1. Running head: GROUP THERAPY ABUSED CHILDREN 1
Lenia Smith
Group Therapy for Sexually Abused Children
Argosy University
August 2013

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Abstract
Sexual abuse is one of the most perplexing and confusing problems facing families. Those that
should be protecting their children are either the perpetrator or oblivious to the fact that their
child is being sexually abused. So what should be done? The number of families affected by
sexual abuse is heart breaking. According to the American Association for Marriage and Family
Therapy, 2012, 1 out of 4 girls and 1 out of 5 boys are sexually abused by the time they are 18
years of age. Child abuse occurs at every socioeconomic level, across ethnic and cultural lines,
within all religions and at all levels of education (Swan, 1998).Treatment of child sexual abuse is
a complex process; however, research suggests that group therapy for abused children is
effective however the impact of group therapy for sexually abused children requires more
research; therefore, this paper will further explore the research on sexual abuse among children,
the signs and symptoms of sexually abused children, the nature of therapy with children who
have been sexually abused, the aspects a counselor should consider when working with sexually
abused children and most importantly the benefits of group therapy for those who have suffered
from sexual abuse.

3. 3GROUP THERAPY FOR SEXUALLY ABUSED CHILDREN
Group Therapy for Sexually Abused Children
No one really wants to talk about it. No one wants to hear about; in fact, many pretend as if it
doesn‘t exists- even if it is taking place in their very own home. They wear blinders when it is
very clear what is going on. Most people do not want to believe that it is usually a close relative
or a close friend, but the truth is loved ones can destroy and interrupt homes to the point that it is
unbearable and those who do know it exists pretends it does not and only hope it will stop
eventually and as a result, the victim suffers faces their demons alone and for eternity. A reader
may ask, ―What is this author talking about?‖ What is she hinting to?‖ The answer is child sexual
abuse. The American Association for Marriage and Family Therapy (2012) gives a clear
definition of sexual abuse. It describes sexual abuse asany sexual contact between an adult and a
child defined as touching with the intention of sexually arousing the child; for example, kissing,
or fondling in a sexual or prolonged manner, oral genital contact, sexual intercourse or manual
stimulation. Furthermore, any behavior that is intended to stimulate the child sexually, or to
sexually stimulate the abuser through the use of the child, including showing the child erotic
materials like pornographic films or magazines, taking still shots of the child in a sexual manner
or talking sexually to the child (American Association for Marriage and Family Therapy, 2012).
Sexual abuse is one of the most perplexing and confusing problems facing families.
Those that should be protecting their children are either the perpetrator or oblivious to the fact
that their child is being sexually abused. So what should be done? The number of families
affected by sexual abuse is heart breaking. According to the American Association for Marriage
and Family Therapy, 2012, 1 out of 4 girls and 1 out of 5 boys are sexually abused by the time
they are 18 years of age. Child abuse occurs at every socioeconomic level, across ethnic and
cultural lines, within all religions and at all levels of education (Swan, 1998). Furthermore, the

4. 4GROUP THERAPY FOR SEXUALLY ABUSED CHILDREN
overwhelming majority of these children are abused by someone they know; for example; as
previously mentioned, a family member, a close friend, a member of clergy, or a youth leader.
Overall, it is typically someone they know and trust (Swan, 1998). Most would agree that child
sexual abuse is a painful and traumatic event that has torn families apart. However, therapy for
families who have been impacted by sexual abuse can help them heal from the pain and find the
pieces to help them re-build their lives and most importantly, help them create coping skills to
assure no further abuse will ever happen in their families again, and hopefully for generations to
come (Swan, 1998).
Treatment of child sexual abuse is a complex process; however, research suggests that
group therapy for abused children is effective however the impact of group therapy for sexually
abused children requires more research; therefore, this paper will further explore the research on
sexual abuse among children, the signs and symptoms of sexually abused children, the nature of
therapy with children who have been sexually abused, the aspects a counselor should consider
when working with sexually abused children and most importantly the benefits of group therapy
for those who have suffered from sexual abuse.
Sexual Abuse among Children:
According to the American Academy of Child and Adolescent Psychiatry (2011), child
abuse has been reported up to 80, 000 times per year, but the numbers of unreported instances
are far greater because the children are afraid to tell what happened. Many may question, who is
vulnerable to child sexual abuse? All children are vulnerable to sexual abuse but there are some
risk factors that make some children more vulnerable than others; for example, the age of the
child, the socioeconomic status of the child, and the relationship to the offender. The most

