Art therapists' approaches to the treatment of body image distortion and guilt in sexually-abused girls ages 4, 8, and 13




Marrion, Leslie Virginia

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(Finkelhor, 1986; Haugaard & Dickon Reppucci, 1988) have concluded that there is insufficient information on how to treat child sexual abuse (CSA). The reported incidence of CSA has substantially increased, hence, the need for treatment approaches has escalated. The purpose of this study was to provide clinicians who treat CSA with a descriptive account of the methods currently used by art therapists to treat sexually-abused children of differing ages who present with different issues. One hundred and forty-six certified and/or diplomaed art therapists, aged 26 to 66, who had training and experience in CSA treatment were solicited through the national art therapy associations in Canada and the United States. They responded to case-simulation surveys which consisted of a case history, photograph, and self-portrait of a hypothetical sexually abused girl aged 4, 8, or 13 who presented with either the issue of body image distortion or guilt. Open-ended or multiple choice research questions on the art therapist's treatment approach, choice of media, directives, use of time, use of therapeutic interactions, use of debriefing process, opinions on the function of art in the session, and method of evaluation were utilized to obtain a qualitative description of the art therapy approach to working with a child of a certain age presenting with a particular issue. A content analysis of the qualitative data resulted in the identification of thematic categories which described the goals, directives, debriefing process, and the function of art in the session. The responses to the questions on time use and media were analyzed similarly. The frequency of responses for the multiple choice answers and the thematic categories were calculated and then compared across the age and issue variables, in the form of percentages. A comprehensive clinical description of the art therapists' approaches to CSA treatment was obtained for the whole sample, and across age, and issue. The subjects' responses were paraphrased to illustrate these differences for each question. The main findings were: (a) art therapists addressed the main issues of CSA, as described by traditional verbal therapists (Sgroi, 1982), and employed both directive and nondirective styles in their approaches; (b) art therapists were sensitive to the developmental level of the child depicted in the case simulation and adapted their approach to meet the child's needs (i.e., the sessions with younger children were characterized by different media choices, and directives, the therapists spent more time being supportive and nurturing, provided physical contact, snacks, used art-as-therapy, spent less time discussing and more time playing and doing, allowing the child to work out her issues through using her body and the media whereas with the adolescents, art was used as psychotherapy and catharsis more frequently and discussion and debriefing were utilized to help change her thinking about the abuse experience), (c) art therapists responded differently to the body image distortion and guilt case simulations (i.e., activities designed to solicit representations of feelings and of the offender were more frequently reported for the guilt case simulations while self-portraits and safe places were more frequent in the responses to the body image distortion case simulations, and (d) the findings on the function of art in treating CSA replicated the earlier study by Marrion, Landell, and Bradley (1988). This study provided a clinical description of art therapists' approaches to treating CSA. It illustrated the function of the art directives, the use of media, the debriefing process, and the art products themselves. The descriptions of these may aid clinicians in understanding how this sample of art therapists worked with sexually-abused children and may prompt them to undertake training in this discipline as a way broadening their approach to working with sexually-abused children.



Child sexual abuse, treatment, Child sexual abuse, psychological aspects