Treating Adult Survivors of Sibling Sexual Abuse: A Relational Strengths-Based Approach

Sibling sexual abuse is a far more common manifestation of family violence than is often recognized. Researchers agree that it has received less attention than other forms of child abuse trauma despite the fact that good evidence suggests it is no less injurious than child sexual abuse when a parent or other adult is the perpetrator. This paper describes a relational, strengths-based approach to psychotherapy with adult survivors of sibling sexual abuse guided by trauma-informed principles. Cultural considerations are discussed as well as an overview of the clinical research on sibling sexual abuse and its harmful effects. Clinical case material, treatment strategies and a case illustration demonstrate therapeutic principles of the approach in action.     

THE FORGOTTEN BONDS: THE ASSESSMENT AND CONTEMPLATION OF SIBLING ATTACHMENT IN DIVORCE AND PARENTAL SEPARATION

Attachment theory is increasingly being considered when contemplating post‐divorce parenting plans. Historically, there has been a strong emphasis on assessing the strength of the parent‐child bond as well as a child's attachment style. Surprisingly little research has focused on sibling bonds and the implications for post‐divorce parenting plans. This article provides an overview of sibling attachment theory, sibling attachment considerations in foster care decisions, and the limited research examining sibling attachment in divorce and parenting schedules. Several key questions are offered for mental health and legal professionals to consider when factoring sibling relations into post‐separation parenting plans.     

Trauma‐Informed Interventions in Parent–Child Contact Cases

Parent–child contact problems may arise in the context of high conflict separation/divorce dynamics between parents. In cases where there are parent–child contact problems and children resist or refuse contact with one of their parents, there may also be incidents of child maltreatment, intimate partner violence, or compromised parenting that can be experienced by a parent or child as traumatic. The circumstances around separation and/or post‐divorce often result in intense stress for families. In this paper we distinguish between the stressful circumstances that may arise as a result of high interparental conflict and pulls for alignment from a parent, and the real or perceived trauma as a factor which contributes to resistance or refusal of a child to have contact with a parent. Interventions to address both trauma responses and the resist‐refuse dynamics are differentiated and discussed. After screening and assessment, the intent is to treat trauma responses with short‐term, evidence‐based therapy, either before or concurrent with co‐parent and family intervention.     

ASSESSING THE PARENT–CHILD RELATIONSHIP IN PARENTING CAPACITY EVALUATIONS: CLINICAL APPLICATIONS OF ATTACHMENT RESEARCH

The lack of an articulated model of parenting competence and the limited use of empirically based assessment procedures is a weakness of current parenting capacity assessment protocols. The current article attempts to address this issue through the application of attachment theory and research in assessing one of the most critical components of parenting capacity assessments: the parent–child relationship. New empirically and attachment‐based assessment tools and procedures, well suited for the assessment of parental fitness, are presented, along with recommended practice guidelines to enhance the assessment of the parent–child relationship in cases of young, maltreated children (under 6 years of age).     

Strengthening Coparenting Relationships to Improve Strained Parent–Child Relationships: A Follow‐Up Study of Parents’ Experiences of Attending the Overcoming Barriers Program

Several interventions have been developed to address children's resistance and/or refusal to have contact with a parent following separation and divorce. There remains little agreement about how best to evaluate the success of these approaches. To explore the experiences of parents in the Overcoming Barriers Program (OCB), an online survey was distributed to all previous participants. Of the 40 parents who completed the survey at least six months after attending OCB, findings suggest mixed results. Benefits of OCB were more pronounced when changes were made to the coparenting relationships. Improvements in the coparenting relationship were specifically related to children's spending more time with both parents and better parent–child outcomes postintervention. Findings suggest that both the quality of parent–child relationships and the time that the children spend with both parents are associated with reported improvements in the cooperative coparenting relationship as a result of attending OCB. Implications are discussed in terms of lessons learned for developing, delivering, and evaluating similar programs for strained parent–child relationships.     

