Abstract
Teenage sexual assault has detrimental effects on the family’s ability to function. Adolescent sexual abuse is a serious health problem due to its widespread prevalence and dire health consequences. The purpose of this research paper is to explore the effects of adolescent sexual abuse on the family using the case of a teenager who was sexually assaulted. The research paper looks into the social issue of sexual assault among young people, effects on the family dynamic and a family-based intervention. The paper is divided into two parts, with the first part giving the general overview of the social problem and the second part summarizes the functional family therapy approach on adolescent sexual abuse.
1) ADDRESSING A SOCIAL PROBLEM
Sexual Abuse among Teenagers
Teenage sexual abuse is a big problem in the society. Reilly & Williams (2015) define adolescent sexual abuse as unwanted sexual of a teenager by another person. Sexual abuse takes many forms; it can be unwanted sexual touching, rape, sodomy, incest, forcible object penetration, and sexual solicitation through the internet. Sexual abuse can happen to any teenager, regardless of gender and sexual orientation. The World Health Organization (WHO) has a broader definition of child sexual abuse. WHO defines child sexual abuse as sexual activity with a child who does not fully comprehend, unable to give informed consent, who is not developmentally prepared, or that violates the laws or social taboos of the society. Adolescence is a period of sexual and reproductive maturity, but adolescents are not fully developed to engage in sexual activities with adults, which is why the legal age of consent is 18.
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According to the Rape, Abuse & Incest National Network (RAINN) statistics, child and teenage sexual abuse are rampant. After every eight minutes, Child Protective Services (CPS) in the US finds evidence to substantiate child abuse. Between 2009 and 2013, CPS reported that 63,000 children were victims of sexual abuse. Two out of three child sexual abuse victims are between the ages of 12 to 17. Reilly & Williams (2015) add that sexual abuse is frequent among girls in comparison to boys with 82% of the victims as female. One in nine girls, and one in 53 boys under 18 experience sexual abuse or assault in the hands. Females between 16- 19 are four times more likely to be sexually abused in comparison to the general population.
RAINN statistics and CPS reports suggest that the perpetrator of ASA is mostly the parent with 80% of the perpetrators are parents, 6% are relatives, 5% are other siblings or strangers, and 4% are the unmarried partner of the parent. In the 2013 CSA cases, CPS found 47,000 men and 5,000 perpetrators of CSA. 88% of the perpetrators are male, while 9% of the perpetrators are female. In most cases, perpetrators of ASA are known to the victim, and they are within the family or friend social cycles.
Adolescent sexual abuse (ASA) has long-lasting effects on the victim’s physical and mental health. The immediate and short-term consequences on the victim include sexually transmitted infections, HIV, HPV, and pregnancies. According to Fernandez (2011), the typical reactions for sexual abuse victims include intense fear, helplessness, anger, depression, suicidal ideation, and a decline in self-esteem. When the victims do not get immediate treatment, they continue suffering from post-traumatic stress disorder throughout their lives.
Dillard & Putnam (2014) report that victims of ASA are four times more likely to develop symptoms of drug abuse and PTSD as adults. Victims of ASA are three times more likely to experience major depression as adults. According to Amado et al. (2015), numerous studies have established the relationship between ASA and psychological injury. Psychological conditions such as major depressive disorder, generalized anxiety disorder, and phobic disorders often manifest in the short-term, and in some cases, they become chronic in victims of ASA. Aside from the many psychological health consequences; teenage pregnancies are common among victims of ASA. Suicides are also high among ASA victims because of the depression and helplessness.
The severity of the physical and mental health injury depends on the ASA prevalence rates. Some victims of ASA are victims of continuous abuse, and they are afraid to speak up. Some victims do not open up about it and choose to suffer in silence. Amado et al. (2015) note that the severity of injury also dependents on the type of abuse and cultural aspects associated with sexual abuse. The effects of ASA varies among victims depending on the help they get.
Family Dynamics familiar in Families with Substance Abuse Problem
CSA affects the family, and yet members of the family are often the perpetrators of sexual abuse. Essabar et al. (2015) point out that CSA is a perplexing and confusing problem for the family. Parents are often at a loss on how to help the child, and in most cases, they blame themselves for the incident.
