Offender Interventions
OFFENDER INTERVENTIONS
Adolescent Sex Offender Therapy Sound Substantial Accepted Some Risk 3
Adult Child Molester Therapy Sound Substantial Accepted Some Risk 2
The empirical support for each of the 24 protocols reviewed were categorized according to the classification system described above. The results are described below:
Classification Number
1. Well-supported, efficacious treatment 1 2. Supported and probably efficacious treatment 1 3. Supported and acceptable treatment 14 4. Promising and acceptable treatment 7
5. Innovative or novel treatment 0
6. Concerning treatment 1
24
Of the 24 treatments reviewed, 16 had at least some empirical support for their efficacy with cases of child abuse. However, only one, Trauma Focused Cognitive-Behavioral Therapy, met the standards of the highest category, and only one, Adult Child Molester Therapy, was rated in the second highest category. Of the 14 having at least some empirical support (category 3), several have very strong empirical support when used with other client populations, but have not been tested specifically with child abuse victims or their families. However, many of these have been used clinically with abuse victims with positive results. These include well-known
treatments such as Behavioral Parent Training, Cognitive Processing Therapy, Multisystemic Therapy (MST) and Eye-Movement Desensitization and Reprocessing (EMDR). Therefore, results of this review show that there are a substantial number of empirically supported treatments available to practitioners working with child victims of abuse and their families.
Empirically supported treatments are available for use with problems experienced by child victims, with problems in parent-child relationships, and with abusive parents. These treatments should be considered first choice treatments when working with child victims and their families who have problems targeted by these protocols, and they are recommended for use.
It should be noted that even for these empirically supported treatments, the level of support enjoyed by all but a few is rather thin. Many have only one uncontrolled outcome study backing their efficacy (e.g., Trauma-Focused Integrative-Eclectic Therapy). Some have multiple randomized controlled trials supporting their utility with other populations and are clearly
efficacious treatments (e.g., Behavioral Parent Training). But, they have not been tested specifically with abused children and their families. To date, none has undergone a true effectiveness trial with child abuse victims and their families, though admittedly, such trials are relatively rare in all aspects of mental health treatment. Therefore, much clinical outcome research remains to be done to test further the efficacy and effectiveness of all of these treatments with children who have been abused and their families.
Practitioners should note that several well-known and commonly used treatments have no empirical support for their efficacy. For example, Trauma-focused Play Therapy is often used with young victims of abuse. It was judged to have a strong theoretical base, have an excellent
clinical literature, carry little risk, and be widely accepted within the field. Yet, it has no empirical evidence to support its claimed therapeutic effects. Therapies such as this one are prime candidates for future research testing their efficacy. Many of these theoretically sound and widely used therapies may be helpful to clients as indicated by the clinical/anecdotal literature. However, the burden is on the developers and proponents of these treatments to provide empirical evidence of their effects before they can be recommended with more confidence.
One protocol, Corrective Attachment Therapy, was rated as having a “Substantial” and unacceptable level of risk and was rated 6, Concerning. This judgment was made for several reasons. First, it was assessed as having a questionable theoretical basis. Recent literature has suggested that this treatment is a misuse and misapplication of theories of child development and childhood interpersonal attachment processes (Speltz, 2002). Second, the techniques and
procedures associated with this protocol were judged to be excessively coercive. Because of the coercive nature of the treatment, the protocol was judged to carry a significant risk for causing psychological and physical harm to children. Third, because of the nature of the procedures used, the treatment was evaluated as having great potential for misuse and misapplication.
Fourth, this protocol has a very rare distinction among psychotherapies in that deaths of children receiving this treatment have been reported (Crowler & Love, 2000). These deaths reinforce concerns about the safety of children receiving this intervention. One small (N = 23) outcome study has suggested pre- to post-treatment improvement on parent-rated aggression and delinquency behaviors by children receiving “Holding Therapy” (Myeroff, Mertlich, & Gross, 1999). Despite this finding, any benefits of this treatment that would outweigh its considerable risks are not clear. Therefore, given the significant risk for negative consequences to children, even death, and the lack of convincing evidence of its therapeutic benefit, Corrective Attachment Therapy was determined to constitute a substantial and unacceptable risk of harm to child
victims and their families. Therefore, this treatment cannot be recommended, and its use is discouraged.
The results above reveal that practitioners working with child abuse victims and their families have several empirically supported treatments available to them that target common problems in the individual and parent/family domains. If an empirically supported treatment exists for a target problem, clinically accepted but unsupported treatments should be viewed as alternative or second-choice therapies. Decisions to use alternative therapies in the place of first choice treatments should be made carefully, with due consideration to all of the issues involved in such a decision. Practitioners considering using alternative rather than first choice therapies should make such decisions cautiously, and consider seeking consultation from knowledgeable peers. When empirically supported treatments are not available, practitioners should use theoretically sound and widely accepted treatments that have an acceptable level of risk.
Concerning treatments, those with few proven benefits and substantial risk, should be avoided.