Child Abuse Review Vol.

4: 263-277 (1995)

Sexual Abuse: Rayleen V. De Luca

Debby A. Boyes
Effects of Group Alana D. Grayston
Elisa Romano
Therapy on Pre- Departmentof Psychology
Unwersity of Manitoba

adolescent Girls Winnipeg

Canada

This article describes the effectiveness of a group therapy program

used at the University of Manitoba with pre-adolescent girls who have
experienced sexual abuse. Thirty-five girls, ranging in age from 7 to 12,
were referred to structured therapy groups of 9 to 12 weeks' duration.
Issues addressed in weekly sessions included feelings about the
offender, problem-solving, sex education,'and prevention of further
abuse. Measurements of self-esteem, anxiety, and internalizing and
externalizing behaviour problems were taken for participating children
prior to and following treatment at 1 and 9 to 12 month intervals.
Parent- and child-reported social validity data were also collected
following treatment. Comparison group data for self-esteem and
anxiety were provided by a non-random sample of 35 girls with no
known history of sexual abuse. Results indicated that following group
therapy, self-esteem increased and anxiety and behaviour problems
decreased. Comparison group data further supported the effectiveness
of group treatment in improving the self-esteem of sexually abused
girls. Social validity reports of children and parents also suggested that
treatment was helpful and worthwhile. Implications of the findings are
discussed as are difficulties encountered in conducting treatment
outcome research with children who have been sexually abused.

C linicians and researchers involved in the areas of child

protection and child mental health acknowledge that
the sexual abuse of children is a growing and serious problem 'Sexual abuse of
(Briere, 1988; Conte and Schuerman, 1987; Hiebert-
Murphy, De Luca and Runtz, 1992). A recent prevalence children is a .
study (Finkelhor, Hotaling, Lewis and Smith, 1990) found growing and
that 27% of adult females and 16% of adult males reported a
history of childhood sexual abuse. In all likelihood, these
serious problem'
figures underestimate the true prevalence rate, because some
cases of childhood sexual abuse are never disclosed or
reported.
The literature suggests that numerous short- and long-
term negative consequences may result from a child having
Corresmndence and reurint reauests addressed to Dr. Ravleen V. De Luca.
D e p A e n t of Psycholob, University of Manitoba, Winnipeg; Manitoba, Canada;
R3T 2N2.
CCC 0952-9136/95/040263-15 Accepted 19 January 1995
@ 1995 by John Wiley & Sons, Ltd
264 De Luca, Boyes, Grayston and Romano
been sexually abused. Some of the negative effects may
include low self-esteem, depression, anxiety, guilt and anger,
as well as problems in sexual adjustment, eating behaviours,
sleep patterns and interpersonal relationships (Adams-
Tucker, 1982; Briere, 1988; Conte, 1985; Finkelhor, 1990;
Friedrich and Luecke, 1988; Gabor, 1988; Kendall-Tackett,
Williams and Finkelhor, 1993).
In order to address these possible negative effects,
‘Treatment has treatment has been widely encouraged for children who have
experienced sexual abuse (Hiebert-Murphy et al., 1992). In
been widely particular, group treatment has been identified as the
encouraged for treatment of choice for several reasons. First, a group setting
may provide sexually abused children with a feeling of
children who have universality by allowing them to interact with other children
experienced sexual who have had similar experiences. As such, group therapy
abuse’ may help to reduce the feelings of isolation reported by many
abused’ children. Second, group therapy may also give
children who have been sexually abused the opportunity to
extend their social support networks. Third, numerous
educational opportunities may arise in group treatment,
including opportunities to improve social skills, develop
alternative ways of coping with the sexual abuse experience,
and learn about healthy relationships, particularly with same-
aged peers. Fourth, compared with individual therapy, group
treatment may be more cost-effective because it can provide
help to a number of children given limited available resources
(De Luca, Boyes, Furer, Grayston and Hiebert-Murphy,
1992; Sturkie, 1992).
The literature on sexual abuse has identified numerous
possible negative effects resulting from sexual victimization
and has emphasized the use of group treatment for children
who have experienced sexual abuse. However, there has been
‘ A paucity of a paucity of empirical research on the utility of group
treatment for victims of childhood sexual abuse (De Luca,
empirical research Hazen and Cutler, 1993; Hoier, 1987; Sturkie, 1992). The
on the utility of few empirical studies (De Luca et al., 1993; Friedrich,
group treatment Luecke, Beilke and Place, 1992; Hack, Osachuk and De .
Luca, 1994; Hiebert-Murphy et al., 1992; Nelki and Watters,
for victims’ 1989) addressing the effectiveness of group treatment have
examined such variables as child reports of self-esteem,
depression, anxiety and loneliness, and parent reports of
children’s internalizing and externalizing behaviour prob-
lems. These variables generally have been measured at pre-,
post- and follow-up treatment stages. Findings suggest that
group therapy may be effective in reducing depression,
anxiety, and internalizing and externalizing behaviour
problems in children who have been sexually abused, as well
 Effects of Group Therapy 265
as increasing children’s self-esteem (De Luca et at., 1993;
Hack et al., 1994; Hiebert-Murphy et al., 1992; Sturkie,
1992). Many of the available studies, however, present
preliminary findings which are based on small sample sizes
(Hiebert-Murphy et al. , 1992). More empirical research,
using a larger number of children, is needed to assess the
efficacy of group treatment for children who have experi-
enced sexual abuse.

