Psychotherapeutic change in children and adolescents who have been sexually abused: a model from participants' perspectives.

INTRODUCTION: Change in psychotherapy research in cases of child sexual abuse (CSA) has mainly emerged from a symptomatologic view, which needs to be complemented by a subjective perspective of change. Thus, this article aim is to describe different outcomes and stages of change during psychotherapy in children and adolescents who have been sexually abused, from the subjective perspectives of those involved in the process. METHODS: A longitudinal qualitative study was developed. Qualitative interviews were conducted at different moments of the psychotherapeutic process (at around 6 months of therapy, 12 months and at the end of therapy) with 28 children and adolescents aged 6 to 17, with their caregivers and therapists. All children and adolescents attended and then completed psychotherapy due to sexual abuse in natural settings, in public specialized centres in Santiago, Chile. Sexual abuse occurred mainly in an intrafamilial context or by acquaintances. Data analysis was conducted using narrative analysis. RESULTS: Three stages of therapy were identified: (1) settling into therapy, (2) approaching CSA and (3) healing from abuse. Three different outcomes of psychotherapeutic change were also identified: (1) protective and psychosocial changes, (2) changes related to diminishing the effects of abuse and (3) changes related to healing from abuse. Psychosocial characteristics of the cases and features of the therapeutic process are described in each group. DISCUSSION: The outcomes of change and the stages of therapy are interrelated in a dynamic and gradual process where change is linked with the case's psychosocial characteristics and the features of the therapeutic process. Results allowed the authors to situate the voices of the participants within a proposed model of psychotherapeutic change for CSA, with clinical practical implications.

Cambio Psicoterapéutico en niños, niñas y adolescentes que han sido víctimas de agresiones sexuales: Evaluación de la continuidad y caracterización del cambio posterior a la psicoterapia / Psychotherapeutic change in children and adolescents who have been victims of sexual abuse: Evaluation of the continuity and characterization of change after psychotherapy

Resumen Antecedentes: Son escasos los estudios sobre psicoterapia en agresión sexual infantil que incluyan un seguimiento tras su finalización. Objetivo: Explorar la continuidad del cambio psicoterapéutico en niños que han sido víctimas de agresiones sexuales luego de finalizada la psicoterapia, y caracterizarlo, integrando sus perspectivas y la de sus adultos responsables. Método: Se realiza un estudio con metodología mixta, incorporando 10 niños/as y adolescentes entre 7 y 17 años. Se evaluó sintomatología al inicio y final de la psicoterapia y luego de 1 a 2 años que ésta había finalizado. En el seguimiento, se entrevistaron a los niños/as y adolescentes y a sus adultos responsables. Los datos cuantitativos (instrumentos sintomatológicos) se analizaron con pruebas no paramétricas y los cualitativos (entrevistas) mediante análisis narrativo. Resultados: Se aprecian diferencias significativas entre la sintomatología pre, post-terapia y seguimiento evaluada cuantitativamente, mostrando que existen cambios al finalizar la terapia, los que se mantienen en el seguimiento. En las entrevistas se identifican diferentes esferas de cambios logrados durante la terapia que se mantienen posterior a su finalización, destacándose factores favorecedores. Conclusiones: Se discuten elementos relevantes para la mantención del cambio post-terapia, tales como el trabajo con el adulto responsable y el cese del contacto con el agresor.

Abstract Background: There are few studies in psychotherapy in child sexual abuse that includes follow-up after therapy. Objective: To explore the continuity of psychotherapeutic change in children that have been victims of sexual abuse after therapy ended and to characterize it, integrating their perspectives and the one of their responsible adults. Method: a study with mix methods was done, incorporating 10 children and adolescents between 7 and 17 years old. Symptomatology was assessed at the beginning and end of psychotherapy, and after 1 to 2 years after therapy ended. At follow up children and adolescents, and their responsible adults were interviewed. Quantitative data (symptomatology instruments) was analyzed with non-parametric tests and qualitative data (interviews) with narrative analysis. Results: Significant differences were found between symptomatology evaluated quantitatively at pre, post-therapy and follow up, showing changes after therapy that maintains at follow-up. With interviews different areas of change accomplished during therapy are identified, which maintains after therapy, highlighting factors that facilitate it. Conclusions: Relevant factors for the maintenance of change after therapy are discussed, such as working with the responsible adult and ending contact with the aggressor.

Growing up in the context of intimate partner violence: Experiences and meanings for adolescents in Chile.

BACKGROUND: Growing up in the context of intimate partner violence (IPV) is associated with a range of mental health problems in childhood. A recent area of research in this field considers the perspectives of children and adolescents in understanding the phenomenon of IPV. OBJECTIVE: To explore the lived experiences of adolescents growing up in the context of IPV and the meanings they construct about the phenomenon. PARTICIPANTS AND SETTING: Ten adolescents (five females and five males), between 12 and 17 years old, who were attending psychosocial programs specialized in child maltreatment in Santiago, Chile. METHODS: The data were obtained through semi-structured interviews and thematic narrative analysis. RESULTS: The results show that many of the adolescents narrate their lived experiences of severe and chronic episodes of IPV as part of their life story, and that they continue to do so even after their parents separate. It was also found that the adolescents suffered other forms of victimizations, such as physical and sexual abuse. CONCLUSIONS: Adolescents growing up in the context of IPV are demonstrated to be not only direct victims of violence but also active agents capable of reflecting on it. The implications of children and adolescents participating in such investigations for the development of effective interventions in IPV are also discussed.

Perspectivas de niños y niñas sobre crecer en hogares con violencia de género en la pareja / Child perspectives on growing up with gender-based intimate partner violence at home

Crecer en el contexto de violencia de género en la pareja (VGP) se ha relacionado con problemas de salud mental en los/as hijos/as, sin embargo, poco se conoce sobre los efectos de la VGP desde el punto de vista de los propios hijos/as. El objetivo de esta investigación fue comprender el impacto psicológico asociado a vivir en contexto de VGP desde la perspectiva de los/as niños/as. Se realizaron entrevistas semiestructuradas con 3 niños y 5 niñas entre 8 y 12 años, que asistían a Programas de Protección Infanto-Juvenil y que habían crecido con diferentes formas de VGP crónica en el hogar. Las entrevistas se analizaron mediante análisis narrativo. Los resultados muestran que crecer en un contexto de VGP posee un impacto psicológico en los/as niños/as, principalmente en su bienestar emocional, las relaciones familiares y, en algunos casos, en las descripciones de sí mismos/as. Se concluye que las experiencias de VGP pueden tener un impacto significativo en la vida de los/as niños/as y afectar diferentes ámbitos de sus vidas. Los hallazgos enfatizan la importancia de comprender los efectos de la VGP desde la perspectiva de los/as hijos/as, con el fin de desarrollar intervenciones clínicas de acuerdo con sus necesidades

Growing up in the context of gender-based intimate partner violence (IPV) has been associated with mental health problems in children yet little is known about IPV effects on children from their own point of view. The aim of this research was to understand the psychological impact associated with living in an environment with IPV, from the perspective of children. Semi-structured interviews were conducted with 3 boys and 5 girls, between 8 and 12 years old, who were attending psychosocial programs specialized in maltreatment and experimented different forms of chronic IPV at home. The interviews were analyzed using narrative analysis. The results show that growing up in an environment with IPV has a psychological impact on children's emotional wellbeing and family relationships, and in some cases on their self-concept. We conclude that IPV experiences had a profound impact on the participants' wellbeing, affecting various areas of the children's lives. The results highlight the importance of understanding the effects of IPV from the children's perspective, in order to develop clinical interventions in accordance with their needs