Evaluating Child Sexual Abuse Interview Tactics

Evaluating Child Sexual Abuse Interview Tactics

            In effort to effectively assess suspected sexually abused children, various interviewing techniques are employed.  Typically, structured interviews, open-ended interviews, and consultations utilizing anatomically correct dolls are implemented.  Such tools enable the practitioner to determine whether or not the child is a victim, test the reliability of the child’s testimony, and refrain from using leading questions which may influence the child’s responses (Butcher, Mineka, & Hooley, 2010).  With the prevalence of such cases in modern times, accordingly, researchers have increasingly analyzed the efficacy of such interview tactics.  An evaluation of this phenomenon is provided hereafter.

            First, journal article, Interviewing Children about Psychological Issues associated with Sexual Abuse (1991), researchers emphasized an open-ended approach.  More specifically, a general psycho-diagnostic interview was suggested to examine ego, cognitive, and socio-emotional functioning as well as affect and personality.  Such questioning offers children the opportunity to disclose personal information in a non-offensive manner, nor is the response swayed by the inquiry.  Additionally, practitioners advise wording appropriate and comprehensive in consideration of the aptitude of the child.  Furthermore, it should be duly noted that the initial questions are generally based on feelings, relationships, and experience in effort to establish rapport prior to more in-depth sexual abuse disclosure.  Also, researchers stressed the importance of offering positive feedback and reassurance to the child throughout the assessment process.  Contrarily, some researchers consider unstructured techniques to be less effective since these approaches may be difficult for the child to follow.  Instead they recommend structured questioning which is capable of overcoming children’s apprehensiveness, shame, and limited communicative skills.  This information was compiled over the course of 3 years with observation of 100+ diagnostic interviews of children aged 3-17 of which nearly 80% were female, inclusive of varying demographics and ethnicities (Shapiro, 1991).

            Another article, Children’s Memories of a Physical Examination involving Genital Touch: Implications for Reports of Child Sexual Abuse (1991), illustrated the effectiveness of the usage of physical examinations in conjunction with anatomically correct dolls, and direct and indirect questioning.  Researchers observed 72 girls, 5 to 7 years of age.  Initially, 50% of them (36) were administered genital assessments while the remaining half was given a non-genital assessment.  Subsequently, recollection of the sexually abusive event was regarded through the presentation of anatomically correct dolls along with a combination of frank and oblique questioning.  Results indicated that younger children responded better to non-genital examination.  However, older children were more expressive in the genital examination group.  This suggests that older children’s bodily awareness is greater than younger children.  Additionally, children were less expressive in terms of mere recollection versus the doll demonstration and direct questioning.  This supports the notion that a direct, structured approach is more beneficial than unstructured, indirect techniques (Saywitz, Goodman, Nicholas, & Moan, 1991).

            Personally, I am inclined to agree with the usage of structured interviewing techniques.  This approach enables the practitioner to observe and evaluate the subject in relation to traditional research while granting the client the ability to successfully disclose personal information, particularly in regard to sexual abuse, without obstructing the therapeutic process.  Additionally, a direct approach grants inexperienced practitioners the ability to follow specific guidelines in order to advantageously diagnose and treat the client.  Considering the child’s proficiency and comfort along with the practitioner’s propensity, the amalgamation of structured, open-ended questioning and the use of anatomically correct dolls are most advantageous to realizing truth and fulfilling effective assessment.    

             

References:

Butcher, J.N., Mineka, S., & Hooley, J.M. (2010). Abnormal psychology (14th ed.).

Boston: Allyn & Bacon.

Saywitz, K.J., Goodman, G.S., Nicholas, E., & Moan, S.F. (1991). Children’s memories

            of a physical examination involving genital touch: Implications for reports of child sexual abuse.

            Journal of Consulting and Clinical Psychology, 59(5), 682-691.

Shapiro, J.P. (1991). Interviewing children about psychological issues associated with

            sexual abuse. Psychotherapy: Theory, Research, Practice, Training, 28(1), 55-66

Sustained Dialogue

 

