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Introduction
Children in families that have violent or coercive parents and guardians are likely to have experienced physical abuse are more likely to develop psychiatric and behavioral problems (De Arellano, 2008). They will have difficulty in adjusting to normal environments they may become traumatized and sometimes develop traumatic disorders. Urquiza & Runyon (2010) observed that their behaviors were characterized by poor interpersonal skills, emotional reactivity, and aggression.
Intervention using Cognitive Behavior Therapy (CBT)
Cognitive behavior theory designed to accommodate families and their children exposed to abuse is ideal (Kolko, 1996). The family of the child needs to be included to ensure that the child does not undergo the same ordeal when returned back to them. The children and adolescents will be included in the monitoring of their progress as they grow up.
Kolko and Swenson (2002) observed that a family-oriented CBT comprehensively addresses the consequences brought by physical and emotional aggression. This mechanism addresses clinical targets in both guardians and children. The guardians are taught how to manage their anger or hostility, managing their perceptions, and accommodating their children in their plans. Effective parenting practices form the core of the guardian program.
This program also targets children with emotional imbalance, poor social skills, behavior problems, and others (Kolko and Kolko 2009). The program is aimed to train children on how to manage their emotions and how to react when some scenarios occur. The focus of this therapy is to improve family relationships and hence conflicts in the families reduce.
Reflects a Comprehensive Treatment Strategy
Kolko, Campo, Kilbourne, and Kelleher (2004) argued that the adjustments to the behavioral and interpersonal skills between the family members would greatly enhance their relationships. The diverse nature of parents and their ideology of a good family will also play a part. A therapy designed to address the problems brought by both the guardians and the children is comprehensive and accurate (Urquiza & Runyon, 2010).
The use of family-oriented cognitive behavior therapy will be appropriate, as it will have a greater impact on society in terms of preventing re-abuse and other mental problems that may arise. As a result, the family-oriented mechanism is one that will comprehensively address the complex issues affecting families.
Integrates Several Therapeutic Approaches
According to Kolko, Campo, Kilbourne, and Kelleher (2012) family-oriented CBT combines various strategies designed to achieve an overall impact on the children, guardians, and society as a whole. Firstly, focusing on the negative thoughts and perceptions might help decrease the abnormal actions of the children. These thoughts are targeted to affect the behavior of the victims positively. Learning to think positively will ultimately affect behavior in a positive way.
Secondly, the therapists also target habitual reactions and responses. The situations that trigger habitual behaviors are changed through a behavioral and learning theory. It applies the change of reaction to certain circumstances.
Thirdly, the interactions between members of the family are also observed. The observation of family relationships will help determine the level of respect they give one another. The interaction mechanism will help in reducing conflicts.
Fourthly, the study of the diverse reaction of children to traumatic and abusive experiences will be identified to give appropriate therapy. The different stages of growth require different strategies to influence the children and parents positively.
Finally, the psychology of aggression, which is characterized by coercion and aggression is developed through the understanding of the thoughts of the contributors and formulation of an appropriate mechanism to treat the various parties: the aggressor and the victim.
Treats Children and Parents Simultaneously
Kolko et al. (2012) and De Arellano (2008) argued that a family-oriented CBT focuses on improving the relationships between the school-going children and their guardians. The sessions are separate, but parallel. The parent-child issues are addressed here, and this will create a better relationship as both parties will know what the other expects of them and will have a chance to improve together.
Discouraging Aggressive or Violent Behavior
Family-oriented CBT promotes favorable inter-personal relationships while discouraging any form of abuse and violence (Kolko, Hoagwood, and Springgate, 2010). The approach is that of forgiveness and a harmonious solution. It includes the three targets the guardians and the children should use to prevent any violence or abuse (De Arellano, 2008):
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It advocates a thought process
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It also influences feelings. It trains how to manage and maintain a sound mind.
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It creates a reaction to certain situations, the behavior, and the operations of the stakeholders.
The promotion of self-control and increased interpersonal effectiveness are some of the objectives of this approach among others that present part of the training process (Kolko, Iselin, and Gully 2011). Effective management of ones emotions, feelings, and behavior will enhance their relationships with other people and thus reduce the conflicts in families.
Treatment to Meet Specific Needs and Circumstances
The initial step is to identify the problems faced by the children, parental and family challenges, and other challenges in the society (Kolko et al., 2010). The identification of these causes will help in formulating a specific plan designed to change the victims and the aggressors. With this information, the treatment can be tailored case by case, and hence one can come up with a plan that will achieve their intended purpose.
Treatment Phases and Key Components
Family-oriented CBT has three treatment steps (Urquiza & Runyon, 2010). The complexity of these steps is revealed when the initial data is recorded. According to Urquiza & Runyon (2010), both caregiver and the child are subjected to these sequential processes. The first process is teaching cognitive and interpersonal strategies. The skills are taught first and then the interpersonal skills come next.
Treatment for School-Aged Children
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Identifying individual goals is important in promoting engagement and treatment motivations.
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The knowledge of the exposure the children have experienced in terms of positive and negative experiences. The circumstances behind them and the extent of the abuse.
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Educating the children on the essence of safety, participation, child welfare, safety, and acceptable responses to certain situations.
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Techniques of anxiety and anger management are outlined.
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Information on any negative thoughts children would have on their guardians or parents. The ways in which these negative thoughts are handled. In addition, the parents ought to be given a chance to prevent self-blame.
