Handbook of Psychological Services for Children and Adolescents

By Jan N. Hughes; Annette M. La Greca et al. | Go to book overview

18
A Dynamic-Maturational Approach
to Treatment of Maltreated Children
PATRICIA M. CRITTENDEN
ANDREA LANDINI
ANGELIKA H. CLAUSSEN

This chapter is intended to describe those specific treatments that are most suitable for maltreated children. The topic seems straightforward, but, in fact, it presents some serious difficulties. First, although it is clear that maltreated children can be helped by treatment (Stevenson, 1999), it is not clear which treatments are most helpful to which children (Kolko, 1998). Second, it is not clear that treatment of abused and neglected children differs in any substantial way from treatment of numerous other forms of emotional and behavioral dysfunction. It has been argued that one of the reasons for this lack of precision is that existing studies are poorly designed. Although that is certainly true, even if the studies were improved, there would remain a lack of clarity about exactly what is being treated and precisely what the outcomes should be. Put another way, a theory of treatment is needed. This chapter presents a “dynamic-maturational” perspective on treatment of emotional and behavioral disorder.

Most approaches to intervention are based on a set of assumptions regarding the relation of a set of causal conditions to a set of detrimental outcomes. For example, physical abuse plus the correlates of abuse (such as poverty, broken families, stress, etc.) are seen as causal to an assortment of symptoms (such as depression, anxiety, aggression, etc.). Primary prevention attempts to eliminate the causal conditions, whereas most psychiatric treatment attempts to control or eliminate the symptoms. In both cases, however, the question of why these conditions are associated with these symptoms often remains unaddressed, as does the process by which the connection between them can be modified. In this chapter we ask what the causal conditions have in common that might explain their

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