Wednesday, February 25, 2009

A HOPE APPROACH WITH CARE-GIVERS AFTER CHILD SEXUAL ABUSE

RENEWING HOPE:
A FAMILY CARE-GIVER PROGRAM OF HEALING AND MOVING ON

Fourteen years have passed since I started work at the Hope Foundation. I remember wondering what kind of work I would really be doing. I remember thinking that it would be nearly impossible to put a positive spin on the difficult situations we had to confront. I remember wondering what sort of organizations would turn to a place like the Hope Foundation for help with program design and delivery. At the time I had no vision of the depth and breadth of the work and learning that would come my way. Most years a new and interesting proposal would be presented. One year I would be directed toward teachers on disability leave. Another year the focus would shift to family care-givers of people with Alzheimer Disease. There was a year when I worked on hope issues relevant to multiple sclerosis, another year it was ALS. 2008 directed me to a project we called Renewing Hope. It was a place I hadn’t expected to go.
The Renewing Hope program is an excellent example of the valuable work that the Hope Foundation can do. Launched in the fall of 2008, it is a collaboration between Zebra Child Protection Centre and Hope Foundation. Zebra provided the participants and the funds, we provided the hope program.
The participants were FAMILY CARE-GIVERS going through the court process that resulted when their children reported sexual abuse. The program was a 2-part, 12-session psycho-educational and peer support class to help non-offending family members connect with supportive peers, rebuild hope, deal with troubling issues and move forward. At the end of the program all participants wrote that the program had been either helpful or very helpful in meeting all four of its stated objectives.
Zebra Child Protection Centre is a program of coordinated child-focussed services that provides a safe and supported environment where the child can be interviewed by police. Zebra staff and volunteers then guide parents on an individual basis through the steps of the court process. Zebra wanted professional help to deliver a group support/counselling program for family care-givers. In this case, all were parents. Executive Director Barb spencer targeted Hope Foundation as one potential service provider because she believed that hope could be integrated in a useful way.
We were unable to find descriptions of any previous hope-focussed programs for this target group. In fact, the literature we read focussed on the negative effects of sexual abuse and the need for group support. Little attention was given to the notion that things could turn out okay despite the terrible things that had happened. With the conviction that hope had a legitimate place alongside the reality of the situation, fellow hope counsellor Rachel stege and I set out to plan a program that would be hope-focussed and supportive. We would have 8 2-hour weekly sessions followed by 4 less frequent 2-hour sessions.

EXPLORING CARE-GIVER NEEDS IN THE CONTEXT OF CHILD SEXUAL ABUSE

While much attention has been given to the needs of child victims of sexual abuse, there has been less focus on the needs of the caregivers of these children. It has been shown, however, that non-offending parents experience distress following disclosure of child sexual abuse, whether the offense is intra-familial (Lovett, 2004; Massat & Lundy, 1998) or extra-familial child sexual abuse (Davies, 1995; Elliott & Carnes, 2001). Researchers have identified the need for clinicians to “expand their treatment focus beyond the child victims to the traumatized families” (Manion et al., 1996, p. 1105). Furthermore, literature in the area of child sexual abuse suggests that addressing the needs of non-offending parents may not only prove beneficial to the parents but could lead to improved adjustment in the child victims as well (Elliott & Carnes, 2001).
When families are forced to deal with child sexual abuse, hope for a positive future for their child and their family can be severely threatened. Group treatment has been demonstrated to be beneficial for parents of children who have been sexually abused (Deblinger, Stauffer, & Steer, 2001; Winton, 1990). In fact, when describing recovery factors for parents, Grosz, Kempe, and Kelly (2000) identified that in cases of extra-familial sexual abuse, a support group for parents “offered a lifeline during a time when many parents described feeling isolated and cut off from normal support systems” (p. 18). Studies have further indicated that therapy with a hope focus can effectively be delivered in group settings (Cheavens, Feldman, Gum, Michael & Snyder, 2006). In addition to being cost effective, groups are able to “provide a natural laboratory that demonstrates to people that they are not alone and that there is hope for creating a different life” (Corey & Corey, 2006, p. 5). In exploring distress and coping abilities of parents after disclosure of extra-familial sexual abuse, Davies (1995) provided several intervention recommendations for families, including a parent support group.
Because Rachel and I planned to make hope very explicit in our work with the parents referred by Zebra, we proposed a hope-focussed process guided by hope-focussed tools (Edey, Larsen & LeMay, 2005; Larsen, Edey & LeMay, 2007). Each 2-hour session would (a) allow time for participants to talk about their issues and (b) require them to participate in at least one hope-focussed activity. We would focus on our four stated objectives, helping participants connect with supportive peers, rebuild hope, deal with troubling issues and move forward. Once the plan was in place and funding secured, Zebra referred participants to the group. They also enrolled Janet, an experienced Zebra volunteer who expressed interest in being part of the process. We invited her to participate fully in whatever way felt comfortable for her.

