Tourigny, M. et Farkas, L. (2008). Effectiveness of group therapy for sexually abused female adolescents: Follow-up six months after treatment. Dans  C. Canali, T. Vecchiato et J. K. Whittaker (dir.), Assessing the «Evidence-bas» of Intervention for Vulnerable Children and Their Families (p. 524-526). Padova, Italie : Alberto Brigo Editore. 

Effectiveness of group therapy for sexually abused female adolescents: Follow-up six months after treatment.

Background: Empirical data provides evidence that sexual abuse (SA) can be associated with devastating effects. The proliferation of research on the consequences of SA has paved the way for the development of innovative approaches to treating SA victims. Group therapy represents one of the most frequently used modalities. Group treatment may be particularly useful for reducing the social isolation and stigmatization often felt by child SA survivors and may be particularly suitable for adolescents who are at a stage of development where the presence of peers is valued. However, few studies have specifically evaluated the effects of group therapy among adolescents as most of the research focuses on youths aged 6 to 17 without differentiating the precise effects among the adolescents. Studies measuring the maintenance of the effects of group therapy are even fewer in number.

Purpose: The present study evaluates a treatment group for SA adolescent girls six months after the end of the therapy. In response to the methodological limitations identified in the literature, this study: (a) includes a control group, (b) relies on a large spectrum of measures, some of which are specific to sexual abuse, (c) documents the level of participation in the sessions and (d) documents the maintenance of gains in a six month follow-up.

Method: A quasi-experimental design with two waves of measurement (pre-test and follow-up six months after the end of therapy) was used in the study. The experimental group was composed of 18 adolescents who received six months of two-hour weekly sessions of closed-group therapy.

The control group was composed of 13 adolescents who requested services from the centre but did not receive treatment for the following reasons: deciding not to participate in the group therapy, withdrawing from the therapy in the first two sessions or having been judged as unsuitable for the therapy (e.g., due to difficulty expressing emotions in a group setting or excessive shyness).

Outcomes measures were the following: 1) the Trauma Symptoms Checklist for Children (Briere, 1996); 2) the Youth Self-Report and Profile (Achenbach, 1991); 3) the Ways of Coping Questionnaire (Knussen, Sloper, Cunnigingham, & Turner, 1992); 4) the Children's Attributions and Perception Scale (Mannarino, Cohen, & Berman, 1994); 5) the Self-Injurious Behaviours Questionnaire (Sadowsky, 1995); 6) the Child's Attitude toward the Mother (Giuli and Hudson, 1977); and 7) the Scale of Empowerment (Rogers, Chamberlin, Langer Ellison, & Crean, 1997).

Findings: First, a series of t-tests were performed to compare the experimental and control groups on the outcome measures at pre-test. Both groups presented similar profiles on all but four variables. Group scores differed on eating-related disorders, attributions linked to interpersonal trust and two coping strategies: seeking social support and planful problem solving. The control group had more symptomatic scores than the experimental group on all these variables. Second, in order to account for the considerable attrition rate, analyses were conducted to compare those who withdrew after the post-treatment evaluation to those who remained in the study for the six month follow-up. No significant differences emerged on any of the outcome measures, suggesting that these participants were indistinguishable from each other.

Concerning statistical changes, repeated analyses of covariance (with the pre-test score used as a covariable) were then computed to explore whether significant differences emerged between the experimental and control groups at the six month follow-up. The ANCOVAs tested the difference between the pre-test and follow-up scores. Results show a significant improvement for the experimental group on all variables besides for the quality of the mother-child relationship. The experimental group presented significant reductions in: 1) posttraumatic stress symptoms for all subscales of the TSC-C; 2) cognitive distortions, particularly interpersonal trust and personal attributions; 3) internalizing and externalizing behaviours and 4) delinquent and self-destructive behaviours. The experimental group also significantly improved their: 1) perception of their relationship with their father; 2) coping strategies, demonstrated by increased use of seeking social support, planful problem solving and decreased use of avoidance; 3) global sense of empowerment, particularly in the optimism subscale and personal effectiveness.

Concerning clinical changes, results show that the percentage of participants in the experimental group with clinical scores reduced on all outcome measures. In contrast, the percentage of participants in the control group with clinical scores predominantly increased, besides for a reduced percentage with clinical scores of depression, dissociation, sexual preoccupations, use of drugs and thought problems and an unchanged percentage with clinical scores of anxiety, attention problems and perception of their relationship with their mother. These clinical results complement the statistical results presented above and further support the effectiveness of the group therapy.

Implications: The findings suggest that the group therapy was effective in reducing symptoms for sexually abused teenagers and corroborate results found by other studies examining the effectiveness of group therapies for adolescents at follow up. Kruczek and Vitanza (1998) also found significant improvement in the coping strategies of sexually abused adolescent girls after treatment and at a three-month follow-up. Furniss et al. (1988) and Lindon and Nourse (1994) stated that the effects of group therapy were maintained in their studies. In a social context where demand for services is high and resources are limited, group therapy offers important economic advantages relative to other forms of treatment.

The present study has some limitations. First, the level of attrition was considerable as 11 of 42 participants withdrew from the study prior to the follow-up. However, these participants did not differ significantly from participants who remained in the study on any outcome variables. Second, the groups were not randomly assigned. Although significant differences did not generally emerge at the pre-test on sociodemographic variables, sexual abuse characteristics or outcome variables, certain characteristics that may differ between the two groups (e.g., motivation to change) may have influenced the results. Third, all measures were self-report questionnaires administered to the adolescents. A more complete and valid portrait would entail the use of various sources of information, such as parents or teachers.

However, this is the only study to examine the follow-up of a therapy using a comparison group. It also used a variety of validated measures directly linked to consequences of sexual abuse and documented the attendance rate in the group intervention. This study therefore fills a gap in the literature on methodologically-sound research on the follow-up effects of group therapy for sexually abused adolescents.

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