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CBT for Child Sexual Abuse and Affect Diagnosis & Treatment
6 CEUs It Wasn't Your Fault- Diagnosis & Treatment of Sexual Abuse in Children & Adults

Section 6
Family Therapy

Question 6 | Test | Table of Contents | Child Abuse CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, & MFT CEU

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In the last section, we discussed some ways to use play therapy when dealing with repetitive rituals, control, and regressive behavior. We also looked at when setting boundaries in play therapy would be beneficial.

In this section, we will examine the Family Stance and the Family Trance, as well as how the two techniques of the "Other Family" exercise and the "Mottos" exercise can be used to bring awareness of where the guilt associated with the abuse comes from.

In helping clients to understand that the sexual abuse was not their fault, I found Foster's concept of a family stance and Bradshaw's concept of a family trance to be extremely beneficial.

♦ Family Stance
Foster refers to family stance as the family's daily attitudes and behaviors. For example, a constructive family life stance consists of such qualities as a zest for life, confidence, resourcefulness and mobility.

There are 4 Destructive Family Stances:
1) Frozenness or flatness; anxiety, doubts and fears;
2) Belief that life is dangerous and resources are scarce;
3) Limitations or helplessness that lead to tunnel vision that can't conceive hopeful possibilities;
4) Rigidity related to control, and unwillingness to alter the status quo.

Terry, age 12 had been molested at the age of 9 while in detention by her teacher, and was referred to me by her counselor at school. During one particular session, I asked Terry to describe some values of her family. Terry stated, "My mom and dad really like to look good to the neighbors and to the rest of my family. I guess our motto is 'Keep it in the family." When I told them about the abuse, they told me there was nothing I could do about it because everyone would think I was bad."

Clearly, Terry's family was suffering from a destructive family stance characterized by valuing appearance over their daughter's emotional health. By making Terry aware of the effect of her family's destructive life stance, this reinforced the belief that she was not to blame for her sexual abuse.

To characterize a client's family stance- familial attitudes, mottos, and behaviors must all be taken into account. As you know, a family's attitude translates feelings into thoughts and beliefs. Terry's family valued appearance and pride above all. Feelings of shame and disgrace, like those that Terry's abuse had produced, were to be avoided at all cost.

Family mottos are sayings that sum up shared attitudes. Terry's family motto of "Keep it in the family" reflected their value in pride and appearance. Such a family experiencing shame might have thoughts such as, "Everybody is talking about us; We can't hold our heads up." Family behaviors are the outer result of these attitudes. Terry's family's behavior was to keep her from talking about the abuse with anybody outside the family in order to maintain the family's pride.

♦ The Other Family Exercise
To more clearly recognize a client's family attitudes, I have found the "Other Family" exercise to be beneficial. In this exercise, I told Terry to recall a family that she enjoyed being with and then to compare that family's attitudes with her own. Terry stated, "It was so exciting being with my friend Amy's family. It felt open and bubbly walking into their house to the noise of music and laughing voices. Her mom and dad made it seem like anything was possible. They supported trying new and crazy activities. My parents worried about every little thing that could go wrong, and if people would think we were 'weird.'"

Terry described Amy's family as open and bubbly while her family was closed off. Think of your Terry. Would he or she benefit from the "Other Family" exercise? Later on in the section, I will describe a second technique, the "Mottos" exercise, that is also useful in recreating awareness about family attitudes.

♦ The Family Trance
Now that we've discussed the family stance, let's examine what John Bradshaw in The Family, calls "The Family Trance," and how Terry broke that trance. The family trance is often an unconsciously agreed-upon view of who a family is and how its members live together. Obviously, children are naturally prone to bond with their parents, demonstrating feelings the same way parents do in similar situations.

Terry had been prone to dismiss hurt feelings, rather than display them or talk about them. Her parents unconsciously created and maintained their family trance by their behavior toward each other and the children. When Terry felt compelled to break the trance by talking openly about the abuse with her school counselor, she threatened the status quo of silence.

♦ Using the Mottos Exercise
When working with Terry in facing family attitudes, I have found the "Mottos" exercise to be beneficial, in addition to the "Other Family" technique mentioned earlier. This exercise helped Terry realize her family's attitude was causing her feelings of guilt. I had Terry write down three spoken or unspoken expressions that she had heard or her family had expressed. These can include sayings, advice, philosophy, cursing, religious sayings, or warnings.

Terry wrote, "Honor you father and mother," "Don't embarrass me," and "I don't want to talk about it." I then had Terry pick one and tell me a situation in which it was used and the kinds of feelings it invoked. Terry picked "Don't embarrass me" and related this story to me. "I think I was five and I was in a department store. I was crying. I wanted to go home. My mother kept tugging on my arm to pull me into an empty aisle. She was whispering to me 'Stop crying, you're embarrassing me. Don't embarrass me.' When I got older and remembered that incident, I felt ashamed for making my mom look bad."

I asked Terry, "How does this reflect one of your family's attitudes?" Terry responded, "It shows that they don't like negative attention." With the help of this and the "Other Family" exercise, Terry began to recognize how her family's attitudes and behaviors led to her feelings of guilt and that the abuse was her fault.

In this section, we discussed the Family Stance and the Family Trance. As well as how the two techniques of the "Other Family" exercise and the "Mottos" exercise can be used to bring awareness of where the guilt associated with the abuse comes from.

In the next section, we will examine four key factors involved in false memory generation and the influence therapy may have in fabricating these false memories.

- Rickerby, M. (jun 2013). Family support and childhood sexual abuse: A powerful force in recovery. Brown University Child & Adolescent Behavior Letter, 29(6), 1-6.

Peer-Reviewed Journal Article References:
Diamond, G., Creed, T., Gillham, J., Gallop, R., & Hamilton, J. L. (2012). Sexual trauma history does not moderate treatment outcome in attachment-based family therapy (ABFT) for adolescents with suicide ideation. Journal of Family Psychology, 26(4), 595–605. 

Pulverman, C. S., Boyd, R. L., Stanton, A. M., & Meston, C. M. (2017). Changes in the sexual self-schema of women with a history of childhood sexual abuse following expressive writing treatment. Psychological Trauma: Theory, Research, Practice, and Policy, 9(2), 181–188.

Shevlin, M., Murphy, S., Elklit, A., Murphy, J., & Hyland, P. (2018). Typologies of child sexual abuse: An analysis of multiple abuse acts among a large sample of Danish treatment-seeking survivors of childhood sexual abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 263–269.

Tener, D., Lusky, E., Tarshish, N., & Turjeman, S. (2018). Parental attitudes following disclosure of sibling sexual abuse: A child advocacy center intervention study. American Journal of Orthopsychiatry, 88(6), 661–669.

Turner, H. A., Finkelhor, D., Ormrod, R., Hamby, S., Leeb, R. T., Mercy, J. A., & Holt, M. (2012). Family context, victimization, and child trauma symptoms: Variations in safe, stable, and nurturing relationships during early and middle childhood. American Journal of Orthopsychiatry, 82(2), 209–219.

Vargen, L. M., Weinsheimer, C. C., Coburn, P. I., Chong, K., & Connolly, D. A. (2018). Youth-perpetrated child sexual abuse: The effects of age at court on legal outcomes. Psychology, Public Policy, and Law, 24(2), 248–258.

What is an exercise you might consider using to facilitate your abused client to more clearly recognize his or her family's attitudes? To select and enter your answer go to Test.

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