Running Head: INTERVENTION PAPER 1

Introduction

Bio-Psychosocial Assessment

Brianna is a 12 year old, African-American child. Client was sexually and physically

abused by her father beginning at age 8 until 11. She has been locked in the closet multiple times

and sometimes without food and water. This client has also witnessed her father physically abuse

her mother and her younger brother on numerous occasions. Brianna has been diagnosed with

Post Traumatic Stress Disorder and Depression. Client often has negative feelings about herself,

isolates herself from others, does not trust many people, has flashbacks of her attacks, refuses to

leave her room, barely and eats.

Considering her situation, first, it should be noted that the therapeutic relationship itself at

times acts as the basis of reminding the youth about her past trauma. Therefore, it will be

essential as a therapist to ensure that I have cautiously calibrated the abilities of the youth,

parents, or caregivers to endure distress associated to the therapeutic relationship to the extent of

decreasing the intensity of the interaction whenever required. Since a child who has been

sexually abused often report upsetting and frequent nightmares, problems concentrating, sleeping

difficulties, and somatic complaints, it will be, therefore, important when carrying out clinical

assessment to her to understand the precautions I have to take on dealing with each symptom.

Whenever ethnic identity is to be used merely as the demographic label in her sexual abuse

prevention, it means that it can end up serving as the proxy variable which masks rather than

illuminating the problem. Mainly the primary indicating factor that the child have been sexually

abused is when a child shows signs of fear on seeing the abuser as well as avoiding his or her

company. Nevertheless, it is, therefore, apparent that some of the traumatic experiences, such as
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emotional abuse, physical abuse, or exposure to domestic violence, are some of the factors which

contribute greatly to the development of sexual abusive behaviors in her.

Moreover, it is essential for clinicians who will be intervening sexually abused children

to ensure that they have assessed and treated posttraumatic stress disorder symptoms in them

before any follow-up clinical intervention. This then indicates that psychological assessment of

her situation will have to be an ongoing process which ultimately demands gathering of clear

information from their parents, caregivers, or adults who have adequate information about the

functioning and history of the child. Likewise, in order to offer effective psychological treatment,

it will be crucial to collect the basic information regarding her trauma experiences as well as the

secondary adversities which are related to her trauma.

Finally, it is essential for the therapist to ensure that he has cautiously calibrated the

abilities of the youth, parents, or caregivers to endure distress associated to the therapeutic

relationship to the extent of decreasing the intensity of the interaction whenever required.

Therefore, in order to be in the position of designing and implementing interventions which take

into consideration the circumstances and culture of the client, to have a clear understanding of

her ethnicity or the conditions under which she was brought up. The main reason for that is

because at tines clinicians tend to address this issue without necessarily taking into consideration

the linguistic or cultural background, or the conditions in which they live.

Background/Literature Review

The sexual abuse of a child is something which has become more prevalent in various

countries particularly in the United States. It is something which have been noted to have the

potential of affecting individuals from different culture although the general characteristics of an

abuse a child is subjected to varies depending on the ethnic group of the victim (Lisa & Mario,
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2001). This might result to long term psychopathology in the abused child. Thus the main

challenge the therapists can encounter is accepting the underlying reason/s that compels the

abuse to deny and not the denial for the offense itself (Crag & Janice, 2005).

Nevertheless, the majority of the child sexual abuse prevention measure or programs are

mainly fostered in schools. The main reason for that is because they tend to be addressed to

children without necessarily taking into consideration the linguistic or cultural background, or

the conditions in which they live. According to Lisa & Mario, (2001), the comprehensive school-

based programs have been noted to have the potential of effectively improving the understanding

of children about sexual victimization. Having difficulty in psychological functioning for the

majority of the sexually abused children indicates that it is essential to collect views from other

non-sexually abused group. Due to the fact that a child who has been sexually abused usually

shows difficulties in mental functioning, it becomes more imperative to ensure that their

symptoms have been addressed at all phases of development (Gonzalez et al., 2017). Child

maltreatment is one of the social problems which have greatly confronted the modern society.

Child sexual abuse, in particular, has the potential of inducing an overwhelming and lifelong

effect on the life of a child. The reason for that is because the previous understanding of the

effects PTSD on a sexually abused child was typically based on the adults recollection of the

past sexual abuse (Lisa et al., 200).

The symptoms which are linked with the posttraumatic distress disorder which are shown

by victims of sexual abuse include issues such as numbering of responsiveness, re-experiencing

of traumatizing event/s, avoidance of the stimuli which is associated with such an incident.

