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Group Counseling with Children Who Have Been Sexually Abused: Manual
Trica L. Peterson, B.A., Ph.D. student
Deborah A. Gerrity, Assistant Professor
Counseling Educational School of Psychology
University at Buffalo/CDHS Partnership
Jere Wrightsman, Unit Director
Foster Care
Acknowledgement:
This research project was funded by the Office of Children and Family Services, Award: 27276,
Project: 1029154, Task 2 through the Center for Development of Human Services, Research
Foundation SUNY, Buffalo State College.
© 2003 CDHS/Research Foundation of SUNY/BSC
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Table of Contents
Purpose of the Manual………………………………………………………………………….3
General Child Sexual Abuse Information………………………………………………………4
Definitions & Prevalence….……………………………………………………………4
Behavioral and Psychological Impact………………………………………….……….4
Severity of Aftereffects…………………………………………………………………7
Aftereffects by Age Group…………………………………………………………..….9
Aftereffects by Gender……………………………………………………………...…10
Family Characteristics …………………………………………………………..…….11
CSA Group Treatment…………………………………………………………………………11
Advantages of Group Treatment………………………………………………….……11
Therapeutic Issues………………………………………………………………….…..12
Group Screening, Structure and Topics…………………………………………….…..13
Group Format by Age…………………………………………….…….…………..…..14
Format for Pre-School Groups………………………….….…….…………..…14
Format for Latency Groups………………………………….…….………..…..17
Group Activities by Age………………………………………..………….……...…….19
Pre-School Group Activities………………….………..………….….……..…..19
Latency Group Activities……………………………..…………….…..………20
Group Counseling Services in Buffalo Area…………………………….……………….……..23
References………………………………………………………………………………………24
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Purpose of this Manual
This manual is intended to highlight some of the crucial information that counselors
should have before attempting to conduct a sexual abuse group for preschool or latency aged
children. It is in no way meant to replace any formal training and is not considered exhaustive in
its content. The references provided at the end of the manual do, however, provide a pretty
comprehensive look at group therapy for children who have been sexually abused. It is
recommended that potential therapists read the relevant literature on CSA groups before
attempting to conduct one on their own. Group therapists should be licensed practitioners with
training in group therapy, normal sexual development, and sexual abuse sequelae and have
experience working with sexually abused children. In order to abide by APA’s ethical guidelines
of competency, it is suggested that new therapists co-lead a group with a more experienced
therapist in the realm of children sexual abuse before running a group on their own. Conducting
a group for sexually abused children is more complicated and emotionally draining than most
other forms of group therapy. Therefore, it is also imperative that group therapists receive
adequate supervision throughout the course of the group.
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Group Counseling with Children Who Have Been Sexually Abused
General Child Sexual Abuse Information
Definition and Prevalence
Child sexual abuse (CSA) involves any sexual activity with a child where consent either
is not, or cannot be, given (Finkelhor, 1979). This includes sexual contact that is accomplished
by force or threat of force, regardless of age. All sexual contact between an adult and a child,
regardless of the child’s understanding of the nature of the activity is considered sexual abuse
(Berliner & Elliot, 1996). There are a variety of behaviors and activities that constitute sexual
abuse. They include sexual penetration, touching, and non-contact sexual acts, such as exposure
or voyeurism (Berliner & Elliot, 1996). Incest is child sexual abuse that occurs between family
members, including blood relatives, stepparents, in-laws and extended family (Finkelhor, 1979).
CSA is a widespread problem that demands significant attention. Large-scale community
surveys indicate that approximately 25 % of girls and 10% of boys have been sexually abused
before the age of eighteen (Cosentino, Meyer-Bahlburg, Alpert, Weinberg, & Gaines, 1995).
Briere (1992) estimates the prevalence of child sexual abuse amongst females in the United
States to be between twenty and thirty percent of the population. A survey of female college
students conducted by Russell (1984) indicated 54% of her subjects had at least one occasion of
sexual misuse ranging from exposure to sexual intercourse before reaching adulthood. Finkelhor
(1994) found that 3 to 29% of men had experienced an incident of CSA.