Sustained Dialogue

              Sustained dialogue would have been a welcomed asset during my early high school experience.  You see, I was ridiculed and discriminated against by those of my own ethnicity, black Americans, as well as white Americans.  (As with the young man in the *Not Just Talk: SDCN’s Informational Video (2009) I also hold contempt for the term African American for several of the same reasons he expressed, and consider ‘black American’ more appropriate).  I attended the oldest public high school in Raleigh, nestled in a predominantly affluent white community.  Jesse Helms grandchildren, Brian McKnight’s son, and Jim Valvano’s daughter were among my schoolmates and alumni (just to give you an idea of how exclusive this public school was and still is).  At the time, circa 1991, our school was racially divided.  This stemmed from a political cartoon illustrated in the student newspaper which depicted a black student hanging by a noose.  Needless to say this was quite disturbing to the student body and the greater community at large.  I remember witnessing more fights and acts of violence than I ever had within a semester before or since.  As a five foot seven, one hundred and five pound freshman, I was already apprehensive.  I did not need a ‘race war’ to add fuel to the fire.  In addition, I was enrolled in various advanced and college prep courses, and involved in various extra-curricular activities which were primarily made up of white students.  Hence, I was ridiculed and criticized by other black Americans.  In addition, considering the nature of the school environment, several of my white friends and classmates were constantly asking, “Well, what do you think about the newspaper? It’s just a cartoon!”  I’m fourteen, and all I did all day was try to answer for and on the behalf of ALL ‘my people,’ then leave class and get ridiculed by ‘my people.’  I hated my freshman year. 

            If sustained dialogue had existed then, it would have been very beneficial.  It would have offered students a forum to freely and non-judgmentally address their feelings, beliefs, and concerns.  At the time our county had initiated a peer mediation campaign which allowed students in the midst of conflict to meet with a trained student mediator in effort to extinguish disputes.  However, to have a group of random students from different ethnicities, who may not have necessarily had interaction with one another, to come together repeatedly over a given amount of time, and discuss culture, race, and ethnicity issues would have been priceless.  This would have planted seeds within the student body that would dispense their understanding, knowledge, and shared experience with their friends and classmates.  The hostile environment which we were susceptible to would have diminished in a more expeditious and favorable manner.

            As it turned out, several minority students, inclusive of self, decided to apply to the student newspaper the following year.  Once accepted, the newspaper staff consisted of thirty-five to forty percent minorities.  Also, the faculty advisor from the previous year resigned, several of those who had perpetuated the racist cartoon and bigotry graduated, and the school implemented more security and upheld a zero tolerance policy for racial slurs, symbols, and blatant discrimination.      

* Not Just Talk - SDCN's Informational Video (13:50) by Chris Wagner (2009)

http://vimeo.com/1746722

Psychotic Symptoms: Hallucinations & Delusions

Hallucinations & Delusions

As a practitioner, it is imperative to develop the ability to distinguish between various psychotic symptoms.  Common examples of such considerations are hallucinations and delusions.  A hallucination refers to an individual’s perception of things which seemingly exist, however in reality the incident or object is merely a figment of their imagination.  These events occur while the subject is conscious.  Various types of hallucinations include bodily sensations, hearing sounds or voices, smelling odors, or seeing patterns, lights, or objects (Berger, 2012).  The practitioner may identify someone experiencing hallucinations from noticing the symptoms associated within inclusive of one’s inability to differentiate reality from an illusion coinciding with bluish tint on the lips or fingernails, experiencing chest pain, variance in skin temperature or texture, high fever, mystification, constant vomiting, breathing complications, seizures, abdominal pain, or illogical, suicidal behavior (Klasco, 2011).  On the other hand, delusions are a form of hallucinations which refer to one experiencing irrational, fixated notions or false beliefs although reality undoubtedly contradicts the perception.  In the subject’s mind, they believe the imaginable.  Furthermore, this experience solely pertains to the subject, excluding others.  Typically, delusions include the belief that the individual’s cognition or behavior is directed or affected by a foreign source or the belief that bodily functions are altered or compromised (Butcher, Mineka, & Hooley, 2010).

Other disorders which the practitioner must distinguish upon are disorganized speech, disorganized and catatonic behavior, and positive and negative symptoms.  If the subject is speaking irrationally while maintaining effective communication, they are generally suffering from disorganized speech.  Disorganized and catatonic behavior involves one’s inability to function properly or maintain normalcy within their daily interactions and practices.  Additionally, positive and negative symptoms refer to an overindulgence or lack of psychotic symptoms or regular activity accordingly (Butcher et al., 2010).  Noticing the characteristics of such symptoms is critical to proper diagnosis and treatment.  The practitioner must determine the specific psychotic symptom as well as the extent to which the subject is afflicted.

References:

Berger, F.K. (2012). Hallucinations. Retrieved from                                              

            http://www.nlm.nih.gov/medlineplus/ency/article/003258.htm.

Butcher, J.N., Mineka, S., & Hooley, J.M. (2010). Abnormal psychology (14th ed.).

Boston: Allyn & Bacon.

