Treating Child-Abusive Families: Intervention Based on Skills-Training Principles

227 Pages·1983·3.78 MB·English

by  Jeffrey A. Kelly (auth.)

Treating
Child -Abusive
Families
Intervention Based on
Skills -Training Principles
APPLIED CLINICAL PSYCHOLOGY
Series Editors: Alan S. Bellack, Medical College of Pennsylvania at EPPI,
Philadelphia, Pennsylvania, and Michel Hersen, University of Pittsburgh, Pittsburgh,
Pennsylvania
FUTURE PERSPECTIVES IN BEHAVIOR THERAPY
Edited by Larry Michelson, Michel Hersen, and Samuel M. Turner
CLINICAL BEHAVIOR THERAPY WITH CHILDREN
Thomas Ollendick and Jerome A. Cerny
OVERCOMING DEFICITS OF AGING: A Behavioral Approach
Roger L. Patterson
TREATMENT ISSUES AND INNOVATIONS IN MENTAL RETARDATION
Edited by Johnny L. Matson and Frank Andrasik
REHABILITATION OF THE BRAIN-DAMAGED ADULT
Gerald Goldstein and Leslie Ruthven
SOCIAL SKILLS ASSESSMENT AND TRAINING WITH CHILDREN
An Empirically Based Handbook
Larry Michelson, Don P. Sugai, Randy P. Wood, and Alan E. Kazdin
BEHAVIORAL ASSESSMENT AND REHABILITATION OF THE
TRAUMATICALLY BRAIN DAMAGED
Edited by Barry A. Edelstein and Eugene T. Couture
COGNITIVE BEHAVIOR THERAPY WITH CHILDREN
Edited by Andrew W. Meyers and W. Edward Craighead
TREATING CHILD-ABUSIVE FAMILIES
Intervention Based on Skills-Training Principles
Jeffrey A. Kelly
In preparation
ISSUES IN PSYCHOTHERAPY RESEARCH
Edited by Michel Hersen, Larry Michelson, and
Alan S. Bellack
A Continuation Order Plan is available for this series. A continuation order will bring delivery of
each new volume immediately upon publication. Volumes are billed only upon actual shipment.
For further information please contact the publisher.
Treating
Child-Abusive
Families
Intervention Based on
Skills -Training Principles
Jeffrey A. Kelly
University of Mississippi Medical Center
Jackson, Mississippi
Springer Science+ Business Media, LLC
Library of Congress Cataloging in Publication Data
Kelly, Jeffrey A.
Treating child-abusive families.
(Applied clinica! psychology)
Bib!iography: p.
lncludes index.
1. Child abuse-Treatment. 2. Sociallearning. 1. Title. 11. Series.
RC569.5.C55K44 1983 616.85'82 83-17667
ISBN 978-1-4899-0365-5 ISBN 978-1-4899-0363-1 (eBook)
DOI 10.1007/978-1-4899-0363-1
© 1983 Springer Science+Business Media New York
Originally published by Plenum Press, New York in 1983
Softcover reprint of the hardcover 1st edition 1983
Ali rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
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Preface
During the past ten years, the problem of child abuse has been the
subject of increased attention both in the professional community and
among the general public. The reasons for this widespread recogni
tion are clear. First, professionals of many disciplines deal with child
abusive families and do so in a variety of ways: Physicians, hospital
staff, and teachers are often the first to assess a child as the victim of
abuse; social workers and child-protective personnel investigate cases
of suspected abuse; court and legal authorities make determinations
concerning the needs of an abused child; and mental health profes
sionals, including psychologists, social workers, and family coun
selors, often have responsibility for treating abusive families. Few
clinical problems have received this kind of widespread interdisci
plinary recognition and, given the nature and seriousness of child
abusive behavior, few problems receive such intensive attention
within each profession's literature.
A second factor responsible for increased study of child abuse is
the fact that violence directed toward children is probably the most
extreme form of family dysfunction seen by counselors, therapists,
and other practitioners. While other types of child-management and
anger-control problems occur far more frequently, the consequences
of child-abusive behavior are much more serious than the conse
quences of other problems seen in child or family clinics. It has been
v
vi PREFACE
estimated that as many as 550,000 children are the targets of parental
abuse in the country each year (Helfer & Kemper, 1976). Among
those children brought to hospitals and determined to be the victims
of physical abuse from their parents, mortality rates of 10% or higher
have been reported (McRae, Ferguson, & Lederman, 1973; Smith &
Hanson, 1974), while other studies project that up to 5000 children
die each year as a result of nonaccidental injury caused by their par
ents (Helfer, 1973). Numerous investigators have described not only
the long-term physical injuries sustained by some abused children
(such as irreversible neurological impairment), but also the perma
nent psychological harm caused by physical violence from one's par
ents. For all of these reasons, child abuse is correctly viewed by prac
titioners as one of the most serious problems seen in families.
A third factor responsible for increased recent attention to child
abuse is that both professionals and the general public have had great
difficulty understanding why child abuse occurs and, as a result,
have had equal difficulty developing empirically based treatment ap
proaches for abusive families. Although a problem like child abuse is
considered important and demanding of our attention, it is not yet
well conceptualized, and a great deal of clinical and research "search
ing" for causes and treatments is likely to occur. In this regard, it is
interesting to note that of the hundreds of studies conducted on child
abuse, the vast majority appear primarily to describe some aspect of
abusive behavior. Numerous reports have attempted to identify par
ent personality characteristics related to abusive behavior, to describe
child characteristics that relate to increased susceptibility for abuse, to
assist physicians in diagnosing cases of nonaccidental injury, and to
delineate the incidence of child abuse in this country. Much more rare
in the literature are efforts to integrate this descriptive knowledge
base into conceptual models that carry direct, practical implications
for the treatment of child-abusive families.
