Grounded theory analysis of therapeutic interventions practiced by professionals in India and the UK with child and adolescent survivors of sexual abuse

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.