Running head: EFFECTS OF SPANKING AND TREATMENT The Effects of Spanking, Corporal Punishment and Physical Abuse on Children and Treatment Implications for Counselors Working in Urban Environments Oscar C. Carr The University of Memphis 1 EFFECTS OF SPANKING AND TREATMENT 2 Abstract This paper explores the literature exploring the short and longer term effects of spanking and physical abuse on children. The literature, however, is unclear about the definition of spanking and this ambiguity is explored. The mental health effects of spanking and physical abuse on large, urban cities like Memphis, Tennessee are also explored. Various interventions and their efficacy are discussed, including community interventions, psychoeducation, family interventions, psychopharmacology, group therapy, various clinical techniques including eye movement desensitization and reprocessing (EMDR), cognitive behavioral therapy (CBT), mindfulness, and spiritual therapy as well as various trauma based therapies. The paper also discusses implications for counselors including the need for specialized training in asking, assessing, and treating clients who have been abused. Keywords: Spanking, Corporal Punishment, Child Abuse, Physical Abuse, Interventions, Treatment, Trauma, post-traumatic stress disorder, PTSD, cognitive behavioral therapy, CBT, trauma focused cognitive behavioral therapy, TF-CBT, EMDR, Family therapy, Multimodal Trauma Treatment, MMT, Seeking Safety, Psychoeducation, Mindfulness, Assessment, Schools, Urban, Poverty, ACE Study, Violence, Substance Abuse, Schools. EFFECTS OF SPANKING AND TREATMENT 3 The Effects of Spanking and Physical Abuse on Children and Treatment Implications for Counselors Working in Urban Environments Introduction and Description of the Problem The issue of spanking and corporal punishment is an important issue in the Memphis metropolitan area for both educators and parents. The Memphis City Schools only banned corporal punishment in 2004. (Kelly, 2013). As of 2014, the Memphis City School system has been absorbed by the Shelby County School System. (Kelly, 2013). In June of 2013, Dorsey Hopson, who was the interim superintendent and now the permanent superintendent, proposed a permanent ban to prohibit corporal punishment in Shelby County Schools. (Kelly, 2013). David Reaves, who was a member of the Unified Memphis and Shelby County School District questioned the academic research presented. (Kelly, 2013). Mr. Hopson that stated there is no academic or disciplinary benefits to corporal punishment. (Kelly, 2013). Mr. Reaves responded, “[m]y own research tells me it works. My kids do great.” (Kelly, 2013). Another board member and experienced educator, Joe Clayton, stated at the school board meeting that not having the right to use corporal punishment is like “like sending a soldier into a combat zone and telling him he can’t take his weapon.” (Kelly, 2013). But does corporal punishment work? Should Mr. Clayton, who uses his “own research”, which appears to be based on anecdotal evidence, be the standard for measuring whether physical violence used on a child is a sound public policy. For parents, does spanking have a positive effect on children’s behavior and mental health? What the possible long term effects of using physical force on children. How can a counselor provide treatment interventions for children who have been spanked, had harsh corporal punishment used against them or who have been or are being physically abused. EFFECTS OF SPANKING AND TREATMENT 4 Additionally, what does it say about the thought process of Memphis educators when one of them refers to the educational environment as a combat zone and corporal punishment as a weapon. Are the children being educated to be seen as enemy soldiers who are to be deterred by possible physical violence with the “weapon” of corporal punishment? The academic literature suggests that spanking is still a tool used by both educators and parents to control and discipline children. The practice continues even though numerous studies have shown that spanking has multiple negative mental health effects on children, which can include a lifetime of emotional, behavioral and interpersonal impairments. Despite the overwhelming research, the Shelby County Unified School District voted to table the potential ban on corporal punishment in order “to research the pros and cons of spanking students.” As of the April 24, 2014, the Shelby County School’s website still has Policy 6025 listed its website which allows a principal or their employee to administer corporal punishment with a paddle. (Shelby County Board of Education, 2013). Literature Review While one might think parents would have more patience and understanding for their children than educators who think they work in combat zones, the academic research shows that parents