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vulnerable age for a victim is preschool children (Brenna, 2006). Preschoolers are more in need
of supervision, especially when dealing with daily activities such as bathing and changing
clothes; these activities open the door to sexual abuse by the caregivers, relatives, babysitters,
and other individuals who come into contact with these children.Low socioeconomic status is
another factor that contributes to the vulnerability of children (American humane association,
2002). In other words, low socioeconomic status is correlated with other variables such as single
parenthood, lower education, parental stress and depression, and marital conflict.Lastly, the
relationship the child has to the offender also plays a role in the vulnerability of a child
(Ramono&Rayleen, 1996). Abuse usually occurs over a long period of time and there is a close
relationship between the victim and the offender (Ramano&Rayleen, 1996). Moreover, the
perpetrator usually targets their victim for months and ―grooms‖ the victim to gain their trust. As
previously mentioned, the victim is typically victimized by someone they know and trust and
unfortunately because of the nature of their relationship, this prohibits the child from speaking
out. In some cases, sexual abuse is routine and expected from the child. In other words, the child
is unaware that he or she is being abused because of the trust they have in the abuser.
A child five years or older who knows and cares for the abuser becomes trapped between
affection or loyalty for the person and If the child tries to break away from the sexual
relationship, the abuser may threaten the child with violence or loss of love. When sexual abuse
occurs within the family, the child may fear the anger of the other family members, or be afraid
the family will break up if the secret is told (Child abuse prevention, 2010).No child is
psychologically prepared to cope with repeated sexual stimulation. Even a two or three year old,
who does not understand the damage that is being inflicted upon them, will develop problems
resulting from the inability to cope with the overstimulation (Brenna, 2006).

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Nancy Swan (1998) states, ―A child who is the victim of prolonged sexual abuse usually
develops low self-esteem, a feeling of worthlessness and an abnormal or distorted view of sex.
The child may become withdrawn and mistrustful of adults, and can become also become
suicidal. She further states ―Some children who have been sexually abused have difficulty
relating to others except on sexual terms. Some sexually abused children become child abusers
or prostitutes, or have other serious problems when they reach adulthood (Swan, 1998)‖.
Signs and Symptoms of Sexually Abused Children:
Child abuse is more than bruises and broken bones. While physical abuse might be the
most visible, other types of abuse, like sexual abuser can also leave deep, lasting scars.Thinking
of what the signs and symptoms of sexual abuse may look like can be a little difficult;especially
since the presence of a single sign does not prove sexual abuse is occurring in a family.
However, the United States Department of Health and Human Services (2007) lists the following
signs that can be strong indications that sexual abuse is occurring, or has occurred, for instance;
if the child shows a sudden change in behavior or school performance, or has learning problems,
for example concentrating that cannot be attributed to specific physical or psychological causes.
Another sign is if he or she lacks adult supervision, is overly compliant, passive, or withdrawn,
comes to school or other activities early, stays late, and does not want to go home (U.S.
Department of Health and Human Services, 2007). Further signs of sexual abuse to consider are
if the child has a difficulty walking or sitting,suddenly refuses to change for gym or to participate
in physical activities, reports nightmares or bedwetting, experiences a sudden change in appetite,
demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior, becomes pregnant

