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CHILD ABUSE & FAMILY THERAPY.
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Issues facing therapist: safety of child, legal aspects, parental resistance, confidentiality, parental power & control.... More...
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Paper Abstract:
Issues facing therapist: safety of child, legal aspects, parental resistance, confidentiality, parental power & control.
Paper Introduction:
ISSUES IN FAMILY THERAPY: CHILDHOOD ABUSE
Introduction
While most parents attempt to do the best they can for their children, some either cannot or will not meet a child's most basic needs; the result is child maltreatment of which, there are several forms, e.g. physical abuse, sexual abuse, neglect, etc. According to Papalia and Olds (1992), the term "child abuse" is used to refer only to those cases of maltreatment involving physical injury. The authors state that, in America, approximately two million children per year suffer from some form of childhood maltreatment with at least half of these experiencing physical abuse either by itself or in addition to other forms of maltreatment.
The purpose of this paper is to discuss some of the major
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Cottrell, D., Jog, S. Chesnay, M. These issues were said to include issues related to:one of more parents whose attendance in family therapy is involuntary;understanding and working with all of the legal and ethical mattersinvolved in such cases; ensuring that the child is and remains safe duringthe course of treatment; knowing when and how to report suspected cases ofabuse; issues of confidentiality; and power issues. The focus producing the bestresults in such situations was said to be when therapists take effectiveaction toward increasing compliance with mandatory reporting laws whileminimizing potential disruption to treatment. Clearly, if the law has been violated, it is the therapist'sobligation to report this. For each of the discussed issues it was noted that there were severalsteps which family therapists could take to manage the sitution. Insuch cases, Peterson and Nisenholz report that the role of the familytherapist must shift from that of facilitator of problem resolution tochange agent working to modify the child's environment in a way thatmaintains safety. (1992). In this regard, they point out thatthis awareness should encompass a systems perspective; that is thetherapist must realize he or she is not only dealing with a family systembut with a system that interacts with a variety of external institutionaland bureaucratic systems, any of one of which can be affected by and/oraffect therapeutic objectives and strategies. Even in situations where there are legal violations of the law, thetherapist must deal with the family's definition of the situation as aproblem; some families, Chesnay (1984) reports, do not automaticallyconsider the fact that their physical (or even sexual) abuse of theirchildren is a particular problem. Inaddition, it is noted that family therapists who report suspected childabuse by their patients should not be required to testify against them inany subsequent criminal proceedings relating to the past abuse. Peterson and Nisenholz (1994) report that power issues can beparticularly salient when working with child abuse in families. For example, Ackerman, Colapinto, Scharf andWeinshel (1991) report that in most cases family therapy for child abuse iscourt-ordered which means that for many of the parents, especially theabusing parent, treatment is involuntary. Itis suggested that if therapists help children appreciate the resources theyhave and their capacity to make decisions, those abused may be able tobetter protect themselves and their own children. Working with "the Welfare" in child-at-risk cases. Specifically,the authors reviewed twelve studies on factors found to influencepracticing psychologists', psychotherapists', and mental health workers'decisions to report suspected child abuse. Ethics andBehavior, 4(1), 1-22. Confidentiality is, of course, a key concern in family therapy ingeneral. (1986). Butz (1985) suggests that when child abuse must be reported, acooperative and concerted effort between clinicians and local childprotection caseworkers will reduce the trauma of an official investigationwhile also protecting the welfare of the endangered child. In this regard,Chesnay (1984) states that in families undergoing therapy related to childabuse, ownership of the problem can be alternately vested in differentfamily members, e.g., the daughter, mother, father, and family. Human development (5th ed.) NY:McGraw-Hill. Cottrell, Jog and Jackson (199 ) report that often when familytherapy is court-ordered, the abusive parent may spend sometime in prison.If the family wishes to continue therapy beyond the abusive parent's prisonsentence, the family therapist must deal with several additional issues.These are said to include all of the stages