Disturbed sleep, reduced interest, are some of the behaviors that are commonly found in sexually

abused or traumatized children (Herman, 2010). Thus, severe mental or psychological problems
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are mainly associated with the experiences of the child sexual abuse. In order to be part of the

intervention goal, the majority of the therapeutic initiatives are established and implemented in a

way that compels an offender to admit being accountable for the sexual abuse (Robst, 2010). As

a result, the therapist should be cautious about accepting the denial for the abuse itself even if it

is the protective component of the offender. The reason is because he or she can be seen as

tacitly excusing the offense hence contributing to confusion of reality (Stanley, 2011).

The majority of the youths end up experiencing or developing complex trauma including

attachment problems, perception, and behavior. In this case, clinicians at time request the

establishment and utilization of various strategies, such as the evidence based treatment (EBT)

for this kind of population (Judith et al., 2012). Therefore, the general assessment of a youth with

complex trauma something which becomes more challenging because of various reasons. In

most cases, in order to offer effective psychological treatment, the therapist is forced to collect

the basic information regarding his or her trauma experiences as well as the secondary

adversities which are related to her trauma. This includes family rejection, medical, legal as well

as other interventions which to them may be another way of increasing their trauma (Malloy et

al., 2011).

Moreover, it should be noted that the effects of actual sexual victimization is something

which remains to be unclear to the majority of individuals. The reason is because there exists no

information to validate whether the prevention programs advanced works well to all cultural

groups. Sexual abuse intervention is alone amongst other child maltreatment prevention

programs aimed at enhancing the wellbeing of a child as compared to that of adults. The point of

consideration in this is whether making a child to be responsible for his or her own safety is the

best rationale to take. It is important to ensure that at all the comprehensive sexual abuse
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intervention have enhanced education to young children, adolescents, parents, and other

individuals who work with children (Bassani et al., 2009). Likewise, the general public

edification campaigns ought to be advanced for achieving both the secondary and tertiary

prevention goals. These goals entail making it easier for a child and their parents to acknowledge

as well as seek assistance for child sexual victimization (Lisa & Mario, 2001).

Self-blame is one of the factors which have been noted to have the capacity of deteriorating the

psychological health of victims of sexual abuse. Amongst the survivors of sexual abuse, self-

blame predicts the negative impacts including ineffective coping, psychological symptoms,

distress, and sexual revictimization (Crag & Janice, 2005). This indicates that, in most cases

offenders end up denying to be in the position of saving themselves from legal consequences

and/or just to defend against the emotional and psychological pain of the childhood trauma

which contributes greatly to their abusive behaviors.

From research regarding the perspectives of the community on sexual abuse, it has been

recognized that the majority of community members are aware and indeed knowledgeable about

this problem. They ultimately consider it as being a significant problem which derives immediate

attention (Robst, 2010). Additionally, it has been noted that some of the victims of sexual abuse

end up becoming offenders with time. Despite that, the education campaign has the capacity of

describing the various ways victims uses coping with their plight (Nancy, 2008). This can be

done through protecting other children, seeking professional counseling or even becoming

professional counselor to sexually abused children and other victims. On the other hand,

effective intervention for sexual abuse should be tailored towards the circumstances and beliefs

of an individual to who they might be directed. The reason is because some of the approaches to
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criminal justice, medical, therapeutic, legal, and child protection interventions may end up failing

in case the services offered contradict the cultural beliefs and practices of that person

Intervention

Considering the situation of the client, the main intervention plan to use in evaluating her

conditions are Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Play Therapy.

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is regarded as being the standard

intervention for the pediatric PTSD (Josh et al., 2015). From the therapeutic point of view,

complex trauma has the potential of impacting several domains of an individuals life and for

that reason it is essential to understand the significance of developing a trusting relationship with

the client who might be suspicious about such an information collection activity (Josh et al.,

2015). The reason is because the development and maintenance of trusted therapeutic

relationship is fundamental in TF-CBT treatment. In this context, tolerating distress is concerned

with the capacity of her to have self regulation whenever experiencing any form of negative

effective states which are ultimately induced by trauma reminders. Thus, this indicates that every

TF-CBT component has the potential of helping her to gain mastery over trauma reminders

(Judith et al., 2012).

Play therapy is basically an interpersonal process in which through the use of play, a

clinician assists a child with emotional, traumatic, behavioral problems to learn skills. Play is

regarded as an ultimate mode of treatment because of the fact that often young children

encounter difficulties in verbalizing their feelings or thoughts. Through playing, particularly

using an animal, she will have the ability of lowering his or her barriers to the extent of

expressing his or her feelings effectively (Porter, 2009). On the same basis, a child who has some
INTERVENTION PAPER 7

sexually abusive behaviors is increasingly being perceived as being the targeted population

which requires specialized psychological intervention.