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or contracts a venereal disease, particularly if under age 14, runs away orreports sexual abuse by
a parent or another adult caregiver. Furthermore, other possibilities to consider is if the parent or
caregiver is unduly protective of the child or severely limits the child's contact with other
children, especially of the opposite sex, is secretive and isolated, and or is jealous or controlling
with family members (U.S. Department of Health and Human Services, 2001). Aside from the
physical damage that sexual abuse can cause, the emotional component is powerful and far-
reaching. Sexually abused children are tormented by shame and guilt. They may feel that they
are responsible for the abuse or somehow brought it upon themselves. This can lead to self-
loathing and sexual problems as they grow older—often either excessive promiscuity or an
inability to have intimate relations.All types of child abuse and neglect leave lasting scars. Some
of these scars might be physical, but emotional scarring has long lasting effects throughout life,
damaging a child‘s sense of self, ability to have healthy relationships, and ability to function at
home, at work and at school.Furthermore, psychological effects of child sexual abuse include
higher rates of depression, anxiety, eating disorders, substance abuse disorders, post-traumatic
stress disorder, self-mutilation and suicide (American Academy of Child and Adolescent
Psychiatry, 2004) The magnitude of these effects ranges from mild to severe to life-threatening
which requires immediate counseling intervention. If the child goes untreated he or she may have
a myriad of problems that could not be reversed. A survey conducted by Benjamin Sounders and
his colleagues found that children who were victims of physical sexual abuse were more likely
than non-victims to meet the DSM IV diagnostic criteria for a major depressive episode,
agoraphobia, obsessive compulsive disorder, social phobia and or sexual disorders (Sounders,
2000). Moreover, the long-term emotional and psychological damage of sexual abuse can be
devastating to any child which is why intensive therapy such as group therapy is warranted.

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The Nature of Group Therapy amongst Sexually Abused Children:
Before discussing the nature of group therapy for sexually abused children, this paper
will briefly discuss the nature of group therapy alone. Group therapy is a counseling group that
is usually comprised of 6-8 people who meet face to face with 1 or 2 trained facilitators and talk
about what is concerning them most (Roeb, D. 1998). Members listen to each other and openly
provide each other feedback. These interactions give members; in this case, sexually abused
children, an opportunity to increase understanding, try out new ways of being with others and
learn more about the ways they interact. The content of group sessions is confidential; members
agree not to identify other members or their concerns outside of group (Roeb, D. 1998). In the
case of sexually abused children; before entering into group therapy, the child must acknowledge
their painful experience and accept it as something traumatic that has happened to them
(Wickham, West, 2002 p. 8). Further, if the abuse is not acknowledged and accepted, the child
will invest tremendous energy in minimizing, suppressing, repressing, and attempting to forget
their traumatic experience in order to manage and or cope with and defend the trauma
(Wickham, West, 2002 p.8). Although the child‘s defenses provides a means to survive and cope
with the trauma, they gradually need to be replaced with more adaptive ways of coping and
functioning and group therapy is one way a child can begin his or her healing process.
The courage to face the reality of childhood sexual assault as a society has led to
increased awareness of the problem and skill in identifying its presence. Grotsky, Camerer,
&Damiano (2000) indicate over the past two decades, the demand for therapy for sexually
abused children has increased dramatically and in order to meet the growing needs of the
vulnerably populated children and families the authors and other clinicians have looked toward
the group therapy model for its therapeutic effectiveness and economy (Grotsky, et al, 2000).

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Yolom (2005) effectively defines group therapy in which he stated ―Group therapy methods have
proven to be so useful in so many clinical settings that no longer is it correct to speak of ―group
therapy‖, instead, we must refer to the group therapies‖ (Yalom, 2005, p.486). In other words,
―the group therapies‖ not only offers the advantages of helping those who are less fortunate at a
lower cost, it is believed to be an effective form of treatment for the cognitive, affective, and
behavioral symptoms associated with children who have been sexually abused (Grotsky, et al,
2007). Furthermore, Grotsky, et al (2007) also mentioned that group work with sexually abused
children is not only effective, it is highly rewarding.
What the Counselor Should Expect/Consider:
Corey and Corey (2010) mentions the main goals of a group for abused children is to foster a
therapeutic relationship in which children who have been abused feel safe enough to risk trusting
other children and another adult and in the case of group counseling, ―other adults‖. The group is
designed to establish a safe environment, empower children, and enhance their sense of self
(Corey, Corey 2010 p. 314). Before the group is established, the counselor (group leader) should
complete a screening. The screening is crucial when counseling children who have been abused,
and good timing is essential in choosing group members (Corey, Corey, 2010). Further, the
children must be ready and willing to interact with other children. Corey and Corey (2010)
indicates group counseling is contradicted if the abuse happened recently, if the abuse is still
traumatizing to the child, if the child has serious psychiatric disturbances such as suicidal
ideations, self-mutilation, or severe mood or thought disturbances, or if the child was abused by
more than one person at a time (Corey, Corey, 2010 p. 319). Children who have been abused
deserve opportunities to express their feelings and reactions in a safe and constructive
environment. Group should provide an environment which children are able to break down the

