functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 2000. The limbic-hypothalamic-pituitary-adrenal axis shows different responses on maltreated children, disabling their ability to regulate their emotions appropriately following the developmental disruption.
[12] R. K. Oates, B. L. O’Toole, H. Swanston & J. Tebbutt. Five Years after Child Sexual Abuse: Persisting Dysfunction and Problems of Prediction. Journal of the American Academy of Child and Adolescent Psychiatry, 1997.
[15] S. Temple. Transactional Analysis Philosophy, Principles and Practice. Temple Index of Functional Fluency. Retrieved from http://www.functionalfluency.com/articles_resources/Philosophy_Principles_Practice, 2006.
[16] A. H. Green. Child Sexual Abuse: Immediate and Long-Term Effects and Intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 1993.
[18] M. O’Reilly-Knapp & R. G. Erskine. Core Concepts of an Integrative Transactional Analysis. Institute for Integrative Psychotherapy. Retrieved from: http://www.integrativetherapy.com/en/articles.php?id=40.
[19] O’Reilly-Knapp & Erskine.
[20] F. Bard. A Narrative Context for Conversations with Adult Survivors of Childhood Sexual Abuse. Progress – Family Systems Research and Therapy, 1996.
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