Chapter 16

Question 1

______ is a highly prevalent health problem.

Answer 1

Child sexual abuse (CSA)

Question 2

True or False. CSA affects children, adolescents, and families across all ethnic groups, religious sets, socioeconomic classes, and regions of the world.

Answer 2

TRUE

Question 3

What are two adverse effects of sexual abuse:

Answer 3

1) may negatively impact brain development

2) increased risk for developing significant mental health disorders

Question 4

What are some mental health disorders associated with CSA?

Answer 4

PTSD, major depression, oppositional and conduct problems, as well as substance abuse disorders. They may also be at risk for suicide, medical difficulties, and interpersonal problems including revictimization experiences in adolescence or adulthood.

Question 5

What 3 things are proven to influence children’s outcomes?

Answer 5

parental response, support, and distress

Question 6

How can a parent’s reaction to disclosure help their child?

Answer 6

protection and support

assist in coping

Question 7

Many studies document that parents whose children have been sexually abused suffer a myriad of emotions including ____________.

Answer 7

self-blame, anger, and depression.

Question 8

One study found that children may experience feelings of shame following disclosure of sexual abuse, but their ability to overcome these feelings is often associated with the _________.

Answer 8

protection and support of others in the months following disclosure.

Question 9

Many interventions are designed to help the __________ in order to enhance their ability to support their children and to assist them in coping with their own distress.

Answer 9

nonoffending caregivers

Question 10

_________ may be particularly vulnerable to distress and feeling alone in managing the crisis of discovering that their child has been sexually abused.

Answer 10

mothers with a personal history of sexual abuse

Question 11

Mothers whose children have been sexually abused by a parent, stepparent, or partner, are more likely to experience _______, often by their child’s abuser.

Answer 11

domestic violence

Question 12

What 3 things are important to asses of the parents?

Answer 12

1) support resources
2) parent’s responses
3) personal histories of abuse and/or trauma

Question 13

Studies demonstrate that children who experience higher levels of self-blame and feelings of shame are more likely to experience ___________ in the aftermath of CSA.

Answer 13

negative outcomes

Question 14

youth who demonstrated more abuse-related processing in the context of therapy showed greater improvement on measures of ____.

Answer 14

PTSD and behavior problems. .

Question 15

_______ is more commonly linked to those who suffer CSA without parental involvement (supervision, education, behavior monitoring).

Answer 15

sexual behavior problems and dysfunctions

Question 16

________ seems to reduce the likelihood of sexual offenses of CSA victims in adolescents and young adulthood.

Answer 16

CBT

Question 17

Without parental involvement, limited progress can be made to ___________.

Answer 17

change behavior and enhance safety

Question 18

Why do survivors of CSA seem to be prone to sexual revictimization in adolescents and young adulthood?

Answer 18

the environment they live in,

Question 19

Incorporating ___________ into treatment is critical in preventing revictimization.

Answer 19

personal safety skills and education (skill development).

Question 20

What does personal safety skills training look like?

Answer 20

body safety skills training that involves parents and utilizes behavior rehearsal for skill development, which leads to increased knowledge and personal safety skills among children who have experienced abuse.

Question 21

____________ training seems to help in non-abused children as well.

Answer 21

personal safety skills training

Question 22

Treatment approaches should encourage the involvement on non-offending parents and employ strategies to restore and/or encourage feelings of ________ and ________ in survivors.

Answer 22

mastery and strength

Question 23

What is the primary purpose of play therapy?

Answer 23

to help troubled children express their conflicts and anxieties through the medium of play in the context of a therapeutic relationship.

Question 24

__________ play therapy can produce a fairly quick change in targeted symptoms, is of briefer duration, and may be manualized with standardized intervention protocols.

Answer 24

Directive

Question 25

________ means documented with clear guidelines for practice.

Answer 25

Manualized

Question 26

The three types of play therapy are:

Answer 26

directive, non-directive and an integration of the two

Question 27

Strengths cited for ________ play therapy include the creation of an environment that is comfortable for the child, a perception of increased control for the child and allowing the child to set the pace and initiate trauma-related play.

Answer 27

nondirective

Question 28

There is concern that _______ play therapy in the absence of any directive work may not be applicable to children who have been sexually abused and that an active approach may be needed to assist sexually abused children process sexual abuse-related memories.

Answer 28

nondirective

Question 29

A purely _______ approach can be confusing to a child who has not been oriented to the purpose of therapy or who does not understand what is expected. A further concern is that the therapist may inadvertently reinforce a child’s belief that the trauma is too overwhelming to address because there is no direct discussion of the trauma.