Although problematic sexual behaviors have been viewed as to be causing no harm to

others, they make other children to be uncomfortable, create risks of sexual abuse to others, as

well as interfering with the psychosexual development of a child (Rasmussen, 2013). Likewise,

the process of having clues form how she will be associating with the animal, in return will assist

in revealing the extent to which the child is coping with trauma caused by sexual abuse. This is

to imply that, the child will be given a chance of conveying her feelings, emotions, or thought

through the animal rather than directly talking to the social worker.

Similarly, with play therapy, the child will be given an opportunity of mastering her

overall trauma or stress. Based on the therapeutic viewpoint, for play to be effective, it is

important to create a working relationship with the clinician, offer an opportunity for diagnostic

evaluation, include a breaking down of protection, enhance articulation, provide therapeutic

release, and prepare a child for future life incidents (Porter, 2009). This indicates that play is a

wonderful psychological tool for parents, or caregivers to learn with, under a certified clinician,

to foster the development of better relationships with their children. This is coupled with the

views that developmentally, it covers the space between abstract thinking and concrete

understanding hence offering a child the capacity of categorizing his or her real-life encounters

which are often abstract and complex (Nancy, 2008).

Additionally, the general use of animals for treating a sexually abused child on an

individual basis is also another effective tool in the clinical intervention process (Elisabeth,

1998). As the animal assisted therapy, it mainly incorporates an animal as part of the
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psychological treatment process a child is subjected to. In this context, the animal is used as a

teacher, mirror, or model by the child. Due to the fact that the animal is absolutely

nonjudgmental, this will assist in boosting her sense of self-esteem as well as promoting the

expression of thoughts or feelings (Elisabeth, 1998).

Naturally, as a child passes through different developmental stages, he or she ascribes

human traits to animals. This then indicates that social workers can dedicate their time in

utilizing animals to educate children about nurturance, self-acceptance, responsibility, empathy,

and affection. In the process of having clues form how the child associated with the animal, it in

return assists in revealing how the extent to which the child is coping with trauma caused by

sexual abuse. This implies that, the client will be given a chance of conveying her feelings,

emotions, or thought through the animal rather than directly talking to the social worker

(Elisabeth, 1998). According to research, regarding play therapy, animal assisted treatment, that

is, storytelling, cannot be utilized on its own in inducing treatment to a sexually abused child.

Her clinical support will, therefore be integrated with other types of therapies.

Nevertheless, the tendency of engaging in active denial is one of the most frustrating

elements which hinder incestuous families from obtaining effective medical intervention. Since

medical professionals are human, they end up finding incestuous abuse as objectionable like the

majority of individuals do. It has been recognized that a number of heath care professionals, who

do expect a small amount of regret from the offending father, are at times incredulous when

being confronted with rejection from both. Thus, it means that the denial of abuse is something

which can turn out to be the main focus of authority struggle her family, with the result that the

treatment becomes stalemated (Crag & Janice, 2005).

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Nonetheless, a large percentage of the youth who have hard complex trauma often end up

under-reporting their sexual abuse encounters and other trauma-related problems. The reason is

because of the desire to avoid the overwhelming trauma material. In other words, they regard

persistent distress and regulation problems as being the common fabric of their daily life or

because attachment related injuries end up making them not to trust or belief the clinical

intervention of the therapist. This indicates that the psychological assessment that she will be

subjected to with respect to these two approaches will be a continuous process which ultimately

demands gathering of clear information from her parents, caregivers, or adults who have

adequate information about the functioning and history of the child (Judith et al., 2012).

As noted, the majority of the non-offending individuals, particularly female, are at times

forced by their community not to disclose any sexual abuse done to them or their child. The main

reason is because it is perceived that they are emotionally and economically dependent on men.

Moreover, it is because their society desires to protect them from physical and emotional pain.

However, to clinicians, the benefits of regarding denial as an advantage or strength rather than a

weakness are numerous (Crag & Janice, 2005). Other than recognizing the denial of the client as

a form of hostility against the psychotherapist, which can result into defensive posture, as a

counselor who sees denial as a form of self-protection as well as the coping mechanism, I will be

free to treat it just the same way as any other kind of clinical interaction. Integrating such a

concept is the positive view of denial which has the capacity of allowing respectful and more

positive view the victim. This has the impact of opening up the potential for a purposeful

relationship with the client.

Similarly, demanding extermination of denial as a form of coping mechanism is just an

irresponsible position for any clinician to take (Crag & Janice, 2005). Through recognizing and
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understanding denial, it means that it will be easier to anticipate for its occurrence, establish a

successful therapeutic relationship, as well as plan effective intervention strategies that will assist

in controlling her condition.

