Therapeutic Interventions
Plays
Children choose one of the group members to be the director. The director decides a story to be played by all of the children. Sometimes the therapists guide the children to explore and play a story with a meaningful topic. The director decides which role is portrayed by whom. After the first rendition of the play, the director reallocates the roles. Usually, there are strong characters and weaker ones in the play. Children gain an insight into the feelings of a victim or a victimizer by playing these roles. The perspective gained from playing each role can help children understand how it feels to be victimized and how it feels to be the victimizer. Sexual behaviours should not be performed.
“Stop the Action” Game
In the game “Stop the Action”, everyone freezes the moment the words are uttered by a therapist. Then, everyone thinks about what he/she was doing. Children learn to slow down sometimes and ponder on their actions and feelings. Also, the therapists may choose a theme, for example “sadness” and tell the children that they will call “Stop the Action” if they notice sadness in the behaviour of one of the participants.
Cartoons
Drawing cartoons by children is used to explain what happens when they abuse. Children draw frames describing what they were thinking or feeling before they abused, then how they involved a child in sexual behaviour, and finally what happened after the abuse. Children are asked to draw the feelings and thoughts of their victim. The more familiar children become about what triggers their behaviour, what happens during the acting out, how they feel afterwards, and what are their victim’s feelings, the more able they are to stop the behaviour. Subsequently, children draw cartoon frames that depict some alternative behaviours to the molesting ones. They can cut the alternative frame and tape one end of it over the molesting behaviour. Then, they can draw frames showing how the subsequence would look after the alternative behaviour occurs. Children can compare the alternative behaviour sequence with the sequence of molesting behaviour by lifting up the frames.
Progressive Stories
In this technique, the therapist begins to tell a story that is related to the objectives of the therapy and every child adds on to it in their turn. The children sit around a table and each knows their turn. The therapists sit at intervals between the children in order to divert the story when it gets away from the topic. This technique provides the therapists with information about the children’s anxieties, conflicts and thought process related to the story topic.
Making Videos
The therapists choose a topic and children decide whether to do a television talk show, mime the topic, make a “speech” in front of the camera, or make a “commercial”. Children can decide how to make a commercial on sexual abuse prevention.
Making Pamphlets
Children can write and illustrate a pamphlet where the topic is something like how it feels to be sexually abused, what it is like to live in a foster home, or how many kinds of mothers exist in the universe. The therapists can type it or assist children in other ways. An 8.5 x 11-inch piece of paper can be folded in three and its different sides used.
Relaxation Techniques
By learning to relax at will, children gain a feeling of control over their bodies and emotions. The children get in a relaxed posture in their chair with their arms on their sides. The therapist tells them they are going to relax by contracting and loosening their different muscles. The children use only large muscles and move on in some way through the body. The therapist’s voice is calm, gentle, and monotonous. After the exercise, children discuss how they felt. By learning to separate and work on different muscles, children learn to control how they feel and become more able to direct what takes place in their bodies and environment. They can use relaxation technique whenever they notice the presence of a situation that triggers their sexualized behaviour.
Guided Imagery
To do a guided imagery exercise, children get in a relaxed position in their chairs, put their arms on the table, and stretch forth their legs, with their eyes closed. They, then, concentrate on the story being told by the therapist. Children are asked to imagine every scene, recall or guess all the sounds, smells, touches and motions. Stories are about something like taking a walk on the beach. Positive scenes can describe any number of people, being affectionate and respectful to each other, or the child being popular or successful in some endeavor. Negative scenes can depict a child being apprehended after having touched another child and going through an ordeal. The therapist describes the child’s feelings in details. Children are asked to memorize the scene and recall it whenever they feel like wanting to act-out.
Metaphors
Each child may have a metaphor to use when talking about their feeling about a specific touching problem. Some children use the term “tingly” feeling, others use the term “scary” feeling. Once the feeling has a name, it becomes more clear, stronger, and more alive. Metaphors can be chosen and used in other situations where children find themselves. “Space invader” is an excellent term for speaking of someone who violates the child’s physical and emotional boundaries. The term is both humorous and strong, and can be used to warn the children themselves as well as others when they are being invasive.
Metaphorical Stories
The therapists read to the children some metaphorical stories about touching problems or having been abused. They, then, discuss these stories together. Gardner (1971) created a technique called Mutual Storytelling, in which the child or the children tell a story, then the therapist retells the same story with the same characters and the same conflicts, but suggests a different ending to the events, an ending that is healthy and socially appropriate.
Role-Plays
Children can learn to solve problems by doing role-plays. Two children perform a problem that one of them has had in the previous week. If one of them had a negative interaction with a teacher, he/she can play the teacher and show the group how the teacher behaved and how he/she reacted. The second child will now play the teacher and the first child plays himself/herself. Then, the group evaluates the interaction and recommends substitute ways for the child to behave. The child alters the way he/she behaved and tries to see if the new behaviour changes the teacher’s behaviour. Finally, the children reverse roles in order to understand how it feels to be in different people’s shoes.