Answer 29

nondirective

Question 30

the _______________ seeks a balance in terms of trauma focus-not avoiding the topic of trauma while not over focusing on it.

Answer 30

the integration of directive and non directive approach

Question 31

Treatment goals for the integration of directive and non directive approaches include

Answer 31

developing a therapeutic relationship of mutual trust and respect, assisting children with emotional expression and regulation, helping children enhance their feelings of competence, bringing trauma memories into awareness through direction and creation of verbal or nonverbal trauma narratives, encouraging the releasing of energy and affect through symbolic expression, and processing the trauma experience within a family context.

Question 32

________ is a model that involves selecting toys to be used as symbols of the trauma, directing children to play with the toys in cases where the toys are avoided for more than three sessions, observing and documenting the play, providing a verbal narrative, inviting the child to verbalize during play, observing the evolution in the play, encouraging dynamic movement, and when the child’s play is repetitive, noting the expression of affect and changing the sequence of play to create adaptive outcomes and provide a sense of mastery.

Answer 32

Trauma-focused play

Question 33

With group/individual and eclectic approaches, more therapy does not necessarily produce ______.

Answer 33

better results

Question 34

Abuse focused therapy combines _______,________, and ______.

Answer 34

CBT, play therapy, and psychodynamic therapy

Question 35

cognitive behavioral therapy includes _______,______,___________, and _______.

Answer 35

education, skill development, gradual exposure of child to sexual abuse memories and triggers and safety skills training.

Question 36

Although CBT requires therapists to ______ sessions, engaging the child and caregiver in the therapeutic process in a collaborative manner is central to therapeutic success.

Answer 36

actively structure

Question 37

____ in the CBT treatment condition reported greater decrease in self-blame and greater increases in caregiver support of the child and were more optimistic about the future.

Answer 37

Caregivers

Question 38

________ is a components-based approach that incorporates individual child and caregiver sessions as well as conjoint sessions.

Answer 38

trauma-focused CBT

Question 39

List the components of TFCBT (PPRACTICE)

Answer 39

psychoeducation
parenting skills
relaxation techniques
affective expression
cognitive coping
trauma narrative and processing
in vivo mastery of trauma reminders 
conjoint child-parent sessions
enhancing future safety and development

Question 40

_______ helps children and their caregivers review, integrate, and practice skills that not only help them cope with the trauma of sexual abuse by are intended to support their ability to manage the natural and unanticipated stressors of life they are likely to face in the future.

Answer 40

Trauma-focused CBT

Question 41

______ invloves teaching safety skills to help children feel empowered and enhance their ability to protect themselves as much as possible.

Answer 41

enhancing future safety and development

Question 42

_________ are included to enhance communication between the child and caregiver, review educational information and skills, and read the child’s narrative.

Answer 42

Conjoint Child-parent sessions

Question 43

______ includes praise, selective attention, time-out, and contingency reinforcement schedules.

Answer 43

parenting skills

Question 44

________ involves building skills to help children express and manage their feelings more effectively, which is important given that children who are sexually abused often have a number of distressing feelings that may overwhelm them.

Answer 44

affective expression and modulation

Question 45

_______ involves written, verbal, art and/or play activities that encourage the child in a graded manner to share and process abuse-related experience; including the associated abuse-related thoughts, feelings, and body sensations.

Answer 45

Trauma narrative and processing

Question 46

The trauma narrative and processing approach focuses on the premise that repeated exposure to trauma reminders leads to a _________.

Answer 46

decrease in the distress associated with those reminders, thereby decreasing the need for avoidance strategies.

Question 47

__________ involves gradual exposure to feared stimuli when the previous trauma-focused component is not sufficient to extinguish avoidant behaviors.

Answer 47

In vivo mastery of Trauma reminders

Question 48

________ initially involves presenting the relationship between thoughts, feelings, and behaviors (“the cognitive triangle”) and then identifying and challenging unhelpful and inaccurate thoughts that can lead to anxiety and depression.

Answer 48

cognitive coping

Question 49

_______, which is interwoven throughout treatment, involves providing children and non offending caregivers with information about trauma and common reactions to normalize the experience and provide accurate information to combat distorted thinking.

Answer 49

psychoeducation

Question 50

__________ are presented and practiced to reduce the physical manifestations of stress and trauma and to aid in coping with trauma reminders that may be triggered.

Answer 50

relaxation techniques