Behavioral and Psychological Impact
With only a few exceptions, most of the studies conducted within the last ten years in the
area of CSA have found a link between reports of CSA and subsequent mental health problems
(Berliner & Elliot, 1993; Trowell et al., 2002). Finkelhor (1998) has described a traumagenic
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dynamics model of sexual abuse to explain the unique factors associated with the experience of
CSA. The model acknowledges the different effects of CSA depending on the nature of the abuse
while specifying its impact on a child’s development. The model consisted of four key
experiences that alter a child’s cognitive or emotional orientation to the world and distort the
child’s self-concept, view of others and affective functioning (Alpert, Browne & Courtois, 1998;
Finkelhor, 1998; Spaccarelli, 1994).
The first experience is called traumatic sexualization. This involves exposure to sexual
experiences that are developmentally inappropriate. Traumatic sexualization is thought to
increase sexual acting out, confusion regarding sexual identity, and compulsive sexuality or
sexual aversion. (Finkelhor, 1998).
Powerlessness, the second experience in Finkelhor’s model, denotes the inability of the
child to stop, or prevent, the abuse. This experience is thought to cause anxiety, a tendency to see
oneself as a victim in a multitude of situations and may lead to identification with the
perpetrator. Some behavioral outcomes of this experience are somatic complaints, depression,
dissociation, sexually aggressive behavior and phobias (Finkelhor, 1998).
Thirdly, stigmatization occurs when negative connotations of the experience are
communicated to the child. This is thought to lower self-esteem, and cause feelings of shame and
guilt. Stigmatization often leads to substance abuse, social isolation, suicidality and self-harm
behaviors (Finkelhor, 1998).
Realization that a trusted person has manipulated or failed to protect the child comprises
the fourth and final experience explained in the model. This experience of betrayal shatters the
child’s confidence that trusted people are capable of protecting them. When experiencing this
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stage of the model, children often exhibit clingy behavior. They additionally display conduct
problems, mistrust, grief, and anger (Finkelhor, 1998).
In general, researchers agree that children who have been sexually abused evidence more
negative psychological symptoms than do their similar aged, non-abused peers. Findings by
Kendall-Tackett, Williams, and Finkelhor (1993) support this view, showing that sexually
abused children in their review had more symptoms than non-abused children, with abuse
accounting for 15 to 45% of the variance. The aftereffects of CSA however, have a vast range
from mild emotional or behavior problems, such as low self esteem and poor school or work
performance, to severe psychopathology, such as post traumatic stress, depression, anxiety and
various personality disorders. For preschoolers, the most common symptoms were anxiety,
nightmares, PTSD, internalizing and externalizing, and inappropriate sexual behavior.
For
school aged children, the most common symptoms included fear, neurotic and general mental
illness, aggression, nightmares, school problems, hyperactivity, and regressive behavior (i.e.,
enuresis, encopresis, tantrums). Among adolescents, symptoms included depression, withdrawal,
suicidal, self-injurious behavior, somatic complaints, illegal acts, running away, and substance
abuse.
Sexualized behavior is considered the most characteristic symptom of CSA in children.
It is displayed throughout the different age ranges in various manifestations and has
distinguished CSA children from non-abused children in general and psychiatric settings
(Constentino et al., 1995).
Kendall-Tackett et al. also specify sexualized play with dolls,
excessive or public masturbation, seductive behavior, and age inappropriate sexual knowledge as
possible indicators of CSA.
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There is no one-to-one correspondence between a history of sexual abuse and any
specific psychiatric diagnoses, yet a history of childhood sexual abuse is an important risk factor
found in clinical populations at a rate that is greater than the expected rate would be if sexual
abuse were a random factor (Alpert et al., 1998). These diagnoses include: borderline personality
disorder and other Axis II disorders, affective disorders, eating disorders of varying severity,
dissociative disorders, and addictive disorders (Berliner & Elliot, 1996).