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Improvement in interpersonal skills is necessary to develop an enabling environment for building a positive relationship.
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specified trauma program is done to ensure that children with signs of posttraumatic stress disorder (PTSD) can handle their emotions.
Treatment for Parents/ Caregivers/Guardians
The parents also require therapy to ensure that the progress gained in the childs program progresses goes parallel with the parents program. The following steps are to be taught (Kolko Dorn, Bukstein, Pardini, Holden, and Hart 2009):
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The relevance of the CBT program to both, them and their children
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The commitment by the parents to limit the use of force and listen to their children
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The programs on managing conflicts before any drastic measures are taken.
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The revelation of the nature of abuses, their causes, characteristics, and possible consequences. Education of the impact of these events on their children is done to enable them to think soundly before taking any actions.
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Effective management of emotions and ways of handling conflicts. Alternative ways of handling such cases are proposed, and the parents reactions will be limited and thoughtful.
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The contributors to conflicts and their consequences to the children are discussed.
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Teaching on how parents should treat their children. They should encourage positive behavior and thoughts and lead by example.
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The advice that the parents and guardians have a responsibility to protect their children and help them grow physically, economically, and socially is important.
Treatment for Families (Both Parent and Child)
The family composed of both the children and parents or guardians. For a family to function properly the parents should take care of their children in a manner that is conducive for growth. A family requires joint sessions to iron out certain issues as follows (Kolko et al., 2010):
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Identifying family treatment goals using multiple assessment methods aimed at identifying the cause of the problems.
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Encouraging the use of non-physical means in settling or solving problems
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The guardian or parent should be able to accept their mistakes and apologize to the children. They should also start taking the responsibility of the child and treat them in a humane manner. He/she should provide all the basic needs and especially education and keeping them safe.
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The training in interpersonal communication skills will be necessary to ensure that the family communicates and averts conflicts.
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Nonaggressive problem-solving methods and their application to the home environment.
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The involvement of the community at large is also important in maintaining a cordial relationship between the family members.
Summary
Family-oriented cognitive behavior therapy is the best and most comprehensive in handling issues that relate to children, parents, and society as a whole. Firstly, the parents are to take responsibility for the welfare of the families. They should use more effective discipline mechanisms as opposed to violence. They increase self-control and thus comes the reduction of the child abuse potential to the families. Reduced intoxication and drug use should also enhance the parents ability to handle emotions.
Secondly, childrens response to the therapy will be visible in the reduced cases of violence, anxiety reduction, and increased safety of the child.
Finally, child welfare programs should also be supported by society. Special centers providing counseling on child welfare programs will bring great benefits to society and thus, cases of violence and inappropriate behavior will reduce.
References
De Arellano, M. A., Ko, S. J., Danielson, C. K., & Sprague, C. M. (2008). Trauma-informed interventions: Clinical and research evidence and culture-specific information project. Los Angeles, CA, & Durham, NC: National Center for Child Traumatic Stress.
Kolko, D. J. (1996). Individual cognitive-behavioral treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children, 1, 322342.
Kolko, D. J. (2004). Individual child and parent physical abuse-focused cognitive-behavioral treatment. In B. E. Saunders, L. Berliner, & R. F. Hanson (Eds.), Child Physical and Sexual Abuse: Guidelines for Treatment (pp. 4344). Charleston, SC: National Crime Victims Research and Treatment Center.
Kolko, D. J., Campo, J. V., Kelleher, K., & Cheng, Y. (2010). Improving access to care and clinical outcomes for pediatric behavioral problems: A randomized trial of a nurse-administered intervention in primary care. The Journal of Behavioral and Developmental Pediatrics, 31(5), 393404.
Kolko, D. J., Campo, J. V., Kilbourne, A., & Kelleher, K. (2012). Doctor-office collaborative care for pediatric behavior problems: A preliminary clinical trial. Archives of Pediatrics & Adolescent Medicine, 166, 224231.
Kolko, D. J., Dorn, L. D., Bukstein, O. G., Pardini, D., Holden, E. A., & Hart, J. D. (2009). Community vs. clinic-based modular treatment of children with early-onset ODD or CD: A clinical trial with three-year follow-up. Journal of Abnormal Child Psychology, 37, 591609.
Kolko, D. J., Hoagwood, K., & Springgate, B. (2010). Treatment research for trauma/ PTSD in children and youth: Moving from efficacy to effectiveness. General Hospital Psychiatry, 32(5):46576.
Kolko, D. J., Iselin, A. M., & Gully, K. (2011). Evaluation of the sustainability and clinical outcome of alternatives for families: A cognitive-behavioral therapy (AF-CBT) in a child protection center. Child Abuse & Neglect, 35(2), 105116.
Kolko, D. J., & Kolko, R. P. (2009). Psychological impact and treatment of child physical abuse of children. In C. Jenny (Ed.), Child Abuse and Neglect: Diagnosis, Treatment and Evidence (pp. 476489). Philadelphia: Saunder/Elsevier, Inc.
Kolko, D. J., & Swenson, C. C. (2002). Assessing and treating physically abused children and their families: A cognitive behavioral approach. Thousand Oaks, CA: Sage Publications.
Urquiza, A., & Runyon, M. (2010). Interventions for physically abusive parents and abused children. In J. E. B. Myers (Ed.), The APSAC Handbook on Child Maltreatment (3rd edition). Thousand Oaks, CA: SAGE Publications.
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