Case Study: Keeping it All in the Family

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[. . .] For example, adults are generally wary of situations that repeatedly locate children in a private or intimate environment -- even within their own homes ("Child Welfare Gateway," Finkelhor, 1984). To put this in concrete terms, the Renata Steigenberger could reasonably have been expected to notice that one after another of her daughters would end up at home alone with their father ("Child Welfare Gateway," Finkelhor, 1984). The mother could also reasonably be expected to notice that her husband favored one daughter over another, encouraging her to go places with him and attend to his personal needs ("Child Welfare Gateway," Finkelhor, 1984). For instance, Angie commented that she would get her father's slippers, tie his tuxedo tie, compliment his appearance, and the like.

Apparently, the Elijah Colvard had experienced sexual abuse in his own family as a child -- although he had never directly disclosed this to his children. Regardless, current research does not support the cycle of abuse theory (Rezmovic, et al., 1996). The majority of people who were sexually abused as children do not become adult offenders (Rezmovic, et al., 1996). Moreover, a history of sexual abuse is not reported by adult offenders (Rezmovic, et al., 1996).

Treatment Plan. Since this is an intra-familial case, a multimodal model-integrated treatment plan that involves a multidisciplinary team whose members will be variously engaged with the family ("Child Welfare Gateway," Finkelhor, 1984). Since the children have all reached the age of majority, the focus for social work services is the development and oversight of a treatment plan for the adult victims ("Child Welfare Gateway," Finkelhor, 1984). This case is complicated by the fact that the events took place several decades ago, and that the presenting issues are those of grown-ups living independently and separately from the parents. Of notable concern, there appear to be three minor children in the extended family (sons of Angie and Chici, and a daughter of Chici). Chiquita is concerned that she gets very angry at her daughter, and hits her, because she sometimes resembles her grandfather, Elijah Colvard (Whealen, 2007).

Individual Treatment -- Angie, Paula, and Chici will all have the option of participating in individual treatment. Of the three, Chiquita (Chici) appears to be the most impaired since she has been diagnosed as schizophrenic, has two elementary age children living at home, and is concerned about her angry outbursts that are often directed at her daughter. For each of the three daughters, there is a focus on alliance building -- first to trust the therapist, and later to extend that trust to the other siblings ("Child Welfare Gateway"). Paula and Angie, in particular, have residual issues about trust due to the failed mutual attempt to expose their father's sexual abuse. Individual therapy will address the residual cognitive distortions that Paula, in particular, appears to experience as she addresses the range of emotions that talking about her father evoke ("Child Welfare Gateway"). There is scant recognition by the victims of the extent of their father's superego deficit (Finkelhor & Browne, 1986).

Dyadic Treatment -- Angie, Paula, and Chici will be encouraged to participate in dyadic treatment in order to work on their relationships with one another ("Child Welfare Gateway"). Unfortunately, since the sisters do not live in close proximity, the dyadic treatment sessions will be limited to one every quarter.

Multiple Therapists -- Primarily due to logistics, more than one clinician will be provide treatment, although stable client-therapist relations are encouraged for the individual therapy sessions ("Child Welfare Gateway").

Treatment Issues for the Victims -- Despite the fact that many years have transpired since the sexual abuse, a number of issues are still relevant in the treatments proposed for Angie, Paula, and Chici (Steele & Alexander, 1982). These issues include developing appropriate levels of trust and emotional, behavioral, and cognitive reactions to the long-term sexual and physical abuse ("Child Welfare Gateway," Steele & Alexander, 1982)).

Treating emotional responses to sexual abuse: An important aspect of the treatment plan is to help the clients intellectually understand that they were not responsible for the sexual abuse (Steele & Alexander, 1982). Relieving any guilt the clients may still be experiencing will entail revisiting the positive aspects of the sexual abuse and the negative aspects of the physical abuse that they have expressed (Steele & Alexander, 1982).

Positive aspects include special attention or privileges given the victim, physical pleasure, and control over family members due to the shared secret with the offender (Courtois, 1988; Steele & Alexander, 1982). For example, Dr. Judith Herman, a psychiatrist who consulted with David Colvard, explained the complexity of intra-familial sexual abuse. She particularly explained how the daughters would have experienced the sexual intercourse as pleasurable, and how this would have confounded their relationship with their father and their mother.

