Each year, in the United States, over 3.6 million investigations and assessments are made by social service agencies regarding an incidence of child abuse (the Administration for Children and Families, 2008), and it is estimated that five children die each day as a result of abuse or neglect (U.S. Department of Health and Human Services, 1995). Research has shown that children who live in abusive environments, often manifest a plethora of short and long-term pathological effects including; emotional and mental functioning, decreased social skills, delayed development, failure to thrive (Herrenkohl & Herrenkohl, 2007; Gallo-Lopez, 2006; Briere & Runtz, 1993), and often report feelings of loneliness, shame, guilt, and fear (Osgood & Chambers, 2000), all which left untreated can manifest into depression, PTSD, and suicide attempts (Herrenkohl & Herrenkohl, 2007) . Additionally, there is a concern that these childhood victims of abuse can grow to become adult abusers, perpetuating the cycle of abuse (Cicchetti & Toth, 2000). However, studies have shown that group therapy and membership within a support group, have been effective in treating these pathologies and lessening the persistence of long-term effects of this abuse, thereby often ending the cycle of abuse (Powell & Faherty, 1990). Given these frightening statistics that denote the continued prevalence of child abuse, coupled with research that has shown that support groups can be an effective treatment, it is imperative that these groups be made available to all children exposed to or direct victims of violence and abuse.
Literature Review
Child abuse or maltreatment commonly occurs throughout the United States and across other countries of the world. In fact, data has shown that a referral of suspected abuse is filed every 10 seconds in the Unites States alone. Child abuse or maltreatment can be defined as any act which in which the child is subjected to physical, sexual, emotional, and mental abuse, cruelty, neglect, and/or exposure to domestic violence, (Herrenkohl & Herrenkohl, 2007; DeMause, 1998). Data collected by the Administration for Children and Families (2008) found that “during Federal fiscal year 2006, an estimated 3.3 million referrals, involving the alleged maltreatment of approximately 6.0 million children, were made to CPS agencies. An estimated 3.6 million children received an investigation or assessment,” (para. 10). While this number seems staggering, many speculate that the incidence of child abuse is actually higher, because the majority of abused children never gain the attention of government agencies. This under-reporting is especially true for children who are mentally, emotionally, or sexually abused, and therefore shown no outwardly physical signs of abuse. While the immediate consequences and effects of this abuse onto children is documented, i.e. the presence of short and long term psychological, emotional, physical and social disorders (Noll, 2008), research has found that these victims often develop pathologies which continue on into their adult lives, (Cicchetti & Toth, 2000). Even more frightening is the prevalence of these childhood victims to later become the abuser themselves, (Cicchetti & Toth, 2000). A National Institute of Justice study, in an attempt to confirm the existence of the cycle of abuse, found "that childhood abuse increased the odds of future delinquency and adult criminality overall by 40 percent" (Widom, 1992), but could not confirm the percentage of abusees who later become abusers.
The issue of child abuse is not a new one; in fact children have long been the victims of their abusers’ torment, rage, and dysfunction. DeMause (1998) purports that historically, throughout the world, children have been used as “receptacles, into which adults project disowned parts of their psyches,” (para. 5). Children, by their subordinate nature, have traditionally been viewed as expendable and therefore, have historically been subjected to routine rapes, beatings, mutilation, sacrifice, and abandonment. Only within the last decade, and primarily in developed countries, have children been considered as valuable persons, thereby freeing them from such ritualistic abuse. While the occurrence of child abuse has lessened, it has not been eradicated, often even perpetuated from generation to generation. Researchers have speculated that victims may even come to view the abuse as a natural tradition of child rearing, and thus passing it onto their own children, although Herrenkohl and Herrenkohl (2007) argue that it m ay be difficult to confirm this as reality, citing a lack of comprehensive, longitudinal research and data regarding the effects of abuse in exclusivity.
