Effecting Change in Maltreating Fathers: Critical Principles for Intervention Planning

Although fathers perpetrate a significant proportion of child maltreatment, the intervention needs of abusive and neglectful fathers have not been adequately addressed or researched. This paper argues that well-designed treatment has the potential to benefit men, their children, and their families. However, the treatment needs of maltreating and at-risk fathers are unique, and programs must be designed accordingly. Based on the integration of parenting, child abuse, change promotion, and batterer treatment literatures, five principles to guide intervention with maltreating fathers are advanced: (a) overly controlling behavior, a sense of entitlement, and self-centered attitudes are primary problems of abusive fathers; thus, the development of child-management skills should not be an initial focus of intervention; (b) abusive fathers are seldom initially ready to make changes in their parenting; (c) fathers' adherence to gender-role stereotypes also contributes to their maltreatment of children; (d) the relationship between abusive fathers and the mothers of their children requires special attention; and (e) because abusive fathers have eroded children's emotional security, the need to rebuild trust will affect the pace of change and potential impact of relapse on the child. These principles are contrasted with the supportive and child-management goals of conventional group parenting programs, and the implications for providing service to fathers are considered.     

Finding Ways to Reduce the Prevalence of Child Maltreatment Among Fathers: A Comment on the Alternative Approaches

Scott and Crooks (this issue) provide a thoughtful and thorough accounting of the characteristics that are more typical among maltreating than nonmaltreating fathers. Despite the merit in the suggested guidelines for intervention programs, questions may be raised about the relative utility of interventions rather than prevention programs with at-risk males. The effectiveness of one such prevention program is described.     

The Impact of Child Abuse in Community Institutions and Organizations: Advancing Professional and Scientific Understanding

Although child abuse by family members has received considerable scientific and professional attention, knowledge on the impact of abuse committed by perpetrators in (nonfamilial) community organizations and institutions is lacking. We present a conceptual framework derived from child abuse studies, the authors' collective clinical experience with adult survivors of nonfamilial abuse, and two independent panels of abuse survivors, practitioners, and researchers familiar with the impact of such abuse. The framework identifies abuse-related factors that contribute to harmful outcomes, and dimensions of harm associated with such acts. Implications of the conceptual framework are discussed in relation to professional education and practice guidelines, policy and prevention initiatives, and research needs.     

239名高中男生儿童期性虐待调查

目的：了解高中男生中儿童期性虐待发生情况，探讨性虐待经历对学生心理健康的影响。方法：用自境式问卷，对某中学以班级为单位整群抽取的239名高中男生就有关儿童期性虐待经历进行不记名横断面回顾性调查。结果：在被调查的239名男生中，有55人(23．0％)报告16岁前曾经历过非情愿的或非身体接触或身体接触的性虐待；其中3人(1．3％)经历过被试图性交，2人(0．8％)经历过被强行性交。49．1％的儿童期性虐待首次发生年龄在11岁及以下。与没有儿童期性虐待经历的男生比较，有儿童期性虐待经历的男生抑郁情绪量表得分高；自尊量表得分和健康状况自我感觉评价得分低，差异有显著性。结论：本研究结果提示我们应重视男童中儿童性虐待问题的研究；儿童期性虐待经历是影响受害者心理健康的一个重要因意。     

Collaboration between child welfare and substance-abuse fields: combined treatment programs for mothers

OBJECTIVE: To review collaboration between child welfare and drug-abuse fields in providing treatment to mothers who abuse drugs and maltreat their children. METHODS: Literature review of studies examining effects of maternal drug abuse on parenting skills and outcomes of interventions for both maternal drug abuse and parenting skills. RESULTS: Parenting skills differ between mothers who do and do not abuse drugs, but these studies are primarily limited to mothers of infants and preschoolers. The evidence base for interventions to address both substance use and parenting in these mothers is growing, but more well-controlled studies are needed. Opportunities for improved collaboration between fields are presented. CONCLUSION: Progress has been made toward collaboration to address drug abuse and parenting skills of mothers who abuse drugs, but more integrated strategies are needed, especially for mothers who use drugs and maltreat their children.     

