Sobre la posibilidad de perdón en el abuso sexual infantil / On the possibility of forgiveness in child sexual abuse

La conveniencia o no de plantear a las víctimas la posibilidad de trabajar sobre el perdón como forma de superar el dolor de la experiencia vivida y sus consecuencias es una cuestión controvertida. Las dinámicas de presión hacia el perdón hacen más probable la revictimización y transmiten tanto culpa como un mensaje de minimización de su dolor. Un perdón mal entendido puede debilitar aún más la capacidad de protegerse de la víctima, hacerla más vulnerable y facilitar la prolongación del abuso. El objetivo de este artículo es revisar las condiciones para que el perdón sea una herramienta psicológica al servicio de la salud mental de las víctimas. El perdón es un concepto complejo, con múltiples dimensiones y posibilidades, y puede ofrecer a las víctimas un valioso recurso para superar su dolor, aunque no es esencial para el proceso de sanación de una víctima.(AU)

Whether or not it is appropriate to offer victims the possibility of working on forgiveness to overcome the pain of the lived experience and its consequences is a controversial issue. The pressure to forgive makes revictimization more likely and transmits guilt and a message of minimizing the victims’ pain. A misunderstanding of forgiveness can further weaken the victim's ability to protect him- or herself, make him or her more vulnerable, and make it easier for the abuse to continue. This paper aims to review the conditions for forgiveness to be a psychological tool for the mental health of the victims. Forgiveness is a complex concept with multiple dimensions and possibilities, and it can offer victims a valuable resource for overcoming their pain. However, it is not essential to the victim's healing process.(AU)

Featured Counter-Trafficking Program: ARPAN.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes a long-term psychotherapeutic intervention started by Arpan in 2010, in an institution named Advait Foundation. Advait runs a rehabilitation home, Project Baharati, in Vasai, Mumbai, India. Project Bharati serves adolescent females who have experienced commercial sexual exploitation and sexual abuse. The psychotherapeutic intervention uses group and individual therapy, employing trauma-focused cognitive behavioral and arts-based therapeutic techniques.

Nightmares and flashbacks: The impact of commercial sexual exploitation of children among female adolescents placed in residential care.

BACKGROUND: Important unresolved questions remain concerning the specific vulnerabilities and intervention needs of female adolescents who experience commercial sexual exploitation of children (CSEC), when compared to other highly vulnerable female adolescents. OBJECTIVE: This study aimed to assess differences in the level of post-traumatic symptoms reported by those who experienced CSEC during adolescence and those who did not. PARTICIPANTS AND SETTING: The study used longitudinal data collected from 125 French-speaking female adolescents who were placed in residential centers between the ages 12 and 17 years. METHOD: Post-traumatic symptoms were assessed at Time 1 and Time 6, while CSEC involvement was assessed at Times 1-5. One-way ANOVAs were performed to inspect differences in the level of post-traumatic symptoms at Time 6 between the participants who reported CSEC during adolescence (n = 70; 56.0%) and those with no history of CSEC (n = 55; 44.0%). Hierarchical regressions examined the effects of CESC while controlling for age, immigration status, child sexual abuse, and post-traumatic symptoms reported at Time 1. RESULTS: CSEC during adolescence predicted higher levels of general post-traumatic symptoms, anxious arousal, intrusive experiences, defensive avoidance, and dissociation. CONCLUSIONS: CSEC experiences intensify the existing vulnerabilities to traumatic sequelae that characterize female adolescents who are placed in residential care.

Featured counter-trafficking program: Kolkata Sanved's model Sampoornata.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Kolkata Sanvedan India-based organization dedicated to utilizing a special form of dance movement therapy (DMT), Sampoornata, as a form of trauma therapy for survivors of trafficking and sexual violence. The Sampoornata model has been employed to promote healing and wellbeing through integration in the individual's social framework and encouraging comprehensive wellbeing.

Featured Counter-Trafficking Program: RELENTLESS.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Relentless, a Berlin-based organization dedicated to providing clinical consultations and trauma informed training for various counter-trafficking organizations and individuals.

Featured Counter Trafficking Program: Reclaim13's 'Cherish House'.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Cherish House, an Illinois residential treatment program for trafficked girls. Cherish House utilizes a trauma-focused, integrated model to provide for medical, mental health, educational and life-skill needs of sex trafficked girls.

Barriers to Utilization of Mental Health Services amongst Male Child Sexual Abuse Survivors: Service Providers' Perspective.

Most research on child sexual abuse has been on survivors to the exclusion of service providers. This paper focuses on one group of findings from a larger qualitative study. The aim of the paper is to identify existing services and highlight the gaps in the current programs available for male CSA survivors from the perspective of service providers. Semi-structured interviews were conducted with 11 mental health service providers, recruited from two Southern and Central Ontario cities. Findings presented here report service providers' perspective of gaps in services for male CSA survivors. "Limited Male CSA Programs", "Institutional Barriers", "Attitudinal Barriers", and "Systemic Gaps" emerged as four major themes from the data analysis. Findings demonstrate the need to re-evaluate currently available service and highlights gaps in mental health service available for male CSA survivors. Implications for policy, practice, and research are discussed.