involved in the abusiveparent's return to the home. However, this concern obviously conflicts with other concernswhen the therapist suspects or knows abuse of a child has occurred.According to Butz (1985), while all 5 states require mandatory reporting,it still needs to be realized that the result of such a report constitutesan invasion of the confidential aspect of the counseling relationship. & Winslade, W.J. According to Papalia and Olds(1992), the term "child abuse" is used to refer only to those cases ofmaltreatment involving physical injury. However, as noted by Chesnay (1984), thereremain a number of issues that must be dealt with. Still, it is noted that even with such a discussion, theclient may also want to know what other kinds of information might bedisclosed and to whom. Journal of Family Violence, 8(1), 71-87.----------------------- 1 A more empirical examination of breaching confidentiality in cases ofchild abuse was conducted by Brosig and Kalichman (1992). In their discussion of privacy, confidentiality and child abuse,Smith-Bell and Winslade (1994) contend that confidentiality should bebreached only to prevent current or potential danger to a child. (1984). As to how to deal with these issues, some suggestions have beenoffered by MacKinnon and James (1992). Peterson, J.V. Treating sexually abused children: Issues of blameand responsibility. Another issue that arises in family therapy for child abuse is makingsure that the child is safe. & Olds, S.W. & Weinshel, M. When placed within the contextof a comprehensive decision-making model, a variety of factors were said toexplain psychologists, psychotherapists, and mental health workers'willingness to report suspected child abuse. Sieber, J.E. To assist with these problems, Butz (1985) recommends that theconfidentiality issue and third-party disclosures be discussed with theclient prior to the onset of counseling in the context of the health careinsurance carrier. With respect to the foregoing, Butz (1995) states that there arethree commonly recognized adverse effects of breach of confidentialityduring treatment: deterrence from seeking counseling, lack of fulldisclosure during counseling, and the destruction of the trustrelationship. A model for using time out as anintervention technique with families. Summary The purpose of this paper was to examine the various issues thatfamily therapists must deal with in their work with families where therehas been child abuse. Casework towards thefamily re-integration of a sexually abusive father: A single case study.Journal of Family Therapy, 12(4), 341-353. With respect tothe foregoing, Brosig and Kalichman (1992) stated that legal requirements,clinician characteristics, and situational dimensions all interacted toinfluence child abuse reporting decisions. Inthis regard, the authors note that in order to effective handle anysituation that may arise, therapists must be knowledgeable about severallegal issues ranging from the possibility of somehow being sued for mal-practice to having to testify in court. Father-daughter incest: Issues in treatment andresearch. Smith-Bell, M. These include: familyprivacy versus the child's rights, practical versus legal definitions ofthe problem, patriarchy versus autonomy, and incarceration of the offenderversus leaving him at home. Veenstra and Scott (1993) report that abuse in families tends to be apower/control issue with parents often being misdirected in their effortsto control their children; and that, as a result, family therapiststreating these families need to provide several different levels ofsupplemental control in order to inhibit family aggression. Itis suggested that the therapist should serve as a power broker, advocating,negotiating, and mediating between child protection professionals andparents so as to create a workable context for therapy. The purpose of this paper is to discuss some of the major issues thatarise in family therapy treating childhood abuse. ISSUES IN FAMILY THERAPY: CHILDHOOD ABUSE Introduction While most parents attempt to do the best they can for theirchildren, some either cannot or will not meet a child's most basic needs;the result is child maltreatment of which, there are several forms, e.g.physical abuse, sexual abuse, neglect, etc. Particularly important are issues related toboundaries, trust, safety, power, and communication. & Scott, C.G. Issues presented by mandatory reportingrequirements to researchers of child abuse and neglect. Sieber (1994) has discussed the various issues associated withmandatory reporting requirements in situations of child abuse and neglect.The best way to handle confidentiality, according to Sieber is to informthe family at the beginning of treatment that they are required to reportcertain matters to the authority. The authors state that, inAmerica, approximately two million children per year suffer from some formof childhood maltreatment with at least half of these experiencing physicalabuse either by itself or in addition to other forms of maltreatment. & Kalichman, S.C. Orientation to counseling.