Aims of The Study

The purpose of the present study was to evaluate the

effectiveness of group treatment for childhood sexual abuse
by examining three areas. First, the study attempted to
extend findings from previous research demonstrating the
effectiveness of group therapy for children who have
experienced sexual abuse. Although numerous variables
could have been examined, the focus of the present study
was on those effects which have been most consistently
demonstrated in the sexual abuse literature (Kendall-Tackett
et al., 1993). As such, child-report measures of self-esteem ‘Measures of self-
and anxiety along with parent-report measures of children’s
internalizing and externalizing behaviour problems were esteem and
administered at pre-, post- and follow-up treatment phases. anxiety along with
Second, the present study attempted to further assess the parent-report of
effectiveness of group treatment by examining the variable of
social validation, as reported by children and parents. children’s
McMahon and Forehand (1983) define social validity as the behaviour
‘necessity of demonstrating that therapeutic changes are
“clinically or socially important to the client” ’ (p. 209). problems’
The collection of information about the social validity of a
treatment program is important because social validity data
can supplement objective measures and help determine the
relationship between treatment-produced changes and sub-
jective evaluations of treatment changes. In addition, social
validity data can help explore the relationship between the
acceptability of a treatment program and its efficacy (Wolf,
1978). In other words, whether individuals benefit from group
treatment may be related to how worthwhile and important
they found the group experience to be. In the child therapy
literature, social validity is typically assessed by adults who are
mediators in the child’s treatment, such as parents or teachers.
Children are rarely asked to evaluate the treatments in which
they have been involved, despite evidence suggesting that
such information may be more useful than only parent reports
or teacher reports about social validity (McMahon and
266 De Luca, Boyes, Grayston and Romano
Forehand, 1983). Thus, the present study investigated the
social validity of group treatment for sexual abuse from the
perspectives of both children and their parents.
Third, in order to draw h e r conclusions regarding the
effectiveness of group therapy for sexually abused children,
the present study incorporated a comparison group of
children with no known history of sexual abuse. Child
reports from the comparison group were compared to those
from the abused group at times corresponding to the pre-
treatment and follow-up assessments.

Method
Subjects
‘Seventy girls, Seventy girls, aged 7 to 12, were recruited for the study.
Thirtylfive of the girls had been sexually abused and were
aged 7 to 12, were consecutively referred to a group therapy program at the
recruited for the University of Manitoba (De Luca, Boyes, Furer, Grayston
and Hiebert-Murphy, 1992) by provincial agencies man-
study’ dated to protect and care for children. Referrals were
included in the study if: (a) they had disclosed at least one
incident of intrafamilial sexual abuse (i.e., sexual abuse
perpetrated by one or more family members, such as fathers,
brothers, grandfathers, uncles, or various father-figures);
(b) they were living in family settings that did not include the
offenders; and (c) they had received parental permission to be
evaluated and treated in the group therapy program.
The comparison group consisted of 35 girls with no known
history of sexual abuse who were recruited from a local
elementary school, as part of a study examining the effects of
sexual abuse (Grayston, De Luca and Boyes, 1992). Permis-
sion forms were provided to parents or guardians of female
students aged 7 to 12, and only those children returning
signed consent forms participated in the study. Permission
for each girl to participate was also obtained from the school
principal and school division head.