CSA survivors are also likely to develop symptoms related to Post-Traumatic Stress
Disorder (PTSD). The risk for developing PTSD is especially high if the abuse involved
penetration or force (Heffernan & Cloitre, 2000; Kendall-Tackett et al., 1993). In the literature, a
prevalence rate of almost 50% for PTSD exists among survivors of childhood sexual abuse
(Kendall-Tackett et al.). The major identifying symptoms of PTSD in children are nightmares,
fears, and guilt (Kendall-Tackett et al., 1993). Symptoms of posttraumatic stress also include
intrusive re-experiencing symptoms, numbing and detachment symptoms, hyper-arousal, startle
response, sleep disturbance, as well as dissociative features and mechanisms, such as
psychogenic amnesia, fugue, de-realization and depersonalization (Alpert et al., 1998).
Overall, there is no one syndrome or symptom that is found in all victims of sexual abuse.
In fact, up to 50% of children who have been sexually abused may be asymptomatic (Beutler et
al., 1994 as cited in Hansen, Hecht, & Futa, 1998). It is unclear, however, what causes some
children to have severe symptoms and some to show no outward aftereffects of abuse.
Severity of Aftereffects
Through empirical investigation, numerous variables have been identified that appear to
influence the impact that sexual abuse has on children. First, age at time of assessment seems to
be a common intervening variable. Kendall-Tackett et al. (1993) found that older children had
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more symptoms than younger children. Unfortunately, these studies did not control for other
factors relating to the abuse, such as duration, in that the older children may have experienced
the abuse longer or endured more severe types of molestation.
Age of onset of abuse is another possible intervening variable. Studies have shown early
age of onset to be associated with amnesia among adult survivors and late presentation for
treatment, thus increasing the impact of the aftereffects of the sexual abuse (Kendall-Tackett et
al., 1993). It is unclear whether late presentation is associated with amnesia or occurs as a result
of the early onset of abuse.
Kendall-Tackett et al. (1993) also found that abuse involving violence, penetration,
multiple offenders, more frequent occurrences, and a closer relationship with the offender appear
to result in a greater psychological and behavioral impact. Likewise, molestations that included
some form of penetration were more likely to produce more symptoms than molestations that did
not. Lastly, these researchers found that the identity of the perpetrator is another factor related to
the impact of abuse, with perpetrators who are close to their victims, usually fathers or
stepfathers, resulting in greater impact of abuse on the child (Kendall-Tackett et al., 1993).
Kendall-Tackett, Meyer, and Finkelhor (1993) found little consistency in differences in
symptomology related to gender. Research on the long-term effects of sexual abuse has tended
to focus on the sequelae in women. Females have a tendency to internalize their traumatizing
symptom effects by showing more signs of anxiety, fear and depression (Kendall-Tackett et al.
1993; Finkelhor, 1990; Spacarelli, 1994). Alternatively, males seem to have a tendency to cope
with their abuse by externalizing their distress, often displaying aggression and anger. They tend
to manifest their anxiety through sexual and physical aggressiveness (Scott, 1992). Additionally,
boys may have a heightened preoccupation with sexual activity, a generalized attitude of hyper-
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masculinity (aggressiveness, explosions of temper, discouraged expression of vulnerability) and
extreme fear of homosexuality. This homophobia makes boys rigid in expression of typical male
characteristics, i.e. machismo, and instills a fear of close relationships with other males.
Zamanian and Adams (1997) support many of Scott’s assertions in that they have found that
male victims often perceive themselves as emotionally and physically weak for being the object
of abuse. These authors assert that male victims will display aggression and a hyper-masculine
stance, sexual identity confusion, and may have a compulsion to repeat their experiences in a
masochistic or sadistic way. Scott also notes the relationship of male victimization and
externalized expression with the high occurrence of perpetrators being men. Reinhart (1987)
found that 96% perpetrators whose victims were males are men.
Scott believes this
victim/victimizer pattern is a means of protection so as not to be re-victimized.
Sexualized behavior is considered the most characteristic symptom of CSA in children. It
is displayed throughout the different age ranges in various manifestations and has distinguished
CSA children from non-abused children in general and psychiatric settings (Constentino et al.,
1995).