It has been a contention that exposure to abuse in childhood results in effects that impinge on all aspects of the victims life, including their; emotional and mental functioning, decreased social skills, delayed development, failure to thrive, and the presence of psychological pathologies which were not present prior to the abuse, (Herrenkohl & Herrenkohl, 2007; Gallo-Lopez, 2006; Briere & Runtz, 1993). Even once the child is no longer in the abusive situation, he or she is likely to experience continued long-term effects, reporting feelings of loneliness, shame, guilt, and fear (Osgood & Chambers, 2000). As result, most children who have been previously victimized are presented for treatment and “are likely to have symptoms consistent with either posttraumatic stress disorder (PTSD), acute stress disorder (ASD), or one of several adjustment disorders,” (Gallo-Lopez, 245). Untreated, these issues persist throughout the victim’s lifetime, manifesting themselves and thus producing a direct correlation with one’s prevalence to; continually suffer from depression (Gallo-Lopez, 2006; Herrenkohl & Herrenkohl, 2007), drop out high-school (Herrenkohl & Herrenkohl, 2007), experience teenage pregnancy (Herrenkohl & Herrenkohl, 2007), attempt suicide (Herrenkohl & Herrenkohl, 2007; Bridgeland, Duane & Stewart, 2001), “and engage in delinquency, violence, and abuse substances,” (Herrenkohl & Herrenkohl, 554), furthermore males are at a higher risk of early onset of these manifestations, as opposed to their female counterparts, and this pre-disposition is “related to alienation, trait anger, interaction anxiousness and pro-use beliefs about alcohol,” (Thomas, 36).
While many researchers have reported that childhood abuse and maltreatment directly results in the development of pathologies (Gallo-Lopez, 2006; Briere & Runtz, 1993; Osgood & Chambers, 2000; Bridgeland, Duane & Stewart, 2001), others contend that the prevalence of abuse in exclusivity may not be the only contributing factor (Herrenkohl & Herrenkohl, 2007). Often, when working with a client who has experienced childhood abuse, one will find the existence of over-lapping risk factors and external stressors within the family unit as well as within the child’s direct community, e.g. poverty, single-parent home, criminality, illness, addiction, et. Because these two areas are so integrated, it is difficult to isolate the effects of the child’s experience and exposure to risk with that specifically of the abuse. Research conducted by Herrenkohl and Herrenkohl (2007), attempted to separately analyze the two influences on the development of the child, i.e. experience and external stress vs. abuse, and found that “the lasting, adverse effects on youths’ internalizing and externalizing behaviors appear to extend from the victimization itself, not the hardship of the family or problems experienced by parents when their children were young,” (p. 560).
While it is unclear the extent that domestic abuse has upon the developing child, nor is there clarity regarding how and to what degree environmental stressors exacerbate the individual response of the child, one can say, without question, that certain pathologies do present after an incident of abuse, which had not been observed prior. Treatment of the abused child is often made difficult because many children are unable or afraid to discuss their experiences or the maltreatment they have endured, (Pearce, 2006). This inability to talk about the abuse may be due to the conditioning that they have received, i.e. the repetitive messages to maintain the secret of abuse, fear of isolation, threats of further harm to the family. Eventually these children become so engendered in their families that they are unable to talk openly and their experiences (McGarvey & Haen, 2005). Furthermore, longitudinal studies have shown a wide range of gender differences in the response to abuse, whereas externalizing behavior problems present in boys and internalizing behavioral problems for girls (Yates, Dodds, Sroufe & Egelnad, 2003). However, the incidence of abuse places both genders at great risk for “developing delinquency, substance abuse/dependence, and problems in social relations with others, inclusive of dating violence as adolescents and IPV [Intimate Partner Violence] as adults,” (Graham-Berman, Lynch, Banyard, DeVoe & Halabu, 2007). Therefore, interventions and treatment programs should focus on a wide range of behavioral and mental health issues, (Graham-Berman, et. al., 2007). Powell and Faherty (1990) report group therapy is the modal of choice for adolescent victims, stating that this is often more effective an individual therapy with this group. In groups, children are presented with others who have experienced similar events, and through the discussion and continued exposure of others who have experienced maltreatment, the child’s anxiety levels decrease, they find a sense of camaraderie, and their ability to discuss their own abuse increases, thus allowing them to talk more freely, (Pearce, 2006). Also, when treating children in groups, a wide variety of topics can be discussed, which will aide to treat children for pathologies that they currently experience and even aide them in dealing with others before they fully manifest, but without treatment are likely to appear.