(2nd ed.) Boston: Allyn & Bacon. Indeed, they report that it shouldbe considered part of professional practice to understand these legalities,and therapists should be given training in these matters both during andafter their professional education in therapy/counseling skills. Issues There are several issues that family therapists must deal with insituations of child abuse. Papalia, D.E. Clinicians' reporting ofsuspected child abuse: A review of the empirical literature. (1994). In some cases, this is taken care of by thecourt; however, in other cases, especially those where the abuse isuncovered as part of the family therapy process, the therapist must decidehow to respond to the situation for the protection of the child. Colapinto, Scharf and Weinshel (1991) statethat the key to dealing with such families is working through their issuesof resistance. American Journal of Orthopsychiatry, 56(2),3 3-3 7. Therapists should then list thesesituations where reporting is mandatory and have parents sign an informedconsent form. According tothe authors, one effective means of exerting this supplemental control isto integrate a time out technique into the therapeutic model. Further, evenif the initial time out intervention fails, the model is said to preparethe family for alternative interventions. Social Casework, 66(2), 83-9 . (1994). Brosig, C.L. References Ackerman, F., Colapinto, J.A., Scharf, C.N. MacKinnon, L. Butz, .A. & Nisenholz, B. Australian and New Zealand Journal of Family Therapy, 13(1),1-15. Specifically, the authors discussedhow family therapists can position themselves in relation to childprotection professionals in cases involving allegations of child abuse. (199 ). Another power issue has been discussed by Lamb (1986) who contendsthat family therapists must take care not to confer victim status onphysically abused or sexually abused children, thereby diminishing afeeling of power that may be important to the children in the future. Reporting child abuse and confidentiality incounseling. Moreover, Peterson and Nisenholz (1994) state that therapists must beaware of not only the legal but the ethical implications of working withfamilies in situations of child abuse. The goal hereis to preserve the helping relationship while the private clinician andagency caseworker unite to conduct the formal investigation and develop anappropriate and comprehensive treatment program. (1992). (1991).The involuntary client: Avoiding "pretend therapy." Family SystemsMedicine, 9(3), 261-266. (1993). Lamb, S. Peterson and Nisenholz (1994) have discussed several issuestherapists in general and family therapists in particular must deal with insituations involving child abuse, many of which involve legalities. Among the issuesdiscussed are confidentiality, and issues of power and control. Veenstra, G.J. There is also the issue of ownership of the problem. Privacy, confidentiality, andprivilege in psychotherapeutic relationships. & James, K. The specifics of the time out approach should, according to theauthors, be strictly tailed to the family's current level of control.Based on preliminary data, Veenstra and Scott (1993) state that, when usedappropriately, the time out technique helps families reframe theirdifficulties as skill deficits rather than character faults. Journal of Psychosocial Nursing and Mental Health Services,22(9), 9-16. Theauthors state that children in general have such environmental control overthem that any change, even constructive change, is difficult on them. ClinicalPsychology Review, 12(2), 155-168. Stepswhich family therapists can take to handle these issues were said toinclude: using strategies to deal with family resistances to treatment;getting additional training on the legalities and ethnics involved in suchsituations; serving as a power broker, advocating, negotiating, andmediating between child protection professionals and parents in order tocreate a workable context for therapy; discussing need-to-report and otherconfidentiality issues with families prior to beginning therapy; havingfamilies sign an informed consent form; if possible, attempting to avoidtestifying in court in any subsequent criminal case related to past abuse;helping children appreciate the resources they have and their capacity tomake decisions; using techniques designed to assist parents in exertingbetter control over their impulses to aggress (e.g., time out); andpossibly working with families to reintegrate into the household a parentwho went to prison for abuse. In such cases, the authors report that family therapists must workwith untrusting families who go through the motions of treatment withoutany real commitment to it. (1994). Chesnay contends that it is crucial for thetherapist to resolve these issues before treatment can be effective. (1985). American Journal ofOrthopsychiatry, 64(2), 18 -193. & Jackson, E. (1992).
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