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Section 4
Family Responsibilities During Therapy
of Sexually-Abused Preadolescent and Adolescent Boys

Question 4 | Test | Table of Contents

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In the last section, we discussed some criteria which indicates individual therapy rather than group therapy: undisclosed personal information about the sexual abuse; assault by a stranger; and if group therapy would be an unnecessary stressful situation.

As you know, clients of a younger, dependent age interact with their parents more than they will with you. Therefore, I believe it is vital to a client's healing and recovery if his parents are involved as much as possible.

In this section, we will examine the four aspects to keep in mind when including the family in off hours therapy: education of the parents; developing and understanding a client's need for security; and reestablishing good self-esteem.

♦ Aspect #1 - Parent Education
Early on in therapy, I educate the parents about sexual abuse and its ramifications. I generally do this through phone calls, letters, or e-mail. Also, I include the many goals that we have made for their son in therapy. The following is a sample letter to the parents of Christopher, age 14:

Dear Mrs. Walsh,

The purpose of this letter is to confirm the details we discussed about Christopher's participation in the boys' group. His group will be meeting here at the clinic every Wednesday from 3:30 to 4:30 pm, starting January 6. Regular attendance is expected and is necessary for Christopher to get the most benefit from his therapy. I would like to emphasize the importance of his attendance. The priorities for Christopher's treatment will be the following:

# 1. Expressing and managing his anger without aggressive or verbally abusive behavior.
# 2. Understanding how he has been affected
# 3. Improving his social skills and relationships with his peers.

I signed the letter with a standard business close.

♦ Aspect #2 - Parents Involvement with Empowerment
As you know, parents are essential in reestablishing a young child's sense of security and power. To better understand how a parent's involvement can reach full potential, I ask my clients to make a "Wish List" of all their requests to their parents. Some examples are as follows:
-- #1 - "I wish my mom hadn't worked nights and then slept during the day. I had to have a baby-sitter and he was the one who molested me."
-- #2 - "I needed love. I needed protection. I wanted my mom to come out and stop it."
-- #3 - "I needed my mom and dad's love and backup."

I then discussed taking the wish list home and telling their parents what they need most from them, if the boy felt comfortable doing this. In this way, the parents will be hearing needs from their own children rather than from another adult. This will help them better understand the important role parents play in recovery.

♦ Aspect #3 - Parents Involvement in the Reestablishment of Self-Esteem
Obviously, the restoration of self-esteem is vital and the participation of the parents is key to this reconstruction.

-- Topic # 1 - First of all, I discuss with the parents speaking to other influential adults in the child's life such as teachers and coaches to let them know about the abuse.
-- Topic # 2 - Secondly, I discuss with them keeping in mind the boy's level of confidence at this stage in life and to increase their awareness of any emotionally crippling words or actions.

Christopher's teacher became very involved in the rebuilding of his self-image. She rewarded Christopher whenever he had a good grade on a test or quiz. Frequently, she asked Christopher to help her in tasks around the room. This gave Christopher a feeling of responsibility and accomplishment, bolstering his self-esteem and bringing him closer to recovery.

♦ Technique: Learning to Trust
To help Christopher develop a better understanding of his family dynamic, I found the Therapeutic Strategy of "Learning to Trust" beneficial, located in the back of your course manual. I made a list of situations and next to it I placed a column for each person that could be influential in his life: Mother (M), Father (F), Grandparent (G), Brother (B), Sister (S), Therapist (T), and Friend (F). I then asked Christopher to take a look at the situations and put a check mark under the letter of the person that he would talk to about the situation.

For the situations "You made an embarrassing mistake", "A friend hurt you", and "You felt lonely" Christopher checked Mother. All of these situations deal with issues of security. As you can see, Christopher's mother is very influential in his feelings of security.

Christopher made no checks under Father, indicating that he did not have a very close relationship with his father. I asked Christopher to examine this lack of trust and to try and include his father when expressing emotions and personal information.

In this section, we discussed the various aspects to keep in mind when including the family in off hours therapy: education of the parents; developing and understanding a client's need for security; and reestablishing good self-esteem.

In the next section, we will examine various challenges inherent when treating sexually abused boys such as: dependency on physical contact; drastic mood shifts; failure to remember session content; dysfunctional attempts to regain power and control; and premature disclosure of the details of the abuse. Also, we will discuss how to address these challenges.
Reviewed 2023

Peer-Reviewed Journal Article References:
Briere, J., & Elliott, D. M. (1993). Sexual abuse, family environment, and psychological symptoms: On the validity of statistical control. Journal of Consulting and Clinical Psychology, 61(2), 284–288.

Kapetanovic, S., Skoog, T., Bohlin, M., & Gerdner, A. (2019). Aspects of the parent–adolescent relationship and associations with adolescent risk behaviors over time. Journal of Family Psychology, 33(1), 1–11.

Karlsson, M. E., Zielinski, M. J., & Bridges, A. J. (2020). Replicating outcomes of Survivors Healing from Abuse: Recovery through Exposure (SHARE): A brief exposure-based group treatment for incarcerated survivors of sexual violence. Psychological Trauma: Theory, Research, Practice, and Policy, 12(3), 300–305.

Katz, C. (2020). “What do you mean the perpetrator? You mean my friend??” Spotlighting the narratives of young children who are victims of sexual abuse by their peers. Psychology of Violence, 10(1), 30–37.

Kelley, E. L., & Gidycz, C. A. (2015). Differential relationships between childhood and adolescent sexual victimization and cognitive–affective sexual appraisals. Psychology of Violence, 5(2), 144–153.

Nash, M. R., Hulsey, T. L., Sexton, M. C., Harralson, T. L., & Lambert, W. (1993). Long-term sequelae of childhood sexual abuse: Perceived family environment, psychopathology, and dissociation. Journal of Consulting and Clinical Psychology, 61(2), 276–283.

QUESTION 4
What are three aspects to keep in mind when including the family the off hours of therapy? To select and enter your answer go to Test.

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