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barriers of isolation, express their inner most struggles, clarify misplaced blame, and generally
feel more comfortable about interacting with others. The authors suggest this is where healing
happens with children who have been affected by abuse (Corey, Corey, 2010 p. 319). Wickham
and West (2002) states consistency in the behavior of the therapists is equivalent to safety and a
prerequisite to successful treatment. Consistency is established by elements such as always being
on time, being reliable, being unconditionally accepting and responsive to the child,
remembering what the child says, the therapist doing what they say they will do, achieving
continuity from one session to the next, being calm and acting in the child‘s best interest
(Wickham, West 2002). Moving forward, some aspects a counselor should consider and look for
when in group therapy for sexually abused children is group members may assume the
problematic roles which may be dysfunctional which may be dysfunctional for them and for the
group; for example, being a scapegoat, the victim, the distracter, the monopolizer, the critical
member, the non-contributor, the disrupter, the martyr, the joker and the needy member. A child
may identify with a certain role, or the group may unconsciously place the role on another
member but it is up to the counselor on how he or she will handle this.
Benefits of Group Therapy for Sexually Abused Children:
In studies comparing group psychotherapy to individual therapy, group therapy has been
shown to be as effective and sometimes even more effective (Flores, 2007). Further, one of the
benefits of being in a group is realizing that although people have many different issues and
varied ways of coping, there are basic struggles that many people share that are intrinsic to being
human. This simple but powerful concept helps to reduce a person‘s sense of isolation and
aloneness. When it comes to the group process, Wickham and West 2002 state the following:

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When the group has successfully sorted out some of the issues of power and
control, it is freed to develop trust, cohesion, and a degree of intimacy, the group
begins to be important to the members, relationships matter, and emotional
investment in ‗Our group‘ develops. Groups emerges (p.140).
Wickham and West gave a wonderful example of what the group process is designed to
be. In the case of abused children, many defenses, when left in place, are maladaptive and result
in dysfunctional behavior as the child matures (Wickham, West, 2002). They also interfere with
the child‘s processing and resolution of developmental tasks, which is a necessary part of their
psychological and emotional evolution. The exploration and process of the trauma in group
therapy is necessary because becoming aware of and experiencing the effective and cognitive
aspects of the trauma helps to lessen dissociative tendencies. Uncovering and exploring
misconceptions about the trauma prevents false beliefs from being repressed (Wickham, West,
2002). Moreover, the returning to the trauma and processing feelings, cognitions, and beliefs
related to the experience would help in making the trauma less powerful and overwhelming. The
therapist and its members can help to contain and soothe one another to strengthen each other‘s
capacity to provide these functions for themselves (Wickham, West, 2002).
Yalom (2005) indicates that a child can benefit from hearing about the experiences of
other children. Group members may provide examples of how other children have reacted to and
coped with abuse and subsequently realize that they are not alone. As a result, the child gains
new insight and he or she gains a new array of coping mechanisms. Furthermore, children have
the opportunity to observe different stages of the healing process and this can encourage them to
anticipate what the future may hold for them. In the group a child may develop friendships, feel
accepted and supported by their peers who increases their esteem and efficacy levels (Wickham,
West 2002).