A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms, suicidality, and self-injury.

BACKGROUND: Adolescent victims of sexual assault and exploitation suffer significant mental health distress including PTSD, self-harm, suicidal ideation, and attempts. OBJECTIVE: This longitudinal observational study investigated the Runaway Intervention Program's influence on trauma responses at 3, 6, and 12 months for adolescents who have run away at least once and have been sexually assaulted or exploited. PARTICIPANTS: Runaways (n = 362) received nurse practitioner (NP) home and community visits, intensive case management, and optional empowerment groups. SETTING: An urban Midwestern city's hospital-based Children's Advocacy Center. METHODS: Trauma responses were measured by the UCLA PTSD-RI index, past 30 days emotional distress scale, and self-harm, suicidal ideation, and suicide attempt questions. Repeated Measures ANOVA assessed trauma response changes over time. Growth curve analyses using intervention doses determined which aspects of the intervention predicted change. RESULTS: From program entry to 3 and 6 months, mean values decreased significantly for emotional distress (-0.67, -.91) self-harm (-.30, -.55), suicidal ideation (-.45, -.57), suicide attempts (-.58, -.61), and trauma symptoms (-11.8, -16.2, all p < .001) all maintained at 12 months. In growth curve models, NP visits independently predicted declines in emotional distress (-.038), self-injury (-.020), suicidal ideation (-.025) and attempts (-.032), while empowerment groups predicted trauma symptoms (-.525) and all others except suicide attempts. CONCLUSIONS: The program, especially NP community visits and empowerment group elements, decreased trauma responses in runaway youth with a history of sexual assault. Given high rates of PTSD and emotional distress among runaways, the Runaway Intervention Program offers promise for improving mental health outcomes.

Qualitative Study on the Impact of Child Sexual Abuse: Perspectives of Children, Caregivers, and Professionals in Indian Context.

With an alarming increase in reported cases of Child Sexual Abuse (CSA) in India, the present study was conceived in an attempt to unearth the impact of CSA from the perspective of children, their caregivers, and the professionals dealing with them using qualitative research methodology. The secondary objective of the study was to discuss the clinical implications of the obtained findings for conducting culturally sensitive psychological assessment and intervention for CSA in India. Thus, in-depth interviews with 11 children and 7 Focused Group Discussions (FGDs) with 21 caregivers and 27 professionals were conducted. A total of 59 sample participants were recruited, and a thematic analysis was done. Six broad themes were identified from 223 generated codes-impact on behavioral, emotional, cognitive functioning and academics, psychopathology, biological, and social functioning. Four essential recommendations were concluded from the study, i.e., multidimensional impact assessment as a mandatory clinical practice, developing and utilizing culturally sensitive assessment & intervention protocols, incorporation of family-focused approach and multidisciplinary treatment team approach to ensure the holistic well-being of each chilsd in India.

Mental health services as a vital component of psychosocial recovery for victims of child trafficking for commercial sexual exploitation.

There has been a plethora of outcomes associated with child trafficking for commercial sexual exploitation; however little attention has been paid to how outcomes are addressed for children who are placed into residential aftercare recovery programs following their identification as victims. Field-based qualitative research was undertaken in South and Southeast Asia, and involved interviews with 213 representatives from U.N. and governmental agencies, nongovernmental organizations, and residential aftercare recovery programs. Findings highlight the mental health needs of child victims of trafficking for commercial sexual exploitation, describe the availability and quality of mental health services and supports in aftercare programs to address prevailing needs and repair the psychological damage caused by trafficking, and report on lessons learned pertaining to elements of good practice and related challenges associated with the availability and quality of mental health services and supports. It concludes by highlighting the implications of the findings for mental health policy and practice and offers suggestions for further research. (PsycINFO Database Record

Linguistic Analysis as a Method for Assessing Symptoms After Sexual Trauma Among Female Adolescent Psychiatric Inpatients.

Using a sample of female psychiatric inpatient adolescents, the current study aimed to extend this literature to an adolescent sample for the first time by examining if linguistic markers and their subcategories (cognitive process words, pronoun use, and somatosensory detail) in a trauma account are related to trauma symptomology and recovery during inpatient care. Results indicated that greater use of body words and fewer insight words were related to increased trauma symptoms at admission. In addition, use of fewer cognitive process words at admission predicted greater symptom change at discharge, extending previous research findings to an adolescent sample. Findings suggest that linguistic analysis may be an important component of adolescent trauma symptom assessment and treatment monitoring.

The Fears and Futures of Boy Victims of Sexual Abuse: An Analysis of Narratives.

Qualitative analysis of boys' narratives about child sexual abuse revealed several themes, including memories of the abuse, the disclosure and subsequent events, the healing journey, and a meta-theme titled "fear and safety." In this article, boys' (N = 19) experiences related to fear and safety and the healing journey are explored. The narratives provided a unique look at boys' road to recovery, perceptions of counseling, and hopes for their futures. Recommendations for counseling boy victims are discussed.

Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited: Findings From a Specialized Treatment Program.

Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors' experiences working with this population.

Treatment Experiences of Child Sexual Offenders in Norway: A Qualitative Study.

This article is an attempt at gaining a better understanding of treatment of adults who have committed sexual offenses against children. In this study we aimed to explore what people who have committed sexual offenses against children find useful in therapy. The study was approached using qualitative methodology, and information was collected through semistructured interviews. Four male child sexual offenders were recruited from the Institute of Clinical Sexology and Therapy in Oslo, Norway. The informants were interviewed with a focus on what factors they found useful in therapy. Through an explorative, thematic analysis, five main themes were found. These themes include: "Why I started going to therapy," "Why did I do it?" "Therapy as life," "Previous and current relationships with others," and "I lived in a fantasy world where everything was okay." Based on this study and other earlier studies and theories it appears that the previously mentioned themes recur as important contributory factors in the treatment of child sexual offenders.

Therapeutic Alliance during Prolonged Exposure Versus Client-Centered Therapy for Adolescent Posttraumatic Stress Disorder.

OBJECTIVES: To examine the relationship between improvements in adolescent ratings of therapeutic alliance and reductions in posttraumatic stress disorder (PTSD) severity over time among adolescent girls during prolonged exposure therapy for adolescents (PE-A) versus client-centered therapy (CCT), as well as to examine differences in changes in alliance between treatment groups. METHOD: A total of 61 adolescent girls (aged 13-18 years) with sexual assault-related PTSD received PE-A or CCT in a randomized controlled trial. Participants rated alliance at session 3, midtreatment, and posttreatment. RESULTS: The rate of improvement in adolescent-rated alliance was greater in PE-A than CCT over the course of treatment. In addition, improvement in adolescent-rated alliance significantly contributed to improvements in PTSD (regardless of treatment condition), but not vice versa. CONCLUSIONS: Contrary to beliefs that trauma-focused treatments fail to establish strong therapeutic alliance in sexually abused adolescents, improvement in adolescent ratings of alliance were greater in PE-A compared to CCT, and improvements in adolescent-rated alliance were significantly associated with better treatment outcome across both types of treatments.

Aftercare Services for Child Victims of Sex Trafficking: A Systematic Review of Policy and Practice.

OBJECTIVE: To explore aftercare services provided to child victims of sex trafficking globally based on the results of a systematic review of published and unpublished research, organizational policy, and current practice. This systematic review serves as a first step toward developing best practices for aftercare service providers. METHOD: A systematic search was conducted of four English language databases, two human trafficking resource libraries, and one Internet search engine for journal articles and "grey" literature published between January 2000 and May 2013 on the services offered to child sex trafficking victims globally. The search yielded 15 documents for inclusion in the review. RESULTS: The 15 documents emphasized the need for aftercare service provision to be founded on children's rights and trauma-informed service provision. They recommended delivery practices such as case management and multidisciplinary, multiagency and multinational coordination to ensure the child victims benefit fully from the services. The systematic review revealed that there are three phases to aftercare service provision: rescue, recover, and reintegration. Each of these phases is characterized by different needs and types of services provided. The recovery phase received the most attention compared to recovery and reintegration phases. CONCLUSION: The literature highlighted that aftercare service provision for child sex trafficking victims is a new area that needs an evidence base from which policy and practice can be formed. There is great need for further research and better documentation of service provision. While this research provides insight into this area, the gap in literature remains wide. The area of aftercare service provision for children who have been trafficked has experienced phenomenal growth within the last 10 years, and with more research and resources being directed to the area, the achievement of international minimum standards of care provision is possible.

The Dialectic of Chaos and Control in the Experience of Therapists Who Work With Sexually Abused Children.

The aim of this study is to contribute to the understanding the interaction between the emotionally destructive intensity of the trauma and forces that foster growth in therapists who treat sexually abused children. Data were collected through in-depth semistructured interviews with 14 experienced social workers. Content analysis reveals two emotional poles. At one pole, the dominant experiences are anxiety, turmoil, and intrusion that disrupted the order in the interviewee's secure world. At the opposing pole, the dominant experiences are positive, such as hope and faith. These formed the basis of empowering meaning construction that engendered a sense of control, enabling the therapists to trust the value of intervention with sexually abused children. The discussion uses a dialectical perspective to examine how interaction between these two poles enhances our understanding of the emotional and existential threats inherent in working with children who have experienced sexual abuse and on the potential for positive change.

Child Soldiers: Children Associated with Fighting Forces.

Around the world, there are an estimated 300,000 to 500,000 children involved in armed conflict. Children can be abducted into a fighting force to fight or serve as sex slaves. Child soldiers have depression, anxiety, and posttraumatic stress symptoms; however, evidence is mixed because of methodologic limitations. Various mental health interventions have been tried, with promising results. Child and adolescent psychiatrists are uniquely trained in understanding and assisting youth to heal from such extraordinary experiences. A public health paradigm could include interventions that are based on a comprehensive assessment of interweaving developmental, biological, psychological, and sociocultural factors.