Must Internal Working Models be Internalized? A Case Illustrating an Alternative Pathway to Attachment

Internal working models of attachment are conceptualized as internalizations of interpersonal dynamics involving attachment—schemata derived from secure therapeutic relationships if not established in childhood. The potential for developing internal working models in the absence of adequate attachment history is demonstrated by the case of a dismissing (avoidantly-attached) client with Dissociative Identity Disorder (DID) abandoned in early childhood. Using the Collective Heart model (Krakauer 2001)—which targets posttraumatic misattributions of power and quickly challenges the client’s perceived brokenness and helplessness—the client formed an intimate bond with a formerly unconscious inner guidance resource experienced as a maternal attachment figure long before a robust therapeutic relationship was established. Verbatim case material illustrates autohypnotic interventions potentiating this “Wise Mother’s” guidance of the client’s identity development and mastery of relational tasks by mining and augmenting fragmentary attachment experiences. Theoretical and clinical implications of the evolution and function of the Wise Mother are discussed.     

Parent–Child Discordance and Child Trauma Symptomatology Throughout Therapy: Correlates and Treatment Response

Children and their caregivers often disagree when reporting on child behavioural and emotional difficulties. But how does parent–child discordance relate to outcomes, particularly among children undergoing trauma therapy? This study examined parent–child discordance in relation to children’s trauma symptoms and therapy outcomes. Participants included 96 trauma-exposed children and their caregivers, who received Trauma-Focused Cognitive Behavioural Therapy. Discordance was calculated using absolute difference scores between child- and parent- reported psychological symptoms. Parent–child discordance, calculated at pre-therapy, post-therapy, and at a six-month follow-up, predicted the severity of children’s posttraumatic stress, dissociation, and internalizing and externalizing difficulties at each respective time-point. Pre-therapy discordance predicted improvements in externalizing behaviours after therapy and at follow-up. Improvements in discordance predicted improvements in trauma-specific symptoms over the course of treatment and at follow-up. The findings underscore how changes in parent–child discordance are related to child trauma symptoms and treatment response. Clinical implications and future directions are discussed.     

Adaptive and Maladaptive Gatekeeping Behaviors and Attitudes: Implications for Child Outcomes After Separation and Divorce

Gatekeeping has been used as a theory and a measure to describe and assess family dynamics within the context of separation and divorce. In this article, we explore adaptive and maladaptive gatekeeping behaviors and attitudes that can affect the other parent's relationship with the child. Implications are presented for connecting adaptive and maladaptive gatekeeping responses to child outcomes of safety, well‐being, and positive parent–child relationships following separation and divorce. We build on the recent attention to gatekeeping as a potential framework within the child custody context.     

Family negativity and delinquent behavior in adolescence: a predictive multivariate latent growth analysis

ABSTRACT

The current study had three aims: (1) to explore whether there is over-time change in adolescent delinquency and negativity in the parent–adolescent, sibling and marital relationships during adolescence; (2) to examine the interactions of negativity across subsystems; and (3) to examine whether levels and changes in adolescent delinquency are predicted by levels and changes in negativity in all family subsystems. Data of 497 families participating in the RADAR-young study were used. Ratings of all family members were used to measure negativity in family relationships, and adolescent self-report was used for delinquency. Multivariate latent growth curve models showed over-time increases in mother-adolescent negativity and over-time decreases in sibling negativity, as well as significant individual differences in these changes. Second, evidence for both social contagion and compensatory processes in family negativity was found. Third, initial levels of parent–adolescent negativity were related to initial levels but not over-time changes of adolescent delinquency, whereas initial levels of sibling negativity were related to over-time changes but not initial levels of adolescent delinquency. Finally, increases in parent–adolescent negativity were related to faster increases in adolescent delinquency, and decreases in sibling negativity were related to slower increases in adolescent delinquency. Implications of these results are discussed.     

