Case History and Discussion
Lili Pintea-Reed, PhD

Abstract
To better facilitate the eradication of child sexual abuse, the helping professional must have good understanding of the types of clinical evidence which court systems all over the world use to convict perpetrators. Professionals must also be fully aware of the types of stress experienced by child victims, and treatment modalities that are useful interventions for a child undergoing the rigors of testifying in court.

Introduction

Child therapists, particularly those in the public sector, quite frequently are called upon to report for, and then treat, the child victims of sexual abuse. This is a far more common professional requirement than those who educate future therapists acknowledge. This causes many therapists first entering the profession to be shocked and surprised when they encounter abuse victims, and inadequately prepared to both render good counseling to their patients and assist them in successfully completing the court prosecution of the perpetrator (National Center on Child Abuse and Neglect, 1987).

This process goes through several stages. Initially, the child and the family are in crisis (Wolfe, 1989). However, the therapist -- particularly if she is also the initial abuse investigator -- is in the position of not only providing emotional supportive counseling, but also of documenting the child's first recollections of the event (Lewington, 1995; Indest, 1989). This is not an uncommon therapeutic intervention particularly in public clinics (Eckenrode, 1985). Critical evidence can be forever lost if this initial crisis intake interview is not thorough (Merskey, 1992; McNally, 1991; Resnick, 1991). Even though it can be perceived as unkind to have the child repeat carefully as much of the event as possible, in terms of long term healing it is very good for the child to tell as much as possible in the initial interview (Bisson, 1994). Fine recall of detail can easily be lost (particularly in young children) if the child is not given the opportunity to speak fully about the events soon afterward (Christianson, 1992).

This also the time to get the parent or parents actively involved in the process of prosecution. Unfortunately, it is often true that the parent or parents are shoved aside, if not actively accused of "failure to protect", by the various state agencies and police services involved with a child victim (Humphreys, 1994). This can have the unfortunate effect of isolating the child from parental comfort at the time she will need it most. At worst it can create a lifelong rift between parent and child. Many parents are not in a much better condition than the child, and need to go through similar processes in healing as the legal case proceeds (Weiss, 1993).

To deny or pretend that the legal process is not a factor is clinically foolish. And to pretend that clinical records are not going to be court ordered is naive at best. The clinical record generated during therapy can be a valuable aid in building a case against the perpetrator. It is a mistaken belief -- even in cases with a lot of what is called "physical evidence" -- to think that the child's recollections are not terribly important to the legal process of protecting the child. The law in most states reads that the burden of proof rests on the prosecutor, who must present a completely compelling case to the judge or jury. The more evidence the prosecutor has to bring to the case, the better (Eckenrode, 1985).

Certainly the police/and or official child abuse investigators bear the brunt of this burden, but a huge amount of clinical evidence is generated by a therapist. This may often be the last bit of "the burden of proof" an overworked judge or jury needs to bring a perpetrator to justice. Like all people, juries wish to feel confident about their decisions and comfortable with them. A weighty "burden of proof" on the prosecution's side can help give them this confidence. In the case below, one of the first in the country to use video taped depositions (statements of their case) by child victims, I shall outline the manner in which therapy had the side effect of helping the legal case while facilitating healing.

Case Studies: Children A, B, and C and the case of D

This study will generally demonstrate the manner in which the cases were handled to best facilitate the dual roles I assumed as abuse investigator and therapist in the case of these children. Specific personal information is withheld to protect their privacy. For more detailed information of the actual case, one should refer to the public court records of The State of Florida vs. Jose Lozano, 1992, and The State of Florida vs Richard Howard, 1993.

Children A, B, and C, were in the age range of 3 years to 11 during the events in question. Their mother's long term paramour, with whom she shared a business, had been the molester. They had split time between the business and child care, and the abuse had taken place while the mother was taking her turn at the business and the paramour watched the children. The two older children were of another father while the youngest was fathered by the paramour.

