Children Speak For Themselves

Using The Kempe Interactional Assessment To Evaluate Allegations Of Parent- child sexual abuse

Clare Haynes-Seman, David Baumgarten

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134860937
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Mental health and legal professionals struggle daily with complex challenges presented by allegations that a parent has sexually abused a child. The majority of these cases involve children who cannot or will not verbally disclose the abuse. This pioneering volume describes a technique that has proven highly effective for evaluation and clarification in such difficult, emotionally laden cases of child sexual abuse. This technique, the Kempe Interactional Assessment for Parent-Child Sexual Abuse, facilitates the emergence of reliable data without the pressure of directly questioning the child. Children Speak for Themselves About Sexual Abuse examines the history, rationale, protocol, and theoretical bases for Interactional Assessment and describes in detail the skills that are required and tasks that must be completed by the clinician in order to use International Assessment accurately and effectively. Firmly rooted in attachment theory, Interactional Assessment is based on the fact that even preverbal and nonverbal children do speak for themselves about experiences with important people in their lives. By accurately recognizing, understanding, and translating children's communication, this method makes available for clinical and legal professionals crucial, firsthand information that might otherwise be ignored. In this book, you'll learn how Interactional Assessment is comprised of three parts: a clinical interview with each parent in the presence of the child, videotaped observations of parent-child interactions, and an individual play interview with the child. Children Speak for Themselves About Sexual Abuse presents highly detailed case illustrations that demonstrate the various ways that children communicate their experiences of sexual abuse and provide insight into how sexually abusing relationships develop and are maintained within a family system. These case studies also clearly illustrate the value of Interactional Assessment where other techniques may not be effective particularly when allegations involve young children, children caught up in an acrimonious divorce, or when the outcry is filtered through untreated survivors. The volume also examines how Interactional Assessment can provide crucial clinical data about the qualities and dynamics of a family relationship that can reliably distinguish between sexually and non-sexually abusive relationships. Finally, the book addresses evidentiary and practical considerations for court presentations of utmost importance since professionals must not only offer evidence that is clinically reliable, but must be prepared to meet and withstand the rigors of increasingly adversarial legal proceedings. This volume will provide clinicians, attorneys, and other professionals involved in decision-making with a reliable clinical procedure that can not only easily reveal available data but can also help to uncover more covert information and verify whether abuse has occurred and by whom.

1

_________

How to Turn a Problem into a Solution

A professional who seeks to make an accurate determination of whether a parent has sexually abused a child is confronted by a host of difficult and seemingly insurmountable obstacles. Many of these obstacles are presented by the real and complex dynamics of familial sex abuse. Many of these obstacles, however, may be self-imposed by an affirmatively narrow consideration of information from the rich and useful range available.

Assessing an accusation of parent-child sexual abuse in the conceptual framework of family attachment relationships permits one to make beneficial use of the family dynamics rather than be stymied by them and requires one to gather and consider all available information rather than to ignore some details.

An accusation or conduct of parent-child sexual abuse occurs within a family and permeates all the relationships in the family. In both cases family relationships are not healthy. Although one important focus of the assessment is the unique relationship between the accused parent and the child, including any evidence of specific incidents of alleged abuse, a complete assessment requires an examination of all the family attachment relationships since these will provide additional, relevant information that the examination of an individual parent-child relationship will not.

An evaluator must accept the dismaying facts of nondisclosure by child victims, the paucity of confessions by perpetrators, and the lack of generalized behaviors specific to children who have been sexually abused. But an evaluator must take advantage of those real and identifiable patterns of behavior that assessment of attachment relationships provides.

HEALTHY AND UNHEALTHY ATTACHMENT RELATIONSHIPS

Attachment theory integrates principles of psychoanalytic, social learning, and animal behavior theory to explain how the initial bond between infant and mother develops and serves as the precursor of the infant's future interactions with others. A primary, secure, and harmonious attachment between infant and mother is necessary for the child's healthy emotional and personality development; such an attachment is a prerequisite for a maturing child to have healthy, secondary attachment relationships as the child's social world expands. Attachment theory and research indicate that attachment relationships are demonstrated in clearly observable attachment behaviors (Ainsworth & Wittig, 1969; Bowlby, 1969).

Parent-child attachment relationships may be healthy or unhealthy. Healthy attachment relationships develop when the parent or caregiver adequately fulfills the needs of the child; unhealthy attachment relationships develop when these needs are not fulfilled on a consistent basis. Children have three basic needs that transcend developmental levels and each child's unique history. These are the need for nurturance, the need for stimulation, and the need for protection.

Nurturance includes both physical and emotional nurturance. Physical nurturance refers to being assured of adequate food, sleep, good hygiene, and medical and dental care. Emotional nurturance is a prerequisite to self-esteem and includes being valued, loved, cared for, and listened to by persons upon whom the child relies for care.

Stimulation includes both social company and involvement in play and exploratory activities that facilitate cognitive, social, and physical development. Initially, parents are the primary mediators of the world for the child, and they themselves meet the child's need for company through playing, talking, and holding. As the child develops, the circle of friends gradually increases from siblings, close family friends, and relatives to include peers, teachers, and other adults outside the family.