Kendall-Tackett et al. specify sexualized play with dolls, excessive or public
masturbation, seductive behavior, and age inappropriate sexual knowledge as possible indicators
of CSA. In addition, children will often blame themselves for break up of their family, feel
shame regarding the abuse and suffer from low self -esteem. They may have an inability to trust
others, become withdrawn, avoid eye contact, have sleeping or eating problems, and may
experience flashbacks of the abuse.
Aftereffects by age group
In addition to the aftereffects mentioned above, a list has been provided here by age
group. For preschoolers, the most common symptoms were anxiety, nightmares, PTSD,
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depression, aggression, and inappropriate sexual behavior. For school aged children, the most
common symptoms included fear, neurotic and general mental illness, aggression, nightmares,
school problems, hyperactivity, and regressive behavior (i.e., bed wetting and soiling, tantrums).
Among adolescents, symptoms included depression, withdrawal, suicidal, self-injurious
behavior, somatic complaints, illegal acts, running away and substance abuse.
Aftereffects by gender
Females have a tendency to internalize their traumatizing symptom effects by showing
more signs of anxiety, fear and depression (Kendall-Tackett et al. 1993; Finkelhor, 1990;
Spacarelli, 1994). Alternatively, males seem to have a tendency to cope with their abuse by
externalizing their distress, often displaying aggression and anger. They tend to manifest their
anxiety through sexual and physical aggressiveness (Scott, 1992). Additionally boys may have a
heightened preoccupation with sexual activity, a generalized attitude of hyper-masculinity
(aggressiveness, explosions of temper, discouraged expression of vulnerability) and extreme fear
of homosexuality. This homophobia makes boys rigid in expression of typical male
characteristics i.e. machismo, and instills a fear of close relationships with other males.
Zamanian and Adams (1997) support many of Scott’s assertions in that they have found that
male victims often perceive themselves as emotionally and physically weak for being the object
of abuse. These authors assert that male victims will display aggression and a hyper-masculine
stance, sexual identity confusion, and may have a compulsion to repeat their experiences in a
masochistic or sadistic way. Scott also notes the relationship of male victimization and
externalized expression with the high occurrence of perpetrators being men. Reinhart (1987)
found that 96% perpetrators whose victims were males are men.
Scott believes this
victim/victimizer pattern is a means of protection so as not to be re-victimized.
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Family Characteristics
Families with a child who has been sexually abused are thought to have certain common
characteristics. Berliner and Elliot (1996) report that families of incest and non- incest abuse are
less cohesive and generally more dysfunctional than families of non-abused children. The
problem areas identified are in the areas of communication, social isolation, and lack of
emotional closeness and flexibility. Parental psychopathology, domestic violence and marital
conflict were also seen as risk factors for CSA. Additionally, children from a single parent home,
whose mother is unavailable or whose mother had a history of abuse are at increased risk for
sexual victimization (Nolan et al., 2002). In over one third of the cases studied by Nolan et al.
(2002), mothers had a history of abuse.
Recent studies indicate that sexual abuse occurs without regard to race, ethnicity, or SES.
Unlike other forms of abuse, socio-economic status does not appear to be related to sexual abuse
(Berliner & Elliot, 1996). Finkelhor (1979) indicated that pre-adolescent children were most
vulnerable to sexual abuse, however, sexual abuse has been reported from ages as young as three
months.
CSA Group Treatment
Advantages of Group Treatment
Gerrity and Peterson (in press) explain that CSA treatment can be long-term and utilize
multiple methods and techniques due to the impact of the abuse, the time between abuse
occurrence and actual treatment for symptoms, and the overall complexity of posttraumatic
reactions. Finkelhor (1986) identified four causes of the trauma: sexualization, stigmatization,
betrayal, and powerlessness, which have been described elsewhere in this paper. In general,
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therapists are attempting to assist the children in reviewing the abuse and in working through all
of the aftereffects.
Briere (1996) explains that group has advantages over individual therapy in that it lessens
isolation and stigmatization, reduces shame, and provides the client with the opportunity to help
as well as be helped. Talbot et al. (1998) also related that therapy with a peer group reduces the
perceived power of the authority figures, through interaction with group leaders, and helps break
down resistance and regression that may occur in individual treatment. Forseth and Brown
(1981) also stated that three-quarters of programs offering treatment for abused children
provided group interventions.