are still very much in favor of using physical force against their own child. For instance, Straus and Paschal (2009) reported that 93% of parents had hit their 2- to 4-year-old child within a 2-week period with or without an object while 58% of parents had hit their 5- to 9-year-old child within a 2-week period. Additionally, 65% of American women and 77% of American men in a national survey in 2008 agreed that child sometimes need a ‘‘good, hard spanking.” (Lansford, Wager, Bates, Pettit, & Dodge, 2012). EFFECTS OF SPANKING AND TREATMENT 5 When asked, parents often say they use spanking to teach their children right from wrong, to respect authority and to treat others fairly. (Taylor, Hamvas, & Paris, 2012). Parents have given four more specific justifications for spanking: (1) it is an expression of love and not harm, (2) it promotes child safety and respect, (3) it works when all else fails, and (4) it taught children long-term lessons for operating in the world. (Taylor et al., 2012). While mothers may think loving behavior and attunement can make up for spanking, (Berlin et al., 2010) found that a mother’s emotional responsiveness did not moderate the effects of spanking. While the research shows that child corporal punishment and physical abuse is a national issue, Memphis as an urban metropolitan city in the Southeastern part of the United States has a higher likelihood of approval and use of corporal punishment, especially with its large mix of African-Americans and conservative, white Protestants. In a national survey of parents, parents in the South gave spanking the highest approval rating of any geographic area in the United States. (Taylor, Hamvas, Rice, Newman, & DeJong, 2011). Approval of spanking was also higher among African-American Parents and Conservative Protestant Parents. (Taylor et al., 2011). Numerous studies have consistently shown that African-American parents spank their children more than white parents. (Berlin et al., 2010). However, one smaller, localized study, limited to parents in North Carolina who had children under two years of age, found that African-American mothers reported spanking their children less often than Caucasian mothers (Zolotor, Robinson, Runyan, Barr, & Murphy, 2011) although another study by one of the same researchers revealed that the Deep South had different parental spanking patterns than the Southeast, which included North Carolina. (Zolotor, Theodore, Runyan, D. K., Chang, and Laskey, 2011). Younger, less educated, lower earning, single, and depressed and stressed parents are also more likely to spank their children. (Berlin et al., 2010). EFFECTS OF SPANKING AND TREATMENT 6 Parents with lower socioeconomic status also had higher rates of approval of spanking. (Taylor et al., 2011). The state of Tennessee, of which Memphis has a large part of the population, has one of highest percentages of people living in poverty areas of all of the states in the United States. (Bureau, 2011). Being economically disadvantaged has been linked to emotional and behavioral problem in children, and has been associated with lower levels of material investment by parents in their children. (Rijlaarsdam et al., 2013). Poverty has also been associated with poorer parenting because poverty effects the parental psyche by contributing to depression and other mental health issues in the parents, which, in turn, effects the parenting skills and disciplinary measures used by these parents. (Rijlaarsdam et al., 2013). Not only is the rate of spanking in Memphis likely to be higher than the national average because of its poverty and demographics, the negative effects of urbanization on mental health have been carefully documented. (Anakwenze & Zuberi, 2013). These effects must also be factored into the assessment, intervention and treatment plan for individuals who have been spanked or suffered caregiver physical violence. Memphians, as urban dwellers, also have a higher risk of anxiety disorders, mood disorders and schizophrenia. (Anakwenze & Zuberi, 2013). Urban environments often have less green space, higher crime, more violence and as a result has higher poverty, more unemployment, and higher rates of substance abuse, sexual abuse and numerous other negative factors that lead to mental health issues. (Anakwenze & Zuberi, 2013). As a result of environmental factors, researchers also have shown that children living in urban poverty are more likely to experience chronic and complex trauma. (Collins et al., 2011). Traumatic issues, like multigenerational, family addiction or violence, victimization, gang violence, incarceration, failing schools, and community violence make parenting difficult and often result in a higher risk of child maltreatment. (Collins et al., 2011). EFFECTS OF SPANKING AND TREATMENT 7 It is also important to also counselors to