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As previously mentioned,individuals in group therapy improve not only from the
interventions of the therapist, but also from observing others in the group and receiving feedback
from group members. This writer will further elaborate on the benefits of group therapy as a
whole. According to the University of North Carolina Ashville‘s Counseling Center, the group
format, while not providing the one-on-one attention of individual formats, has several
advantages; for example, participation in the group. The person can control, and are ultimately
responsible for, what, and how much they reveal to the group. The more the person becomes
involved, the more they are likely to benefit. Many people are helped by listening to others and
thinking about how what others are saying might apply to them. Importantly, group therapy is
often more enriching for some than individual therapy (University of North Carolina, 2013). In
the case of children, the child will not feel like a ―special case‖ if they are in a group setting
because it would be revealed that others share similar experiences.A person can benefit from the
group even during sessions when they say little but listen carefully to others. In the group
environment, others serve as ―mirrors‖ in which others can see themselves in others, thus
implementing change (University of North Carolina, 2013). Group members may bring up issues
that strike a chord amongst other members, which the others may not have been aware of; in
essence, some cognitive change may occur (Grotsky, et al, 2000). A natural process or enhanced
acceptance of self and others occurs as one learns to relate more honestly and directly with others
in the group. The group provides an opportunity for personal experimentation - it is a safe place
to risk enough to learn about themselves and others like them (University of North Carolina,
2013).
The University of North Carolina‘s Counseling Center (2013) also mentioned the first
task is to establish an atmosphere of safety and respect; the group leaders are to help the group

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develop an environment conducive to doing the work of personal growth. An important benefit
of group therapy is the opportunity to receive feedback from others in a supportive environment.
The leaders will help members to give positive feedback. Taking a closer look at group therapy
vs. individual therapy, many counseling professionals would agree that groups are often the most
effective method to treat depression and anxiety and in the case of treating sexually abused
children who suffer from depression, also suffer from anxiety can be treated using cognitive
behavior therapy (Simmerman, 2007). Cognitive–behavior therapy (CBT) is a psychological
treatment approach that can be delivered not only on a one-to-one basis but also to groups
(Grotsky, et al, 2000). Lastly,it is common for individuals, especially children to experience
some discomfort over the idea of talking in group initially. This initial anxiety is quite normal as
most individuals have never been exposed to a group therapy environment and don‘t know what
to expect. Within a few sessions members often get comfortable enough to interact in the group
(University of North Carolina, 2013).
Conclusion:
According to Yalom (2005), the child constructs an individual inner world that can be
reconstructed through interactions with others and although some counselors report an
immediate response to group therapy, they should not be deterred by the lack of immediate
response with sexually abused children. Children who have experienced trauma such as sexual
abuse have a very difficult time trusting others because of what they have endured. Therefore, it
is very important for the counselor to be mindful and most importantly readily available for their
healing process to begin.
References

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American Academy of Child and Adolescent Psychiatry. (2011). Child sexual abuse: facts for
families. Retrieved April 18, 2013 from http://www.aacap.org
Barcai A, Robinson EH. Conventional group therapy with preadolescent children. Int J Group
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Brenna, S. (2006). Siblings incest within violent families; children under 12 seeking nurture.
Health sociology Review, 15(3), 287-292.
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http://www.americanhumane.org/children/stop-child-abuse/fact-sheets/child-sexual-
abuse.html
Corey, M. Corey, G. (2010) Process and Practice Groups. (5th ed). Belmont CA: Brooks/ Cole
Grotsky, L, Camerer. C. Daminao, L (2000). Group work with sexually abused children: A
practitioners guide. Thousand Oaks, CA: Sage Publications.
Ramano, E. Rayleen, D. (1996). Characteristics of perpetrators with histories of sexual abuse.
international journal of offender therapy and comparative criminology, 40(2), 147-156.
Roeb, D. (1998). Aspects of group therapy with sexually abused children: Symbolic processing
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Saunders, B. (2000). Risk factors for adolescent substance abuse and dependence data from a

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national sample. American Psychological Association. Journal of consulting and clinical
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Simmerman, J. (2007). Weighing the pros and cons of group therapy: Get the facts about
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py.aspx
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CA: Sage Publications.
Yalom, I. Leszez, M. (2005). The theory and practice of group psychotherapy (5th
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York, NY: Basic Books.
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