Pre-Trial Treatment of a Child in Sexual Abuse Cases

Whether or not a child should be treated for sexual abuse prior to a determination of abuse by the justice system is affected by several considerations.

• The system requires a substantiation or indication by a child protection worker or law enforcement official prior to an accusation entering the justice system for adjudication. It is often mistakenly perceived that such a step establishes the facticity of the accusation and a child is immediately treated by adults and by the system as if the child had truly been abused. However, the information available from research data shows the substantiation of an accusation at this level is, at best, affirmed by the action of the justice system in only 50% of the cases. If plea bargains and dismissals are considered as questionable determinations, the proportion drops even lower than 50%. The decision to substantiate or not is affected by variables other than facticity (Besharov, 1990; Jones,1993; Stevenson, & Grauerholz, 1993, April). Personal biases, personal factors, and significant variables having to do with the workers impact on the decision making process (Jackson, & Nuttall, in press; Mosher, 1991). There is widespread ignorance of research and acceptance of unfounded dogma by workers (Brodie & Rogers, 1993). There is significant overreporting and false positives (Winefield, & Bradley, 1992). Beginning with Starr (1979) and continuing to Lindsay and Read (in press), every scientific analysis of the level and direction of error in the decision making process concludes there is an unconscionable level of false positives (Wakefield & Underwager, in press). The ratios range from 3 – 1 to an astonishing 2000 – 1 (Horner, 1992). This unanimous finding, a rarity in any scientific area, strongly suggests that the system we have established does far more harm to far more children that it helps or benefits. Substantiation or indication of a specific case based upon the decision and judgment of a child protection worker, or even a multidisciplinary team, cannot be permitted to determine facticity nor should it lead to actions based on an assumption of abuse.

• The nature of the customary sexual abuse treatment given to children when there is an accusation of sexual abuse is insight oriented, dynamic, and feeling expressive psychotherapy (Wakefield & Underwager, 1988). A child is forced to continue talking about feelings, acting out in play, and responding to questions about having been abused. Researchers, after reviewing records of several hundred cases, have found at most a half dozen where the therapy provided to a child was anything other than insight oriented, feeling expressive therapy. With younger children, it is exclusively play therapy. In the videotapes of therapy that researchers reviewed, they have seen children being given a toy gun and taught to shoot a Bobo doll identified as Bad Daddy, children encouraged to throw darts at pictures of the person accused, make clay figures of the person accused and then pound them with mallets and hammers, and throw dolls identified as the person accused in boxes labeled jail. Children are reinforced for yelling screaming, saying angry and hostile things about the person accused. Children are taught to be fearful, to believe they have been victimized, and to believe people they love are wicked and evil. Play therapy of this nature cannot be anything other than destructive and harmful to the child (Campbell, 1992a; 1992b; Russ, 1987; Trad, 1992; Casey, & Berman, 1985).

• This approach to therapy for young children is based upon the model of therapy developed for adult victims of rape. That approach has simply been imposed upon children with no effort to find out if it works. There is no evidence that this treatment has any utility, efficacy, or benefit to children who have been sexually abused. The research reviews of therapy with children consistently demonstrate that the most effective therapeutic modality for children is a behavioral, learning theory based therapy, not insight oriented, feeling expressive therapy (Weisz, Weiss, Alicke, & Klotz,1987; Weisz, Weiss, 1989; Weisz & Weiss, 1993; Fantuzzo & Twentyman, 1986). This finding strongly suggests that there is little or no benefit from this therapy approach to children who have been abused. In fact, the most recent meta analysis of the research literature on child therapy reaches the distressing conclusion that when the research conducted in a real world clinical setting is evaluated separately, the results show that child therapy as it is actually dispensed is harmful to children and not beneficial (Weisz & Weiss, 1993). The conclusion is that the most likely cause for child therapy harming children is that it is dynamic, insight oriented, and feeling expressive therapy that is actually given to children in the real world rather than the learning theory based techniques that are positive.

• A consideration often overlooked by prosecutors, law enforcement, child protection, and judges is the effect on a child if adults make a false positive mistake. When adults treat a child who has not been abused as if the child had been abused, it is not an innocuous or benign experience for the child. It is devastating and runs a high risk of causing a child to be psychotic. It is an assault upon a young child’s ability to develop the capacity to tell what is real from what is not real. There is a little discussion of this type of error but a growing body of research on the issue. A false negative error, missing real abuse, may also be harmful to a child. In either direction, adult errors may have tragic consequences for a child. Most recently, a study by Westminster College, part of Oxford University, examined the effect of a false accusation on the children and concluded the impact was like that of growing up in a war zone. It was as if the children had been raised in Beirut (Prosser & Lewis, 1992; Prosser, 1995 a, 1995b). Davis & Reppucci (1992) also report on the harm done to children, including siblings, by a false accusation. Specific damage done to children by a false accusation include precipitating suicide (Smith, 1991), school failure and delinquency (Richardson, 1990), and destruction of the family (Schultz, 1989).

• Another possible consequence to a child treated for sexual abuse prior to the adjudication is described in the following material taken from an Amicus Curiae Brief submitted by Wakefield and Underwager to the U. S. Supreme Court in Maryland v. Craig. Point IV. In the interim between accusation and a trial, therapy for a child thought to be a victim is feeling-expressive, insight oriented therapy which may well have the effect of teaching a child to be afraid of a defendant. Especially in criminal trials there is often a long time between an accusation and a child testifying. During this interim, many children are placed in therapy for having been sexually abused, a decision made before the factual issue is determined in the courtroom. Analysis of records of therapy given to 405 children and study of 617 articles and books dealing with treatment show the therapy given to children focuses on getting their feelings about being abused out and acting out those feelings in a variety of techniques. However, all in one way or another encourage and reinforce the expressing of anger and hatred toward the alleged perpetrator.

• All therapy is essentially a learning process. It does not matter what the theoretical approach is or the technique employed. Any impact any form of therapy has derives from its ability to teach a disturbed person something that makes a difference. Therapy with a child is a learning experience. When the usual insight-oriented, feeling-expressive therapy is given to a child when there is an accusation of child sexual abuse, it may teach a child inaccurate and unreliable memories for events that did not occur (Ceci & Bruck, 1993; Goleman, 1993). The research evidence on the impact of misleading information on the memories of adults and children is strong and clear. The effect is to generate inaccurate and unreliable accounts (Loftus, 1993). If this occurs with a child in such therapy, there is likely a marked contaminating impact upon the ability of the child to personally recall actual events.

• If a child is truly demonstrating problematical behaviors, the most successful therapy is going to be a behavioral, learning theory based therapy that targets specific troublesome behaviors and changes them. In the interim period between an accusation and an adjudication, the welfare of the child does not require treatment for sexual abuse. Instead, any difficulties a child may be showing can best be treated by a behavioral therapy that does not need nor require a child to muck about in feelings about being abused or act out aggression and hatred.

• When a child who has not been abused is treated by adults who have concluded the child has been abused, it is tragically the case that the adults teach the child to be a victim. If a child continuously denies the abuse the adult believes in, the adult does not accept that no abuse occurred. Instead, the adult concludes the child is dissociating, repressing the memory, and may give a diagnosis of Multiple Personality Disorder. The child is then coerced and forced to develop this most serious iatrogenic malady. The end result may well be the destruction of the child for any normal adult life.

• Putting together the above considerations, the risk of a child who has not been abused being treated with sexual abuse therapy can be avoided and the serious negative consequences of being forced to undergo wrong headed or inappropriate therapy, whether abused or not, can be averted by ordering no sexual abuse therapy.

References in support are as follows;