lnstruments
‘Several Several standardized measures were used in the present
study in order to evaluate the effectivenessof group therapy
standardized for children who have experienced sexual abuse.
measures were
used’ Child-Report Measures
Children in the treatment and comparison groups completed
two measures designed to assess their levels of self-esteem
 Effects of Group Therapy 267

and anxiety. Measures were completed during individual

interviews with female graduate students in Clinical
Psychology.
The Self-Esteem Inventory (SEI; Coopersmith, 1981) was ‘The Self-Esteem
used to measure children’s self-perceptions in the domains of
social, family, academic and personal experience. The scale
Inventory was
consists of 58 statements (e.g.,‘I like to be called on in class’), used to measure
to which a child responds like me or unlike me. Higher scores children’s self-
on the SEI reflect greater self-esteem (Coopersmith, 1981).
For purposes of the present study, the overall self-esteem perceptions’
score was considered.
The Revised Children’s Manifest Anxiety Scale/What I
Think and Feel Questionnaire (CMAS; Reynolds and
Richmond, 1978) was used to assess levels of anxiety. The
scale consists of 37 statements (e.g., ‘I worry when I go to bed
at night’), to which a child responds yes or no. Higher scores
on the CMAS reflect higher levels of anxiety (Reynolds and
Richmond, 1978). In the present study, the total anxiety
score was used.

Parent-Report Measure
During individual interviews with a group therapist, parents/ ‘Parents
guardians of children participating in the group therapy
programme completed one measure designed to assess the
completed one
overall adjustment of their daughters. measure designed
The Child Behavior Checklist (CBCL; Achenbach and to assess the
Edelbrock, 1983) was used to identify and monitor various
problem behaviours in children. The scale consists of 113 overall adjustment
items (e.g., ‘runs away from home’) which are rated by of their daughters’
parents or guardians as not true of the child, somewhat or
sometimes true, or very true or often true of the child. The
CBCL yields scores on Internalizing and Externalizing
dimensions, as well as scores on several subscales (e.g.,
depression, hyperactivity). Higher scores on all scales reflect
greater numbers of behaviour problems (Achenbach and
Edelbrock, 1983). The present study considered overall
scores for the Internalizing and Externalizing scales.

Social Validation Measures

Following termination of each therapy group, participating
children and parents were asked to complete social validation
measures designed to assess their perceptions of and satis-
faction with the group therapy program.
The Child Feedback Questionnaire, developed for our
group work at the University of Manitoba, was used to assess
268 De Luca, Boyes, Grayston and Romano
children’s feelings about the therapy groups. The scale
consists of seven questions (e.g., ‘What did you dislike about
group?’), to which a child provides a short verbal response.
‘The Parent The Parent Feedback Questionnaire, also developed for
Feedback our group work at the University of Manitoba, was used to
assess parents’ or guardians’ perceptions of the group
Questionnaire was therapy program. The scale consists of nine questions,
used to assess similar to those on the Child Feedback Questionnaire (e.g.,
‘What did your child dislike about group?’), to which a parent
parents’ provides a short verbal response.
perceptions of the
group’ Procedure
Child-report and parent-report measures were individually
administered by female graduate students in the Clinical
Psychology Program. Scale items were read aloud to each
child to control for differences in reading ability and to
facilitate clarification of ambiguous phrases and words (e.g.,
double negatives).
Children who had been sexually abused were assessed
individually with the measures up to one month prior to
commencement of the group therapy program. Following
this pre-test assessment, 33 of the children participated in
one of five therapy groups conducted at the University of
Manitoba between 1988 and 1991 (see De Luca, Boyes,
Furer, Grayston and Hiebert-Murphy, 1992). Two other
children opted out of the therapy program following this
initial screening session.
‘Each therapy Each therapy group consisted of 6 to 8 girls and was led by
female graduate students in the Clinical Psychology
group consisted of Program. Groups met for 9 to 12 weeks and followed a
6 to 8 girls led by standard 90-minute format. Each group session began with
female graduate 15 minutes of ‘circle time,’ which facilitated children’s
transition from daily life to the group environment and
students in allowed children to share experiences and events occurring in
Clinical their lives (e.g., changes in custody arrangements, happen-
ings at school). Following ‘circle time,’ 45 minutes were
Psychology’ structured around specific activities (e.g., games, arts and
crafts projects) designed to address issues and themes
regarded as central in the treatment of sexual abuse (e.g.,
feelings about the offender, body image and self-esteem
enhancement, social skills, sex education, prevention of
abuse). Detailed descriptions of the tasks and issues involved
in ‘activity time’ have been presented elsewhere (e.g., De
Luca, Boyes, Cairns, Gilman and Grayston, 1991; De Luca,
Boyes, Furer, Grayston and Hiebert-Murphy, 1992; De
Luca, Grayston, Boyes and Romano, 1992). The last 30
 Effects of Group Therapy 269

