by Frank C. Sacco, Ph.D., CSI President, Scholar in Residence
In order to effectively treat an abused child, it is critical for the therapist to be able to understand what abuse does to the child. The tragedy of abuse is difficult for an adult to comprehend from the child’s perspective. Effective therapy with abused kids begins with a therapist’s trying to put him or herself into the child’s shoes within the abusive family environment.
Play therapy is an opportunity for the therapist to experience through the child’s expressive play what it was like for a child to be abused or sexually overstimulated. Week after week, year after year, the child will try to play out what happened, and try to express to the therapist how these events made him feel about himself and others.
Every child will react to abuse differently. The following are some common examples of how abuse affects children:
- TATOOS THE CHILD AS DIRTY AND BAD
Children have the uncanny ability of blaming themselves for the badness and filth that happens around them. Children are associational beings, they do not process experiences with careful thought, and they act as sponges and simply absorb the energy and identify with it.
If the energy is aggressive, a child is likely to assimilate it as badness; if it is sexual, a child is likely to internalize a feeling of being dirty.
- INTERFERES WITH BONDING AND FUTURE SOCIAL RELATIONSHIPS
Being hurt by a primary caregiver rips away the child’s essential bonding figure and leaves him suspended in an anxious state without the comfort of a protective relationship with a survival figure. This creates a weak foundation for future healthy relationship building. The child does not learn how to relate to people because his parent(s) have not provided an adequate example for satisfying interpersonal relationships. The child learns to model the aggressive and selfish relationship style exhibited in the abusive family.
- EMBEDS PACKAGES OF OVERSTIMULATED ENERGY WITH SPECIFIC THEMES
Repeated abuse or sexual overstimulation creates packages of unprocessed energy organized around specific themes such as:
- Helplessness and vulnerability
- Loneliness and alienation
- Torture and betrayal
- Violence and victimization
- Neediness and jealousy
- Self Hatred
- Fear and hiding
- Vengeance and terror
Since these thematically organized packages of energy cannot be processed cognitively, they exist as unprocessed energy that acts like batteries for behavior that expresses the various themes absorbed within the abusive family.
- FORCES KIDS TO USE PRIMITIVE COPING MECHANISMS
Abuse literally turns kids into animals forced to survive through basic instinctual moves such as:
- Fight or flight
- Distrust of all outsiders
- Take without asking
- Splitting world into all bad or good
- Get what you need through force
- Act as if everyone wants to take food away from you
- Deny strong affect
- Act before talking or thinking
- Think of survival not grooming
- Disregard for other’s safety
Socially more advanced skills are never learned and the primitive coping mechanisms usually contribute to the child’s becoming progressively more alienated from other kids and adults.
- CREATES CONSTANT FEAR AND ANXIETY
When a child is abused or sexually overstimulated, he has to live with the unpredictability of the abuser. The child never knows when he will be hurt again and anxiety is generated as a warning signal that eventually never gets turned off, the child is always on guard, never can relax. This anxiety and fear follows the child wherever he may go, even if the environment is safe as in schools or foster homes. The child becomes frozen in hypervigilance and progressively less flexible in assessing danger in his environment. Eventually, the child simply creates a vision of the world as hostile and adjusts his relationships accordingly.
- ERODES INNER CONTROLS
Inner controls are learned by interacting with adults who can teach self control gradually through daily instruction and enforcement of sensible limits. In abusive families, the message is: “do what you can and hope you do not get caught.” thus, the child never learns to stop him or herself, and eventually, the child requires external controls in order to function. The ultimate end product of this abuse is the criminal needing the prison wall of the “cement womb.”
- THICKENS A CHILD’S SKIN
Chronic exposure to aggression or premature sexuality forces the child to deaden him against the external onslaught of stimulation. Once the child begins developing this emotional callous, the looses the ability to tell the difference between good and bad energy, and eventually lets no feeling enter from the outside. The survival wall also blocks the love and warmth necessary for normal healthy social and emotional development.