know the institutional racism and systematic oppression that may affect how parents care for their children in a city like Memphis, which has a large African-American population. In The New Jim Crow: Mass Incarceration in the Age of Colorblindness, Stanford law professor Michelle Alexander wrote that there is "a stunningly comprehensive and well-disguised system of racialized social control" that has created a "segregated, second-class citizenship" for black men in America (Alexander, 2010, pp. 5, 21). In large American cities, like Memphis, the young, black male population may have criminal records up to eighty percent of the time. (Alexander, 2010). Having a criminal record can result in the lifetime denial of housing, public benefits, access to employment and societal stigmatization. (Alexander, 2010). The effect of these societal inequalities on how children are raised and parented cannot be underestimated. Operational Definition of Spanking, Corporal Punishment and Physical Abuse Defining spanking versus corporal punishment versus physical abuse is a confusing issue in the academic literature. Gershoff (2002) reviewed over 300 academic research articles including 65 dissertations searching for a definition of corporal punishment. Gershoff (2002) noted that none of the studies included in her meta-analysis questioned the parents about how they identified corporal punishment but rather provided differing definitions to the parents to decide whether the parent’s behavior fit the researcher’s definition. At the end of her metaanalysis, Gershoff (2002) calls for researchers to be more precise in their definitions when conducting research. Despite Gershoff’s (2002) meta-analysis and warning to researchers, Gromoske and Maguire-Jack (2012) did not provide a definition of spanking to mothers completed ten years later. They did note that mothers likely had different conceptualizations of what spanking EFFECTS OF SPANKING AND TREATMENT 8 actually is, which is a fact that may constitute a measurement problem. (Maguire-Jack, 2012). Other scholars have noted numerous studies have investigated spanking without defining the term, nor have they even asked for parents’ own definitions of spanking. (Berlin et al., 2010). Other researchers have noted that spanking is one form of corporal punishment that may consist of swatting a child with a hand or the use of an object to hit a child including but not limited to a paddle, belt or switch and that the definition of spanking will differ from parent to parent and researcher to researcher. (Lansford et al., 2012). While there is disagreement within academia, the majority of spanking researchers hold that spanking is a subset of corporal punishment, which has been defined as “the use of physical force with the intention of causing a child to experience pain, but not injury, for the purpose of correction or control of the child’s behavior.” (Lansford et al., 2012, p. 225). Other researchers have classified corporal punishment as “bodily punishment of any kind as a form of discipline.” (Baumrind & Larzelere, 2010). Baumrind & Larzelere (2010, p. 60) define spanking as a type of corporal punishment that is “a. physically non-injurious; b. intended to modify behavior; and c. administered with an opened hand to the extremities or buttocks.” The authors then state that they are adopting a definition of spanking which is limited to “nonabusive usage” and also excludes severe corporal punishment. (Baumrind & Larzelere, 2010, p. 60). The problem with these authors’ definition is that they fail to define what is abusive as well as what they consider to be severe corporal punishment. (Baumrind & Larzelere, 2010). The Center for Disease Control and Prevention (CDC) defines child abuse as “words or overt actions that cause harm, potential harm, or threat of harm to a child.” (Center for Disease Control and Prevention, 2014). The CDC (2014) definition of child abuse is much more expansive and inclusive than most spanking researchers have defined it to be. (Gershoff, 2002). EFFECTS OF SPANKING AND TREATMENT 9 Throughout the rest of this paper, the CDC definition of abuse will be the measurement of what constitutes abuse, a fact, which means that spanking, corporal punishment and physical violence are all considered to be forms of child abuse when counselors treat clients. Spanking and Corporal Punishment as a Form of Child Abuse and Violence Many researchers consider any corporal punishment to be a form of child physical abuse (Perrin, 2011). In her meta-analysis of over 300 academic articles on spanking and corporal punishment, Gershoff (2002, p.540) notes that “the majority of child abuse researchers view corporal punishment and potentially abusive techniques as points on a continuum of physical acts toward children.” Some researchers hold that hitting a child