minutes of each session were devoted to diary completion and

snack. During ‘diary time,’ children were encouraged to write
or draw in large scrapbooks supplied by the therapists. Use of ‘Use of the diaries
the diaries allowed children to express thoughts and feelings
that might have been difficult for them to verbalize to other
allowed children to
members of the group and provided therapists with express thoughts
opportunities to work individually with each of the children. and feelings that
‘Snack time’ supplied children with a chance to share their
diaries with the group and to ‘wind down’ from the session. might have been
During snack, therapists also had opportunities to praise diflcult for them
group members for their hard work in the session and to
celebrate holidays and birthdays.
to verbalize’
Individual post-test assessments of children, using the
child- and parent-report measures, as well as the social
validation scales, were completed approximately one month
after group termination. Follow-up assessments, using the
child- and parent-report measures, were conducted 9 to 12
months following treatment.
Girls in the comparison group, who were not involved in
the therapy program, also participated in individual pre-test
and follow-up assessments, using the child self-report scales.
Assessments were conducted by female graduate students at
the children’s school.

Results

Of the 35 sexually abused girls who initially presented for

group intake interviews, two declined to participate in group ‘Two declined to
treatment. Three other children moved prior to group
termination, leaving a total of 30 girls who completed the participate in
therapy program. At follow-up, data were unavailable for group treatment’
some children because of considerable difficulties in locating
children and their families (e.g., families had moved or had
no phone), or in gaining consent to evaluate the children
(e.g., some children were in new placements or had been
apprehended). Thus, analyses of child-report data were
based on 33 pre-treatment, 30 post-treatment and 15 follow-
up scores.
Although parent-report data were obtained for all 33 girls
prior to group therapy, a number of these girls experienced
multiple foster placements over the course of therapy. As a
result, the same caregivers were not available to complete
reports at each assessment time. Only measures completed by
the same parent were analysed in the present study. This
procedure was used in an attempt to ensure that chinges in
children’s scores reflected actual changes in behaviour rather
270 De Luca, Boyes, Grayston and Romano
than the different perspectives of separate raters. Thus,
analyses of parent-report data were based on 23 pre-treat-
ment, 23 post-treatment, and 11 follow-up scores.
Comparison group data were initially obtained for 35
children but follow-up data were only available for 21 girls,
because 7 had changed residence and 7 other children had
declined to participate in further evaluations. Thus, analyses
of comparison group data were based on the child-report
scores of these 21 girls.

