Grounded theory analysis of therapeutic interventions practiced by professionals in India and the UK with child and adolescent survivors of sexual abuse
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Date
29/11/2016Author
Narang, Javita
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Abstract
There is a high prevalence of child sexual abuse (CSA) in India and the UK (Laccino,
2014). However, there is a lack of research on culturally-specific aspects of
psychotherapy offered to child and adolescent survivors of CSA in both these
countries. Therapeutic interventions with sexually abused children raise complex
concerns due to the heterogeneity based on the developmental stage of children;
varied impact, presenting difficulties and needs; and characteristics of abuse, age,
gender, ethnicity and cultural factors. Numerous therapeutic interventions for CSA
have been documented, with varying theoretical constructs, structure, content and
outcome (Reavey & Warner, 2001), ranging from cognitive behavioural,
psychoanalytic, humanistic and feminist paradigm (Misurell, Springer, & Tryon,
2011). Most of these approaches do not provide sufficient guides to therapy (Reavey
& Warner, 2001). Few of these are widely studied and clinically accepted, while
most lack empirical evidence. Although existing studies conclude that therapy is
better than no treatment, there is lack of consensus on treatment characteristics
important in child and adolescent sexual abuse therapy (Hetzel-Riggin, Brausch, &
Montgomery, 2007). Further, little is known about culturally-specific holistic and
coherent responses to CSA.
A Constructivist Grounded Theory (Charmaz, 2006) study was conducted to
investigate therapeutic approaches practiced by professionals in India and the UK
with child and adolescent survivors of CSA, and to understand the factors that
govern the choice of an approach or model adopted. In-depth, semi-structured
interviews were undertaken with 32 professionals (16 each in India and the UK)
from different settings including statutory, voluntary and private sector. NVIVO 10
was used for data management and analysis of the digitally recorded and transcribed
interviews.
Although there is a growing emphasis on evidence-based therapies, with most
empirical studies focussing on traditional forms of psychotherapy, the actual practice
of the professionals interviewed reflected a more fluid, flexible, multi-modal,
ecological and integrative approach to CSA-therapy. The findings indicate that the
therapeutic interventions progress through four different phases, based on the goals
identified by professionals. The goals in turn are influenced by the socio-cultural
context, structural factors, and/or trauma understanding of the professionals. Four
phases identified in the study are: 1. Social Action Framework, with the goal to
identify silenced and invisible children, particularly in a culture of silence and
suppression in India; 2. Stabilisation and Resilience Building Framework, found to
be practiced in India and the UK, with the goal to ensure safety and build the
foundation for ensuing phase of therapy; 3. CSA-Trauma Resolution Framework,
where the goal is to uncover the sexual abuse details to facilitate recovery and
reintegrate the traumatised child, more visible in therapeutic practice in the UK; and
4. Maintenance and Relapse Prevention Framework, with the goal to prevent relapse
and protect from revictimisation and future developmental difficulties. These phases
may be mutually exclusive, follow a linear trajectory, or there may be a back and
forth movement from one phase to the other. These four phases were integrated to
construct a culturally relevant, ecological-based theoretical model of CSA therapy
with child and adolescent survivors.
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