Family-Focused Trauma Intervention: Using Metaphor and Play with Victims of Abuse and Neglect

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These stories and family-focused interventions help clients regulate affect in order to reduce frequency and intensity of troubling symptoms. This volume is the 'missing link' in the current literature on therapy and metaphor, as it focuses specifically on parent-child interaction and trauma. The content of this book, which may be used within any theoretical framework, provides a wide variety of practitioners with a needed bridge between theory and practice.

Ch01 Impact of Trauma and Overview of Treatment. Ch03 The Fight of Fight or Flight. Ch04 Reducing Hyperactivity and Agitation. Ch06 Reducing Worry Fear and Anxiety. Ch07 Disrupted Attachment. Ch10 Responsibility and Accountability. Ch11 Safety and Protection. What happens now? Can the family stay together? Will the child be placed in care? Will the abuser go to prison? Who will know?

What shall we say to friends and relatives? In crisis interviews one meets the child unconditionally on his or her own ground.

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The child describes what has happened and expresses his or her thoughts and feelings. The child is offered various modes of self-expression - in words, play and pictures. By the same token, the non-abusing parent or parents are given the opportunity of expressing themselves.

After these one or two introductory interviews, the important thing is to set about strengthening the relationship between child and non-abusing parent, especially if this tie has previously been weak or has intermittently failed. Seeing and supporting the child and assuring it of continued protection becomes an important theme for the parent in these interviews. The initial contact also includes instruction about crisis, crisis reactions and how people usually react in crisis or after a trauma.

The early contact occurs parallel to the social and police inquiry. Networking meetings, attended by the social welfare officer responsible, are common during this phase. For some children and families, the crisis response can be all the help they need. Others need treatment of varying duration.

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The early contact has two advantages: it captures children and families when they are most motivated and desirous of help, and it creates a possibility of assessing any need for further treatment. Assessment The need for treatment is always assessed, irrespective of whether BUP-Elefanten meets child and family when they are in crisis or later on. Questions relating specifically to the abuse. The assessment leads to a recommendation concerning the form and content of treatment.

The main focus of the treatment is on the actual trauma and its implications for the child's mental health and development, the child's functioning and adjustment and the child's relations. If the abuse and the situation connected with it have affected the child over a protracted period during its formative years, the treatment usually needs to be broader and more generalised.

It is important that different forms of treatment should all have the same objective. A case officer in the team has the task of linking together all the measures taken at BUP-Elefanten with those possibly taken by the social services or in school.

Treating Adolescent Survivors of Sexual Abuse

Network meetings are an important method of co-ordination and of giving everyone a feeling of participation and responsibility. Trauma-focused therapy For some children, focused therapy of brief duration is all the help they need. Describing the abuse and variously expressing and processing one's thoughts and feelings about it and what it has entailed are an important part of the treatment. Describing the abuse is considered "to make it really real" and thus accessible for processing together with the therapist.

The interview is enough for some children, but often a child needs help with different types of play material such as ordinary dolls, anatomical dolls, puppets, soft toys of different kinds or drawing materials. During the processing it is important that the child should be enabled in various ways to express the experiences and feelings connected with the abuse.

These can, for example, take the form of feelings of sadness, fear, abandonment and anger. Once again, the child can express this in the interview, but things are often made easier for the child if it can use various kinds of play material. These can symbolise different themes which the child often has to wrestle with, such as good and evil, fear and security. For some children who have difficulty in expressing their feelings, ready-made sentences or pictures expressing different feelings can be a useful aid.

In between, but above all at a later stage of the treatment, it is important for the child to find a way of speaking out and protecting itself from abuse in future. Role play and study materials, for individual or group use, can come in very handy here.

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Self-assertion training and the corporeal and spatial significance of integrity and limits are worked with, as well as training to say Yes and No. Other strategies reviewed are not having bad secrets and knowing whom one can talk to. Finally, it is important for the children to be able to move on, establish peer contacts, go in for leisure activities - in short, come to terms with what has happened, accept it and not allow the abuse to govern the rest of their childhood and adolescence.