Child-Report Measures of Girls in Group

Treatment
A related measures t-test revealed a significant increase in
self-esteem from pre-treatment (Mean = 56.79) to post-
treatment assessments (Mean = 64.53, t = 4.53, p<O.OOl),
sexually abused indicating that the self-esteem of sexually abused children
children was was higher following group treatment than prior to inter-
higher following vention. A second paired t-test revealed a statistically
significant difference between sexually abused girls’ pre-
group treatment’ treatment (Mean = 56.79)and follow-up self-esteem scores
(Mean = 72.67, t = 3.95,p <0.001). Thus, improvements in
self-esteem were significant 9 to 12 months following
treatment.
Children’s anxiety scores were analysed in the same
manner as scores for the self-esteem measure. Group therapy
was again found to have a significanteffect on sexually abused
girls’ functioning, with anxiety lower at post-treatment
(Mean = 12.00) than at the pre-treatment assessment
(Mean = 15.45, t = -2.84, p<O.Ol). A statistically signifi-
cant difference between pre-treatment (Mean = 15.45) and
follow-up anxiety scores (Mean = 10.67) revealed that the
decrease in anxiety was still significant 9 to 12 months
following treatment ( t = -2.39,p <0.05).

Parent-Report Measure of Girls in Group

‘Girls who had Treatment
been sexually Parent reports of girls’ internalizing behaviour problems
abused decreased significantly from pre-treatment (Mean = 68.09)
to post-treatment assessments (Mean = 57.70, t = -6.06,
experienced fewer p<O.OOOl). Similarly, there was a significant decrease in
behaviour parent reports of girls’ externalizingbehaviour problems (pre-
problems treatment Mean = 68.30, post-treatment Mean = 61.78,
t = -4.12, p<O.OOl), suggesting that girls who had been
~ following group sexually abused experienced fewer behaviour problems
~ therapy’ ,following completion of group therapy.
 Effects of Group Therapy 27 1
A statistically significant difference between parent reports
of pre-treatment (Mean = 68.09) and follow-up internalizing
scores (Mean = 58.18) demonstrated that the decrease in
internalizing behaviour problems was maintained 9 to 12
months following treatment (f = - 2.52, p < 0.05). Although
the children’s externalizing behaviour problems also ap-
peared to decrease further by follow-up assessment
(Mean = 59.82), this finding was not statistically significant.

Child and Parent Reports of Social Validation ‘Both children and

At post-treatment, 17 children and 16 parents completed their parents
measures of social validation. Table 1 illustrates the found the group to
frequency of responding and provides some examples of
responses to the open-ended questions answered by the be a positive and
children and their parents. Generally, the social validity data helpful experience’

Table 1. Social validity reports for group therapy

Percentage Percentage
of children of parents
responding Examples responding Examples
What did children 100% Liked group members, 94% Liked feeling understood, having
like about group? leaders and activities a place for children to talk about
the abuse, and realizing they
weren’t the only families that this
had happened to
What did children 58% Disliked some group 73% Disliked some rules and talking
dislike about group? members, about sex and abuse
disagreements and
filling out measures
What frightened children 12% Frightened by puppets 12% Frightened by the fact that some
about group? and by the idea that girls said their mothers didn’t
the abuse might believe them
happen again
What confused children 0% N/A 12% Confused about why they were in
about group? group and by others’ reactions to
what they learned in group
What helped children 100% Group helped me get 94% Helped children confront feelings
about group? things off my mind, and talk about the abuse
taught me how to say
yes, no and who to
tell, and taught me that
the abuse was not my
fault
Were you satisfied with N/A NIA 94% Yes, keep it the same
group?
Were you satisfied with N/A N/A 31% Would have liked to observe
parental involvement? sessions and receive phone calls
every few weeks to discuss
children’s participation
272 De Luca, Boyes, Grayston and Romano
suggested that both children and their parents found the
group to be a positive and helpful experience.

