Child abuse can be defined as the crime of harming a child physically, sexually or emotionally. An abused or neglected child is one whose physical or mental health or welfare is harmed or threatened with harm by the act or omission of his or her parents or other person responsible for the child’s welfare. It is considered to be one of the major causes of psychopathology.
There are different types of child abuse. These are sexual abuse, physical abuse, psychological abuse and emotional neglect. Physical abuse is said to occur when a non-accidental injury is inflicted on a child by the parents or the caretakers. Indicators of physical abuse include injuries to the skin, face head, burns, eye injuries, brain injuries, abdominal or bone injuries.
Sexual abuse is defined as sexual contact that ranges from fondling to intercourse between children in mid adolescence or younger with a person at least five years older.
Psychological abuse occurs when the child is ignored or the caretaker is indifferent to the child’s needs. It is defined in terms of the following types of parent or caretaker behaviors: rejecting, degrading/ devaluing, terrorizing, isolating, corrupting, exploiting, denying essential stimulation, emotional responsiveness or availability and unreliable and inconsistent parenting.
Emotional neglect occurs when there is no positive emotional support and stimulation. It is an act of omission, usually due to parents’ ignorance or indifference. Sometimes, it may lead to emotional or/and physical abandonment. Child neglect may take the following forms: abandonment, lack of supervision, nutritional neglect, medical or mental neglect, inappropriate or insufficient clothing, shelter neglect, hygiene neglect and educational neglect. Mothers may neglect their children due to a variety of reasons some of which are poverty that makes them unable to provide for their basic needs, mentally sick mothers, unplanned parenthood and other environmental hardships.
Most of the interventions tend to focus on immediate concerns such as attending to physical injuries, removing the child from the abusive environment and prosecution of the perpetrator. However, although these are necessary for the child’s welfare, they do not address the child’s psychological suffering and pathological personality changes that result from the abuse. In most cases, the impact of the abuse on the developmental sequence is not addressed. This usually lead to developmental deficits that when combined with psychological disorders lead to pathological damage later in life. In most cases, when the physical scars are gone, the child is left to cope with the psychological trauma alone. Given that young children are cognitively and socially immature to adopt positive coping mechanisms alone, they live with the emotional scars which appear in adulthood period as major psychological disorders.
Given that child abuse in childhood can lead to major psychological disorders later in adulthood and that children are not able to devise effective coping mechanisms by themselves due to their immature cognitive, emotional and social development, it is suggested that child workers and caretakers be equipped with knowledge and skills that can be used to identify and help children who may have been abused. The below listed techniques help abused children to recovery easily from their psychological and emotional scars positively.
- Use of Art and Drawing
Rationale for using Art in therapy with children:
- Children lack the cognition to acknowledge and process traumatic events. They have internal conflicts and they are unable to communicate their experiences
- For children who have been abused, Art allows processing and healing to occur at the level of the child
- The use of Art allows unconscious motivations to emerge.
- It enables the therapist to evaluate relationships and interactions in the life of the child.
2. The use of Anatomically correct doll
The doll is used to focus the interview, assess the child’s knowledge of sexuality, stimulate memories of the sexual experience and enable the child to show what happened (Boat and Everson). It has detailed genitalia and is used to allow young children who may not be able to express themselves in words to show the examiner what the perpetrator did to them. The child can be asked to name the parts of a doll to find out whether the child has more sexual knowledge for his age. The dolls allow children to remember and demonstrate what happened. While playing with the doll, children can show anger or fear toward the perpetrator.
3. The Use of Play
Play can be used as a therapeutic technique with children who are abused. This is especially important given the role of play in child development. Play is used as a means of communication in therapy as well as a more structured and distinct approach to treatment rather than relying on verbal transactions with children. Play can be used as the basis for psychoanalytic interpretation or as only one potential mode of expression.
4. Expressive Art Therapy (EAT)
Expressive Art Therapy (EAT) is used with children who are not able to accurately articulate the abuse to others due to age or ability. It also helps to minimize the feelings of guilt and shame that the child may feel when discussing the abuse (Johnston & Jones 2005). The purpose of the EAT is to help the child to recover the memories of the abuse, help the child tell his or her story, disclose the abuse to the abuse if appropriate and to help the child move past the abuse. Stages in the use of EAT include:
- Use Art and play to initiate communication and establish rapport with the client.
- Therapist uses art and verbal communication to allow the child to express themselves in a creative way.
- The writing, drawing and talking helps the child look at the experience as a cognitive experience instead of an emotional experience. This changes the child’s view of the event.
- The therapist asks questions about the pictures, projects and drawings. Also asks questions about the structures, choice of size and color. The discussion is what is therapeutic. However, the therapist must be aware of inconsistencies between the pictures and the verbal communication
Beck, A. T. (1976) Cognitive therapy and the emotional disorders. New York. International Universities Press
Briere, J.N., (1992). Child abuse trauma. Theory and treatment of the lasting effects. London, Sage Publications.
Glasser, D. (1988). Child sexual abuse. London. Macmillan Education Limited.
Hibbard, R.A., Roghmann, K., & Hotelman, R (1987). Genitalia in children’s drawings: An association with sexual abuse. Pediatrics, 79 (1), 129-137
Kelley, S.J (1984). The use of art therapy with sexually abused children. Psychosocial nursing, 22(12), 12-18