Claudia Capella

Winning a Race: Narratives of Healing and Psychotherapy in Children and Adolescents Who Have Been Sexually Abused

ABSTRACT This article explores the process of recovering from sexual abuse according to children and adolescents who have been sexually abused and have successfully completed psychotherapy. In this qualitative study, interviews were conducted with 20 participants from 8 to 18 years of age and then subject to narrative analysis. Results show that participants’ narratives of recovery involve an improvement of psychological well-being. Moreover, they feel better equipped to overcome future challenges, feeling empowered and able to retake control of their lives. Factors that support and inhibit recovery are examined, as are developmental differences. Discussion underlines the valuable role of psychotherapy in helping children and adolescents in their healing process, changing the meaning of the abusive experience, and developing new capacities.

Meeting in difference: Revisiting the therapeutic relationship based on patients′ and therapists′ experiences in several clinical contexts

Despite decades of research on the therapeutic relationship and the therapeutic alliance and their connection with therapeutic outcomes (Horvath, Del Re, Flückiger, & Symonds, 2011), only a handful of studies have examined how they are experienced by the therapy participants. The aim of the present study is to describe the therapeutic relationship from the subjective perspective of the patients and therapists involved in 3 clinical cases: (a) a 7-year-old child diagnosed with attention deficit hyperactivity disorder, (b) a 29-year old woman diagnosed with a personality disorder, and (c) a 22-year-old man diagnosed with schizophrenia. We conducted semistructured interviews with patients and therapists that were later analyzed following grounded theory coding procedures (Corbin & Strauss, 2008). The results obtained reveal that the constitutive elements of the therapeutic relationship are linked to 2 dimensions of the patient-therapist meeting experience: the technical and role-related dimension, characterized by relational asymmetry, and the affective exchange dimension, characterized by relational symmetry. The article discusses the possible association between the asymmetrical technical dimension, whose roles are defined by the organization of the helping relationship, and the notion of therapeutic alliance as commonly conceptualized and assessed; on the other hand, the experience of the bidirectional and symmetrical patient-therapist affective exchange is linked with concepts such as real relationship and intersubjectivity.

Introduction to the special section on child and adolescent psychotherapy research

Anna Freud National Centre for Children and Families, London, UK; Psychology Department, Universidad de Chile, Santiago, Chile; Clinical Psychology Doctoral Program, Long Island University, Brooklyn, NY, USA; Department of Developmental Psychology and Socialisation, University of Padua, Padova, Italy; Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands; School of Social Work Mount Scopus Campus Jerusalem, Hebrew University, Jerusalem, Israel & Child and Adolescent Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

Disequilibrium and Loss of Narrative Coherence in Identity Construction: A Piagetian Perspective on Trauma in Adolescent Victims of Sexual Abuse

Previous authors have presented contradictory views of trauma as either the over- or under-elaboration of experience. This article provides a new theoretical perspective on trauma by incorporating Piagetian constructivism. On a theoretical level, it argues that both forms of narrative disruption following a traumatic episode are not contradictory. Rather, both over- and under-elaboration indicate disequilibrium and loss of narrative coherence in the construction of personal identity. Results are presented from an empirical study of the autobiographies of 15 adolescent victims (between the ages of 12 and 17) of sexual assault. Participants were enrolled in the initial stage of a psychotherapeutic treatment program for abuse in Santiago, Chile, at the time of study. Analysis of participant autobiographies reveals multiple forms of disorganization. The majority of adolescent narratives referred to predominance of traumatic experiences, whereas a small number of cases excluded traumatic experiences altogether. Discussion of study results shows that both forms of narrative disorganization indicate disequilibrium and loss of narrative coherence. Piagetian constructivist theory provides insight into this phenomenon by supporting and advancing understandings of trauma from a constructivist perspective. Implications for therapeutic treatment of sexual abuse, which may help generate clinical guidelines, are presented.

Change during psychotherapy through sand play tray in children that have been sexually abused

This paper presents the results of a qualitative study on the use of sandplay, or sand tray therapy, in the psychotherapeutic process of children who have been sexually abused. A longitudinal study was carried out with seven participants between the ages of 7 and 10 years old. Data was produced during observation of the therapeutic activity over the course of three different phases of treatment, using a rubric created especially for this observation. Three sandplay sessions were recorded: one at the start of therapy, one at the 3-month mark, and the third and final session after 6 months of treatment. Sessions were then transcribed for later analysis. A rubric was developed in order to help researchers identify central themes, behaviors and content of creative play, as well as the therapeutic relationship. Transcribed sessions and observation rubrics were evaluated using qualitative content analysis, and information was categorized according to verbal and behavioral characteristics of the game. Results of the present study reveal common and transversal forms of playful expression among this group of children shown by their engagement with sandplay. During this activity, participants elaborate personal stories that feature violence as a central theme, often involving aggression between two or more individuals. They also express their need for care and protection and work to resolve conflicts using fantasy. The shifting dynamics of sandplay at each stage of therapeutic treatment is an important finding that reveals the progress made during psychotherapy. In the third phase of treatment, sandplay encouraged movement among children, allowing them to act out meaningful scenarios and create structured situations with positive outcomes. Finally, the value of sandplay as an important therapeutic tool is discussed, primarily its role in supporting processes of change and allowing participants to assign new meanings to traumatic experiences. Its application to the field of clinical psychology, particularly when working with victims of sexual abuse, is also explored.

Change during psychotherapy: the perspective of children and adolescents who have been sexually abused

The aim of this research was to identify the meanings of psychotherapeutic change of children and adolescents who have suffered sexual abuse and were in psychotherapy. In order to do this, a qualitative study was carried out in which in-depth interviews complemented with drawings were conducted with 10 children and adolescents, aged between 6 and 16 years, who were taking part in psychotherapy due to sexual abuse. The interviews took place between 6 and 10 months after the start of the therapy and before it ended. Thematic narrative analysis was used for the interviews and visual narrative analysis for the drawings. The main findings showed that children and adolescents visualized psychotherapeutic change as a process in which gradual progress is made. The participants notice changes from an initial state of sadness and distress, mainly describing a positive shift in terms of emotional well-being. In addition, in this phase of the therapy only a few participants identified changes in their feelings regarding the abusive experience. The participants identified aspects of the therapy and supportive relationships with significant others as elements that foster these changes. In their view, hindering elements include changes of therapist, legal factors, and not being believed by their family. It is discussed the importance of knowing the children and adolescents’ perspective regarding psychotherapeutic change while participating in therapy processes, using multiple methodologies, to generate interventions that suit the needs of this population and match the pace of children and adolescents’ change.

Identidad personal y compromiso deportivo en adolescentes nadadoras de nivel competitivo

The aim of this research is to understand how adolescent swimmers of a competitive level build their personal identity and how this relates to the construction of meanings associated with sport commitment. A qualitative methodology was used, from an evolutive constructivist approach, in order to access to the meanings constructed by the adolescents about sport and the place it has in the construction of identity. Autobiographies and semi-structured interviews were used, which then were subjected to content analysis. From results, it was concluded that, the practice of competitive swimming can have three places in the construction of adolescent identity. These places are related to a greater or lesser sports commitment. It was also disclosed the construction of meanings associated with sports practice that would bind greater permanence in sport or abandonment. Finally, the contributions from a constructivist evolutive perspective in sports psychology research are emphasized, to consider not only the competitive aspect but also the achievement of a comprehensive and adaptive development.