Comparison Group Child-Report Data

The inclusion of a comparison group in the present study

made it possible to determine whether changes in sexually
abused children’s self-esteem and anxiety were due to their
involvement in group therapy or to other factors such as
maturation and the passage of time. In order to rule out other
factors of this kind, 2 x 2 repeated analyses of variance
(Abuse x Assessment Time) were conducted on self-esteem
and anxiety scores of sexually abused girls in treatment and of
girls in the comparison group. In this design, an interaction
of Abuse and Time would indicate that the change in scores
from the pre-treatment to follow-up assessment was different
for sexually abused girls and comparison subjects.
Although the interaction effect was not significant, changes
in self-esteem scores from the pre-treatment to follow-up
assessments tended to differ according to group membership.
Results suggested that prior to group treatment, sexually
abused children’s self-esteem was significantly lower than
that of children in the comparison group (Means = 57 and
70, respectively). Following group treatment, children who
had been sexually abused showed significant gains in their
self-esteem (Mean = 73), whereas the cornparison group
children showed only modest gains (Mean = 73). In fact,
‘After group after group therapy, the self-esteem of girls who had been
sexually abused was the same as that of girls in the
therapy, the self- comparison group. Therefore, although the self-esteem of
esteem of girls sexually abused girls increased significantly from pre- to
who had been follow-up assessment times, it did not vary significantly from
that of girls in the comparison group. Nevertheless, further
sexually abused analyses, including only those girls who completed group
was the same as therapy, did result in a statistically significant interaction
that of girls in the effect (F(l,l,= 4.94, p < 0.05), demonstrating that the
improvement in self-esteem d.f girls in the treatment groups
comparison group’ was greater than could be expected by time or maturation
alone. Thus, the group experience appears to have
contributed to an increase in the self-esteem of sexually
abused girls.
Children’s anxiety scores were analyzed in the same
manner as scores for the self-esteem measure, yielding a
non-significant interaction of Abuse and Time. Anxiety
scores of sexually abused children and children in the
comparison group were similar at pre-treatment
 Effects of Group Therapy 273

(Means = 15 and 16, respectively) and follow-up assessments

(Means = 11 and 13, respectively) and decreased at a
similarly modest rate. Further analyses, including only those
girls who completed group therapy, also did not result in
statistically significant findings. Thus, an effect of group ‘Eflect of group
therapy on sexually abused children’s anxiety was not
supported by the results. Changes in scores for both treat- therapy on
ment and comparison groups may instead be due to factors sexually abused
such as familiarity with assessment, maturation or the
children’s anxiety
passage of time.
was not supported
by the results’
Discussion

Although clinicians have been encouraged to use group

therapy in the treatment of sexual abuse victims, there is
currently little empirical evidence regarding its effectiveness.
Findings from existing treatment outcome research are
preliminary, as suggested by the small number of subjects,
the absence of comparison groups involving alternative
treatments, and the failure to assess both the maintenance
of treatment effects and the social validity of interventions.
The main objective of the present study was to expand the
research on the efficacy of group treatment for sexually
abused children. The study implemented more rigorous
research methods, such as inclusion of a large sample size,
multiple measures, formalized treatment procedures, social
validity data, statistical analyses, and a comparison group of
children with no known history of sexual abuse.
Results from the current study are encouraging and point
to several conclusions:

1. Brief group interventions appear to be helpful in

treating specific sequelae of sexual abuse in children. Self- ‘Self-esteem and
esteem and behaviour problems in children decline after
treatment, with improvements in functioning being main- behaviour
tained at 9- to 12-month follow-up assessments. At this time, problems in
it is difficult to draw firm conclusions regarding which children
components of the group experience contribute most to
treatment outcome (e.g., whether the effects of therapy result decline after
from specific treatment procedures or from more general treatment, with
aspects of the group intervention, such as social support and
safety from abuse). As knowledge accumulates, researchers
improvements
may wish to explore the critical ingredients of effective group maintained at
treatment and address more directly the impact of factors 9- to 12-month
external to the therapy group, such as developmental changes
and family functioning. follow-up’
I