Research shows that an overwhelming majority of the CSA perpetrators are within the family or known to the family. The family is then conflicted on how to solve the issue. Most family members condemn the perpetrator and report him/her, but there are a few cases where families decide to handle the situation at home, putting the victim in danger of further abuse. In the past, family therapists also treated incest as a “family affair,” and in most cases, all the other family members blamed the victim of CSA (Karakurt & Silver, 2014). Recent trends in family therapy view incest as a breakdown in healthy family life while focusing on the specific individuals involved.
A study by Karakurt & Silver (2014) concludes that victims of ASA perpetrated by a parent or family member have problems trusting and forming intimate relationships. Karakurt & Silver (2014) uses the attachment theory to show how CSA damages the mental health of the victims and the family dynamics. The attachment theory states that an emotional bond between the child and the caregiver (parent) is necessary for healthy development. However, when the parent is responsible for perpetrating ASA, the child develops an insecure attachment. The three forms of insecure attachment styles are avoidant, resistant-ambivalent, and disorganized-disoriented.
The family systems theory states that a family unit is made up of different interconnected parts that operate in harmony. When a child is a victim of CSA, the family system is disrupted. The family is thrown into chaos when the perpetrator of CSA/ ASA is within the family. When a family member sexually abuses another member, the relational ties and family roles are betrayed. The victim’s ability to trust and interact with the family is affected, and she blames herself or the family for not protecting her.
Evidence-based Intervention
A review by Foster (2014) explores various evidence-based intervention for adolescent sexual abuse. The intervention programs can be delivered to the community or in a healthcare system setting with the aim of increasing the teenager’s resilience. Family-based intervention is the best strategy for teenagers struggling with substance abuse as the whole family is included in the intervention. According to Zimmerman et l., (2013), some risk and protective factors for CSA are within the family. A family is the most influential ecosystem in adolescent development. Parent-teenager communication, monitoring, supervision and parental involvement, parent protection, and model and family management strategy can prevent ASA within the family home.
According to Fernandez (2011), ASA has ripple effects; it affects the victim and the entire family. A family-based intervention program aims to equip the teenager with knowledge and skills to address the psychological trauma and improving protective factors and resilience (Downing et al., 2011). Family-based intervention programs promote positive youth development by strengthening proper parenting and family relation skills. The intervention focuses on increasing parent/ child attachment, useful monitoring skills, and communication. There is substantial evidence showing that family-based intervention results in positive outcomes in participants (Kumpfer, 2014). Active participation by parents has a positive effect on ASA programs with adolescents with regards to long-term outcomes. A review by Foster (2014) concludes that working with the teenager alone might not result in substantial positive changes in behavior, but it will lead to increase in knowledge.
A notable strength for family-based intervention is that it has been proven to produce positive outcomes for the individual with the social problem in comparison to other interventions programs. The victim will acquire new skills while improving interactions with family members for long-term and sustainable positive development (Sexton & Lebow, 2015). Another strength of family intervention is that it is beneficial for the whole family, including parents, siblings, caretakers or other extended family members living at home with the participant. A family-based intervention for ASA can help the family work on a broad range of issues affecting the adolescent and the whole family (Fernandez, 2011). Family-based intervention programs can be implemented in a variety of settings including family home using DVDs or computer, faith communities, community programs or in a clinical setting.
The family-based intervention program is hugely beneficial, but it has its downsides. The program does not work when the family is not dedicated to making it work (Kuntsche, 2016). Some families are too busy or do not want to engage in a family-based intervention program because they feel guilty for letting their child endure sexual abuse at the hands of someone they trusted.
Part # 2: Working with a Client and Family
Describe the client, including the client’s family and system dynamics
The client is Abby*, she is 15 years old, and she was referred to the center for behavioral problems. Her mother’s boyfriend sexually abused Abby. When Abby was ten years old, her father, who was a heavy drinker left the family and never came back. Abby’s mother got another job to provide for Abby and her two siblings. In most cases, Abby would stay home to take care of her siblings while her mother was at work or out with her partner/s.