Treatment of older children and teenagers follows much the same theme, but play material is less relevant here and group therapy tends more often to be an option. Some children and young persons develop PTSD, post-traumatic stress syndrome. The symptoms can be nightmares, recurrent, painful flashbacks, avoidance of things associated with the trauma, anxiety and panic reactions, concentration difficulties and sleep difficulties. Signs of dissociation can also occur. BUP-Elefanten has begun working with symbol drama and EMDR Eye Movement Desensitization Reprocessing, Shapiro, to make it possible for teenagers and adults to start processing the emotions and memories which they feel haunted and tormented by.

Overarching aims of the treatment The overarching aims which BUP-Elefanten has defined for its therapy work are: for the individual to protect himself and set limits, to be able to identify and handle his thoughts, feelings and behaviour, to rely on others, to achieve greater self-esteem and a better self-image, to develop social skills, not to sexualise relationships, not to assume the role of victim in relationships, and to find his or her own sources of enjoyment and happiness.

Individual therapy. Family or individual therapy. Group therapy Groups have comprised teenage girls, adult women, young, sexually assertive boys aged , young sexual abusers aged , foster "family home" parents.

Family-Focused Trauma Intervention: Using Metaphor and Play with Victims of Abuse and Neglect

Network therapy Network therapy is used both as a method in crisis treatment and as a recurrent element of ongoing work. To facilitate and encourage communication between different therapeutic contexts, use is also made of the techniques described by Sheinberg in the multimodal model Owing to the difficulties involved in continuously assembling groups of individuals with similar problems and with the right age structure, group therapy is not usually offered until after a brief introductory contact for trauma processing or prolonged therapy.

Its most distinctive characteristic is the importance of early intervention for the treatment process. Evaluation of the therapy work is in progress but has yet to be published.

Evaluation of treatment The section dealing with the evaluation of treatment is based on the studies reported in Finkelhor and Berliner's conspectus article published in Finkelhor, Berliner, and in Reeker and associates' meta-analytical study of group treatment Reeker, Ensing, Elliot, , together with supplementary data searches of the well-known Medline and Psychlit databases for Only studies with more than 15 participants are included.

A study with fewer participants than this can in principle be both interesting and informative, but there were three reasons for choosing this limit. Firstly, studies with few participants are limited by low statistical power. That is to say, with few participants it can be hard to demonstrate differences between groups, e.

The second reason is that in group therapy a lower limit of 15 will automatically mean the evaluation being based on at least two therapy groups and not just one, which in certain aspects can be regarded as a single case-study. The third reason was a desire to keep the volume of this report within bounds. Only the studies published in scientific articles or books have been included. These are presented in three groups according to design. Studies with an experimental design have been put before studies with a quasi-experimental design, which in turn come before studies with a simple before, after and during design.

source The reason for this division is that the scientific value of a study is greatest with a randomised control group procedure and least with a simple before and after measurement of a treatment period. In the following review of different studies, the rating form used has been replaced with a number x. The forms used are explained on page Experimental design In these studies, the individuals examined have been either randomly placed in a treatment or control group or else randomly distributed between two groups receiving different treatment.

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Group treatment of girls - control group Verleur, Hughes and Dobkin de Rios compared group treatment of 16 girls aged between 13 and 17 with a control group of 14 girls of the same age, all of them institutionalised. The group treatment continued every week for 6 months. Both groups had significantly better self-esteem at follow-up, but the therapy group had better self-esteem than the control group. Group therapy with girls - waiting list group Burke made a randomised sample for a 6-week group therapy with 12 girls aged or alternatively a waiting list group of 13 girls.

The children receiving group therapy reduced their symptoms of depression 3 , anxiety 24, 7 , abuse-related malaise and internalised symptoms 2 compared with the waiting list group. Play therapy group - individual play therapy - control group Perez compared three groups of sexually abused children aged years with each other: children in group play therapy 21 children , individual play therapy 18 children and a control group 16 children.

The results showed that the children who had received play therapy improved their scores on the measuring instruments. There was no difference between group and individual play therapy. Group therapy with girls - matched control group McGain and McKinzey's study comprised 30 girls aged who had been sexually abused. The girls were matched to 15 pairs and randomised to a treatment group and a control group.