Children need assurance of safety in their environment, and rely on parents or parent-figures to protect and buffer them from abuse from persons and from dangers in the physical environment. They need consistent and predictable limits that can give them freedom to explore and to express themselves in ways that are not harmful to themselves or to others.

As the child develops, the content of what parents should provide in each of these areas changes, yet there is continuity with the child always needing assurance of nurturance, stimulation, and protection as he or she faces each new developmental task.

In evaluating whether the child's current needs are being met, one needs to look at the child's present needs both developmentally and in relation to the child's history. Assessment of the degree to which each of these needs is being fulfilled is most accurate when behavioral observations of the child with the parents are integrated with information obtained in clinical interviews of the parents about their experiences with the child.

The parents' own histories of attachment and parental care influence their relationships with their children (Main & Goldwyn, 1984; Steele, 1970, 1980, 1983). Parents who them selves received empathic care from their parents tend to provide empathic care for their children and to develop healthy attachment relationships with them (Kohut, 1977; Steele, 1983). The child who experiences empathic parental care develops a secure, healthy attachment relationship with the parents and a healthy, coherent sense of self.

Unhealthy attachment relationships develop when parents who had poor attachments with their parents are unable to develop healthy relationships with their children and to provide empathic care. Steele (1983) describes how the cycle of inadequate parental care is repeated from generation to generation:

Because of deprivation in her own early life, a mother is unable to fully attach to her new baby. In the absence of good attachment, she cannot provide adequate empathic care. She thus brings up an emotionally deprived baby who will grow up to be a parent who attaches poorly and cannot provide empathic care, and so the cycle tends to repeat from generation to generation. (p. 235)

When parents are unable to respond appropriately to their child's needs, an integrated sense of self does not develop. Steele (1983) explains:

If (parental) responses to the infant's needs are not reliably and repeatedly appropriate, the infant's inner sensations are not validated or integrated, and an integrated sense of self does not develop…the infant remains persistently oriented toward the outside world for cues and guidance, disregarding to a greater or lesser extent its own internal sensations, needs, and wishes. The subsequent diminished, often tragically low self-esteem is a characteristic which we see throughout life into adulthood. (p. 241)

There are two basic forms of unhealthy attachment relation ships: an “anxious-avoidant” (or “unattached”) pattern and an “anxious-resistant” (or “insecure”) pattern (Ainsworth & Wittig, 1969; Bowlby, 1988; Egeland & Sroufe, 1981). An anxious-avoidant attachment pattern develops when a parent expresses rejecting attitudes and behaviors toward the child and is emotionally unavailable to meet the child's needs for nurturance and attention. An anxious-resistant attachment pattern develops when a parent confuses his or her emotional, and sometimes sexual, needs with those of the child and uses the child to satisfy those needs. In an anxious-resistant relationship, the child's needs are not met on a consistent basis. However, the child, yearning for closeness and approval of the parent, may learn to accept whatever parental attention is available (including sexualized attention) (see Haynes-Seman & Krugman, 1989), although it is not healthy for the child. Each of these two basic forms of unhealthy attachment relationships can be identified by a different set of observable behaviors in the relationship.

The child's behavior in interactions with the parents are legitimate indices to the broader experiences that have given rise to these behavioral patterns. Observation of behavior provides a window into experiences that are not always available in words. Kohut (1977) describes the value of observations in the psychoanalytic situation and the need for broader application of what is learned from observation:

Yet I cannot help but maintain that the access to the significance of the experiential world of man, and thus to the significance of behavior, that is opened to us by the observation of…deeply rooted phenomena in the psychoanalytic situation is unequaled and that the conclusions to which we come on the basis of these observations deserve indeed to be applied broadly. (pp. 115–116)

When one observes the child with the parent, the observer is viewing the history of the child's relationship with that parent. For this reason, one or two episodes from the child's interactions with the parent illustrate the kinds of day-to-day experiences that have led to the more general pattern. Stechler and Halton (1987) speak to this issue:

The selection of one or two episodes from each family together with a summary of the characteristic developmental pattern does not imply that the events of the selected episodes have produced the general pattern. You are asked to envision a multitudinous repetition of similar episodes, each unique, but qualitatively similar, that has created the general configuration. (pp. 829–830)

PARENT-CHILD SEXUAL ABUSE AS A DISORDER OF ATTACHMENT

Parent-child sex abuse is a disorder of attachment; it can occur only in an unhealthy attachment relationship. Because an unhealthy attachment relationship can be directly observed, even if the actual abuse cannot, one may conduct an assessment analysis that first identifies and appropriately eliminates healthy attachment relationships as suspect for sex abuse and then examines unhealthy attachments for specific indicators of abuse. If abuse has occurred in an unhealthy attachment relationship, there will be unmistakable behavioral and clinical indicators.