Therapeutic Issues
It is imperative that leaders be cognizant of potential legal issues, sexual abuse
aftereffects, and general group therapy techniques (Knight, 1997). Since group members may
disclose continuing or current abuse of someone else in their family, knowledge of legal statues
regarding mandated reporting of abuse is also critical. For a more complete list of concerns that
leaders should attend to before starting a sexual abuse group for children, please read the
“Purpose of this Manual” section of this paper. Many authors agree that CSA groups should be
co-led (Courtois, 1993; Knight, 1997), in order to buffer the stress and risk of burnout. Utilizing
a co-leader to review personal reactions, group dynamics, and countertransference issues is
valuable.
The availability of a co-leader can be helpful in both prevention (due to sharing of stress
and processing of group) and early detection of problems. In addition, co-leaders can model
healthy discussion and confrontation as they interact with each other within the group sessions
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(Herman, 1992). It may be the first time that members have seen healthy discussion and
tolerance of differences.
Children who have been sexually abused often exhibit different behaviors in a group
setting than do children who have not (Pearl, 1988). Pearl (1988) states, “they will be slower to
respond and appear withdrawn and indifferent to warm, caring adults…will respond with less
predictability…because they have been living in an unstable and confusing environment…The
usual techniques to encourage a child to participate and respond frequently get no response or
indiscriminate superficial response (p. 185). She continues to point out that abused children will
often avoid eye contact, show hypervigilance, and either internalized or externalized behaviors.
Internalized children appear shy, withdrawn, and depressed, while externalized children present
with aggression, anger, and hostility. These children need a structured environment where the
rules are clear and consistent from week to week. It is likely that they will push limits, in order to
test if the rules can keep them safe.
Group Screening, Structure and Topics
When selecting members for an upcoming group for children, it is important to screen
children properly for their appropriateness for group therapy. Homeyer (1999) has recommended
that children be at similar developmental age, same physical size (to avoid physical
intimidation), and same gender. Other authors have utilized mixed sex groups with preschool
aged children, but older groups are almost always same sex. A balance should also be struck
between children exhibiting externalizing behaviors and those showing internalizing behaviors,
so as to not have an overly aggressive or passive group or a situation where children could be
retraumatized by group members. In addition, children who have recently been victimized or
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who were victimized in a group may be better served in individual therapy before joining a
group.
Preschool groups provide services to children between the ages of 4 and 6 years old and
are usually either mixed gender (e.g. Glover, 1999; Grosz, Kempe, & Kelly, 2000), or only
female (Pescolido & Petrella, 1986). Latency groups, ages 7 to 11, usually contain same-sex
children (Friedrich, 1990). Adolescent groups are modeled after adult groups. Those interested in
more information regarding adolescent/adult groups should utilize Gerrity and Peterson (in
press).
The topics addressed in sexual abuse groups for children remain fairly consistent,
however, and often include a combination of: feelings regarding abuse and the perpetrators (e.g.
Berliner & Elliott, 1996), feelings toward self (e.g. Grosz, Kempe, & Kelly; Homeyer, 1999), sex
education (e.g. Hack, Osachuk, & DeLuca, 1994; Hyde, Bentovim, & Monck), sexual abuse
prevention (e.g. Sirles, Walsma, Lytle-Barnaby, & Lander, 1988), court preparation (e.g.
Berliner & Elliott; Heiman & Ettin), and identification of a support system (e.g. Berliner &
Elliott; Heiman & Ettin).
