The Psychological Assessment of Abused and Traumatized Children

The Psychological Assessment of Abused and Traumatized Children

The Psychological Assessment of Abused and Traumatized Children

The Psychological Assessment of Abused and Traumatized Children

Synopsis

The past decade has seen more and more clinicians involved in the assessment and treatment of abused and traumatized children. They have contributed to an impressively large body of literature on the impact of abuse and trauma at all ages, the focus of which has been the short and long-term sequelae apparent in the child's behavior, emotional experience, and social interaction. But there have been few efforts to investigate the ways in which abuse and trauma damage the intrapsychic systems and structures that often guide, direct, and inform the child's manifest adjustment and functioning. The need to redress the balance was the major impetus for this book.

Kelly offers a clinical paradigm for the personality assessment of abused or traumatized children via projective instruments--the TAT and Rorschach--and shows how various projective measures and indices can be utilized as sensitive barometers of changes in self, object, and ego functioning following therapeutic interventions and other corrective experiences. But further, integrating the tenets of trauma theory and those of psychoanalytic theory, he sets this clinical paradigm in a meaningful theoretical context, and draws on both theory and clinical experience to develop a comprehensive psychological composite of the child who has been maltreated.

Part I provides an overview of theoretical models relevant to the assessment and diagnosis of the maltreated child. Contemporary psychoanalytic theory serves as one frame and is discussed first, with particular emphasis on object relations and ego functions. Equal attention is devoted to developmental psychology as another frame.

Part II reviews relevant research. The Mutality of Autonomy Scale (MOA) and the Social Cognition and Object Relations Scale (SCORS) are introduced as examples of reliable and valid instruments readily employed to assess the impact of abuse or trauma on a child's object relations functioning. Additional Rorschach indices--boundary disturbance measures, thought disorder indices, trauma markers, and defensive functions measures--are discussed as measures of the impact on different facets of ego functioning. These various projective measures can be utilized as sensitive barometers of changes in self, object, and ego functioning following therapeutic interventions and other corrective experiences.

Part III includes a variety of extended clinical illustrations.

Seven cases of boys and girls subjected to varying degrees of abuse and trauma are presented to demonstrate the clinical utility of projective material for assessment, diagnosis, and treatment planning. For the clinician who takes the idiographical-phenomenological approach, appropriate given the uniqueness of each situation of abuse or trauma and the frequent brevity and barrenness of the protocol, such material can open a window onto a rich vista of the child's psychological terrain. The resulting map can point the way to wise decisions about type, timing, and level of therapeutic intervention, the resolution of such process issues as transference and countertransference, plus additional questions.

Two cases of adult women who were abused as children and find themselves continuing to struggle with enduring unresolved issues vis a vis their own children are also presented. These cases underscore the value of TAT and Rorschach material, and object relations measures, in assessing and understanding the abusive and potentially abusive parent.

Excerpt

Like many of my colleagues, over the course of the past 10 years, I have become increasingly sensitive to and aware of how noxious experiences of abusive and neglectful environments may dramatically alter the course of a child's developmental odyssey. For those assessing children, it has become commonplace to inquire about abuse, not traditionally a focus of interest for reasons that are, in retrospect, somewhat difficult to comprehend. If we briefly reflect on history, it is possible to understand why this may have been the case. Freud, in his initial considerations of hysterical patients (mostly women), thought that their symptomology was linked to sexual abuse. He later modified this position (Herman, 1992) and subsequently viewed his patient's symptoms as being an outgrowth of intrapsychic conflict, sexualized wishes and fantasies, which led to a quite different interpretive perspective and subsequent therapeutic course--one that denied both the obvious fact that many of his patients had been sexually abused and that their symptoms were the sequelae of this rather than a reflection of drive-defense conflict.

I often find myself reflecting on why 10 or 20 years ago I, and the majority of my colleagues, did not consider or accord more relevance to abuse and trauma as salient etiological factors that should be paramount in the clinical formulation. In almost all instances, it did not enter our consciousness: In other cases, it was probably a factor that somehow did not figure into the final information that firmed up and ordered our diagnostic thoughts. I especially muse about those more disturbed children and adolescents often described as borderline and find myself thinking about their life situations: How many of them were abused, traumatized, chronically neglected? How many of the hospitalized children and those in residential care were manifesting the predictable sequelae of pre-oedipal and latency years marked by maltreatment and trauma, manifestations that should have figured prominently when diagnostic and disposition issues were considered. In seeing . . .

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