Contextual Treatment of Dissociative Identity Disorder

Abstract

Evidence for the effectiveness of contextual therapy, a new approach for treating adult survivors of prolonged child abuse (PCA), is provided via case studies of three women with Dissociative Identity Disorder (DID). Contextual therapy is based on the premise that it is not only traumatic experiences that account for PCA survivors' psychological difficulties. Even more fundamentally, many survivors grow up in an interpersonal context in which adequate resources for secure attachment and acquisition of adaptive living skills are not available. As a result, they are left with lasting deficits that undermine not only their current functioning, but also their ability to cope with reliving their traumatic memories in therapy. The primary focus of this treatment approach, therefore, is on developing capacities for feeling and functioning better in the present, rather than on extensive exploration and processing of the client's trauma history or, in the case of DID, of identity fragments. Treatment of the three cases presented ranged from eight months to two and one-half years' duration, and culminated in very positive outcomes. The women's reports of achievements, such as obtaining and maintaining gainful employment, greater self-sufficiency, and the establishment of more intimate and gratifying relationships, indicated marked improvements in daily functioning. Objective test data obtained at admission and discharge, and in one case, at follow-up, documented substantial reductions in dissociative, posttraumatic stress, depressive, and other symptoms.     

Child Sexual Abuse in Asian American Families: An Examination of Cultural Factors That Influence Prevalence, Identification, and Treatment

Child sexual abuse affects thousands of families each year. Issues pertaining to the prevalence, identification, and treatment of sexual abuse have been relatively well explored in the literature as they pertain to the dominant European American culture. These issues, however, are still relatively unexplored in terms of how sexual abuse affects Asian American families and the Asian American community. We review the relevant literature in Asian American families. These matters are explored in the context of Asian American values such as collectivity, conformity, inconspicuousness, middle position virtue, shame, self-control, and fatalism. Attitudes toward family, sexuality, and the mental health system are also discussed. Cultural and institutional barriers to underutilizing mental health services are also explored, and suggestions for overcoming these barriers are offered.     

Reflective functioning in mothers with drug use disorders: Implications for dyadic interactions with infants and toddlers

In this study, we examined maternal reflective functioning as a bi-dimensional construct in a sample of 47 mothers with drug use disorders caring for infants and toddlers. We first tested a two-factor solution with scale items from the Parent Development Interview and confirmed the presence of two related but distinct dimensions: self-mentalization and child-mentalization. We then tested predictions that (a) self-mentalization would be associated with overall quality of maternal caregiving and that (b) child-mentalization would be associated with (i) maternal contingent behavior and (ii) child communication. Results partially supported hypotheses (a) and (bii). Unexpectedly, self-mentalization alone was associated with maternal contingent behavior. Findings suggest that self-mentalization may be a critical first step in improving mother-child relations involving mothers with drug use disorders. Implications for theory and practice are discussed.     

Some Considerations About Sexual Abuse and Children with Sexual Behavior Problems

SUMMARY

In the mid 1980s treatment programs for children twelve years and younger who molested other children began to appear. There was little known about these children and there were numerous misconceptions about this population. It was believed that the primary etiological factor in the development of this behavior was previous hands-on sexual abuse to the child. It was also believed that a majority of sexually abused children would engage in problematic sexual behaviors and that it was quite likely that they would go on to molest others. In the intervening years a great deal has been learned about children who molest. The diversity of reasons for the development of problematic sexual behavior has been researched. Another important finding is that there is a range of disturbed sexual behaviors in children. This is important as there has been an overidentification of children who engage in problematic sexual behaviors as children who are molesting. A continuum of sexual behaviors in children is described which delineates three groups of children who engage in problematic sexual behavior, only one of which is molesting other children. With this understanding professionals can distinguish between children who engage in natural and healthy sexual behaviors, sexually-reactive behaviors, extensive but mutual sexual behaviors, and children who molest. This assists in more accurate assessment and treatment planning in an era in which children can be placed on sex offender registries and potentially be subject to community notification.     

Scientific Expert Testimony in CSA Cases: Legal, Ethical, and Scientific Considerations

We strongly agree with Sbraga and O'Donohue (2003 , this issue) that the science and ethics of clinical psychology, as well as the legal standards of Daubert v. Merrell Dow Pharmaceuticals, Inc . (1993), prohibit testifying that a child has been sexually abused based on the child's postabuse psychological functioning. Moreover, based on a review of the literature, we argue that it is highly unlikely that a symptom marker of childhood sexual abuse (CSA) will ever emerge that could be used in court to prove a history of childhood abuse. In light of the current status of literature on CSA, we offer some practical suggestions and guidelines for practitioners who accept the role of expert witness in this area.     