Dysfunctional parent-child relationships develop when parents fail to maintain generational boundaries and to fulfill their parental roles with their children. These dysfunctional patterns may or may not be manifested in parent-child sexual abuse. Lidz (1968) describes the distorted patterns that emerge when parents rely on their children to meet their needs:

The parents are the guiding, nurturing, teaching generation who must give of themselves so that the children can grow. They may be dependent upon one another but should not be dependent upon immature children. The children must be dependent on parental figures and be free to invest their energies in their own development. While a sexual relationship between the parents is not only permitted, but expected, all overt sexual behaviors between a child and other members of the family is prohibited, which helps assure the child will seek fulfillment outside the family. Parents can inappropriately break the generation boundaries in a number of ways; for example, by utilizing a child to fill needs unsatisfied by the spouse; by a mother's failing to establish boundaries between herself and a son whom she expects to live out the life closed to her because she is a woman; by a father's behaving more like a child than a spouse and offering his wife little except satisfaction of her needs to mother. (p. 59)

Unhealthy parent-child relationships such as those described by Lidz are observable. This includes sexually abusive relationships. Both the child's behaviors and the abusive parent's behaviors, in interaction with each other and separately, provide clues to the inappropriate nature of their relationship.

FACTORS THAT LEAD TO AND MAINTAIN INCESTUOUS RELATIONSHIPS

The generational repetition of unhealthy attachment relationships is a factor that makes the attachment context particularly useful in determining whether abuse has occurred and, if it has, in identifying the etiology of this particular form of disturbed attachment relations within the family. Clinicians have proposed various explanations for the development of incestuous relation ships within a family.

Gaddini (1983) describes sexual abuse as a search for intimacy and physical closeness:

At the basis of perpetrating what society rightly considers a crime, there is a quest for intimacy and for physical contact, which both partners, the perpetrator no less than the child like every human being, is entitled to receive in early life, and of which, in the case of incest, they have been deprived. (p. 358)

Steele (1991) contends that the “universal wish for company” may be at the root of incestuous relationships:

From earliest infancy there seems to be a basic need….Anna Freud described it as the infant's “wish for company, “ existing along with the basic needs for food, sleep, and protection that are satisfied by the primary attachment figure, usually the mother….This “wish for company” remains with us all of our lives….If the mother has not been adequately there, the need and yearning for that kind of care persists, and the process of separation remains difficult and incomplete. Although physical and hormonal sexual development have matured, the sexual behavior in the incest participant is still deeply determined by the yearning for what is basically primary maternal care….Many incest participants, both adult and child, speak of emptiness, lack of satisfaction, and a yearning for closeness, care, and attention. (pp. 31–32)

In the incestuous relationship, the abusive parent may be trying to recreate with the child the closeness with a maternal figure that cannot be relinquished or to create closeness that was never experienced with the maternal figure in infancy (Steele, 1991):

The continued need for…(an incestuous) relationship may arise from deprivation of adequate care in early development, or just the opposite, it may result from perpetuation of close maternal care and involvement that cannot be relinquished. (p. 17)

Conceptualization of the incestuous relationship as an attempt to fill the void left when each participant has been deprived of normal affection and closeness in other relationships does not remove the responsibility from the abusive parent. As Steele (1991) points out, the adult and not the child is the one who breaks the incest barrier:

…could the incest barrier be broken without the cooperation or coercion of the adult? It seems unlikely that a reasonably normal adult could not resist even the most seductive sexual advances of a child. (p. 31)

Incestuous patterns may continue across generations as parents who grew up in incestuous families recreate their experiences in a new family. This repetition may be different depending on the sex of the victim and perpetrator and on whether the parent identifies with the perpetrator or with the nonprotective parent.

A mother victimized by her father or stepfather may identify with her mother and fail to protect her child from sexual abuse by an adult partner as her mother failed to protect her; or she may project her experiences of abuse by a father or father-figure onto current relationships and mistakenly believe that her child is being abused by father as she was abused by her father as a child.

A father abused by a parent or a person in a position of trust may identify with the abuser and repeat the pattern of abuse with his son or daughter. In incestuous families, the parents' ambivalent or conflicted feelings about their own sexual experi ences with a parent or parent-figure may lead them to conclude that this is not harmful to the child or that the child is seeking this form of intimacy with them.

From this perspective, parent-child sexual abuse is not the problem. It is the attempt to solve the problem. Only by identifying the problems that the parents are trying to resolve, can one provide effective treatment for parents and the child. Understanding of the problem requires that one examine all the relationships within the family. This examination makes available to the evaluator family dynamics and relationships that allowed a child to be abused or le...

Table of contents

• Cover
• Half Title
• Full Title
• Copyright
• Dedication
• Contents
• Preface
• Foreword
• Acknowledgments
• 1. How to Turn a Problem into a Solution
• 2. Design for a Complete and Objective Process: How to Get All the Information You Need
• 3. Evaluation Tasks, Skills, and Pitfalls
• 4. A Parent's Unresolved Childhood Trauma: Variations on a Theme
• 5. Mothers and Grandmothers: Thinking the Unthinkable
• 6. Children Speak Through Metaphors, Stories, and Drawings
• 7. Children Speak Through Behavioral Reenactments
• 8. Behavioral Clues to Experiences
• 9. Children Speak Through Words, Behavior, and Symbolic Play
• 10. Opportunities for the Helping Professions
• References
• Index