HOW THE PROCESS WORKED TOWARD THE OBJECTIVES

Rachel and I drew on our knowledge and experience using a hope-focussed approach and hope tools with individuals and groups. We identified specific strategies we would use in each session. We communicated openly with each other during the sessions and made joint decisions about when it was time to switch from the problem discussion to the hope-focussed activity. Janet helped all of us by showing tremendous enthusiasm for the hope activities. Her full participation established an atmosphere of trust and cooperation. We kept process notes as we went along.

Connecting With Supportive Peers
We looked for ways to draw the participants together in a hopeful context. This would mean doing more than simply sharing their stories of hurt and struggle. In fact, our participants found it difficult to share their stories. It is likely that every parent whose child reports sexual abuse is filled with horror and a guilty feeling that more should have been done to prevent the abuse. Our group was small and the participants were very stressed. Each was wrapped up in an individual story. Conversation occurred in diads between participants and leaders. In the early sessions we did not take overt steps to establish communication between them. They did not seem very connected to each other by the end of the second session. Indications of true connectedness began to appear after we made hope collages in the third session.
Wherever possible the leaders participated fully in the hope-focussed activities. Hope collage is a good example of this. People in the group reflected on hope, flipped through magazines, cut out pictures and made a collage. Since the collages were not focussed on the consequences of sexual abuse, they showed people in a more natural way, their interests and passions, their hobbies, their aspirations. We learned about passions for travel, for figure skating, for jewelry making. Now people saw things to admire. They could talk together about things other than the problem.

Other activities also helped make connections between them. We mapped out the participants’ experience with helpful resources in session 6. This exercise generated a lot of information they could share with each other. We worked at making hope kits in sessions 8 and 9. Hope kits are personal collections of objects that the collector associates with hope. They act as reminders of hope, and can play the role of first-aid kits, helping you respond to a crisis. Like the hope collages, the hope kits helped the participants get to know each other in a broader context of being fully human.
For the final meeting, session 12, we planned a forthright activity that encouraged people to openly support each other. Every member in the group made tags for the other members beginning with the stem: This is what I appreciate about you.
There were clear signs that connectedness was increasing. As time went on we noticed that participants would stand chatting on the street before getting into their cars. They brought brochures and videos to lend to others. People hung back at the close of the final session. Nobody seemed to want to leave.

Rebuilding Hope
Rachel and I are experienced in talking about hope in a variety of difficult circumstances. We take the position that you can view hope alongside reality and still have both. We believe that things can turn out better than we sometimes expect, that impossible things can become possible, that people find comfort in discarding old hopes and exchanging them for new ones.
In planning the program we had made the assumption that participants’ hope would have been threatened by their circumstances. In fact, all participants found it extremely difficult to speak explicitly about hope. To make it a little easier, we began with a practical working definition from the hope research literature. Hope can be defined as “a process of anticipation that involves the interaction of thinking, acting, feeling and relating, and is directed toward a future fulfillment that is personally meaningful” (Stephenson, 1991, p. 1459). With that definition in mind, participants unanimously said they did not feel much hope. They were simply coping.

We guided them through a process of stating personal hopes. We asked, What do you hope will happen? What do you hope to do? What kind of person do you hope to be? They found this difficult. Hope, used as a verb, is an active, emotional word. Other emotions dominated their awareness. They had fears about recrimination from the accused, about their child’s mental health and sexual orientation. They had regrets about exposing their children to dangerous people. They had angry thoughts about the loyalty of family members and a desire for punishment. They had present pressing worries about the behavior of their children.

In this atmosphere of fear, regret, anger and worry we persisted in our quest for personal hopes. By the end of session 2 we had documented six personal hopes, at least 1 from each participant. I hope to have peace. I hope to have a life beyond the mother role. I hope to build safe relationships. I hope to get through the court process. I hope the accused will be punished. I hope my child will be okay.

For the first six sessions we didn’t talk much about the future. The focus remained in the realm of getting through the court process and dealing with fear. Then, in session 7 we played a time machine game, projecting ourselves into a near or distant future. Participants were able to imagine elements of good future for themselves, but we could still feel the burden of residual stress in the room. We reverted to focusing on the present.

