Psychotherapeutic change in children and adolescents who have been sexually abused: A model from participants’ perspectives

Abstract

Change in psychotherapy research in cases of child sexual abuse (CSA) has mainly emerged from a symptomatologic view, which needs to be complemented by a subjective perspective of change. Thus, this article aim is to describe different outcomes and stages of change during psychotherapy in children and adolescents who have been sexually abused, from the subjective perspectives of those involved in the process. A longitudinal qualitative study was developed. Qualitative interviews were conducted at different moments of the psychotherapeutic process (at around 6 months of therapy, 12 months and at the end of therapy) with 28 children and adolescents aged 6 to 17, with their caregivers and therapists. All children and adolescents attended and then completed psychotherapy due to sexual abuse in natural settings, in public specialized centres in Santiago, Chile. Sexual abuse occurred mainly in an intrafamilial context or by acquaintances. Data analysis was conducted using narrative analysis. Three stages of therapy were identified: i) settling into therapy; ii) approaching CSA; and iii) healing from abuse. Three different outcomes of psychotherapeutic change were also identified: i) protective and psychosocial changes; ii) changes related to diminishing the effects of abuse; and iii) changes related to healing from abuse. Psychosocial characteristics of the cases and features of the therapeutic process are described in each group. The outcomes of change and the stages of therapy are interrelated in a dynamic and gradual process where change is linked with the case’s psychosocial characteristics and the features of the therapeutic process. Results allowed the authors to situate the voices of the participants within a proposed model of psychotherapeutic change for CSA, with clinical practical implications.