Klasco, R. (2011). Hallucinations: Symptoms, causes, treatments. Retrieved from,

            http://www.localhealth.com/article/hallucinations.

Evaluating Child Sexual Abuse Interview Tactics

 Evaluating Child Sexual Abuse Interview Tactics

            In effort to effectively assess suspected sexually abused children, various interviewing techniques are employed.  Typically, structured interviews, open-ended interviews, and consultations utilizing anatomically correct dolls are implemented.  Such tools enable the practitioner to determine whether or not the child is a victim, test the reliability of the child’s testimony, and refrain from using leading questions which may influence the child’s responses (Butcher, Mineka, & Hooley, 2010).  With the prevalence of such cases in modern times, accordingly, researchers have increasingly analyzed the efficacy of such interview tactics.  An evaluation of this phenomenon is provided hereafter.

            First, journal article, Interviewing Children about Psychological Issues associated with Sexual Abuse (1991), researchers emphasized an open-ended approach.  More specifically, a general psycho-diagnostic interview was suggested to examine ego, cognitive, and socio-emotional functioning as well as affect and personality.  Such questioning offers children the opportunity to disclose personal information in a non-offensive manner, nor is the response swayed by the inquiry.  Additionally, practitioners advise wording appropriate and comprehensive in consideration of the aptitude of the child.  Furthermore, it should be duly noted that the initial questions are generally based on feelings, relationships, and experience in effort to establish rapport prior to more in-depth sexual abuse disclosure.  Also, researchers stressed the importance of offering positive feedback and reassurance to the child throughout the assessment process.  Contrarily, some researchers consider unstructured techniques to be less effective since these approaches may be difficult for the child to follow.  Instead they recommend structured questioning which is capable of overcoming children’s apprehensiveness, shame, and limited communicative skills.  This information was compiled over the course of 3 years with observation of 100+ diagnostic interviews of children aged 3-17 of which nearly 80% were female, inclusive of varying demographics and ethnicities (Shapiro, 1991).

            Another article, Children’s Memories of a Physical Examination involving Genital Touch: Implications for Reports of Child Sexual Abuse (1991), illustrated the effectiveness of the usage of physical examinations in conjunction with anatomically correct dolls, and direct and indirect questioning.  Researchers observed 72 girls, 5 to 7 years of age.  Initially, 50% of them (36) were administered genital assessments while the remaining half was given a non-genital assessment.  Subsequently, recollection of the sexually abusive event was regarded through the presentation of anatomically correct dolls along with a combination of frank and oblique questioning.  Results indicated that younger children responded better to non-genital examination.  However, older children were more expressive in the genital examination group.  This suggests that older children’s bodily awareness is greater than younger children.  Additionally, children were less expressive in terms of mere recollection versus the doll demonstration and direct questioning.  This supports the notion that a direct, structured approach is more beneficial than unstructured, indirect techniques (Saywitz, Goodman, Nicholas, & Moan, 1991).

            Personally, I am inclined to agree with the usage of structured interviewing techniques.  This approach enables the practitioner to observe and evaluate the subject in relation to traditional research while granting the client the ability to successfully disclose personal information, particularly in regard to sexual abuse, without obstructing the therapeutic process.  Additionally, a direct approach grants inexperienced practitioners the ability to follow specific guidelines in order to advantageously diagnose and treat the client.  Considering the child’s proficiency and comfort along with the practitioner’s propensity, the amalgamation of structured, open-ended questioning and the use of anatomically correct dolls are most advantageous to realizing truth and fulfilling effective assessment.    

References:

Butcher, J.N., Mineka, S., & Hooley, J.M. (2010). Abnormal psychology (14th ed.).

Boston: Allyn & Bacon.

Saywitz, K.J., Goodman, G.S., Nicholas, E., & Moan, S.F. (1991). Children’s memories

            of a physical examination involving genital touch: Implications for reports of child sexual abuse.      

            Journal of Consulting and Clinical Psychology, 59(5), 682-691.

Shapiro, J.P. (1991). Interviewing children about psychological issues associated with

            sexual abuse. Psychotherapy: Theory, Research, Practice, Training, 28(1), 55-66.

Differential Diagnosis: Mental Health Disorders vs Substance Abuse

 Differential Diagnosis:

Mental Health Disorders vs Substance Abuse

            In many instances those abusing substances compromise their mental health or realize symptoms common among mental health disorders.  Excessive use of varying drugs or alcohol may induce any number of these (Butcher, Mineka, & Hooley, 2010).  As a practitioner, one must consider the signs, symptoms, and affects of these phenomenon when assessing and treating clients. 