with an object such as a paddle, switch or spoon is not normal corporal punishment. (Baumrind, Larzelere, & Cowan, 2002). Researchers have found that escalated spanking often results in Child protective services becoming involved and substantiating the behavior as abuse. (Zolotor et al., 2011). There is also research finding that abusive parents are more likely to spank than parents who are not considered to be abusers. (Zolotor et al., 2011). Parents who had abused their children noted that up to two thirds of their abusive episodes began as efforts to influence children’s conduct or to “teach them a lesson.” (Gershoff, 2002, p. 542). Sociologists do not believe that there is anything such as normal violence, including corporal punishment (Perrin, 2011). Citing Albert Bandura’s social learning theory, they assert that caregiver violence models to children that authority figures can use violence and that it is acceptable and condoned when the authority figure has the power to use it. (Perrin, 2011). Other recent research shows a strong association between corporal punishment and violence. In fact, corporal punishment has been shown to be a strong risk factor for child maltreatment. (Taylor et al., 2011). When there is intimate partner aggression and violence in the home, there is more EFFECTS OF SPANKING AND TREATMENT 10 likely to be corporal punishment of children. (Taylor et al., 2011). It is also interesting to note that the American Academy of Pediatrics strongly opposes hitting a child for any reason (Afifi, Mota, Dasiewicz, MacMillan, & Sareen, 2012). The Effects of Spanking and Child Abuse Whether it is spanking with an open hand, using an object to spank, or more severe violence, numerous studies have documented the negative effects of using physical force on children. In what they claim to be first study using a nationally representative sample, researchers, after adjusting for variables including differing social, demographic, and family history, found that harsh physical punishment was associated with increased chances of anxiety disorders, mood disorders, alcohol and drug dependence and abuse, and numerous personality disorders. (Afifi et al., 2012). Weitzman (2005, p.323) has noted that even one act of violence towards a young child can “constrict personality functioning and, if untreated, burrow itself into the child's personality to create massive characterological distortions.” Mistreated children also have a greater risk of suffering from cognitive impairments. (Buckstein & Horner, 2010). Numerous studies have also shown that child spanking is associated a child’s later externalizing or acting out behavior, (Gromoske & Maguire-Jack, 2012) which includes hyperactivity as well as the development of Oppositional Defiant Disorder and Conduct Disorder in children. (Lansford et al., 2012). In her meta-analysis, Gershoff (2002) found that corporal punishment was associated with increased aggressive behaviors, violence, antisocial behavior, delinquency, and adult criminality in the punished children. Gershoff (2002) also found that harsh punishment has been linked to decreased assertiveness and confidence in children as well as feelings of helplessness and humiliation. EFFECTS OF SPANKING AND TREATMENT 11 Additionally, children who have had physical force used against them may have greater interpersonal issues as a children and adults. Spanking can hurt the parent-child relationship because children can become anxious and fearful of the parent, which may result in the child failing to bond with the parent because of issues of trust. (Gershoff, 2002). As adults, these children may also be more likely to continue the intergenerational transmission of trauma and antisocial behavior to the next generation. (Coley, Carrano, & Lewin-Bizan, 2011). Mistreated children also have a greater risk of unstable peer relationships (Conrad, 2006) and more difficulty in having healthy interpersonal relationships. (Habib, Labruna, & Newman, 2013). Recent research has also shown that physical abuse is associated with higher rates of juvenile delinquency and PTSD in girls between the ages of 13-17. (Ford, Steinberg, Hawke, Levine, & Zhang, 2012). Abuse may also create a combination of acting in behaviors including depression and anxiety mixed with acting out behaviors like impulsivity, aggression and substance abuse which can combine to create emotional chaos in the victim leading to the emotionally hijack the victim’s physical and cognitive response systems in stressful situations. (Ford et al., 2012) Physical abuse also puts a severe economic strain on communities and families. When compared to other hospitalized children, children admitted to hospitals for documented physical abuse were more likely to die, have to stay longer, had twice the diagnosis rate, and double the financial charges