Group Dynamics
Unfortunately, support groups, like other social service and therapeutic programs are reactive in nature (Turnell, 2006) and therefore all participants will have experienced some level of abuse or mistreatment within their home. While many support groups are open to the public, running this sort of group can be difficult because abuse can be experienced at many levels, and it would be quite difficult to create a “one size fits all” type of treatment. For those children who have experienced higher levels of abuse, it is important that they be placed accordingly, with others who have been subjected to similar levels. For this reason is, groups which aim to treat more severely abused children, may only accept participants who have been recommended by social service agencies, transitional living homes, or emergency placement shelters for abused women and children. Tjaden and Thoennes (1998) have estimated that more that 2 million women are victims of domestic violence each year in the United States, a staggering figure. However, these statistics fails to account for the children of these women. Pyles and Mee Kim (2006) find that these women come from diverse backgrounds, “including women of color, women with disabilities, and women from both urban and rural settings,” (p.222). And most often, victims trying to escape the abusive situation are further victimized by the multitude of barriers they face when trying to attain a safety from their abusers (Tolman & Rosen, 2001). Furthermore, it is estimated that women, on average, attempt to leave their abuser four to six times before finally leaving for good, (Oths & Robertson, 2007) and are at their greatest risk for lethal violence immediately after leaving the relationship (Websdale, 1999). Therefore, children who participate in these programs will have likely encountered numerous of these barriers, and while there current status will indicate their momentary safety, a great likelihood remains that they will find themselves being cared for by their abuser again at some point in the future. Even given the great potential for diversity, the children of this program will share the commonality of abuse itself and the materials presented will be applicable regardless of cultural differences.
Researchers have suggested that some of the most effective domestic violence support groups include teachings and considerations from the family systems theory (Dickstein, 2002). This is because “domestic violence is a pattern of behavior involving abuse of family members and includes physical, sexual, emotional, and psychological abuse,” (Shepard-White, 499). When utilizing the family systems theory, facilitators understand the importance of family interaction and the influence of such encounters, especially when the family unit fails to adhere to the norms of the family ritual. Systems theorists identify that regulated activities, such as rituals and daily routines, serve as the foundation for structure and stability, setting the tone for healthy families (Dickstein, 2002). Bente Storm Mowatt Haugland (2005) suggests “families have a tendency to maintain established patterns of behavior in the face of change or adversity,” (p. 226). Therefore, the level and frequency at which one experiences a disruption of the rituals and routines related to parental abuse can be an important indicator of how the abuse affects the family functioning, (Bente Storm Mowatt Haugland, 2005). In almost all cases, children who attend support groups for domestic violence, will have suffered from frequent disruptions of rituals and routines normally found in their family cycle due to the fluctuation between different phases of the abuse continuum, i.e. honeymoon period, to the tension-building, then the triggering event, and finally the abuse or acute battering stage, only then to repeat itself again. Because of the many stressors and traumas the children will have endured during their life cycle, coupled with the indirect affects of such disruptions to the normal family cycle, it will be imperative that issues related to healthy functioning and development be discussed.
Regardless of the level of abuse the child client has suffered, there are a great number of topics that should be focused on throughout the duration of the group, the first and most important aspect being that of safety (Carter & McGoldrick, 1999). McGarvey and Haen (2005) suggest that establishing a feeling of safety forms the foundation of treatment for abused children, safety which can first be formed by the therapist-client relationship and then extended to include the other members within the group, thus the purpose of pre-screening clients for suitability for inclusion of the group. While safety is foremost, facilitators should aim to include teachings that will provide; education on the effects and severity of abuse, safety planning, power dynamics (Carter & McGoldrick, 1999), feelings recognition, and treatment that should aid in the child in the transition of leaving the abuser, offer a sense of camaraderie, and provide a starting point for further psychotherapeutic treatment of the child. Even given the greatest potential for diversity, the children within the group will share the commonality of abuse itself and the materials presented should and will be applicable regardless of cultural differences. While gender effects differ, externalizing versus internalizing pathologies, age of onset, and severity, research has found that treatment need not be radically different or adapted for these groups, (Opland, Winters and Stinchfield, 1995).
Conclusions
In the United States, it is estimated that five children die each day as result of abuse or neglect (U.S. Department of Health and Human Services, 1995). Those children who survive the abuse develop short and long-term effects to include: emotional and mental functioning, decreased social skills, delayed development, failure to thrive (Herrenkohl & Herrenkohl, 2007; Gallo-Lopez, 2006; Briere & Runtz, 1993), additionally reporting feelings of loneliness, shame, guilt, and fear (Osgood & Chambers, 2000), all which left untreated can manifest into depression, PTSD, and suicide attempts. Additionally, there is a concern that these childhood victims of abuse can grow to become adult abusers, perpetuating the cycle of abuse; this due to the way abuse has been normalized within their family structure. Group therapy and attendance of support groups has been found to be independently effective and therapeutic for the adolescent client (Powell & Faherty, 1990). Therefore, given the risks associated with abuse and the therapeutic benefits of group therapy and support, it is imperative that these types of programs be made available, further expanded, and facilitated by knowledgeable leaders….. America’s children depend upon it!
Stephanie Lowrance-Henckel
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