The mother reported that she started to get a "funny feeling" when she came home from work, and thought her paramour acted anxious, but the children didn't seem unusually upset, so she ignored these warning signs. Finally one day when away from the paramour, the older child, then 9 years old, told the mother that he had "touched her down there." Further questions by the mother revealed that he had been taking the child into the bedroom while the mother was at work, and fondling her genitals and rectum, and having the child fondle his penis. From the child's description he did not obtain an erection from these activities (this was assumed as the child didn't understand questions about the perpetrator's penis "changing.") Child A reported being frightened by these activities, but uncertain what to do as the perpetrator had told her he would "kill her mother," if she told on him. These activities had gone on for some months, before child A told her mother as they had made her "feel too bad."

The mother was, as one would expect, very upset by all this. She returned home and made an excuse to take all the children with her. Once outside the home, the younger ones reported similar acts of perpetration with the same threats. None of the children had known about the others, so careful had they been to protect their mother. The mother contacted the state abuse 800 number and reported the abuse. She was afraid to return home, so she waited at a relative's home. The police came with the state abuse investigators. The children underwent physical examination for the reported events and were found to have physical changes that indicated the truth of their allegations. The perpetrator was arrested and taken to jail. However, he contacted a wealthy relative who posted $600,000 bond for him within moments of the booking. He was released and told to stay away from the children and their mother. The mother was told to take the children to counseling at the local mental health center, but they were only seen twice before funding problems ended the employment of the child therapist. Six months passed before the children were seen again in therapy.

During that six month period, the case had still not returned to court. The perpetrator had come to his former residence and threatened the girls and their mother with a knife. The mother called the police and had him arrested, but he once again posted a high bail and was released. The mother and children were very stressed by these events, as is typical in these cases, but could not leave their place of livelihood. Unlike many women, this mother was determined to "not let him get away with this and hurt other children." She had her own income, so she was not in the position of many mothers of having to drop the charges due to the many burdens which collapse the efforts of many women to prosecute (no income ... no residence ... loss of a relationship ... physical threats ... etc.)

Just at this point, the local agency hired a child/family therapist (myself). The beleaguered mother and children finally had a place to go for emotional support and to further the investigation and healing of the events. Using a post-stress treatment model of acknowledgement and catharsis, a good deal of new evidence was also produced for the case, as the slow wheels of justice turned to the time of the trial, still some months away.

Though it was not the intent, the process of clarifying and verbalizing the events lead to much new evidence for the case. The children were encouraged to draw pictures of the events. This led to the creation of a large file of descriptive pictures. These drawings confirmed that the children had indeed seen and touched non-erect male genitals and had been touched and had digital intromission of their genitals and rectums.

Questions like "tell me more" or "lets draw some more" lead to much productive discussion. This was also documented thoroughly, producing hefty casenotes. (If I were to repeat this case, I would tape or video tape these sessions.) A month or so before the trial, the children went to visit the court house to see what it looked like. They went also to the room where the depositions would be taken, so they would be familiar with it and less frightened on trial day. This visit proved that the children were still terribly anxious and frightened about facing their perpetrator. The prosecutor and child abuse investigator also observed this. The prosecutor had never tried a rape case before, so he was surprised. It was pointed out to him that grown women were fearful of confronting their perpetrator in court, so it was hardly surprising small children with even less mental resources would be able to easily do so. It was planned that the children would practice "playing court" in therapy, and that the youngest child would be very clear on the difference between "truth and lies."

This role playing went on in therapy, and the children also saw a film of a child successfully testifying on the stand. However, their perp was still out on bail. As the trial date neared, the mother's house was broken into and entered. The family was not there at the time, as we had devised a safety plan. The mother's family had made fun of this, but were glad now. During one of these times, the home was entered and a number of objects broken. Just enough to let her know he could do it, without actually leaving enough evidence to be charged. As the trial date approached these, sort of behaviors on his part and those of his family increased. For example, my car had mud put in the oil, causing it to overheat on the long journey home. The mother's truck tires were cut. Children at school began to make fun of the children, saying they had "F**d their father," etc. Threatening phone calls were made to the home.