In session 12 we asked participants to express hopes for future participants. When they seemed to have difficulty, we modeled by expressing our hopes in sentences beginning with “I hope”. Ultimately they did not focus on expressing specific hopes. They turned to words of comfort and reassurance instead.

 to feel – What you’re feeling is natural.
 Take comfort in knowing you are not alone!
 Ask the questions & Do not fear.
 I hope you grow comfortable enough to share. You are in a safe place.
 Take one day at a time. The sun will come.
 It’s not your fault!
 You’re doing the best you can.
 Share your story. You will be heard.
 Know that you are not alone. Take hold of any hand that is extended to you.

In general, the process of making hope explicit in this group was more difficult than we leaders had anticipated it would be. We were surprised when participants said the program had been helpful in renewing their hope. We contented ourselves with the knowledge that attendance was consistent, all participants said the group was valuable and all said they would recommend it to other parents.

Dealing With Troubling Issues

We began the process knowing we would be dealing with troubling issues and agreeing that we would make time to resolve issues that could be resolved. By the end of Session 3 we had identified three particular issues that could provide an educational focus for the group: understanding the steps in the court process, applying for financial assistance and writing victim impact statements. Our Zebra volunteer was very knowledgeable about these details. She played an active educational role as we focussed on these topics in sessions 4, 5 and 6. This was a time of learning for Rachel and me. We became students along with the participants.

Moving Forward

We could see the importance of support and strength after a child reports sexual abuse. The wheels of court grind very slowly. Years can elapse between the first disclosure and the final sentencing. Our program began in mid September and ended in early January. All of the participants were in the process when the group began and were still in it when the group ended. Rachel and I didn’t see anyone through the whole process.
Fear was a pervasive issue. We talked about fear in almost every session, less near the end. We fought fear with accurate information about the court process. We fought it by allowing it to be expressed openly. When we saw an opportunity, we tried to replace a stated fear with a stated hope. For example, if we were talking about the fear that the accused would retaliate upon being released from prison, we talked about the fact that he was in prison now, and the hope that he would be there for a long time.

Our main weapon against fear was strength, and we tried hard to recognize it, build it and reinforce it. In session 5 we named things they appreciated about their children. In session 6 we mapped out helpful and supportive resources. In session 10 we administered a personal strengths test (Seligman, 2002) and talked about the meaning of the results. In session 11 we reviewed the strengths and resources named in other sessions. We were happy that many of the appreciation tags written in session 12 acknowledged strength.

FINAL NOTES

In summary, we were very happy with the results of this program. The participants expressed satisfaction. Janet and the Zebra staff said they noticed a change in the participants. We had the satisfaction of using a hope-focussed approach to create an environment of hope and strength with highly stressed people under circumstances that were extremely daunting. Zebra allocated funding to support future Renewing Hope programs for parents. Noting the need for a more comprehensive educational process, Janet worked with Zebra to establish an on-going timely educational program that could teach parents about the court process, victim impact statements and obtaining financial assistance.
For me there remains one important outstanding issue. Perhaps it is really a wish. I wish that we professional helpers would make more of an effort to collect evidence of recovery and wellness. We could make it available to our colleagues as an external source of hope to help them feel hopeful when they work with their clients. We could make it available to care-givers as they go through the court process.
Hopeful evidence would clearly establish the possibility of a light at the end of the tunnel.
It would have been hope-inspiring for these parents to learn that some children grow up healthy and happy after reporting sexual abuse. The resources we found did not offer this. When professionals prepare resources, they tend to focus on the problem. The hope, they imply, will come through the professional help. Professional help and group support are indeed important. But the professionals providing the help need the factual grounding of knowing that things have been okay in other circumstances.
Lacking factual material to inspire hope, Rachel and I built a program using the hope tools to bring out the hope and strength of the group. The process was effective because the hope tools are reliable and we have experience in using them. Working as a team we could ground each other. That said, the work would have been easier with external hopeful resources on childhood sexual abuse to support the hope work we were doing.

REFERENCES

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Corey, M.S., & Corey, G. (2006). Process and Practice Groups. (7th Ed.). Toronto, ON: Thomson Brooks/Cole.

Davies, M.G. (1995). Parental distress and ability to cope following disclosure of extra-familial sexual abuse. Child Abuse & Neglect, 19(4), 399-408.

Deblinger, E., Stauffer, L.B., & Steer, R.A. (2001). Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment, 6(4), 332-343.

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Massat, C.R., & Lundy, M. (1998). “Reporting costs” to nonoffending parents in cases of intrafamilial child sexual abuse. Child Welfare, 77(4), 371-388.

Seligman, M.E.P. (2002). Your Signature Strengths. In Authentic Happiness: Using the new positive psychology to realize your potential for lasting fulfillment (pp. 134-161). Toronto, ON: Free Press.

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