For instance, alcohol abuse is prone to promote personality disorders such as depression, delirium, or anxiety.  Furthermore, victims are susceptible to suicide, self-harm, psychosis, stomach pains, cirrhosis of the liver, malnutrition, chronic fatigue, oversensitivity, or behavior modifications.  In addition, signs of alcoholism include (a) repeatedly neglecting responsibility, (b) drinking when it may be physically dangerous, (c) having legal issues as a result of drinking, (d) drinking ruining personal relationships, and (e) drinking to relax (Smith, Robinson, & Segal, 2012).

Next, opium causes delirium, anxiety, hallucinations, and manic reactions.  Additionally, abusers may suffer from cardiovascular issues.  Those abusing opium may experience mood swings, depression, tension, insecurity, inadequacy, problematic relationships, or impulsiveness (Butcher, Mineka, & Hooley, 2010). 

Another drug which compromises mental health is cocaine.  Users may experience cognitive impairment.  Furthermore, during treatment victims are susceptible to tension and depression.  Common factors associated with cocaine usage are hallucinations, acute schizophrenia, or apprehensiveness.   Furthermore, the subject may have employment, family, psychological, and legal issues (Butcher, Mineka, & Hooley, 2010). 

Lastly, marijuana smokers are liable to suffer from short-term memory impairment, mood swings, paranoia, anxiety, hallucinations, delusions, or depression.  Symptoms of marijuana abuse include increased heart rate, reduced reaction time, contraction of the pupils, bloodshot eyes, dry (cotton) mouth, or increased appetite (Butcher, Mineka, & Hooley, 2010).

As a practitioner, one must realize that the previously mentioned occurrences frequently run concurrent to mental health disorders.  Hence, researchers suggest “there is a need to focus more intently on mental health issues…given that mental health disorders are often comorbid with substance use” (Coleman-Cowger, 2012, p. 345).  Furthermore, “substance use disorders represent the most frequently occurring mental health problem.  The prevalence of problematic alcohol / drug use is reliably higher in health care delivery settings than in the general population” (Miller & Brown, 1997, p. 1269).  Thus, much of the research offered on the topic appropriately suggests utilizing risk or comprehensive, structured intake assessments in effort to determine what substances, if any, the subject is abusing.  For instance, criminal offenders are often evaluated using the quadrants of care model.  This tool determines the severity of mental health and substance levels within subjects, separating mild and severe cases (Ruiz, Douglas, Edens, Nikolova, Lilienfeld, 2012).  Additional research regards the manner in which intake assessment ascertains problem identification, referral, and treatment of individuals exhibiting alcohol and drug abuse symptoms as well (Winters, Latimer, & Stinchfield, 2002).  Personally, in effort to provide an accurate diagnosis the utilization of such tools would be advantageous.  Addressing and evaluating the client’s reasons for seeking professional assistance, present life conditions, health history, and actual drug history enables the practitioner to familiarize themselves with the client’s situation, start to determine the client’s needs, and acclimate the client to treatment (Seligman & Reichenberg, 2009).  

References:

Butcher, J.N., Mineka, S., & Hooley, J.M. (2010). Abnormal psychology (14th ed.).

Boston: Allyn & Bacon.

Coleman-Cowger, L.H. (2012). Mental health treatment need among pregnant and

            postpartum women / girls entering substance abuse treatment. Psychology of

            Addictive Behaviors, 26(2), 345-350.

Miller, W.R. & Brown, S.A. (1997). Why psychologists should treat alcohol and drug

            problems. American Psychologist, 52(12), 1269-1279.

Ruiz, M.A., Douglas, K.S., Edens, J.F., Nikolova, N.L., & Lilienfeld, S.O. (2012).

            Co-occurring mental health and substance use problems in offenders:

            Implications for risk assessment. Psychological Assessment, 24(1), 77-87.

Seligman, L. W. & Reichenberg, L. W. (2009). Theories of counseling and

psychotherapy: Systems, strategies, and skills (3rd ed.). Boston: Pearson.

Smith, M, Robinson, L., & Segal, J. (2012). Alcoholism and alcohol abuse: signs,

symptoms, and help for drinking problems. HelpGuide.org. Retrieved from

http://www.helpguide.org/mental/alcohol_abuse_alcoholism_signs_effects_treatment.htm.

Winters, K.C., Latimer, W.W., & Stinchfield, R. (2002). Clinical issues in the assessment

            of adolescent alcohol and other drug use.  Behaviour Research and Therapy,

40(12), 1443.