The children began to have nightmares, fearing that the perp would indeed carry out the threats against the mother. The youngest child recanted her testimony in a therapy session after some children at school said she "had sucked her father's dick." Good communications among the helping professionals saved the case. The prosecutor was informed of the increase in harassment and a number of legal steps took place. A tap was put on the phone, the local police had a personal phone call from the prosecutor asking for quick response to calls for help. The mother was told she could use the agency watts line rather than run up her long distance bill calling for the various child welfare and legal agencies involved. The judge was informed of these problems and intended to hold the perpetrator without bail should an incident occur. I did much of this work, as I had the local phone to call the 35+ miles to help.

In some manner (possibly during a grocery store parking lot shouting match between the clients' mother and the perp's mother) the perpetrator became aware of the fact the law was perched to strike, and direct harassment of the victims stopped. However, harassment of the children at school increased. We suspect that the children in question were relatives of the perpetrator. This type of abuse was very saddening and difficult to deal with. It was suggested to the mother to remove the children from school, but the mother disagreed. Family sessions were scheduled so that the whole family could plan how they would handle these problems. They all agreed they did not want to quit school and have a tutor come to their home. The children all learned how to dial 911 and practiced making a report. The children practiced telling the teacher about harassment. They were taken on a trip to the police station, so they knew where it was.

As the time for the deposition approached the children were still very rattled by these events, and the prosecutor petitioned the judge for permission to let the children give their depositions on video tape. Statements on their emotional condition from myself, the state abuse worker, and the mother enabled the judge to feel comfortable about this decision. It was decided that depending on how well the children held up in deposition, the judge would accept their testimony via video also, thus sparing them the new trauma of a court room confrontation with their perpetrator.

The case finally came to deposition. Their mother, myself, and the child protection worker were there for support, while the prosecutor and defense attorney asked them questions about the episodes. Despite all the preparation, the youngest child fell apart while testifying, even though it was just before a video camera. She was just too frightened "to tell" very much. She did manage to confirm some of the fondling behaviors before shrinking down into the pillows she was sitting on. It was very striking and served as evidence with which to present a case for the excusal of the children from courtroom testimony. The eldest child as expected presented the best, but the obvious fear was indeed quite apparent in the films. The depositions and the physical and clinical evidence served to help convict the perpetrator, but the full weight of all the evidence was very necessary to present the case. Just physical evidence alone would "not have done it," to quote the prosecutor.

The perpetrator received 11 year sentences for each child totaling 33 years total time. He will be eligible for parole in ten years.

Child D:

The case of child D is very similar. The mother's paramour increasingly molested the child while he and the mother worked opposite shifts to make ends meet. In this case, a full intromission rape took place which required surgery to stop the bleeding. The child reported the events of the rape the night of the surgery to the child protection worker who interviewed her at the hospital. However, after awaking from the surgery she had lost recall of the act of full rape. It was postulated she had retrograde amnesia from the physical shock of the events. However, she had full recall of the fondling episodes which had led up to the event. Proving this was significant, and the rapist was charged with the fondling and rape. As this case followed the one described prior, and since the child almost died, the judge denied the rapist all bail on the grounds of the severity of the attack. He was imprisoned until the trial.

Providing adequate evidence of the fondling was very important as this was the child's strength in testimony. The physical DNA evidence from the semen samples was to be challenged very much like the recent popular case in the USA (California vs Simpson). That made therapeutic evidence very significant once again. I used the child's drawings of the events once again to help give the judge something tangible to look at. A drawing of particular significance was that of "The monster." The child, who was quite young, often couldn't make herself speak the perp's name as she was too frightened. She called him "the monster." When asked to draw a picture of "The Monster" she drew a fleshy pink "mushroom like" shape with "stuff" spurting out of the top. This proved to be a very convincing piece of evidence.

Tapes and extensive clinical descriptions of the child's unusual play helped build the case. One example of this was in answer to the therapist's question, "How would the paper dolls be safe to go to sleep?" The child placed them in the doll house, taped paper over the door to the room of the doll house, taped paper over all the windows and doors, then placed the therapist's desk chair over the doll house. Finally, she told the therapist that they now had to stand guard. This was the only way for the paper dolls to sleep safely. Evidence of this sort can be very telling in court, as well as a good therapeutic technique.

