Psychotherapy of Abused and Neglected Children
Anyone who treats abused children will be familiar with the feeling of chaos that can be invoked. The child struggles to make sense of the trauma; immediate caregivers wallow in anger and guilt; professionals pull in opposite directions. The therapist, charged with containing it all, reaches for structure in order not to be overwhelmed. This book provides that structure.
To begin with, the book looks good. It is well written, stylish, and clear, with regular tables to summarize its difficult content—the sort of book that invites you to read it. Second, it offers a consistent developmental framework in an area where so many practitioners, and therefore the clients they are trying to help, have no sense of why the child is behaving in a particular way. Third, it is set out in a practical "chronology" that is testimony to the clinical experience of these two authors. They speak from the real world of the therapy room, not from the ivory tower of theory.
A splendid review of background literature sets our understanding in context; schedules for assessing the child and family orient the goals of work; and the chapters on treatment are brimful of creative ideas to encourage the child to share feelings in words and in play when words are too difficult, too dangerous, or too inadequate to tell the story. The final chapters are a recognition that work does not end for the child with the termination of therapy. The child needs coping strategies to deal with life thereafter.
Within this overall "shape," the authors are free to approach the feared material with an appropriate mixture of unanxious directness and gradual, onion-skin-like unwrapping that is the stuff of sensitive therapy. It sets a perfect tone. At the same time, the authors are aware of the interlocking external factors that surround therapy. They give clear guidelines for multidisciplinary liaison that should ensure that this book is useful to all allied professionals looking for clarification of their role.
If there are any drawbacks to the book, most of them have been noted by the authors themselves. It is very much oriented toward individual psychotherapy rather than other work that might be complementary; it is limited to work with younger children and has little to say about the many teenagers we see who are repeat victims or victimizers in their turn; and much of it is as yet unvalidated by research. In its sensitive handling of the parents, it also seems at times to forget that it may have been one or both of them who perpetrated the abuse rather than a fond uncle or someone outside the family.
The authors are almost apologetic for being dull, presumably in contrast to the free-wheeling, charismatic followers of intuition who frequently plunge in and out of the child's life and may add to the "abuse" in the process. At the outset these authors nail their colors to the mast: "We are traditionalists." If this is traditionalism, count me as a member of the crew.
Dr. Shooter is consultant psychiatrist and clinical director of child and adolescent mental health services for the Gwent Community Trust and Nevill Hall Hospital in Abergavenny, Wales.