Responding to Severe Parent–Child Rejection Cases Without a Parentectomy: A Blended Sequential Intervention Model and the Role of the Courts

There have been significant developments over the past two decades that have expanded our understanding of the dynamics of parent–child contact problems post‐separation, which have resulted in some changes in judicial processes to respond to these cases. One significant advancement is a more sophisticated differentiation of the nature and severity of contact problems, which better assists legal and mental health professionals to provide more suitable legal and clinical interventions. However, the issue of innovative court processes has received limited attention. The authors describe a subgroup of families within the “severe” category, for whom an expanded intervention model, referred to as a Blended Sequential Intervention is proposed. This approach involves a reversal of care with court mandated therapeutic support for the rejected parent and child, but also involves the favored parent in the therapeutic plan from the outset, and is intended to avoid a permanent “parentectomy” of the child from either parent. The authors discuss how the courts should respond to these cases, and posit that until all therapeutic treatments are exhausted, interim orders should be preferred to final determinations, and judges should maintain oversight. The authors discuss the critical role of judicial leadership in working with lawyers and mental health professionals to manage and address the issues in these high conflict cases.     

Separation and Reunification: Using Attachment Theory and Research to Inform Decisions Affecting the Placements of Children in Foster Care

Determinations regarding removal of children from home in maltreatment situations typically take into consideration the physical safety of the child. Less recognized and often underappreciated is the severe risk endured by the child as a result of separation from the caregiver, and the long‐term effects of the separation on the child. This article describes recent developments in attachment theory and research and their usefulness for placement decisions. We will explain how a child develops a secure attachment to a caregiver and review the deleterious consequences associated with maltreatment and separation. The case of a child in a foster/adoptive placement will be discussed in order to clarify common misinterpretations of attachment research and how attachment theory and research can inform permanency decisions that are in the best interest of the child.     

COMMENTARY ON "FAMILY BRIDGES: USING INSIGHTS FROM SOCIAL SCIENCE TO RECONNECT PARENTS AND ALIENATED CHILDREN" (WARSHAK, 2010)

This commentary reviews the goals, structure, and content of the intensive educational intervention described by Warshak (2010); raises concerns; considers the meaning of "success" in child alienation cases; and makes suggestions for future research. Titled Family Bridges: A Workshop for Troubled and Alienated Parent-Child Relationships, the program is a rigorous and disciplined approach designed to help participants repair severely derailed parent–child relationships. Family Bridges uses evidence-based instruction principles to maximize learning and create a safe atmosphere enabling the alienated child(ren) and rejected parent to be, and work, together. The multimedia materials selected for the 4-day program draw from social science research and focus on multiple and universal processes by which distortions of perception, memory, and thinking occur; negative stereotype formation; the impact of high conflict on children and parent–child relationships; effective communication and dispute resolution; and parenting skills training. Based on a small and diverse sample of families, Family Bridges demonstrates considerable promise as one type of intervention designed for these severely troubled relationships. Concerns include the cost of the intensive intervention, the absence of a parallel program for the favored parent, and whether the program can be replicated effectively. The family psychology and law fields would benefit significantly from research that evaluates Family Bridges and other educational and therapeutic interventions designed to help alienated children repair and strengthen balanced relationships with both parents.     

PARENTAL REACTION TO THE DISABLED CHILD:

The special needs child demands adept and flexible care. This becomes harder to provide when the child resides in two homes or when the parents are in conflict about the child's diagnosis. To secure effective intervention, parents must become mini-experts in their child's condition, advocating tirelessly to secure necessary educational, financial, and medical assistance. These parents, confronted with the reality of their child's diagnosis, must also face the reality of a different future than the one they had imagined for their child and themselves. This can trigger a complex and fluid grieving process that is different for every parent. Understanding the role of grief in custody proceedings can provide a useful lens for viewing the vastly dissimilar opinions these parents often present. Failing to recognize the distorting effect of grief places family law professionals at a distinct disadvantage in dealing with these complex issues.     

FAMILY LAW AND THE NEUROSCIENCE OF ATTACHMENT,PART I

In this far‐reaching interview, Allan Schore, renowned scientist, clinical psychologist, and clinical neuropsychologist, considers the place of neuroscience in facilitating developmental knowledge and better decision making in family law matters. He details current science on the neurology of attachment formation, the function of early caregiving relationships, gender, neuroscience perspectives on conflict and family violence, and implications for parenting arrangements. At the meta level, Schore describes the responsibilities of the family law system in promoting the development of the child. On the faculty of the Department of Psychiatry and Biobehavioral Sciences, UCLA, Schore is on the editorial staff of 35 journals in various academic and clinical fields. His integration of neuroscience with attachment theory is documented in three seminal volumes, Affect Regulation and the Origin of the Self, Affect Dysregulation and Disorders of the Self , and Affect Regulation and the Repair of the Self, as well as numerous articles and chapters. He has justifiably earned the nickname of “America's Bowlby.”     