274 De Luca, Boyes, Grayston and Romano

2. The effectiveness of group treatment in addressing
other predicted sequelae of sexual abuse in children is more
difficult to assess. Although group treatment in the present
study reduced the anxiety scores of sexually abused children,
a similar reduction was observed for comparison group
children. This finding, however, is not surprising given that
both groups of children had similarly low initial levels of
anxiety. In our research program, comparable findings have
also been found with measures of other dependent variables,
such as loneliness and depression. Children appear to exhibit
a diversity of reactions following experiences of sexual abuse
(Kendall-Tacken et al., 1993), and on some measures, may
not consistently report clinically significant problems.
However, this does not negate the fact that some individual
children may experience difficulties with anxiety, loneliness
and depression following sexual abuse. Ongoing compre-
hensive assessments are needed to ensure identification of the
effects of sexual abuse specific to each child.
‘Group treatment 3. Social validity data suggest that group treatment is
highly helpful from the perspectives of both the children and
is highly helpful their parents.
f r o m the
perspectives of
both the children Challenges in Conducting Treatment
Outcome Research
and their parents’
Efforts to provide and evaluate treatment services for
children who have been sexually abused are beset with many
practical, ethical and clinical problems. For example,
researchers and clinicians face the challenges of recruiting
group participants, determining whose needs are most suited
to a group intervention, and locating services for those
children who may require alternate forms of treatment (e.g.,
individual play therapy). Additionally, it may be difficult to
ensure regular attendance at group sessions and prevent a
high drop-out rate.
‘Many referred Many referred children live in unstable and changing
environments where a range of difficulties present them-
children live in selves, from no transportation to sessions to frequent moves
unstable and in residence. Consequently, children and their caregivers
changing often cannot be located to provide the data necessary for
follow-up assessments. Similarly, there are times when the
environments’ caregiver who completes pre-treatment assessment measures
is different from the caregiver who is present during post-
treatment or follow-up assessments (i.e., children may be
placed in several foster homes over the course of group
treatment). Data which are not obtained from the same
 Effects of Group Therapy 275

caregiver need to be excluded from statistical analyses and

therefore, sample size may be considerably reduced. With
respect to questionnaires, challenges may also arise in the
interpretation of findings due to potential biases associated
with parent and child reports (Hack et aZ., 1994; Hiebert-
Murphy et al., 1992). Use of additional measures in future
research (e.g., direct observations of behaviour) may be
important in addressing this issue. However, while it would
be advantageous from a research and clinical perspective to
assess children with many more measures across time,
practical limitations exist. Children and caregivers experi-
ence boredom, fatigue and irritation with ‘filling out
questionnaires.’ Use of reasonable time constraints during
assessment periods may guard against loss of subjects and
their participation in treatment and against unreliable
findings.
Results in treatment outcome research with children who
have been sexually abused may be further strengthened by
more extensive methodological controls than those em-
ployed in the present study. One possible evaluation
strategy is the use of a comparison group of abused children
not receiving therapeutic intervention (i.e., wait-list con-
trols). Although this research design would be of particular
value in assessing the efficacy of group interventions with
sexually abused children, it would also present a potential
dilemma. Clinical and ethical considerations may militate
against withholding treatment for long periods of time,
particularly from clients unable to advocate for their own
rights. One possible solution may be the use of a design that
minimizes delay of implementation of treatment for children ‘Minimize delay of
who have been sexually abused (e.g., designs involving a
short waiting list, partial treatment designs, multiple implementation of
baseline designs). treatment for
In summary, the results of the present study suggest that children who have
group treatment may be a promising means of reducing some
of the negative effects of sexual abuse on children. As been sexually
researchers progress in their study of treatment outcome for abused’
children who have been sexually abused, important
information will be forthcoming regarding the relative
efficacy of alternative treatment formats, the efficacy of
group treatment for boys who have been sexually abused and
the efficacy of group treatment for victims of intrafamilial
‘Continued
and extrafamilial sexual abuse, as well as victims of varying evaluation of
ages. Continued evaluation of treatment programs is treatment
necessary to ensure that clinicians can provide maximally
effective interventions to children who have experienced programs is
sexual abuse. necessary’
276 De Luca, Boyes, Grayston and Romano
Acknowledgements

This research was supported by a Manitoba Mental Health

Research Foundation Grant to Rayleen V. De Luca, a
Medical Research Council of Canada Graduate Studentship
to Alana D. Grayston, and by a Social Sciences and
Humanities Research Council of Canada Doctoral Fellow-
ship to Elisa Romano. The authors wish to acknowledge and
thank Sharon Cairns, janine Cutler, Deborah Gilman,
Andrea Hazen, Diane Hieben-Murphy and Marsha Runtz
for their assistance as therapists. Participating children and
families and the St. James-Assiniboia School Division No. 2
are also gratefully acknowledged for their support.

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