Format By Developmental Level
Format for Pre-School Groups
As preschool aged children are in a much earlier stage of cognitive development (Damon,
Todd, & MacFarlane, 1987), it is difficult for them to understand abstract concepts (Burton,
Rasmussen, Bradshaw, Christopherson, & Huke, 1998). Therefore, groups with preschool
children use more concrete, action-oriented activities and interventions, whereas latency groups
begin to shift the focus to discussing psychological concepts that are more abstract and may be
less comprehensible to preschoolers (i.e., self-esteem). Groups for children aged 4-6 tend to be
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mixed gender, or only female. Membership is usually limited to 4 to 8 children, who meet for 10
to 12 weekly sessions for 1-2 hours (e.g. Homeyer, 1999). While there is some literature showing
open groups for this age (Grosz, Kempe, & Kelly, 2000), the majority of preschool groups are
closed and time-limited (Berliner & Elliott, 1996), allowing group cohesion and safety to
develop more quickly.
The best manner in which leaders of preschool age groups can attend to developmental
concerns is by incorporating age-appropriate techniques and activities into their group format.
Concrete language and experiential interventions are routinely utilized (Burton et al., 1998).
Additionally, most groups for this age range incorporate a snack and play time (e.g. Mitchum,
1987; Pescolido & Petrella, 1986) to provide a nurturing reprieve from intense feelings and to
promote peer interaction.
While sexual abuse groups for preschool aged children can take the form of counseling,
psychoeducational, or therapy, counseling groups utilizing nondirective play therapy techniques
are most common in the literature. There are many reasons why play therapy is deemed valuable.
Homeyer (1999) promoted play therapy as the most effective treatment for preschoolers who
have been sexually abused because it is developmentally appropriate and because children in this
age range usually lack a framework to understand the trauma they have experienced, making
verbal, emotional expression difficult. Play therapy allows emotional expression through play,
which may even be more accurate than a child's verbal statements (Marvasti, 1988).
In play therapy groups, children have access to a range of materials chosen to facilitate
creative and expressive play (Jones, in press). The purposeful lack of instruction regarding the
correct manner in which to play with the materials allows the children to choose. Children are
not pressured to verbalize frightening experiences and beliefs, but are encouraged to
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communicate those messages via different methods of play. Seipker (1985) described play
therapy as being essential for preschool aged children because it involved the "interpretation of
the meanings and feeling of the play and behavior" (p. 36). As preschool children tend to act out
their emotions rather than discuss them (Jones, in press), nondirective play therapy can provide
the therapist with an opportunity to receive, validate and interpret the messages that the child is
sending. Reflecting the feeling to the child and interpreting the meaning behind it aids in the
development of the therapeutic alliance between the child and therapist. Additionally, "the
therapist may observe the child's self-view and the role that he or she assumes in the family"
(Marvasti, 1988, p. 1). Homeyer (1999) cautioned against therapists pushing an agenda, as it
could create anxiety and distrust. Therapists are urged to trust that children will deal with their
concerns in the order most important to them.
Several behavior patterns commonly emerge within the play therapy group format.
Children may exhibit aggression toward the therapist or peers, withdraw from the group, become
hypervigilant, reenact the abusive situation, dissociate, or may be unable to negotiate conflict
with peers. Boundary issues may also be apparent, as children become regressive or nurturing
and produce more sexualized behaviors (Jones, in press). Jones (in press) and Homeyer (1999)
provide suggestions for successful therapeutic interventions that enable therapists to convey an
understanding of the child, the reasons for the child's behavior, and to "put words to their
experience" (Homeyer, 1999, p. 308).
Although many sexual abuse groups for this age group incorporate an educational
component, strictly psychoeducational group formats appear to be uncommon, which is not
surprising given the developmental limitations of preschool children. Most sexual abuse groups
for preschool aged children appear to incorporate some play therapy techniques, while infusing
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psychoeducational interventions (Pescolido & Petrella, 1986), structured weekly topics (Grosz,
Kempe, & Kelly, 2000), or a more directive stance (Damon, Todd, & Macfarlane, 1987).
Stauffer and Deblinger (1996) described a manualized, cognitive behavioral therapy
group for preschool aged children. This treatment approach incorporated age appropriate
playtime and structured educational time, and also used cognitive behavioral techniques to
manage children's behavior (selective attention, timeout) and help the children develop
communication skills (modeling, roleplays).
