Exploring the Meanings of Posttraumatic Growth in Spanish Survivors of Clergy-Perpetrated Child Sexual Abuse: A Phenomenological Approach.

A healing and recovery perspective related to child sexual abuse (CSA) has gained attention in the past two decades, a concept that accurately refers to the process is posttraumatic growth (PTG). Scarce empirical research on PTG in clergy-perpetrated CSA survivors shows evidence of the presence of growth after the abusive experience and a tendency to create accounts of trauma as a way to heal. The general aim of the study is to explore the experiences and meanings of PTG as lived by survivors of clergy-perpetrated CSA. Seven clergy-perpetrated CSA survivors were interviewed with semi-structured in-depth interviews conducted in person. Using reflexive thematic analysis, we identified three dominant themes in the participants' stories: (a) the hindering of PTG; (b) the meanings of PTG, and (c) the internal and contextual and facilitators of PTG. The present study brings new insights into the meanings of PTG, the close relationship between damage and growth, and the mechanisms (both internal and contextual) that are involved in healing from clergy-perpetrated CSA in Spanish culture.

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.

The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists.

Through the perspectives of children, parents and therapists, this study explored the therapeutic relationship as a change facilitator in different moments of psychotherapy. The children, parents, and therapists (N=15) who formed part of five therapeutic treatments were studied using a qualitative, longitudinal design. Thirty semi-structured interviews were done; half at the beginning and half after four months of psychotherapy. Children's drawings were incorporated, and data were analysed through grounded theory methods and qualitative analysis guidelines for drawings. Participants identified several aspects of the therapeutic relationship as change facilitators. From the first encounters, the therapists' close and adaptable attitude promoted an improved motivation for psychotherapy and enhanced engagement among children and parents. Later in the process, a positive, child-centred and affective therapeutic relationship fostered the child's trust with the therapist as well as a positive relational experience, promoting associated changes in children and the development of socio-affective tools. Parents and therapists saw their own relationship as a change facilitator, as well as a broader understanding in parents of their children and an improved relationship with them. Parent's and child's changes helped each other. Specific and common aspects between participants' perspectives provided a richer understanding of the studied phenomena. This study supports the view that a positive therapeutic relationship facilitates early changes in the motivation of children and parents, and provides them with a healing, relational experience as it develops. A positive parent-therapist relationship is also key for changes to further progress.

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.

Identidad personal en niños y adolescentes: estudio cualitativo / Personal identity in children and adolescents: a qualitative study / Identidade pessoal em crianças e adolescentes: estudo qualitative

Resumen (analítico) La construcción de identidad personal es un proceso evolutivo. Escasas investigaciones estudian este proceso en la infancia. El objetivo de esta investigación es describir la construcción de identidad personal de niños y adolescentes entre 6 y 18 años, desde un enfoque constructivista evolutivo. Se realiza un análisis temático de narrativas autobiográficas escritas por 119 niños y adolescentes. Los resultados se organizaron en torno a tres dimensiones de la identidad personal: unidad de identidad, integración de identidad, integración con otros; observándose que desde la infancia hay un reconocimiento personal, luego se integran diferentes eventos vitales significativos y en la adolescencia se complejiza su construcción, incorporando mayor reflexión y aspectos ideológicos. Se discuten implicancias para favorecer un desarrollo adaptativo de la identidad en todas las edades, validando diversidad de opciones.

Abstract (analytical) Construction of personal identity is a developmental process. Few research investigates this process in children. The research objective is to describe the personal identity construction of children and adolescents between 6 and 18 years old, from a developmental constructivist approach. Thematic analysis of autobiographical narratives written by 119 children and adolescents is performed. Results were organized around the three personal identity dimensions: unity of self, integration of self and integration with others. Results show from childhood there is a personal recognition, then different significant life events are integrated, and in adolescense this construction becomes more complex, integrating more reflection and ideological aspects. Implications are discussed to promote an adaptive development of identity through lifespam, validating a diversity of options.

Resumo (analítico) A construção da identidade pessoal é um processo evolutivo. Poucas pesquisas investigam esse processo na infância. O objetivo desta pesquisa é descrever a construção da identidade pessoal de crianças e adolescentes entre 6 e 18 anos, a partir de uma abordagem construtivista evolutiva. É realizada uma análise temática das narrativas autobiográficas escritas por 119 crianças e adolescentes. Os resultados foram organizados em torno de três dimensões da identidade pessoal: unidade de identidade, integração de identidade, integração com os outros; e mostram que desde a infância há um reconhecimento pessoal, logo diversos acontecimentos significativos da vida são integrados, e na adolescência sua construção torna-se mais complexa, incorporando mais reflexão e aspectos ideológicos. As implicações para promover o desenvolvimento adaptativo da identidade em todas as idades são discutidas, validando a diversidade de opções.

The therapeutic relationship in child psychotherapy: integrating the perspectives of children, parents and therapists.