When Abby was 14, her mother’s boyfriend raped her in the basement when her mother had gone for work. This was not the first incident as he had made advances on her by making sexual suggestions and advances. Abby had complained to her mother that her boyfriend should not stay in the house, but the mother did not listen.
After the rape incident, Abby did not know who to turn to. The situation got worse because Abby’s mother, Debra, was still seeing the same man who abused Abby. The perpetrator would make sexual innuendos or wink at Abby. She was forced to lock herself in her room and cry all day. Abby began missing school and drinking alcohol to cope with the depression, helplessness, and suicidal ideation. Abby has gotten in trouble at school over violence, failure to do homework, and skipping classes.
After noticing her drastic behavior change, Debra tried talking to Abby who did not want to listen. Debra had an argument with Abby and Abby told her mother that it is her fault that she was sexually abused and the reason she wants to end it all.
Treatment Phases
The treatment method is called functional family treatment (FFT). It is a short-term, intensive and evidence-based model aimed at treating substance abuse and juvenile crime. According to Sexton & Turner (2011) evidence shows that FFT produces positive outcomes when therapists stick to the program. High adherent therapists using FFT witnessed a 35% reduction in felony, 30% reduction in violent crimes and a 21% reduction in misdemeanor recidivism.
FFT is the right family-based intervention model for the client. FFT is short-term and it aims at addressing the dysfunction in the family to improve support and client resilience. FFT will guide the treatment program from the beginning to the end. FFT specifies ways in which the therapist can interact with the client and family with the aim of addressing a client’s issue and factors within the family that cause/ worsen the issue. However, FFT is a short-term intervention model and it might not address all the underlying issues. FFT moves through three phases, with an average of 8 to 12 sessions within three to five months. FFT works to change the family dysfunctional dynamic while addressing the issue of sexual abuse (Hartnell et al., 2017).
i. Beginning Phase
The beginning phase starts engagement and assessment of the client and the family. Engagement begins before contact, and it involves activities that enhance the family’s willingness to show up for sessions (Friedberg & McClure, 2015). A counselor can start the engagement session through telephone calls to get to know the client, history and what the client/ family hopes to attain from counseling. During the engagement phase, the counselor is not limited by formal therapeutic techniques as the counselor aims to make the client/ family comfortable during the initiation process. The therapist must have experience with patient culture and other characteristics that will affect the treatment.
The goal of the session is for the counselor to enhance responsiveness and credibility, demonstrate a desire to listen and help and establish cultural competence. The counselor develops a relationship with the client (Abby) and her mother based on credibility and genuine desire to help. The counselor also initiates motivation therapy using change focus and change meaning strategies such as relabeling and reframing to change how the client and the family view an issue (Filges et al., 2018). The counselor also sets goals for the first phase and the entire program with the help of the client.
When engaging with Abby and her mother, the counselor takes notes of the poor communication, conflicts, and unhealthy family dynamics. The counselor interrupts and diverts the client or the mother when they begin saying something that will disrupt the process or hurt the other person. By looking at Abby’s behavioral problems as a way of coping, and giving Abby a non-judgmental environment to talk about her problem while her mother listens, both the client and the mother will be motivated to change (Bolton et al., 2000). During the first session, the counselor will also assess relational functions by evaluating the family interaction patterns. Abby and her mother have problems communicating; they do not listen to each other, and they keep hurting each other by bringing up past mistakes. The counselor can use strength-based relational techniques or change meaning techniques to reframe the family dynamic and help Abby and her mother communicate better.
By the end of the engagement and assessment, the counselor documents the sessions and schedules the next session within five days. The counselor also has additional conversations with all the systems involved with Abby’s case, including the child welfare worker, school, and other treatment providers to develop relationships and understand their perspectives on the case.
ii. Core Phase
The core phase builds on the previous stage. The goal of this phase is for the counselor to analyze information about the Abby and relational patterns in the family with the aim of building skills, changing constant problematic interaction and equipping them with other coping mechanisms.