Treating an altered sense of self: The "invasive and intrusive nature" of sexual abuse puts victims at risk of suffering from damaged goods syndrome -- an effect that is psychological and physical (Courtois, 1988; Steele & Alexander, 1982). The victim's self-perception is that of difference from others, with an altered feeling about their bodies (Courtois, 1988; Steele & Alexander, 1982). Since these emotional responses can trigger self-sabotage in later life, Angie, Paula, and Chici will be encouraged to visit these issues in therapy. Paula, in particular, may need to focus on this area since she has undergone so many debilitating physical problems since the abuse took place, and she continues to suffer from the gunshot wound (Courtois, 1988; Steele & Alexander, 1982).

Treating generalized anxiety and additional emotional reactions: The therapist will look for manifestations of reactions to the abuse, which may include "anger, depression, revulsion, or posttraumatic stress disorder" (Whealin, 2007).

Sexualized Behavior -- Although it is not evident from the film, the victims could engage in sexualized behavior. For instance, one of the sisters spoke in the film about pursuing white boyfriends and pursuing social opportunities with white youth -- which suggested an element of trading favors in order to be accepted in the more (in her eyes) highly esteemed group (Courtois, 1988; Steele & Alexander, 1982; Whealin, 2007).

It is essential to treat sexualized behavior in order to avoid the victim-to-offender cycle, in which victims identify with the offender (as aggressor), sexually acting out to cope with their trauma and vulnerability group (Courtois, 1988; Steele & Alexander, 1982; Whealin, 2007).

DSM Diagnosis -- Primary Client. Chiquita (Chici) has been diagnosed with schizophrenia. In the film, she describes episodes of paranoia, disordered thinking, and period of mania (Widom, et al., 2007). It is probable that she experiences bipolar episodes. Chici parents two children and appears not to have an adult partner living in her home. Thus, it will be critical to her well-being and healing that she remain under the care of a watchful physician or psychiatrist.

Conclusion

A multimodal, practice-oriented, and model-integrated treatment plan has been developed for the adult female victims of child abuse: Angela, Paula, and Chici. Therapy will include individual and dyadic sessions for the victims. Chici's treatment will require coordination with her current psychiatrist as she continues to require medication for her schizophrenia and co-morbid conditions. For each of the victims, the focus of therapy will need to address the past traumas and to forge plans for continuing to strengthen the wholesome quotidian facets of their life.

References

Child Welfare Information Gateway, Administration for Children and Families, U.S. Department of Health and Human Services. [Website]. Retrieved https://www.childwelfare.gov/pubs/usermanuals/sexabuse/sexabusef.cfm

Conte, J. And Schuerman, J. (1988). The Effects of Sexual Abuse on Children: A Multidimensional View. In G. Wyatt and G. Powell (Eds.), The Lasting Effects of Child Sexual Abuse (Newbury Park, CA: Sage.

Courtois, Christine A. (1988). Healing the incest wound: adult survivors in therapy. New York: Norton. p. 208. ISBN 0-393-31356-5.

Family Affair. (2010). IMDB.com. Retrieved http://www.imdb.com/title/tt1515059/

Finkelhor, D. (1984). Child Sexual Abuse: New Theory and Research. New York: The Free Press, 53-58.

Finkelhor D. And Browne, A. (1986). The Effects of Sexual Abuse. In D. Finkelhor et al. (Eds.), Sourcebook on Child Sexual Abuse. Newbury Park, CA: Sage.

Steele, B. And H. Alexander, H. (1982). Long-Term Effects of Sexual Abuse in Childhood. In P.B. Mrazek and C.H. Kempe, Sexually Abused Children and Their Families, London: Pergamon Press.

Rezmovic, E.L., Sloane, D., Alexander, B Seltser, B., and Jessor, T. (1996). Cycle of Sexual Abuse: Research Inconclusive About Whether Child Victims Become Adult Abusers. U.S. Government Accountability Office General Government Division United States.

Whealin, J. (2007, May 22). Child Sexual Abuse. National Center for Post Traumatic Stress Disorder, U.S. Department of Veterans Affairs.

Widom, C.S., DuMont, K., Czaja, S.J. (2007, January). A prospective investigation of major depressive disorder and… [END OF PREVIEW]

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"Keeping it All in the Family."  Essaytown.com.  March 24, 2014.  Accessed June 17, 2019.
https://www.essaytown.com/subjects/paper/keeping-family/8946970.