Author Topic: Principles of treatment for child abuse trauma  (Read 1109 times)

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Principles of treatment for child abuse trauma
« on: August 06, 2006, 08:27:43 PM »

3. Principles of treatment for child abuse trauma

There are several important principles of treatment that anyone seeking good professional help in dealing with the effects of child abuse should know about. I cannot list them all or spell them out in great detail. However, in this section some crucial ones are introduced and described, to aid with interviewing potential therapists or consultants and reflecting on one's experiences in treatment. Reflecting on these principles can be particularly helpful at the beginning of therapy, while establishing trust, as well as during other difficult phases.

    Competence. Not all professional therapists are competent to provide treatment to people with histories of severe child abuse, or with particular sorts of problems that can result from extreme forms of abuse. Competence requires but is not guaranteed by extensive experience and training in work with survivors of child abuse, or ongoing supervision with a more senior and qualified therapist. (Section 4 below has resources for interviewing therapists to gather information about their likely level of competence.)

    Empowerment. The core experience of child abuse, like all severe traumas, is disempowerment: one's needs, wishes and choices (including not to be abused) are ignored and trampled upon. Because child abuse involves violation and betrayal of trust by a more powerful person, it is essential that the therapist and therapy not repeat these patterns.

        * Thus good treatment is not something that a more powerful professional requires the client to accept and "comply" with, as the medical model of therapy tends to assume. Therapists with this approach and/or attitude are much less likely to be helpful.

        * Rather, the client must be educated about the treatment process, informed of options, and involved as a partner in the formulation of treatment goals and decisions about how to go about achieving them. (There are exeptions, of course, in cases where clients are at immediate risk to harm themselves or others and not able to make safe choices on their own; however, even then, the client should be given as many options and choices as possible.)

        * Two other principles related to the therapist working to empower the client are worth noting here: neutrality and disinterestedness.
                By "neutrality" is meant that the therapist does not take sides in clients' inner conflicts (e.g., Should I leave or should stay? Do I trust her or not?), but helps clients identify and work through their mixed feelings and come to their own decisions and solutions. Often people expect therapists to give them advice or tell them what to do ? but this can take power away from clients, prevent new learning and growth, and even increase their attachment to maladaptive patterns as they react negatively to being "told what to do".
                By "disinterestedness" is meant that the therapist does not use the client to meet his or her needs. This principle not only covers more extreme examples, like sexual exploitation of the client, but more subtle things like the therapist using the client to gratify needs to be admired, respected, etc. This also refers to the therapist not using the client to promote a personal agenda, for example, about how abuse survivors should relate to family members or the perpetrator. Of course, as Judith Herman points out, this is "an ideal to be striven for, never perfectly attained" ? since therapists are, after all, human beings with their own needs and motives for doing therapy, personal biases and limitations, etc.

    Connection. Disconnection is another core experience of child abuse. Thus a therapist must be capable of connecting with her or his client, of being present as another human being with genuine relatedness and empathy.

        * However, some people with severe abuse histories may be unable to accurately perceive the therapist at times, and may "project" their own difficulties connecting (or those of the perpetrator or an unprotecting parent) onto the therapist.

        * Also, connection does not mean "closeness" or "intimacy" in the traditional sense of non-therapy relationships. Boundaries between the therapist and client are absolutely essential. Therapists who share too much of their own experience, become over-involved or engaged in "rescue missions" are not helping their clients, but violating the principles of neutrality and disinterestedness. This can do tremendous damage to the therapy relationship, disempower the client, prevent healing, and even retraumatize the client.

    Therapeutic frame. Because the therapy relationship can be an intense experience, and involves addressing vulnerable areas of one's life, it is absolutely necessary that the relationship is bounded by a "frame." This can be understood as the collection of "ground rules" that create consistency and stability in several dimensions of the relationship, thereby ensuring that it can be safe and healing.

        * Elements of the therapeutic frame include the length of sessions, starting and ending on time, cancellation and payment procedures, confidentiality and its limits, etc.

        * The frame helps ensure that the relationship will be a healing one, in which expectations can be established and clarified, boundaries can be maintained, and intense emotions, memories and other experiences can be contained and managed.

Much more could be said about principles of treatment. The point here has been to spell out a few that are particularly relevant to people with abuse histories. Please know it is your right to ask potential therapists to describe the principles of treatment that guide them in their work with people who have experienced child abuse.
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