In the early sessions of the core phase, the counselor continues to match and build relationships between Abby, her mother and the rest of the family members change focus and change meaning interventions. The counselor continues relational assessment to address the problems in the family dynamic before dealing with the issue of behavioral problems and sexual abuse. Intermediate and long-term goals to enhance family relations functions are developed.
In the next sessions, the counselor applies behavior change strategies that are consistent with the relational functions of the family members. At this stage, the Abby learns skills to deal with her trauma. The counselor changes narrative presented by Abby where she blames herself and is ashamed of the rape incident. The counselor helps Abby process the wide range of emotions, process memories and anxiety triggers that make her act out. The counselor can use an individual approach if Abby is not comfortable sharing some of the details when her mother is around.
The family is also equipped with skills on how to handle the situation to avoid making it worse for Abby. The counselor identifies sequence within family behaviors and reframes them to help the family deal with the underlying issues such as lack of communication and trust between Abby and her mother. The counselor aims to reduce Abby’s psychological distress through a supportive approach to instill hope, increase interpersonal learning and decrease Abby’s sense of isolation.
By the end of the core phase, the problems within the family, sexual abuse, and behavioral issues will have been identified and addressed. The counselor also facilitates independence in the client while taking into consideration the relational functions of the family members. Abby has to learn to manage negative emotions of helplessness, anger, and PTSD by bringing her conflict and psychic tensions from the unconscious into conscious to encourage healthy functioning. By the end of the core phase, Abby’s relationship with the mother and siblings will have progressed, and the family will be in a positive space as the issues causing the dysfunction will no longer affect the family.
iii. Termination and Follow-up
The intervention last for three months, therefore the counselor should put in place termination process towards the end of the stipulated time. The goal of the termination and follow-up phase is to reinforce and expand positive family functioning and address remaining psychological symptoms of distress. The termination process only takes place when Abby has achieved the goals of the other stages.
The counselor continues with a thorough behavioral assessment of Abby’s psychological and behavioral state outside the family behavior, and patterns that characterize her trauma. Abby’s emotional responses and cognition towards certain situations within her social network and community will be evaluated. By the end of counseling, Abby will have addressed her trauma, anxiety, and depression from the rape incident. The program also aims to improve Abby’s social adjustment and self-esteem.
The family is dedicated to helping Abby address her trauma. The program also allows Abby’s mother to learn from her mistakes, and to protect her children. The counselor will check up on Abby and her mother regularly to evaluate Abby’s wellbeing and the family dynamics after the intervention program.
Discuss how your personal values, theoretical stance, and culture intersect
The counselor’s personal values, theoretical position, and culture have effects on the intervention method and the treatment outcomes. The counselor’s values towards sexual abuse should align with the goals of treatment for Abby and her family. The counselor is guided by Bowen’s family systems theory (BFST) which views the family as an emotional unit. Family members have profound effects on each other’s thoughts, feelings, and action (MacKay, 2012). Teenage behavioral issues can be signs of dysfunction in the family system. Additionally, when a family member is battling with trauma, the proper functioning of the family is interrupted leading to a chain of reaction that destroys harmony within the family.
The counselor recognizes the effects of culture on intervention and outcomes. The counselor shares the same cultural background as the client and her family, and this increases the chance of positive results. The counselor is aware of the risk of countertransference. Sexual abuse is an emotional issue for families, and this can influence the counselor’s emotions. The counselor will be mindful and aware of countertransference. Practicing self-insight and empathy minimizes the effects of countertransference.
Conclusion
Family-based intervention programs have proven to be effective in comparison to other forms of intervention. The research paper is a summary of the functional family therapy (FFT) aimed at addressing sexual abuse in an adolescent client. FFT is phasic and developmental, and it addresses individual and family issues while taking into consideration cultural and external factors. FFT begins with the engagement phase, followed by the motivation phase. At the core phase, the counselor utilizes change focus techniques, change meaning techniques and relational assessment to address the underlying issues before equipping the client and the family with the necessary behavioral change strategies. As seen in Abby’s situation, FFT effectively changes the family dynamic to enhance family support for the individual suffering from sexual abuse trauma. FFT stabilizes the client and the family with the aim of improving client resilience.
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