Parental/Caregiver Support of Child Abuse Victims

By Lindsey Getz

The importance of caregiver support of child abuse victims is not a new concept. According to a 2006 study by Herbert et al published in Child Maltreatment, support from primary caregivers can help counteract the negative effects of child sexual abuse.

Still, many treatment models focus solely on the child. One characteristics unique to trauma-focused cognitive behavior therapy (TF-CBT) is its emphasis on family involvement in the recovery process. Many clinicians who have used TF-CBT believe it is this caregiver support that is the key to the model’s effectiveness.

“We’ve found that when a caregiver is involved, the child does better,” says Anthony Mannarino, PhD, chairman of the department of psychiatry and director of the Center for Traumatic Stress in Children and Adolescents at Allegheny General Hospital in Pittsburgh. “The child presumably spends most of his or her time with a caregiver, so their involvement allows the therapeutic process to continue at home.”

“There is a parallel process going on in the implementation of this model,” says Kay Connors, LCSW-C, an instructor in the department of psychiatry at the University of Maryland School of Medicine and project director of the FITT Center. “The therapist works with the child, then with the parents, and then ultimately brings them together in the end. In this way, the child is getting the full support he or she really needs. The therapy is connected to caregiver support, and they continue to receive that support at home. The research shows that when the full model is really adhered to—including the parental component—that’s when it’s most effective. I think the healing factor has to do with the family support. Building up that support system at home is so important.”

The parental/caregiver support component is a large portion of the TF-CBT model. In fact, about one-half of active therapy time is spent with parents or caregivers. Child therapists who aren’t accustomed to working with adults may find this model difficult at first, but that’s where training comes in. Much of the training for TF-CBT focuses on role playing with parents/caregivers so that the therapist becomes more comfortable in these settings.

“With TF-CBT, the parent is actively involved in treatment,” says Lucy Berliner, MSW, director of the Harborview Center for Sexual Assault and Traumatic Stress in Seattle. “It’s not always comfortable, but it’s effective.”

Berliner says it’s not uncommon for parents to avoid the topic of their child’s traumatic event. The pain associated with hearing their child talk about sexual abuse may cause them to sweep the issues under the rug and pretend like they didn’t happen. But the TF-CBT model teaches children to be open and communicative about what happened to them so that instead of holding on to the bad memories, they can begin to move on. Perhaps even more importantly, nonoffending parents or caregivers also learn the skills needed to be supportive of the child as they work through the recovery process.

“The parent learns everything about the child,” Berliner says. “They learn to be present and to hear the child talking about the trauma and how it affected them. They’re also helped to learn specific parenting skills.”

Child victims of sexual abuse may feel uncomfortable talking to their caregivers or parents about what happened to them, but TF-CBT aims to help them communicate better. “Building up family support will help these children be able to talk about the terrifying and horrific things that happened to them without activating the parent,” says Connors. “These are tough things to talk about, but research shows that in order for therapy to be really effective, children need to be able to lean on their families for support.”

Engaging the Family
Having a parent or caregiver present is just half the battle. Berliner says the real challenge lies in actually engaging the caregiver. “There are a lot of caregivers who have somehow been under the impression that they don’t need to be involved,” says Berliner. “Dr. Judith Cohen [of Allegheny General Hospital] has called it the ‘dry cleaner approach to therapy.’ These are the caregivers that want to drop the child off and pick them up when they’re fixed. They don’t understand the importance of their role in the therapy process.”

And even parents who do understand the dry cleaner approach is not ideal may be difficult to engage for other reasons. “Sometimes it’s just that they aren’t comfortable or familiar with the way you’re trying to engage them in the process,” Berliner says. “They also might be uncomfortable being so ‘present’ in the narrative of what happened to the child. Or sometimes there’s a problem in the parent/child relationship that makes working together a real challenge. Learning to engage parents is definitely a skill that has to be learned and practiced.”

The guide How to Implement Trauma-Focused Cognitive Behavior Therapy also suggests that while most parents or caregivers do their best to help the child recover, there are other barriers that can stand in the way of the treatment process. “Oftentimes, the parent may have distortions about the child’s trauma, whether it is a result of their own emotional discomfort with what happened or for some other reason,” Mannarino says. “This can pose a potential barrier and has to be overcome.”

The first step is identifying such barriers so that the parent or caregiver can be fully engaged in the process. According to the guide, released by the National Child Traumatic Stress Network and the Child Sexual Abuse Task Force and Research & Practice Core, potential barriers include the following:

• The parent/caregiver does not agree that the trauma occurred (most common in cases of physical or sexual abuse).

• The parent/caregiver agrees that the trauma occurred but believes that it has not affected the child significantly or that addressing it will make matters worse.

• The parent/caregiver is overwhelmed or highly distressed by his or her own emotional reactions and is not available or able to attend to the child’s experience.

• The parent/caregiver is suspicious, distrustful, or does not believe in the value of therapy.

• The parent/caregiver is facing many concrete problems such as housing, finances, or legal concerns that consume a great deal of energy.

• The parent/caregiver is not willing or prepared to change parenting practices even though this may be important for treatment to succeed.

Recognizing these barriers and addressing them up front is important in being able to move forward. Once clinicians can fully engage both the child and his or her primary caregiver, the odds of achieving the best possible outcome are increased. Even if the caregiver is not a biological parent, having some sort of additional support is emphasized.

“Children never live by themselves, so there is someone in their lives taking on the caregiver role, even if it’s not the biological parents,” Berliner says. “When you’re teaching a child—especially a young child—a coping strategy, it’s common sense that they’re going to do better when the people that child lives with are reminding them of the strategy and reinforcing it at home. If a kid is going to have a positive change and move on, he or she needs all the help they can get in the real world. That means getting the needed support at home.”

— Lindsey Getz is a freelance writer based in Royersford, PA.