Art Materials
Art materials are used in most types of group therapy with children. A helpful activity for sexualized children is to do the family drawing. Children are asked to explain what people in the drawing are doing, and how they are feeling and thinking. The family drawing is an excellent tool to assess the child’s progress.
Music and Dance
Therapists play piano, or any other musical instrument, for children in order to compel them to think about a topic, listen to the music, and come up with a song. After making the song, children can sing it in their minds as a way to stop a sexual acting-out from happening. They can also get a psychic satisfaction out of singing it to the group. Dancing is very beneficial to children who have been sexually or physically abused and live in tense and stiff bodies. Physical activity related to music and dance releases entangled physical and psychic energy.
Letter Writing
Some children express the desire to communicate with their abusers. Therapists can take note from children who can not yet write. Children feel more comfortable expressing their untold feelings in a letter. Sometimes, they want to express love and affection towards their abusers. It is important that they feel free to do so. The letter may be mailed or not. If they decide to mail it, children should be first aware of the impacts of sending the letter.
Conclusion
Sexualized children are not offenders. According to Lucy Berliner and Les Rawlings, “In most cases, the behaviours are learned responses to abusive experiences and deficits in the family and community environment rather than intentional criminal conduct.” (1991) The obvious objectives of the treatment models is to stop the sexualized behaviours of children. Most therapists agree that in order to bring about these changes, a combination of individual, group, and family therapy are needed. Children with sexualized behaviours are engaged in individual therapy both at the onset of treatment in order to create a therapeutic alliance and develop a context for group therapy, and all along the treatment process in order to discern the underlying reasons for their behaviours. Also, individual therapy provides the best setting for reexamination and clarification of the issues that have emerged in group therapy. Family therapy enables parents or other caregivers to provide children with a sense of safety by mindfully addressing their inappropriate sexual behaviours, and making sure that other children do not fall victim of these behaviours. And finally, group therapy has a critical place in an expedient treatment plan. During group therapy, children come to experience relationships with the therapists and other children in which they are expected to empathize with others and take responsibility for their actions. All these treatment models eventually provide children with the skills to cope with risky circumstances and the insight and understanding of not harming others.
Bibliography
Becker, J. V., C. D. Harris and B. D. Sales (1993). Juveniles Who Commit Sexual Offenses: A Critical Review of Research, in Sexual Aggression: Issues in Etiology, Assessment, and Treatment, G. C. N. Hall, R. Hirschman, I. R. Graham and M. S. Zaragoza (eds). Washington: Taylor and Francis.
Berliner, L. & Rawlings, L. (1991). A Treatment Manual: Children’s Sexual Behaviour Problems. Unpublished manuscript. Seattle, WA: Harborview Sexual Assault Center.
Borduin C. M & S. W. Henggeler, D.M. Blaske, R.J. Stein (1990). Multisystemic Treatment of Adolescent Sexual Offenders. International Journal of Offender Therapy and comparative Criminology, 34, 105-113.
Bonner, Barbara & and C. Eugene Walker, Lucy Berliner, “Children with Sexual Behaviour Problems: Assessment and Treatment”, Report by National Center on Abuse and Neglect, US Department of Health British Columbia Ministry of Education (1999). Responding to children’s problem sexual behaviour in elementary schools : a resource for educators. Victoria, B. C.
Burton, Jan Ellen & Lucinda A. Rasmussen (1998). Treating Children with Sexually Abusive Behaviour Problems, The Haworth Maltreatment and Truma Press.
Cunningham, C., & McFarlane Kee (1991). When Children Molest Children. Safer Society Press, Vermont.
Gardner, R. A., (1971). Therapeutic communication with children: The mutual storytelling technique. New York: Jason Aaronson.
Gil, Eliana & Toni C. Johnson (1993). Sexualized Children: Assessment & Treatment of Sexualized Children & Children Who Molest, Foreword by William N. Friedrich , Launch Press.
Johnson, Toni C., (1994). Decreasing Problematic Sexual Behaviours in Children. Unpublished manuscript. Seattle, WA: Harborview Sexual Assault Center. Katz R. C. (1990). Psychosocial adjustment in adolescent child molesters. Criminal consequences of childhood sexual victimization. Journal of Child Abuse and Neglect, 14: 567-575.
Kaufman, B. & Wohl, A., (1992). Casualties of Childhood: A Developmental Perspective on Sexual Abuse Using Projective Drawings. New York: Brunner Mazel.
Lundrigan, Paul Stephen (2001). Treating youth who sexually abuse: an integrated multi-component Approach. Haworth Press, New York. Ryan, G. D. & Lane, S. L. (Eds.) (1991). Juvenile Sexual Offending: Causes, Consequences and Correction. Lexington, MA: Lexington.
Part 1
http://iranian.com/main/blog/azadeh-azad/treatment-sexualized-children-1
Part 2
http://iranian.com/main/blog/azadeh-azad/treatment-sexualized-children-2
