Dramatic changes

There is now no doubt that childhood sexual abuse, particularly
if it occurs during the child’s early developmental years or is
intrafamilial, causes damage to attachment processes.¹
Recent studies by neuro-scientists such as A N Schore have shown
that the main function of attachment is to assist children in
regulating their emotions, so it follows that damage to these
processes can have serious and lasting effects.²

Children with abusive carers may fragment their own personality as
a coping mechanism in order to survive, and the psychiatrist J L
Herman states that this fragmentation prevents the integration of
identity. Many of these children will, in later years, be given the
diagnosis of “borderline personality disorder”.³

Children with behavioural difficulties are frequently referred to
professionals in social work or the health services. Some of them
will have suffered abuse or neglect during their developmental
years. Sexual abuse, in particular, may have caused difficulties
with attachment relationships. Therapy which forms an attachment
relationship and simulates the stages of development that have been
distorted or neglected in the child may thus give that child a
chance to regulate their own emotions.

Carers can then support such children in changing their entrenched
behaviour without the necessity for medication or other intrusive
treatment. To test this hypothesis, research was carried out with
children and their carers.

Creative therapists (art, music and play therapists, drama
therapists and psychodramatists) often use a Morenian theory of
child development which states that infants progress through three
stages: first they find their identity through their feelings;
second they recognise themselves as separate from others,
especially their main carer; and third they recognise others and
can relate to them.

Clearly, if there is a disturbance in this process or, if their
feelings and identity are denied (as in most kinds of abuse and
neglect) they will be unable to understand who they are and what
they feel.

Many child observers have noticed that in the interaction between a
healthily attached child and a carer there is a mutual creativity
which seems to spark off creative development in the child. This
author hypothesises that the rationale for the use of creative
therapies with sexually abused children is contained in the
following:

• Therapy must repeat developmental processes in a positive
  way.
• Treatment must address physical problems by using therapy which
  involves the body.
• Therapy must feel safe and familiar. There must be no
  re-traumatisation so the use of metaphor and symbolism is essential
  to contain frightening or dangerous feelings.

I ran two research groups with social work and mental health
colleagues at children’s charity NSPCC. One was for children aged
eight to nine and one for those aged nine to 11. The groups lasted
15 and 20 weeks respectively. The children and their carers were
assessed, before the group, in short play sessions. Parents and
teachers completed behavioural questionnaires regarding the
children. The children themselves completed forms to measure their
self-esteem and locus of control. The children also completed a
“sociometric game” to look at their relationships.

Boys and girls were included in both groups. All were suffering
post-traumatic stress disorder and had some attachment problems.
Each group session began with interactive physical games, followed
by puppet sessions in which the children expressed feelings and
told stories. Thus the children were “warmed up” to the action
which followed after the break. This always consisted of art work
(painting or clay) or drama. The final part of the group session
consisted of discussion or sharing and sometimes included dance or
rhythmic movement which the children initiated themselves.

The children devised their own drama sessions and often
spontaneously acted out stories which had elements of fairy tales
but also included scenes of terror which may have echoed their own
experiences. In the second group one girl wanted to “act out her
dreams”. She was referring to “flashbacks” – dissociated episodes
in which she re-experienced terrifying moments from her abuse. The
children were enthusiastic about this idea and over several weeks
all of them acted out 10-minute scenes which they continued to
describe as dreams.

To prevent re-traumatisation I asked a staff member to play the
abused child in each enactment so that the child could watch the
action “in mirror”. Each child spontaneously created a story which
was a fairly obvious metaphor for the abuse which they had
suffered. For instance, one girl who had been abused by a sibling
created a volcano which erupted, killing some members of the family
and injuring others, a powerful metaphor for the disruption which
is caused in such families. The “dream sequences” were followed by
reparative scenes in which the child was able to change events and,
in particular, to call upon others who had not been present when
the abuse occurred.

During the sessions the staff members were encouraged to “double”
children by speaking aloud some of the feelings which their bodies
seemed to be expressing. This technique helped the children to
locate feelings within their bodies, to pay attention to them and
to express them appropriately.

Staff also “mirrored” children in the dream sequences and also at
other times when it seemed helpful to allow a child to see how they
were behaving. Role play came naturally to the children and often
they would ask to play powerful roles such as policemen or judges
so that they could punish their abusers. So the three stages of
child development – identification of feelings, acquiring
self-identity and acquiring empathy with others – were echoed in
the group.

The self-esteem tests were repeated at the end of the group, and
all the children showed improvement, with their locus of control
more evenly balanced. Parental and teacher opinions on the
children’s behaviour were favourably expressed as they completed
the questionnaire again. Each child repeated the sociometric game
and seemed more comfortable within their own social and family
circle.

The comments from children themselves were vitally important in
this qualitative research.

Typical of these is a remark by one girl: “I can sort things out
myself now”, and by another, “I’ve started to get better, I don’t
have nightmares now”. Comments from parents ranged from: “He is
coming out of himself, he’s got more friends now”, to “the group
was magnificent, she stands up for herself now”.

Included in the research were the results of a survey of three
other creative therapists. Together, their work covered children
from age three to 16 and in different settings, including a
residential hospital. They all felt that children did have the
power to heal themselves and they mentioned the importance of joint
creativity. Two of them mentioned the affinity of their therapy to
play which was “natural” for the children. Two specifically
mentioned the importance of the body in therapy, and all mentioned
the use of metaphor and the importance of safety. All three
mentioned the efficacy of “the mirror effect” in their therapeutic
work.

“The Regenerative Model”, which evolved from the study, is in three
stages: assessment, action and resolution. It can be taught easily
to groups of professionals who already work with children. The
model combines experience and theoretical knowledge, is practical
and allows practitioners to develop their own ways of
working.

It allows for the differences in individual children and may be
adapted for use with disabled children, including children with
learning difficulties. It returns the power of regeneration to the
young person. It seeks to facilitate the process whereby children,
who may have been disempowered time after time, can gain the will,
the strength and the creativity to reclaim their lives.

Anne Bannister is a psychodrama psychotherapist and
child protection consultant.

References

¹ B van der Kolk, “The
complexity of adaptation to trauma”, in B van der Kolk, A
McFarlane, L Weisaeth (eds) Traumatic Stress: The Effects of
Overwhelming Experience on Mind, Body & Society, Guilford
Press, 1996

² AN Schore, Affect
Regulation and the Origin of the Self, Lawrence Erlbaum,
1994

³ JL Herman, Trauma and
Recovery: from Domestic Abuse to Political Terror, Pandora,
1994