Rethinking the routine provision of psychotherapy to children/adolescents labeled “sexually abused”.

Abstract

Abstract Whether symptomatic or asymptomatic, children labeled sexually abused are routinely offered treatment at considerable financial cost. One result of this is that mental health professionals are being charged with exploiting the problem of child sexual abuse (CSA). Is the routine provision of psychotherapy for children and adolescents labeled sexually abused warranted? In this paper, it is argued that the evidence indicates it is not warranted. Further, its provision is not in the best interests of either the children or mental health professionals. It is argued it is time to rethink the routine provision of psychotherapy to children and adolescents labeled sexually abuse. A number of recommendations are given which follow from the evidence. Keywords: sexual abuse, child sexual abuse, therapy, trauma, children. Introduction Whether symptomatic or asymptomatic, children and adolescents labeled sexually abused are routinely provided psychotherapy. A 1986 nationwide survey of sexual abuse treatment programs found that in most settings nearly every child/adolescent labeled sexually abused was put in treatment (Beutler, Williams & Zetzer, 1994; Macdonald, Higgins, & Ramchandani, 2006). Finkelhor and Berliner (1995) estimated that among substantiated cases of child sexual abuse (CSA) up to 73 percent receive treatment. A 1996 report of the National Institute of Justice (NIJ) indicated that up to 50 percent of the victims of CSA receive treatment (Miller, Cohen & Wiersema, 1996). This compares with the no more than 4 percent of victims of other crimes. It is, then, common practice to place children and adolescents labeled sexually abused in therapy regardless of whether or not they evidence symptoms. A. A Lucrative Form of Practice Providing psychotherapy is quite lucrative. According to the NIJ, the average cost of mental health services for the typical victim of CSA was nearly sixty times greater than that for the victim of another crime ($5,800 vs. less than $100). In the now infamous Manhattan Beach case, also identified as the McMartin day-care case, the Children's Institute International interviewed about 400 children from late 1983 through 1984. It received $455 for each of the interviews (Nathan & Snedeker, 1995, p. 83). Moreover, the California Victims of Crime Fund will have paid at least $200,000 to a handful of therapists for therapy for the accusers of Dale Akiki (Cantlupe & Hasemeyer, 1994). This occurred despite the fact that experts had testified at trial that the interviews of the children by these very same therapists were experimental, unproven, and had contaminated the children's statements. Akiki was acquitted. He had spent two and a half years in prison prior to trial. One can add to this the cost of treating adults who recalled abuse during treatment through the recovered memory therapies. In Washington State's Crime Victims Compensation Program, the average cost associated with treating adults whose claims were based on repressed memory (RM) of childhood sexual abuse was approximately four times the average cost of other mental health claims (Loftus, 1997; Parr, 1996). average cost of non-RM claims was less than $3,000. average cost of RM claims was more than $12,000. In just more than four years, the citizens of Washington paid out to mental health professionals more than 2.5 million dollars for 325 RM claims. recent child abuse scandal in the Catholic Church has proven to be a multimillion dollar bonanza for therapists. Alleged victim treatment costs were at least thirty million dollars (Terry, 2004, Table 6.1.1, p. 105). Thus, providing psychotherapy to children and adolescents labeled sexually abuse is a lucrative form of practice for mental health professionals. B. Exploitation by the Mental Health Industry or The of Abuse As a consequence, critics, both professional and lay, have charged mental health professionals with exploiting the problem of CSA. …