Format for Latency Groups
As with preschool aged groups, the majority of latency aged groups for children who
have been sexually abused have a similar structure. Groups for this age range usually have
between 4 and 8 children, meet for 8 to 12 weeks, and last 1 to 2 hours. Due to developmental
differences and variation in treatment concerns, latency aged groups are generally same-sex
(Hiebert-Murphy, Deluca, & Runtz, 1992) and contain more group discussion than preschool
groups. The three areas most often targeted in these groups are feelings, social interactions, and
abuse prevention education (Sirles et. al, 1988). Many groups incorporate snack time (e.g.
Reeker & Ensing, 1998), nondirective play therapy time (e.g. Hansen, Hecht, & Futa, 1998), and
sharing time to discuss the previous week (e.g. Hiebert-Murphy, DeLuca, & Runtz).
Unlike preschool aged groups, psycho-educational groups predominate for this age range,
emphasizing cognitive and didactic areas (Heiman & Ettin, 2001) in a structured format. The
rationale described by Sturkie (1983) for utilizing a structured group format was that it increased
the ability of the group to cover all themes in a timely fashion, enabled the planful inclusion of
relevant experiential games and exercises, provided less disruption in the group when there was
an exchange of facilitators, and allowed for the training of graduate students in sexual abuse
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treatment. Many groups have been modeled after Sturkie's (1983) original design, as it was one
of the first publicized, structured group treatments to offer specific therapeutic techniques and
instruction (Burkhardt, 1988).
Traditional, latency aged groups are generally time-limited and use a topical format that
does not focus attention on group process issues (Friedrich, 1995; Heiman & Ettin, 2001).
Recently, practitioners have begun incorporating various techniques into the group setting, in
order to assess the efficacy of an eclectic/integrative approach to sexual abuse treatment (Zaidi &
Gutierrez-Kovner, 1995). Heiman and Ettin (2001) presented a short-term, structured group
design that emphasized the utilization of group processes to maximize treatment efficacy.
Corder, Haizlip, and DeBoer (1990) devised a group therapy program that encouraged members
to develop defense mechanisms used by asymptomatic child survivors. Berman (1990) advocated
for the use of a long-term, insight-oriented, structured group format as the primary therapeutic
intervention for children, rather than group therapy remaining as a short-term addendum to
individual therapy. While group therapy is widely accepted as the treatment of choice for
children who have been sexually abused (Friedrich, 1990; Hiebert-Murphy, DeLuca, & Runtz,
1992), researchers and practitioners continue to explore alternative formatting and
conceptualizations for group treatment.
Many therapists of children's groups mentioned in the literature are offering parallel, nonoffending parents groups, as well (Hansen, Hecht, & Futa, 1998; Hyde, Bentovim, & Monck,
1995). Therapists and researchers assert that parental support after disclosure of the abuse is a
major determinant of the impact the abuse has on the child and of the child's ability to progress
in treatment (Saywitz, et. al, 2000; Stauffer & Deblinger, 1996). Parallel groups also assist in the
child's treatment through alleviating parental resistance about discussing the abuse and by
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treating issues of isolation and guilt that may be present for nonoffending parents (Gaines, 1986).
Additionally, nonoffending parents of children who have been sexually abused may often
experience a number of other reactionary, psychological, and physiological symptoms (Stauffer
& Deblinger).
Group Activities By Age
In this section, I have provided some activities for use in group for pre-school and latency
aged children. These are suggestions taken from the literature and are not in any way intended to
represent a comprehensive overview of the possible activities that could be utilized in a group for
children who have been sexually abused. Instead, it is hoped that these suggestions will
encourage you to create some of your own activities or to tailor these to the needs of your group
members.
Pre-School Group Activities
Mitchum (1987) provides several different types of activities that she used in her group
with pre-school girls, two of which were Pass-It-On and Cradle Rocking. In Pass-It-On, a touch
is passed around the circle to the other group members in succession (or a handshake, pat on the
back, etc.). In Cradle Rocking, each child takes turns sitting on a blanket that the group is
holding. The child is rocked in the blanket while the group sings,“Rock-A-Bye (with the child’s
name here)”. Obviously, this last activity would need to be heavily supervised to avoid any form
of injury to the participants.