This study addresses the therapeutic relationship in child psychotherapy, through an exploration of the experience of the main actors engaged in child psychotherapy.To describe and analyse the therapeutic relationship integrating the views of children, parents and therapists.This study employs a qualitative methodology, assuming a discovery-oriented approach which draws from grounded theory. Twelve psychotherapy triads participated, composed of children aged 6-10, their parents and psychotherapists. Semi-structured follow-up interviews were conducted (N=36), including a drawing in the case of the children.A positive therapeutic relationship with children and parents was viewed as a gradually constructed process, based on a positive emotional encounter between participants. It was facilitated primarily by the therapist's commitment and playful stance, the child and therapist mutual involvement, and the parent's collaboration. These aspects entailed a trustful, validating and caring relationship, that shaped children and parents' motivations towards therapy and facilitated change.From a multiple-perspective approach, therapy was conceived as a relational experience. The development of positive relationships required different and evolving dispositions from therapy main actors. Therapists' genuine feelings and engagement in therapeutic activity seem central, underlining the importance of addressing relational aspects in child therapy research and training.

Adherencia o deserción de adolescentes en psicoterapia por agresiones sexuales: la perspectiva de sus terapeutas / Adherence or Drop Out of Adolescents in Psychotherapy Due to Sexual Abuse: their Therapist's Perspective

Resumen Un alto porcentaje de adolescentes que asisten a psicoterapia por haber sido víctimas de agresiones sexuales desertan de su tratamiento, afectando así su proceso de superación. Existe escasa investigación respecto a qué precipita la deserción o favorece la adherencia en estos casos. Objetivo: describir características del sistema consultante y del proceso psicoterapéutico de adolescentes que han sido víctimas de agresiones sexuales que adhieren y que desertan de la psicoterapia, desde la perspectiva de sus psicoterapeutas, explorando sus similitudes y diferencias. Método: se realizaron entrevistas semiestructuradas a psicoterapeutas que atendieron 16 casos de adolescentes que han sido víctimas de agresiones sexuales, 8 que desertaron de la psicoterapia y 8 que adhirieron hasta el alta. Se realizó un análisis narrativo temático de las entrevistas. Resultados: las principales similitudes identificadas fueron contextos sociofamiliares multiproblemáticos, recursos personales en los adolescentes y una relación psicoterapéutica positiva. Las diferencias se enfocaron en los adultos responsables, quienes en los casos de deserción mostraban bajo apoyo, una relación más conflictiva con el adolescente, escaso involucramiento en la psicoterapia y una relación frágil con el psicoterapeuta. Los adolescentes que desertaron presentaron motivos de consulta no asociados con la agresión sexual y se caracterizaron por ser socialmente poco integrados, a diferencia de los que adhirieron. Discusión: los fenómenos de adherencia y deserción a psicoterapia son complejos y multifactoriales. Junto con factores asociados al sistema consultante, se destacan elementos del proceso psicoterapéutico que propician la adherencia, y que, por tanto, pueden ser abordados tempranamente para favorecer la adherencia a la psicoterapia.

Abstract A high percentage of adolescents who attend psychotherapy due to sexual abuse drop out of treatment, affecting the overcoming. There is little research on what precipitates desertion or promotes adherence in these cases. Aim: describe features of the consulting system and the psychotherapeutic process of adolescents who have been sexually abused who adhere and drop out of psychotherapy, in order to explore similarities and differences from the perspective of their psychotherapists. Methods: Semi-structured interviews were conducted with psychotherapists who attended 16 cases of adolescent victims of sexual abuse, 8 who deserted from psychotherapy and 8 who continued until discharge. Thematic narrative analysis of the interviews was developed. Results: the main similarities described were multiproblematic social and family contexts, personal resources in the adolescents and a positive psychotherapeutic relationship. Differences were focused on caretakers, who in the drop out cases showed low support and a more conflictive relationship with the adolescent, little involvement in psychotherapy and a poor relationship with the psychotherapist. Adolescents who deserted had consultation purposes not related with sexual abuse and low social integration, unlike those who adhered. Discussion: the phenomena of adherence and dropout of psychotherapy are complex and multifactorial. Along with factors associated with the consulting system, elements of the psychotherapeutic process that support adherence stand out, which can be addressed early in the process.

Change during psychotherapy: the perspective of children and adolescents who have been sexually abused.

The aim of this research was to identify the meanings of psychotherapeutic change of children and adolescents who have suffered sexual abuse and were in psychotherapy. In order to do this, a qualitative study was carried out in which in-depth interviews complemented with drawings were conducted with 10 children and adolescents, aged between 6 and 16 years, who were taking part in psychotherapy due to sexual abuse. The interviews took place between 6 and 10 months after the start of the therapy and before it ended. Thematic narrative analysis was used for the interviews and visual narrative analysis for the drawings. The main findings showed that children and adolescents visualized psychotherapeutic change as a process in which gradual progress is made. The participants notice changes from an initial state of sadness and distress, mainly describing a positive shift in terms of emotional well-being. In addition, in this phase of the therapy only a few participants identified changes in their feelings regarding the abusive experience. The participants identified aspects of the therapy and supportive relationships with significant others as elements that foster these changes. In their view, hindering elements include changes of therapist, legal factors, and not being believed by their family. It is discussed the importance of knowing the children and adolescents' perspective regarding psychotherapeutic change while participating in therapy processes, using multiple methodologies, to generate interventions that suit the needs of this population and match the pace of children and adolescents' change.