- WEARS DOWN EXTERNAL DEFENSES
Some children do not form callouses, they simply have their external boundaries worn down to a raw and painful nerve receptor. The child lives his life with a very short fuse, and over-reacts to the slightest of stimuli. These children eventually cannot function in environments with a great deal of stimulation and live their lives painfully hypersensitive.
- MAKES THE CHILD PAINFULLY AWARE OF HIS VULNERABILITY
Abuse and sexual overstimulation by survival figures makes a child very aware of just how exposed and vulnerable he is. The child may also develop rather elaborate defenses such as oppositionalism or withdrawal, but the bottom line remains that the child in his “heart of hearts” knows how defenseless he really is without a parental protector.
- ROBS THE CHILD OF COMFORT OF TOUCH
Once a child has been overstimulated or aggressively overwhelmed by physical energy, a healthy distrust of adult’s touch is developed. The child equates touch with pain and disgust, and therefore develops a deep affectional void, a need to be touched, but a very deep fear of allowing people close enough to touch and comfort. The child often develops self destructive substitutes such as promiscuity.
- MAKES THE CHILD OLD BEFORE HIS TIME
Pseudomaturity and parentification often occur after aggressive or sexual overstimulation. The children react like adults, loose the ability to play, and develop in mean little kids acting like the abusive figures within the family. Gradually, the kids decrease their spontaneity and increase their rigidity in responding to the world.
- INTERFERES WITH LEARNING
A child that is being abused often has parents who are so self absorbed that little or no attention is paid to the child’s academic progress. In addition, the constant anxiety and primitive behaviors interfere with the child’s ability to absorb incoming information. The child might be genetically quite bright, but the overstimulation has blocked learning. The farer the child falls behind other kids, the more alienated he becomes. The cycle repeats itself over and over again year after year until the child requires special classes.
- FORCES THE CHILD TO SATISFY HIMSELF THROUGH ILLUSIONS
While the child is being abused by a primary caregiver, it is quite common for him to gratify himself through the use of fantasy substitutes. He may satisfy himself by mentally creating an image of his caregivers as all giving and good. As an adult, the abused child often seeks out mates that hurt him and replay this abusive scenario. The abused wife returns to the illusion of a loving mate and learns to ignore the reality of the abusive relationship. The abusive male believes that he is dealing with a bad woman who deserves to be hurt.
- COMPELS THE CHILD TO BLAME OTHERS FOR HIS OWN FAULTS
Abused kids cannot take blame. They have been injured for nothing and they become convinced that if they take any blame they will be severely beaten. Thus, the child is constantly denying responsibility and blaming the world around him for anything bad. This is the most common beginning for a later lifestyle of addiction, alcoholism, and crime.
- SENDS THE CHILD ON A VOYAGE INTO THE STATE SYSTEM
Once abuse is disclosed, the child is often removed from the illusion of parental of familial safety. The child was never really safe, but in order to survive, the child develops the illusion of being protected and safe in the abusive family. When the child is removed, he may be placed in a strange foster home, program, or with adults and children he or she does not know. It is difficult for an adult to understand how this feels to a child. The child’s sense of badness and responsibility for the badness is reinforced. The child is moved into the system and may return home periodically feeling like a traitor.
Play therapy is the treatment of choice for kids. Once a child has lived for some time within an abusive family, it is necessary for the child to come to grips with the past. The child may benefit from family therapy and other services, but there still remains the scars from the past that need to be addressed individually between the child and a play therapist.
There are many different schools of thought within play therapy. Techniques range from very directive to analytic and child focused. The common element remains: the abused and overstimulated child is HURTING AND NEEDS:
TO BE UNDERSTOOD
Anyone who has travelled to a foreign land for some time with nobody that can speak his language will tell how great a relief it is to find someone that can understand him and talk his language. Similarly, the abused child lives in a different world, behaves according to different rules and is hurt in ways that he cannot easily express in a language understood by adults. Thus, the primary goal of play therapy is to create a forum in which the child can be understood or gain the feeling that somebody understands what has happened to him and why he behaves as he does. Troublesome symptoms are often the way the child attracts the world’s attention to his inner world of hurt. Quick symptom relief is common in the beginning phases of play therapy because the child begins to believe that someone understands, and therefore the need to externalize feelings through behavior is reduced.
