Child Sexual Abuse

Abstract:

Child sexual abuse (CSA) is a pervasive problem that significantly impacts many youth and their families. CSA has been associated with a variety of internalizing and externalizing problems for sexually abused youth. However, the effects of CSA are rarely limited to victims, and nonoffending caregivers and siblings often experience distress following the disclosure of abuse. Due to the heterogeneous symptom presentation exhibited by victims of CSA, and the potential impact of CSA on the entire family, it is important for clinicians to use assessment strategies that are multi-method, multi-symptom, and multi-informant. Similarly, treatment planning for sexually abused youth is complicated by the diverse impact of CSA on families, and psychosocial interventions often include victims of CSA as well as nonoffending family members. While several psychosocial interventions exist for CSA, most have not been rigorously examined. However, CSA treatments typically include similar mechanisms for change, such as psychoeducation, anxiety management, exposure, cognitive coping, behavior management, and social support. Due to the complex nature and potential long-term consequences of CSA, it is important for clinicians who work with sexually abused youth to understand and demonstrate mastery levels of clinical competencies in this area. This chapter examines CSA-related clinical issues and describes competencies for addressing the heterogeneous impact of CSA on youth at both the basic and expert level. Competencies discussed include using an evidence-based approach, possessing scientific knowledge of CSA and treatments, case conceptualization skills, building rapport and the therapeutic alliance, treatment planning and monitoring, understanding client characteristics, monitoring legal and ethical issues, evaluating risk for harm to self and others, working with interdisciplinary teams, and understanding the effects of medication on treatment. Methods of mastering these competencies through education, training, experience, supervision, and self-assessment are discussed.