Meeting in difference: Revisiting the therapeutic relationship based on patients' and therapists' experiences in several clinical contexts.

Despite decades of research on the therapeutic relationship and the therapeutic alliance and their connection with therapeutic outcomes (Horvath, Del Re, Flückiger, & Symonds, 2011), only a handful of studies have examined how they are experienced by the therapy participants. The aim of the present study is to describe the therapeutic relationship from the subjective perspective of the patients and therapists involved in 3 clinical cases: (a) a 7-year-old child diagnosed with attention deficit hyperactivity disorder, (b) a 29-year old woman diagnosed with a personality disorder, and (c) a 22-year-old man diagnosed with schizophrenia. We conducted semistructured interviews with patients and therapists that were later analyzed following grounded theory coding procedures (Corbin & Strauss, 2008). The results obtained reveal that the constitutive elements of the therapeutic relationship are linked to 2 dimensions of the patient-therapist meeting experience: the technical and role-related dimension, characterized by relational asymmetry, and the affective exchange dimension, characterized by relational symmetry. The article discusses the possible association between the asymmetrical technical dimension, whose roles are defined by the organization of the helping relationship, and the notion of therapeutic alliance as commonly conceptualized and assessed; on the other hand, the experience of the bidirectional and symmetrical patient-therapist affective exchange is linked with concepts such as real relationship and intersubjectivity.

Change during Psychotherapy through Sand Play Tray in Children That Have Been Sexually Abused.

This paper presents the results of a qualitative study on the use of sandplay, or sand tray therapy, in the psychotherapeutic process of children who have been sexually abused. A longitudinal study was carried out with seven participants between the ages of 7 and 10 years old. Data was produced during observation of the therapeutic activity over the course of three different phases of treatment, using a rubric created especially for this observation. Three sandplay sessions were recorded: one at the start of therapy, one at the 3-month mark, and the third and final session after 6 months of treatment. Sessions were then transcribed for later analysis. A rubric was developed in order to help researchers identify central themes, behaviors and content of creative play, as well as the therapeutic relationship. Transcribed sessions and observation rubrics were evaluated using qualitative content analysis, and information was categorized according to verbal and behavioral characteristics of the game. Results of the present study reveal common and transversal forms of playful expression among this group of children shown by their engagement with sandplay. During this activity, participants elaborate personal stories that feature violence as a central theme, often involving aggression between two or more individuals. They also express their need for care and protection and work to resolve conflicts using fantasy. The shifting dynamics of sandplay at each stage of therapeutic treatment is an important finding that reveals the progress made during psychotherapy. In the third phase of treatment, sandplay encouraged movement among children, allowing them to act out meaningful scenarios and create structured situations with positive outcomes. Finally, the value of sandplay as an important therapeutic tool is discussed, primarily its role in supporting processes of change and allowing participants to assign new meanings to traumatic experiences. Its application to the field of clinical psychology, particularly when working with victims of sexual abuse, is also explored.

Winning a Race: Narratives of Healing and Psychotherapy in Children and Adolescents Who Have Been Sexually Abused.

This article explores the process of recovering from sexual abuse according to children and adolescents who have been sexually abused and have successfully completed psychotherapy. In this qualitative study, interviews were conducted with 20 participants from 8 to 18 years of age and then subject to narrative analysis. Results show that participants' narratives of recovery involve an improvement of psychological well-being. Moreover, they feel better equipped to overcome future challenges, feeling empowered and able to retake control of their lives. Factors that support and inhibit recovery are examined, as are developmental differences. Discussion underlines the valuable role of psychotherapy in helping children and adolescents in their healing process, changing the meaning of the abusive experience, and developing new capacities.

Regulación emocional en niños y adolescentes: artículo de revisión: nociones evolutivas y clínica psicopatológica / Emotional regulation in children and adolescents: review: developmental concepts and clinical psychopathology

El presente artículo revisa los principales conocimientos que se han generado en los últimos años a nivel internacional y nacional respecto a la regulación emocional. Se define el concepto y las principales estrategias de regulación emocional en niños y adolescentes, los factores involucrados en la regulación emocional, así como su desarrollo a través de las distintas etapas evolutivas. Se revisan las investigaciones que han estudiado la relación entre regulación emocional, salud mental y psicopatología. Las conclusiones destacan la relevancia de estos conocimientos como marco para la evaluación y tratamiento de dificultades de regulación emocional en niños y adolescentes.

This article is a review of the knowledge about emotion regulation developed in the last years internationally and in our country. The concept and main strategies of emotion regulation in children and adolescents are defined, as well as the factors involved in emotion regulation, and it`s evolution in the different developmental stages. Research about the relation between emotion regulation, mental health and psychopathology are reviewed. Conclusions highlight the importance of this knowledge as a framework for the assessment and treatment of emotion regulation difficulties in children and adolescents.