than the non-abused children. (Rovi, Chen, & Johnson, 2004). The directs costs, which include the investigation of abuse and neglect, and the funding of judicial, law enforcement, health, and mental health systems is estimated to be 24 billion dollars a year. (Conrad, 2006). The indirect costs of child abuse, which include associated juvenile and adult criminal activity, mental illness, substance abuse, and domestic violence as well as the cost of EFFECTS OF SPANKING AND TREATMENT 12 special education services, loss of efficiency due to joblessness and underemployment, and greater use of the health care system are estimated at 69 billion dollars a year. (Conrad, 2006). The long term health effects of childhood maltreatment and abuse are severe. 30% of all victims of child maltreatment have chronic health problems associated with the abuse. (Conrad, 2006). The Center for Disease Control and Prevention (CDC) and Kaiser Permanente also completed assessed the association of childhood maltreatment and later life physical well-being. (CDC, 2013). The ACE Study investigated over 17,000 individuals who had experienced Adverse Childhood Experiences (ACE) as children. (CDC, 2013). ACE events were separated into three different categories including abuse, neglect and household dysfunction. (CDC, 2013). Abuse events were defined as emotional abuse, physical abuse, and sexual abuse. (CDC, 2013). Neglect events were defined as emotional neglect and physical neglect. (CDC, 2013). Household dysfunction events were mother treated violently, household substance abuse, household mental illness, parental separation or divorce, or incarcerated household member. (CDC, 2013). The ACE Study defined physical abuse as being “sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at you or ever hit you so hard that you had marks or were injured.” (CDC, 2013). Under the ACE definition of physical abuse, it is likely that most forms of spanking would be included under that definition although some proponents of spanking may dispute that assertion. (CDC, 2013). The ACE study found that the greater number of ACE events in a child’s life the greater likelihood of negative mental, physical, and emotional issues later in life. While the ACE study is too exhaustive to be fully developed in this paper, the ACE researchers created an ACE Pyramid which best captures the association between negative childhood events and later life consequences. EFFECTS OF SPANKING AND TREATMENT 13 Figure 1 The ACE Pyramid showing the links between Adverse Childhood Experiences and issues and consequences later in life adapted from CDC (2013). Effective Treatment Interventions for Abuse Victims There are a number of interventions available to counselors to both prevent spanking, corporal punishment and child physical abuse and to treat children and adult survivors. At the societal and communal level, counselors can advocate and educate for changes that may decrease the risks associated with growing up in a poor, urban environment. At the individual and family level, counselors can use psychoeducation, family interventions, psychopharmacology, group therapy, various clinical techniques including eye movement desensitization and reprocessing (EMDR), cognitive behavioral therapy (CBT), mindfulness, and various trauma based therapies. At the community level, there are a number of preventative programs and interventions that can be used to ameliorate the harm of growing up in urban poverty where there is a greater likelihood of physical abuse and spanking as well as mental health issues. Researchers suggest that mental health coalitions made up of various agencies, institutions, parents and government entities at the state, local and federal level ally themselves to address the needs of children in urban environments and to increase beneficial social networks for children. (Anakwenze & Zuberi, 2013). Urban children have a harder time accessing mental health services, and studies have shown that minority children living an urban environment are never connected to a mental health service providers at two-thirds less than other children. (Anakwenze & Zuberi, 2013). EFFECTS OF SPANKING AND TREATMENT 14 Researchers also suggest that mental health questionnaires and screening for child abuse be administered in public health clinics, preschools, daycares, and pediatrician offices. (Stephens, 2006). Other strategies are to have trained mental health workers, who are culturally sensitive, engage the family of the child who is suffering from a mental health disorder and to provide family services as well as child services. (Anakwenze & Zuberi, 2013). The promotion, support and engagement of school based services and education about mental health and spanking is also another effective strategy for reaching children in an urban environment. (Anakwenze & Zuberi, 2013). Counselor engagement of urban churches and pastors to educate them and use them as allies and referral sources for children suffering from physical abuse or mental health issues. (Anakwenze & Zuberi, 2013). Finally, researchers have suggest public information campaigns against spanking, like those campaigns against alcohol and tobacco use, to reduce the incidence of spanking by parents. (Taylor et al., 2011). Researchers have also created a trauma based community approach based on family interventions as well as evidence based trauma therapies. (Collins et al., 2011). This family trauma intervention approach targets children and families living in cities with urban poverty who are more likely to have child mistreatment. (Collins et al., 2011). The focus of the intervention is on breaking the chain of multigenerational trauma family interventions focusing on normalizing trauma reactions, emotion regulation, family-shared meaning of trauma and social support. (Collins et al., 2011). While the family focused trauma intervention model appears to be very comprehensive, it may cost prohibitive for many communities because of the amount of staff and training it would take to implement such a plan in urban areas with millions of EFFECTS OF SPANKING AND TREATMENT people. Unfortunately, the authors of the study did not include a cost component in their recommendation. (Berlin et al., 2010). Other researchers have found that trauma informed therapy for disenfranchised urban children and youth can be helpful if it is done in the proper manner. (Becker, Greenwald, & Mitchell, 2011). Trauma informed treatment involves Fairy Tale therapy, a modality where children are encouraged to engage in a narrative where they face and overcome their trauma. (Black, Woodworth, Tremblay, & Carpenter, 2012).Trauma informed therapy also includes more traditional trauma exposure and emotional regulation exercises (Black et al., 2012). A 2012 study of traumatized adolescents using from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Substance Abuse Treatment (CSAT) found that traumatized youth need an integrated care system for trauma and substance abuse issues. (Suarez, Belcher, Briggs, & Titus, 2012). Suarez et al. (2012) noted that numerous research studies have shown the link between childhood trauma and the later development of substance abuse in adolescence, yet there have been few studies showing how specialized care can be delivered to adolescents who suffer from both trauma and substance abuse. After analyzing the data set Suarez et al. (2012) found the need for mental health, community and school systems to engage in systematic screening and assessment for trauma exposure, traumatic stress symptoms and substance abuse problems should be routinely provided across service systems and for youth to have access to a wide range of treatment options and services that provide higher levels of care. Suarez et al. (2012) also noted the need to develop structural resources that facilitate communication and connections among mental health providers to foster integrated service sectors, and cross 15 EFFECTS OF SPANKING AND TREATMENT training of providers in both trauma and substance abuse so that mental health services can provide comprehensive services to abused adolescents. While there are numerous community and family intervention type interventions, a counselor may be working with a child, teenager or adult who no longer lives with their family of origin or who does not have access to their client’s family. In this case, individual or group therapy interventions may be the best approach. Music and art therapy have been shown to be effective in helping abused clients. (Weitzman, 2005). EMDR has also shown to be effective in reducing the anxiety related to specific memories of abuse and has been shown to be more efficient with children and adolescents than CBT. (Becker et al., 2011). Counselors also need to be aware of a client’s use of psychopharmaceuticals and have a working relationship with a psychiatrist who can prescribe antidepressants and other medications as needed. (Perrin, 2011). Other researchers claim that CBT that is specifically designed for children, which is called Multimodal Trauma Treatment (MMT), is the most effective therapy for children and adolescents. (Black et al., 2012). MMT consists of a group of children or adolescents who engage in a number of exercises with a counselor including psychoeducation, narrative therapy, including journaling about their trauma, exposure to memories of the trauma, relaxation techniques and cognitive restructuring. (Black et al., 2012). Psychoeducation is usually a counselor’s first option and is used to help a person understand what a traumatic event is, how experiencing trauma affects that person, and how trauma-related symptoms may continue long after the traumatic event. (Black et al., 2012). 