Individual psychotherapy for the sexually abused child

This paper describes one Center's experience using individual psychotherapy to help the sexually abused child. The approach described rests upon a five-part conceptualization of the traumatic experience: trauma, threat to ontogeny, neglect and emotional unavailability by the caregiver, child's feeling of exploitation, and the child's adaptation. The process of treatment is divided into three phases: starting, middle and closing. Some common issues which occur are guilt, loss and anger, as well as alterations in the child's sexual feelings. The psychotherapeutic approach to these and other issues is coordinated with other therapies. If the child is to appear in court, the experience of testifying provides a reality-based focus for treatment and is not a divisive problem for the therapist. At times, therapists experience feelings of anger, hopelessness and a desire to rescue their patients. The therapists meeting in a supervision group provided a means of understanding and working through the therapists' experiences. Future study of the therapy process with long term follow-up could reveal the issues necessary for an abused child to negotiate in order to achieve full recovery. Further research could establish which treatment modality is primarily suited to a particular type of sexually abused child taking into account differences in age, duration and severity of abuse, family dynamics and psychological impact.