Fowler, Burns, & Roehl (1983) discuss how they have children play house in group. The
children are told to focus on the good things that parents do for their children. Some examples
include singing to them or reading a story. In this activity, each of the children gets a turn to be
both a parent and a child.
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20
Latency Group Activities
The Point System. Scott (1992) discussed the utilization of a point system in his group
for boys, in order to control some of the acting out behaviors evidenced in the group. Each week,
boys would gain points for following the group rules and once the total group score was high
enough the group would earn a pizza. This activity reportedly let the boys experience positive
competition to get the most points, while still emphasizing the collective whole.
Indirect Communication. Berman (1990) described using indirect methods to discuss
difficult topics with the female members of her group, such as puppet shows, dramatic scripts,
contests, and novel games. These activities reduced the children’s anxiety about talking about
serious issues and were especially useful in the beginning stages of group when relationships
between members had not yet formed.
The Hat Game. Zaidi and Gutierrez-Kovner (1995) used the “Hat Game” as a way to get
their latency aged, female group members to open up about the details of their abuse experience.
Questions about the specific experiences and the child’s thoughts and feelings about the
experiences were put on slips of paper in the hat. As the hat was passed, a question was pulled by
a member who read the question, answered it and then passed the slip of paper around the circle
until each member had answered that question. At that point, another question was drawn from
the hat.
“What Would You Do If..”Game. Zaidi and Gutierrez-Kovner (1995) also utilized the
“What Would You Do If..” Game which was previously described by Hart-Rossi (1984). In this
game, group members responded to a variety of hypothetical situations that they could face in the
future. Topics included: sexual advances, physical abuse, birth control, drug/alcohol use, etc.
This activity was placed in the prevention education portion of the group format.
© 2003 CDHS/Research Foundation of SUNY/BSC
21
Group Naming. Another technique used by Zaidi and Gutierrez-Kovner (1995) involved
letting the group members create a name for the group. This was used as a bonding exercise in
the first session and reportedly also increased participant comfort with the group environment. At
the end of the group, the leaders provided each member with a small gift that represented the
name of the group (Ex. The Teddy Bears group members were given small teddy bears).
Emotional Charades. Hansen, Hecht, and Futa (1998) discussed the use of “Emotional
Charades” in their latency group. In this game, each child is given an emotion to act out. At that
point, the discussion focuses on how to recognize this emotion in other people.
5 Week Drawing. Sirles et al. (1988) described a 5 part drawing exercise that they used
over a 5 week period with their group. Each week, the children were asked to draw a picture
depicting one of the following questions: Week 1). What it was like before the abuse, Week 2).
What it was like the first time it happened, Week 3). What it was like during the time you were
abused, Week 4). What it was like when you told someone, and Week 5). What you think your
future will be like. Directions were left as vague as possible to allow the children to draw exactly
what they were feeling. If time allowed, the children were asked to act out their drawing in some
manner (ex. Through a puppet show or a play using peers as actors).
The Inside Me and The Outside Me. Focusing on the theme of bodily integrity, Burkart
(1988) created an exercise called “The Inside Me and the Outside Me”. In this exercise, the
children were to draw two pictures, one of how they appeared to other and one of what they
really were. The children then talked to the group about their drawings.
The Feelings Cube. “The Feelings Cube” was used by Zamanian and Adams (1997) in
their group with latency aged boys. An emotion was written on each side of the cube. Each
member of the group rolled the cube and told a story of a time when they had experienced the
© 2003 CDHS/Research Foundation of SUNY/BSC
22
emotion listed, then acted out the emotion, and took questions from the group members and
leaders about their experience with that particular emotion.
© 2003 CDHS/Research Foundation of SUNY/BSC
23
Group Counseling Services for Children in the Buffalo Area
Child Advocacy Center of Buffalo
Edward Suk, Director
556 Franklin St.
Buffalo, NY 14202
716-886-5437
Lutheran Service Society
Michael Cabalero, Director
6680 Main St.
Williamsville, NY 14221
716-631-9212
© 2003 CDHS/Research Foundation of SUNY/BSC
24
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