PARENTAL ATTACHMENTS AND DELINQUENCY*

Using the 1972 National Survey of Youth, we analyze attachment to mother and father along several dimensions (i.e., intimacy of communication, affectional identification, supervision, and family activities). We test two hypotheses: (1) as long as a child is strongly attached to one parent, strong ties to the other parent play an insignificant role in reducing delinquency further and (2) single-parent homes are not associated with delinquency as long as the child is strongly attached to the custodial parent. Generally, we find that children who are strongly attached to both parents have a lower probability of self-reported delinquency than children who are strongly attached to only one parent. Further, children living in single-parent homes who are strongly attached to the custodial parent generally have a greater probability of committing delinquent acts than children living in intact homes who are strongly attached to both parents.     

ATTACHMENT PERSPECTIVES ON DOMESTIC VIOLENCE AND FAMILY LAW

Lieberman and Zeanah are specialist clinicians, researchers, and prolific publishers in the areas of infant mental health, attachment development in high‐risk environments, and treatment of infant–parent relationship trauma. In this article, Lieberman and Zeanah discuss the impacts of domestic violence on the attachment security and development of infants and children and address a number of implications for the family law context. Conundrums for parenting visitation and living arrangements are considered, together with the need for multidisciplinary, early response and the pivotal role of family courts in directing this response.     

Attachment styles and psychological profiles of child sex offenders in Ireland

When 29 child sex offenders, 30 violent offenders, 30 nonviolent offenders, and 30 community controls were compared, a secure adult attachment style was 4 times less common in the child sex offender group than in any of the other three groups. Ninety-three percent of sex offenders had an insecure adult attachment style. Compared with community controls, the child sex offender group reported significantly lower levels of maternal and paternal care and significantly higher levels of maternal and paternal overprotection during their childhood. Compared with all three comparison groups, the child sexual offenders reported significantly more emotional loneliness and a more external locus of control. With respect to anger management, the child sexual offenders' profile more closely approximated those of nonviolent offenders and community controls than that of violent offenders.     

Attachment styles and violence in child molesters

Abstract

It has been suggested that sexual offenders lack the capacity to engage in or to maintain intimate relationships and that their attachment styles are insecure. The present study tested some of the implications of this theory with a group of incest offenders, nonfamilial child molesters, nonsex offenders, and nonoffenders recruited from the local community. Subjects completed a self-report questionnaire detailing their characteristic relationship style, and the level of violence employed by all sexual offenders was obtained from institutional files. Nonfamilial child molesters were five times more likely to report a fearful avoidant relationship style than a secure style compared to the community group. When they rated the degree to which they considered themselves to be fearful avoidant, the ratings of the nonfamilial child molesters were significantly higher than the ratings of community subjects and incest offenders. Incest offenders did not differ from community controls or from nonsex offender controls. Of the pooled group of child molesters, dismissively avoidant offenders employed higher levels of aggression in their offences than did secure or fearful avoidant offenders. These results are discussed in the light of current theory, and suggestions for future research and treatment initiatives are offered.     

Young Children Exposed to Intimate Partner Violence Describe their Abused Parent: A Qualitative Study

The negative impact of intimate partner violence (IPV) begins early in the child’s relationship with a caregiver. Children’s relationships with, and internal working models of, abused parents have rarely been documented. The aim of this study was to collect and interpret young children’s accounts of their abused parent. Interviews were conducted with 17 children aged 4 to 12 years who had witnessed IPV. Thematic analysis identified three main themes and seven sub-themes: “Coherent accounts of the parent” (sub-themes of “general benevolence”, “provision of support, protection, and nurture”, and “parental distress”); “Deficient accounts of the parent” (“vague accounts” and “disorganized narrations”); and “The parent as a trauma trigger” (“avoidance” and “breakthrough of intrusive memories and thoughts”). The results indicate these children may hold integrated, deficient, or blocked internal representations of an abused parent, and they illustrate the benefit of including young children as informants in research.