The purpose of this book is to assist mental health practitioners
who, in their professional roles, are called upon to treat child-abusive
families. The first two chapters summarize present knowledge con
cerning the scope and prevalence of physically child-abusive behavior
and review some of the major characteristics of abusive parents and
their children. In Chapter 3, this information is integrated into a social
PREFACE vii
learning conceptual model that can both account for the development
of child-abusive behavior patterns and also suggest appropriate
methods of clinical information with these families. Thus, beyond
simply reviewing "facts" concerning abuse, the chapter develops a
conceptual/theoretical model with direct treatment implications.
The balance of the book is oriented specifically toward practi
tioners, counselors, and therapists. Chapter 4 presents a detailed
description of clinical assessment techniques (including interview
procedures, techniques for the assessment of parent-child interaction
problems, parent self-monitoring procedures, and other measures)
that can be used to develop an intervention plan for abusive parents.
Chapters 5-8 outline the types of intervention that are often neces
sary to treat child-abusive families, such as training parents to use
effective, reinforcement-based child-management skills rather than
punitive, violent child control strategies (Chapters 5 and 6), teaching
abusive parents anger-control skills (Chapter 7}, and intervening to
reduce other more general life-style risk factors that involve problems
in joblessness, problem-solving ability, marital discord, and social
isolation (Chapter 8). In each of these chapters, clinical research on
the treatment approach is reviewed, especially as it relates to child
abusive families or other families with severe interaction problems.
The chapters are intended to provide the practitioner with specific,
practical suggestions and guidelines for using these techniques with
families.
Consistent with the social-learning theory conceptual framework
taken in this book, most of the treatment approaches described here
rely on a skills-training behavior change model for parents. In some
cases, the required skills training focuses specifically on changing an
abusive parent's disciplinary style toward his or her child; child-man
agement training that teaches parents to use reinforcement-based
strategies rather than physical punishment to control a youngster's
misbehavior is an example of this kind of skills training. In other
cases, more complex intervention is needed; some parents also re
quire treatment that helps them learn to solve everyday problems and
control temper, thereby reducing general frustration and anger/
arousal levels. Regardless of the exact nature of treatment called for in
a particular case, the interventions described in this book are all
viii PREFACE
intended to increase the child-abusive parent's repertoire of appropri
ate coping skills and to reduce the likelihood of continued family
violence.
Treating Child-Abusive Families is intended primarily for profes
sionals who see these families in ongoing treatment. For this reason,
topics such as determining whether a child is an abuse victim based
on the youngster's injuries, legal and judicial questions related to
child abuse, and similar issues are not stressed in this book. Howev
er, because mental health professionals treating abusive families al
most invariably have contact with other workers (such as caseworkers
who first investigate abuse reports, court judges, physicians, and
community resource support groups), the matter of interdisciplinary
team coordination in a family's treatment is of importance. Chapter 9
discusses some of the practical issues that are encountered when the
therapist or counselor consults with a family's welfare department
caseworker, court judge, and others. While treating abusive families
is of immediate concern to psychologists, social workers, and other
counselors, efforts that can prevent or reduce the incidence of child
abuse are equally important. Based on a social-learning conceptual
ization of why abuse occurs, it is possible to draw inferences not only
for treatment but also for prevention. This is the subject of the book's
final chapter.
A good deal of progress is now being made in the treatment of
abusive families, and well-controlled treatment studies are appearing
regularly in the literature. Whenever possible, the techniques de
scribed here are based directly on empirical findings with child-abu
sive families. However, certain treatment methods that seem highly
relevant and important for abusive parents (such as anger-control
training) have not yet been studied extensively with this specific pop
ulation. Nonetheless, these techniques are included here because
they appear to be clinically useful and because consideration of them
may serve to stimulate further applied research on their effectiveness
with child-abusive families.
Acknowledgments
A number of persons contributed to this book in both direct and
indirect ways. One of the most important and direct contributors was
David Wolfe, whose expertise and interest were responsible for the
development of a child abuse treatment program within the Child
Psychology Clinic at the University of Mississippi Medical Center. I
deeply appreciate his collaboration and respect his already substantial
contributions to the child abuse treatment field.
Karen Christoff and Doreen Fairbank devoted a great deal of
their time and talents to researching subjects for this book and pro
vided many helpful suggestions during its development. Wauline
Carter's assistance in preparing the manuscript was superb. My fac
ulty colleagues and the psychology residents at the Medical Center
have provided a stimulating clinical and research setting conducive to
work in this area, and Michel Hersen was encouraging of my efforts
to write this book. Finally, a special thanks must go to Krystal Num
bers 4 and 5, where most of this book was written.
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