16 EFFECTS OF SPANKING AND TREATMENT Trauma Focused Cognitive Behavioral Therapy has (TF-CBT) also been shown to be effective in treating single or multiple trauma by numerous studies involving both Caucasian and African-American children. TF-CBT has been shown to positively reduce post-traumatic stress disorder (PTSD) symptoms, depression, and behavioral issues in children when compared to other therapeutic modalities (Black et al., 2012). Seeking Safety is a treatment that focuses on trauma related symptoms as well as substance use disorders in adolescents and adults. (Black et al., 2012). Seeking safety has been shown to be effective in reducing symptoms of PTSD and substance abuse. (Black et al., 2012). It focuses on five basic principles: personal safety as a priority, the integrated treatment of both trauma and PTSD, an emphasis on a client’s needs, attention to the therapeutic process, and an emphasis on four definite client content areas— behaviors, interpersonal interactions, cognitions and case management. (Black et al., 2012). For adults and adolescents, enhancing spiritual connection and mindfulness may help relieve the effect of physical abuse. “Mindfulness is described as moment-tomoment, non- judgmental attention and awareness actively cultivated and developed through meditation.” (Kimbrough, Magyari, Langenberg, Chesney, & Berman, 2010). Mindfulness has been empirically shown to reduce symptoms of depression, anxiety and somatic complaints. (Kimbrough et al., 2010). In one of the first studies of its kind, Kimbrough et al. (2010) measured PTSD and depressive symptoms in childhood sexual abuse survivors and found that after only eight class sessions, one all day retreat and light homework assignments that PTSD symptoms including avoidance, numbing, reexperiencing, hyperarousal and depressive symptoms all decreased at clinically 17 EFFECTS OF SPANKING AND TREATMENT 18 significant rates. (Kimbrough et al., 2010). While this research did not address children who were abused, it does lend support that PTSD type symptoms and depression in adult child abuse victims may be treated by mindfulness. Implications for Counselors in Urban Areas Counselors living in Memphis need to know how to treat clients that have been spanked, harshly punished, or physically abused. The research shows that a large proportion of the Memphis population has likely been spanked or physically abused. Memphis has all of the attendant risk factors for high rates of spanking and abuse. Memphis is a large, urban city located in the Deep South with a large religiously conservative, white population, a large AfricanAmerican population and high rates of generational poverty and crime. At a general level, it has also been shown that mental health clients were likely abused as children so counselors should be prepared to treat such abuse wherever they may be working. For example, a review of 46 studies of female in-patient and outpatient population showed that 48% of them had suffered from physical abuse during childhood and the male in-patient and outpatient population showed that 50% of them had suffered from physical abuse during childhood. (Read, Hammersley, & Rudegeair, 2007). When counselors perform an intake and assessment of a client living in Memphis, the counselor should take a careful trauma history of their client. Studies have shown that survivors of childhood abuse often wait ten to fifteen years to tell anyone about child abuse. (Read et al., 2007). Individuals are not more likely to tell mental health professionals about abuse (Read et al., 2007) so counselors should not wait to be spontaneously told about abuse. In fact, studies have found that psychiatric patients may actually underreport their abuse. (Read et al., 2007). Studies have also shown that mental health professionals often fail to ask clients about abuse and that EFFECTS OF SPANKING AND TREATMENT 19 statistically clinicians miss more than half of the abuse that is reported to researchers. (Read et al., 2007). One study that asked mental health service client if they had been asked about abuse found that 78% of them were not asked about it in their initial assessment. (Read et al., 2007). Counselors often fail to ask clients about abuse because they believe other issues are more important and pressing, are afraid it will disturb or anger the client or that questioning may cause false memories to appear. (Read et al., 2007). Studies have shown that clients are often angry if they are not asked about abuse. (Read et al., 2007). Additionally, client reports of childhood abuse have been shown to be quite reliable even with those client who have psychosis. (Read et al., 2007). Other barriers to asking questions about abuse are a clinician’s fear of being vicariously