On the last track, we discussed the various aspects
to keep in mind when including the family in off hours therapy: education of the
parents; developing and understanding a client's need for security; and reestablishing
On this track we will examine various challenges
inherent when treating sexually abused boys such as: dependency on physical contact;
drastic mood shifts; failure to remember session content; dysfunctional attempts
to regain power and control; and premature disclosure of the details of the abuse.
Also, we will include therapy strategies that address these challenges.
Five Challenges in Treating Sexually Abused Boys
Challenge #1 -
Limiting Physical Contact
As you know, young boys frequently request physical
contact to secure a feeling of security. In these cases, as you know it is important
to set limits regarding physical contact while at the same time validating the
importance of nurturance and comfort.
Danny, age 7 who was callously abused by
his babysitter, would constantly follow Charles, Danny's therapist, around during
group therapy sessions. Many times he asked to sit in Charles' lap. To address
Danny's overwhelming need to be close to someone, ethical limits needed to be
set on physical contact. Keeping in mind that his perpetrator ignored his needs,
Charles felt he needed to provide a supportive experience.
He reminded Danny of
the rule of no physical contact without permission. Charles then made an agreement
with Danny that he would give him a hug before and after each group session. In
this way, Charles fulfilled Danny's need for nurture while still respecting his
personal space. Another way that might benefit you with overly physically dependent
clients is to give them regular pats or hugs of encouragement, but only after
a request to do so is asked.
Your opinion may vary regarding physical contact.
Then, slowly diminish the number of contacts over a number of sessions. This will
make the client less and less dependent on physical contact from an authority
figure for security.
Challenge #2 - Mood Shifts
you probably have encountered in therapy with sexually abused boys is when one
of your clients experiences dramatic mood shifts. As you know, traumatized children
can sometimes develop an inability to regulate emotions. As you are aware, without
an outlet, these feelings build up until the client releases them with an explosion
of activity and emotion. Ten year old Nicholas was a reclusive sexual abuse client.
Generally, Nicholas didn't participate in group discussions and kept an unanimated
approach to any play therapy.
Finally, in one session, his therapist William witnessed Nicholas have an explosion of emotion. He cried and lashed out at the other group
members. William took Nicholas aside until he calmed down. William helped Nicholas
to develop exercises to soothe himself when he feels that his emotions are going
to manifest themselves in destructive ways.
Some of these exercises included:
holding a stuffed animal or blanket, Nicholas had a small rubber dinosaur that
he named Rex; creatively venting through drawing, painting, or writing; repeating
or reading calming statements; and deep breathing. In this way, Nicholas learned
to begin to deal with his emotions on his own without the assistance of a higher
Challenge #3 - Dissociation in Sessions
to Physical contact and dramatic mood shifts, another challenge is that sometimes,
clients have trouble remembering session content. John, age 11, when his therapist
Henry asked him the routine question, "What was your favorite part of today's
session?" he responded with, "I don't remember". In some cases,
this can be the effect of the trauma. Beverly James reports evidence that memories
of traumatic events is processed differently and levels of awareness can fluctuate.
However, in John's case, he was using dissociation to cope with his trauma. Some
indicators that John was experiencing dissociation and not affected memory were:
he appeared to be unaware of his surroundings; he would stare off as though in
a trance; experiencing frequent withdrawal; he would deny behavior that the rest
of the group had witnessed; and he would appear disoriented or confused.
he went through one of his dissociative episodes, Henry would talk to John as
though he could hear his therapist until his awareness of his surroundings returned.
Henry then explained to John how he was trying to go somewhere safe to cope with
what had happened to him.
To keep track of his episodes, Henry asked John's parents
and teachers to observe John and note any of the above indicators if they occurred.
Over the course of therapy, as he began to work through his abuse more successfully,
the frequency of the episodes diminished.
Challenge #4 - Dysfunctional
Means of Regaining Power
As you are aware, in group therapy, boys will
try to regain their sense of power through dysfunctional ways. Jonathan, a colleague
of mine, has observed the following six key dysfunctional behaviors in his group
-- Behavior #1 - passive aggressive behavior
-- Behavior #2 - manipulation
-- Behavior #3 - provocation
-- Behavior #4 - ridicule
-- Behavior #5 - scapegoating
-- Behavior #6 - silence.
Robbie, age 13, was ridiculing some of the younger boys in the group. Jonathan discussed with the group this behavior immediately after it occurred
and identified it as a dysfunctional power and control behavior. He then asked
the group to discuss this behavior and how these actions made them feel. Jonathan
pointed out the difference between
-- 1. self-empowerment, a positive goal, and
-- 2. exerting control, a negative goal.
During this incident, it was vital that Jonathan
didn't involve himself in a power struggle in which one boy is right and the other
is wrong. This of course would split the group and undo much of the trust we had
Challenge#5 - Premature Disclosure
I have encountered is a client prematurely disclosing details of the abuse during
a group session. In the early stages of group therapy, most boys are not ready
to recall the details of their abuse. When one boy takes the initiative to disclose
his own details, can serve to intimidate the other boys. Also, premature disclosure
can result in feelings of extreme vulnerability on the part of the boy who shares.
To prevent premature disclosure, I involve the boys in activities early in therapy
that build rapport, create a safe atmosphere, and clarify the purpose of the group.
I ask the group to brainstorm and discuss together the rules with which they are
most comfortable. I finalize the rules once they have all agreed.
However, I imposed
a few that were nonnegotiable such as: no betraying confidences about what is
said in the group; no substance abuse; and no hands-on behavior toward another
group member. By deciding on their own rules, the group was beginning to regain
their sense of control over their surroundings in a positive manner.
this track, we discussed various challenges inherent when treating sexually abused
boys such as: dependency on physical contact; drastic mood shifts; failure to
remember session content; dysfunctional attempts to regain power and control;
and premature disclosure of the details of the abuse.
On the next track,
we will examine the effect of male sexual abuse on sexual identity.
What are some challenges that you may face in therapy when treating
sexually abused boys? To select and enter your answer go to .