Training competent psychologists in the field of child maltreatment

Child maltreatment is a serious threat to children's physical and psychological well-being; therefore, it is critically important to develop high-quality educational programs to train psychologists in effectively addressing child abuse and neglect. Various health care disciplines and areas within the field of psychology have established competencies as a guide for student training curricula; however, none have been established for the area of child maltreatment. The present article presents training competencies for the field of child maltreatment that have been developed from a program designed to train psychology graduate students to practice and conduct research in child maltreatment. The competencies have been divided into eight core areas including assessment, treatment, multidisciplinary collaboration, advocacy, ethics, research, research ethics, and professional development.     

Behavioral Assessment: Advancing Methodology in Pediatric Psychology

The value of applying behavioral assessment methods to the fieldof pediatric psychology is addressed. Three major areas of behavioralassess ment are examined: behavioral interviews, rating scales,and direct observa (ion measures. Examples of recently developedinstruments with particular utility in pediatric research andclinical practice are described. The paper emphasizes the potentialof behavioral measurement to advance our knowledge of the behavioralcorrelates of childhood illness and the effects of interventionand to facilitate precise communication of this informationamong professionals.     

Moroccan women with a history of child sexual abuse and its long-term repercussions: A population-based epidemiological study

Summary. Childhood sexual abuse is defined as sexual contact imposed on a child whose development is still, from the emotional, cognitive and maturity point of view, lacking. The objective of this epidemiological study, conducted among a representative sample of the female population aged 20 and over in Casablanca, Morocco, is to determine the prevalence of the childhood sexual abuse and its long-term repercussions.The main results were that 9.2% (n=65) reported childhood sexual abuse. The mean age of this subgroup was 31.34±9.43 years (20–63); 66.1% were housewives; 40% were single and 10.8% were divorced. The prevalence of genital abuse with penetration was 33.8% (22 cases). The abuser was known in 56.2% and was a family member in 20.4% of the cases. Of the 728 women interviewed, 27 (43.5%) abused women and 83 (29.5%) non-abused women during childhood reported depressive symptoms with a positive association (p=0.03). There was also an association between the most severe types of abuse and vaginismus. Generally speaking, all those who were abused during their childhood suffered sexual disturbances during their adult life.     

Behavior Problems in Sexually Abused Young Children

A sample of 85 children, ages 3 to 12, and sexually abused withinthe previous 24 months, were evaluated with the Child BehaviorChecklist (CBCL, Achen-bach & Edelbrock, 1983). Data relatingto the nature of the abuse were also collected. This samplewas clearly more deviant behaviorally as measured by the CBCL.Internalizing behavior was related to the frequency of abuse,the sex of the child, the relationship of the perpetrator tothe child, and the severity of abuse. Externalizing behaviorwas related to the duration, perpetrator's relationship, timeelapsed, and sex of the child. Sexual behavior in this samplewas related to frequency of abuse and number of perpetrators.     

The Language of Sexual Abuse

Abstract

We sought to determine whether the psychological effects of sexual abuse systematically affect the language of abuse survivors. To accomplish this, we used a computerized lexical analysis system to compare the Rorschach responses of 30 female psychiatric inpatient abuse survivors with those of a matched group of female psychiatric inpatients with no abuse history. We then replicated the results in a holdout sample of 20 additional female inpatients. Our findings suggest that childhood sexual abuse has enduring and identifiable effects on the language of abuse survivors.     

Are fathers involved in pediatric psychology research and treatment?

Background Recently, there has been a growing awareness of theimportance of the roles of fathers in understanding normativedevelopmental processes. Increased attention has been givento the roles of fathers in the area of clinical child researchand therapy. However, the presence of fathers in research andtreatment in pediatric psychology has not been fully examined.Objective To explore the status of including fathers in bothresearch and treatment in the area of pediatric psychology.Method An extensive review of published research. Results Thefindings suggest that pediatric psychology research lags evenfarther behind clinical child research in including fathersin research designs and analyzing for maternal and paternaleffects separately. There is also a concomitant lack of inclusionof fathers in family-based interventions in pediatric psychology.Conclusion These patterns are discussed, with an emphasis onstrategies to increase the inclusion of fathers in researchand treatment of pediatric psychology issues. Future directionsfor researchers and clinicians are also included.