TO BE NURTURED AND LOVED
Abused kids need to have plenty of food to eat. Kids love to eat, be fed, and they often use food as a way of communicating their feelings and experiences. Kids often equate food with love and can gain a feeling of being loved by the therapist when both share some food in therapy.
TO EXERCISE THE TRAUMA
It is common for any sensitive adult to want to make an abused child feel less pain, to spare him the pain by distracting him away from the painful feelings. This stance toward the child reinforces denial of the child’s reality. A child needs to exercise the feelings and fear developed while being abused. Just as a burned wound hurts while being cleaned, the child’s terror, fear, and hurt need to be externalized and played out in therapy in order for the healing to take place. The abused areas are likely to be tender, but with steady exercise and loving acceptance by the therapist, the wounds can heal.
TO BE ALLOWED TO FEEL DIRTY OR BAD
Again, it is normal to say: “You are not bad or dirty” to a child and try to make him feel better, to explain that it was not his fault. This stance blocks the child’s expressions of how he may feel about himself. The play therapist needs to play along and even help the child amplify the distorted views of himself. Interpretations of the real blame can be made at critical moments usually during the pregnant pause after the child has wildly expressed a fear or feeling in a dramatic play scene.
TO BE ALLOWED TO WEAR DISGUISES
Abused children are forced to wear disguises to hide their pain and weakness. It is tempting for a play therapist to rip the child’s disguise away in the name of reality and force the child to face what has happened to him. The play therapist needs to spend a least several months trying to understand the nature and style of the disguises. The defensive operations of the child are of key significance to helping the child come to grips with healthier ways of coping with the scars of abuse. If the therapist rips the disguises away from the child, the child will become overwhelmed with primitive anxiety and no therapeutic progress can be made.
TO BE TOLD THE TRUTH IN UNDERSTANDABLE WAYS
Life for an abused child can be very confusing. It is very common for the kids to have a number of questions that need an answer that they can understand. Explaining difficult ideas to a child can tax the adult’s ability to communicate effectively. It is not enough to say that a child’s mother is an alcoholic or drug abuser, it is essential that a play therapist explain that the child’s mother is sick with drugs, and that drugs are like fire, they can warm a person up and cook their food, but they can also destroy by burning up whole buildings and lives. Children who have been removed from their homes need information about why they do not live at home, where their parents are, who is making decisions, when can they go home, etc.
TO HAVE AT LEAST ONE RELATIONSHIP THAT IS SECURE AND TRUSTWORTHY
Abused kids live in a very unsettled world and their experiences have taught them not to trust people. The adults in their lives have taught them to be insecure and to distrust other people. In addition, these kids often are moved from foster home to foster home, with intermittent time back in the abusive family situation. Play therapy need to be long term and be the one steady experience that the child can count on at the same time every week, month after month, year after year. Play therapy can be one or two hours that anchors the child to a positive adult regardless of the chaos in the rest of his life.
TO HAVE THE FREEDOM TO WISH
Abused kids in therapy need a chance to practice solutions to conflicts in their lives. This most often takes the form of wishes. The child can gain some relief from wishing that he had great parents or wishing that he was strong enough to stop daddy from hurting mommy. Play therapists need to encourage the child to express and act out his wishes as a way of tapping into the fantasy or illusory world developed by the child in response to the abuse. Identifying and working with wishes can be the first step in reconstructing a child’s vision of himself.
TO HAVE THE FREEDOM TO EXPRESS AND FEEL ANYTHING AND EVERYTHING WITH NO CENSORSHIP
The essence of play therapy is the creation of a PLAY or theater in which the child can let his feelings fly, let his impulses take whatever shape they may. Abused kids have many deep conflicts about expressing feelings, and they need to be encouraged to externalize, and then, eventually, these feelings can be analyzed and interpreted, but first the child needs to feel that it is desirable to pull out all the stops and let his emotional world unfold in its many dimensions.
TO HAVE A CHANCE TO WIN AGAINST THE VILLAIN
Abused kids are accustomed to losing against the abused adult, and the most common pathological reaction involves their becoming bullies and repeating the acts of the villain (abusive parent) on a younger child. Play therapy can give a kid a chance to win, to be the hero, to practice overcoming the villain in ways that do not contribute to his alienation from other kids and adults in the community, especially in school.