traumatized, the client being male or client being the opposite gender of the counselor, lack of clinician’s training on how to respond to abuse, and a strong belief that mental health problems are a result of biology and genetics rather than traumatic abuse. (Read et al., 2007). Researchers recommend that clinicians take a number of steps to address abuse. First, clinicians should ask every client about abuse not just clients that appear to have PTSD. (Read et al., 2007). Second, even when clinicians do ask about abuse, they often do not offer a sufficient response in that they do not offer additional resources to clients, refer them to additional or specialized counseling, document the abuse in their files, include treating the abuse in their treatment plan, or consider reporting the abuse to authorities. (Read et al., 2007). Clinicians must become more aware of how to follow all of these protocols by seeking proper training and following through with what they have learned. Clinicians must learn how to ask the proper questions in the proper way. Instead of asking questions like, “were you abused traumatized a child”, which may lead to an answer of EFFECTS OF SPANKING AND TREATMENT 20 “No”, a counselor should ask questions without using professional jargon. (Read et al., 2007). It is suggested that clinicians use a “funnel” of questions that start with the general and become more specific as they are being asked. (Read et al., 2007). For instance, a counselor might ask a client, “please tell me about your childhood” and then ask, “how did your parents punish you as a child?”, or “what was the angriest you ever saw one of your parents? What did they do to you?” (Read et al., 2007). When responding to abuse, experts suggest a few things. First, the clinician should affirm that it is a positive thing for the client to share about the abuse. (Read et al., 2007). A clinician can then ask if this is the first time that the client has told anyone about the abuse. (Read et al., 2007). If it is the first time, it may have been years since the abuse, and the client may need more support than someone who told someone right after the abuse and received treatment and support at the time. (Read et al., 2007). The first sharing, however, is not the time for the clinician to gather every, specific detail about the abuse. (Read et al., 2007). It is also important for the clinician to offer specific treatment options to the abused client. (Read et al., 2007). The clinician should then ask their clients if they believe their current emotional issues are related to their past abuse. (Read et al., 2007). This question about a causal connection should be asked even if the clinician does not think that is the case. (Read et al., 2007). At the end of the session, clinicians should do an emotional check-in to ask how the client is doing after disclosing abuse and provide support resources and phone numbers in case the client becomes upset at a later date. (Read et al., 2007). Clinicians should also take very detailed notes and include quotations, in cases of abuse, and consider reporting to authorities as required or needed. (Read et al., 2007). It is also suggested that clinicians seek out a specific training program or workshops on assessing and EFFECTS OF SPANKING AND TREATMENT 21 treating abuse. (Read et al., 2007). Clinicians with specific abuse training have been shown to identify abuse at higher rates than those who have not received such training. (Read et al., 2007). Conclusions As show by the research above, the implications for counselors in urban areas like Memphis are great. Counselors need to seek greater training for treating abuse victims. The literature shows that a large percentage of both children and adults are likely to have been effected by spanking or more serious physical abuse. Counselors working with this population may also need to seek greater training as to the specific interventions to be used like EMDR, TFCBT, art and music therapy, family interventions, Seeking Safety, and MMT. Counselors need to be able to assess, diagnose, and treat both victims and perpetrators of violence. Counselors may also choose to become publicly involved in advocating the abolishment of corporal punishment in public schools like the type used in Shelby County, Tennessee or any other school system or institution for children. Despite one school board’s comments, the academic literature shows that corporal punishment is not an effective “weapon” against children who misbehave. In fact, spanking is associated with higher rates of mental health issues. Counselors should inform current and future parents, educators and caregivers as to the massive amounts of academic research showing both the short and long term negative effects of spanking on children. 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