Typically, in order to be able to prevent or curb the onset of the incest-related

psychological health patterns in the victim, the widespread provision of social work intervention

services will mainly target the current situation of her family. Moreover, it is essential to ensure

that her posttraumatic stress disorder symptoms have been clearly assessed before any follow-up

clinical intervention. This is because a higher level of the posttraumatic stress disorder (PTSD) in

the client will indicate that that she might be encountering trouble or difficulties in more than one

of these areas. Thus, this suggest that the clinical intervention that a sexual abused child will be

subjected to will only be successful in case such areas of functioning are effectively targeted. It

is important to acknowledge that interest in activities, socialization, and self-esteem issues are

some of the areas which may be of less concern when offering clinical intervention (Lisa et al.,

200).

The empirical information suggests that the use of therapeutic methods such as cognitive-

behavioral intervention or dynamic/expressive play treatment has the capacity diminishing the

sexual behavior problem in a child. This supports the need of having integrative models which

will assist in combining strategies from other intervention approaches and which can be

effectively applicable to her in case she might show such behaviors such behaviors (Rasmussen,

2013).

Evaluation
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Considering the above case, the problems associated with the history of a child who has

been sexually abused include eating disorder, anxiety, low self-esteem, avoidance, somatization,

guilty, and substance abuse (Lisa et al., 200). Although the occurrence of posttraumatic stress

disorder (PTSD) amongst sexually abused children have been documented by various researches,

it is important to have a clear understanding of the extent at which the levels of PTSD impacts

their daily functioning. Fundamentally, when making use of integrative approach, as a therapist,

there is the need of selecting intervention strategies which are different from other therapeutic

models for the purpose of addressing the certain needs of the client (Rasmussen, 2013).

Denial, like any other form of resistance, it not inevitably pathological, rather it can be

understandable and important protective device. Whether it is social denial, whereby the decision

for denying is conscious or psychological denial thus implying the decision for denying is

unavailable and unconscious for a person even when confronted by reality, the underlying

objective is to offer protection to the family and/or individual from the irresistible social and

psychological consequences of incest (Crag & Janice, 2005). This is to say that that the majority

of the children who are the victims of sexual abuse end up endorsing negative self-esteem in the

event of recalling their past sexual abuse trauma.

Moreover, it is suggested that there is the need of examining all the supported self-blame

indicators within diverse populations of a child (Audrey et al., 2010). Considering the social

setting, a child who has sexual abusive behaviors provides an exceptional challenge to therapists

because they ultimately present in therapy with perpetration and victimization issues. Researches

about sexual abuse on children indicate that such a child could have been the victim of sexual

abuse.
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Conclusion

From the above illustrations, in order to be in the position of designing and implementing

interventions which take into consideration the circumstances and culture of the client,

professionals in different levels and contexts should be trained in cultural competency.

Seemingly, the differences in style of conversation amongst groups ought to be taken into

account to make intervention programs to be effective in curbing this problem. In order to be

more effective, the truth is that the prevention measures which have been advanced should have

the potential of targeting the specific needs of the victims population. Moreover, the programs

that are aimed at reducing substance abuse amongst teenagers should target the specific needs in

respect to gender, age, or their cultural background. The reason for that is because the child

abuse prevention measures which have been advanced remains to be remarkably generic. This is

to say that they are often established through and for the members of the racial group/s.

Through recognizing and understanding denial, it means that the clinician can anticipate

for its occurrence, establish a successful therapeutic relationship, as well as plan effective

intervention strategies. Self-blame, rejections, low-self-esteem, and avoidance, are some of the

factors which have been noted to have the capacity of deteriorating the psychological health of

victims of sexual abuse. Thus, this suggests that the clinical intervention that a sexually abused

child will be subjected to will only be successful in case all the domains of his or her daily

functioning are effectively assessed. This, in return, increases the likelihood of a child to employ

self-protection strategies whenever being threatened as well as increasing his or her chances of

disclosing victimization or attempted victimization. By taking into consideration the increasing

rates of the psychological difficulties encountered by sexually abused adults as children, it,
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therefore, becomes vivid that social work ought to be directed towards early stage of sexual

abuse intervention and prevention

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Raymann, B. W. (2009). Child sexual abuse in southern Brazil and associated factors: a

population-based study. BMC Public Health, 9(1), 1-11. doi:10.1186/1471-2458-9-133

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TREATMENT. Thomson Learning Press

Elisabeth R. (1998). Individual Counseling for Sexually Abused Children: A Role for Animal and

Storytelling. Child and Adolescent Social Work Journal.

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Josh M. C, Benjamin A. S, Teresa L. K, Sonet S, Karin V, Joy, P & Clinton, D. K. (2015).

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Lisa, A, Carol, R.P.M & Marta L. (2000). Posttraumatic Stress and Mental Health Functioning

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