TO HAVE A CHANCE TO FACE FEAR AND WIN
Abused kids cope with fear in self destructive ways. They may deny it, identify with hit, run away from it, or become a slave to it. Play therapy can offer the child a weekly chance to practice and win in situations that have caused the child great fear. Instead of being pathological, the child can play out more heroic solutions, can feel in control in the face of the danger and the fear.
TO TERRORIZE A VARIETY OF VICTIMS
Kids that have been subjected to terrorism by abusive parents need to gain some balance, need to lash out and hurt someone in the way they themselves have been hurt. Kids need the controlled opportunity to be mean, to replay the terror not as the victim but as the victimizer. They can pay back the abusive parents, take out their aggression on teachers, friends, or anyone they like within the safety of the playroom.
TO SLOWLY REFRAME THEIR SELF IMAGE
After a child has externalized his feelings and expressed his traumatic themes, it is important for the play therapist to help the child slowly rebuild a more reality-based view of himself. The child can learn that he was not to blame, that he was and still is a victim and not the villain. The child can be made aware of his strengths and taught to evaluate himself and others more realistically.
TO HAVE AN ADVOCATE WITH FAMILY, SCHOOL, AND STATE AGENCIES
Play therapists often are the child’s best friend in the world, and as such become an excellent candidate as spokesperson for the BEST INTERESTS OF THE CHILD. The play therapist cannot remain disconnected from the child’s world. Every opportunity to speak out for the child at home or in school needs to be seized. The play therapist as advocate can help the world adjust a little to the child while the child is trying to adjust to the world.
Phases of Play Therapy
Play therapy with abused and sexually overstimulated children takes time. Abused kids are often exposed to the noxious stimuli for long periods of time. Child abusers work day and night, day after day, year after year to create the emotional mess for the child. Therapy at best is 2-3 hours per week. It is impossible to guide a child back from the depths of emotional ruin in anything less than several years of 2-3 times per week treatment.
If a child is traumatized for a short period of time by a stranger as in many cases of sex abuse, the need for longer term treatment is less. The length of treatment is directly proportional to: (a) length of abuse (b) intensity of abuse (c) closeness of the abuser to the child (d) circumstances surrounding the abuse (e) response of adults to abuse. A careful analysis of the abuse is essential for adequate treatment planning.
Phase One: Connection
Before any therapeutic intervention is possible, the child must feel confident that his guide is trustworthy. This phase of connection is tantamount to building a CORRIDOR OF TRUST between adult and child. The child needs to know that the adult can PLAY, can interact at THEIR level. The child knows quickly whether the therapist cares about him or whether the adult is trying to force the child into the adult world of talking and asking questions.
Phase Two: Identification of Traumatic Themes
Throughout the first 9-l8 months the child will develop 4-8 consistent games or play patterns each of which reflects his attempt to externalize feelings around specific themes drawn from past and current life. Each game is a communication and repeated themes are especially significant. This middle phase of therapy is dedicated to mapping out the child’s important themes and gaining an understanding of their dynamic inter-relationship with each other.
Phase Three: Exercising Control and Healthy Solutions
After the groundwork is laid, the themes are well played out and a larger global picture of the child is developed, play therapy can begin to be more directive and encourage the child to practice more productive solutions to his common conflict themes.
Phase Four: Reintegration and Rebuilding
After the child has externalized thematic conflicts, practiced more healthy solutions to them, it is time to pull everything together through interpretations. Although mini-interpretations are made throughout therapy, in this phase, everything is related back to the interpretation. The child’s play can be refocused directly back to real life experience. Replaying the traumatic themes is discouraged, and the child is directed back to why he or she started play therapy.
Phase Five: Termination
Terminating play therapy is often more difficult for the therapist than the child. At least 3-6 months’ notice needs to be given the child and the therapy times thinned down gradually to every other week and then monthly. The child usually begins acting out again, and these flare ups need to be interpreted and support given to the child’s new-found strength.