This case also took over a year to finally prosecute. The rapist received a 25 year to life sentence due to the severity of the attack and the prolonged nature of the fondling behaviors. His sentence would not have been as long without the clinical evidence to support the extensive fondling, which made it clear he was far more pathological than the "one time" rapist that the defense attempted to portray him as.

Discussion:

As is plainly evident, being a therapist of a child rape victim indeed involves more than is usually expected in the "sugar and spice" world of child therapy. Obviously the child and parent experience stress from not just the rape(s), but from insecurity surrounding their personal safety. Very seldom are victims protected, and often the perpetrator is freed on bond. These fears and concerns on the part of the client and parent are very real experiences, and not to be brushed off by the therapist as "paranoid" ( Magwaza, 1991; Mowinski, 1990; Cole, 1988).

Helping the child and parent develop good coping strategies for possible physical safety problems and allowing them to ventilate their fears and concerns in the therapeutic setting are important clinical concerns (Parrott, 1990). The children can be monitored in age appropriate ways . Obviously, older children can simply be asked if they have worries and what those worries consist of. Younger children can be asked about bad dreams, asked to tell stories about their fears, and can draw and express in play therapy. Anxiety can be lowered by verbalizing the concerns (Thompson, 1992), particularly in family sessions, and planning appropriate strategies. Children can practice dialing 911 and review basic safety rules. There are commonly available tools to teach personal safety to children that any agency can keep on hand for free. These can greatly increase a child's feeling of empowerment and give the beleaguered parent(s) some relief from what may seem unmanageable worries (Spaccarelli, 1994).

Involving the parent in the process helps maintain the parent-child bond in a situation that could easily fracture the relationship. Parents can easily reject children in these situations for a number of reasons. The first is simply guilt. Parents can have an extremely deep sense of failure in these situations and can take it out on the child. They need to be told that children frequently keep quiet in these situations in order to protect the parent from threats made by the rapist. They need to understand it was the child's deep loyalty to the protected person that kept the silence in cases where prolonged abuse occurred (Humphreys, 1994).

Helping professionals who focus solely on the child in these cases and see the parent only as inadequate do a disservice to the child (Briggs, 1994) who certainly wishes to maintain their family, as well as to the parent. Many of these women are single parents perceived as vulnerable by long-term perpetrators, who seek them out. They often work long hours for low pay and are simply too exhausted to notice or question behaviors a more rested, informed person would see (Wodarski, 1988). Getting parents to their own therapy is a very necessary step in successfully resolving many issues. Blaming them as an easy target is simply cruel, and will frustrate therapeutic efforts to provide emotional support and safety for the child (McFarlane, 1994). Family therapy can be extremely effective in these cases (Allen, 1994) and breaks up the vicious cycle of blame and anger that can be generated (Williams, 1992).

A related issue is to keep communications between the helping professionals open and current. In legal cases where the day to day reporting of events and crisises is usually to the therapist, special effort must be made to keep the written and oral communications current. An example would be where a panicked client calls the therapist to tell her that the car tires have been cut. After checking the clients location and safety, the therapist can insist that the client call the police and report it, with a follow-up made by the therapist to be sure it took place. One finds that emotional exhaustion is a strong factor in these cases and the therapist must keep communications moving. No one else is going to in many areas. Therapist supervisors should be kept involved in the need for the extra effort and time involved in these cases. This requires a team commitment from all staff. The receptionist and fellow staff persons must be aware that these cases involve legal issues beyond those commonly associated with therapy. Proper documentation of all messages and a timely relay of client calls is essential and can quickly become part of the legal process as well. Extra time needs to be taken to carefully document child behaviors and comments. Extra equipment like tape recorders and video tapes of play therapy sessions might be involved (Roesler, 1992). Longer sessions, especially in areas where the therapist is expected to make the diagnostic interview, can be required of the therapist, changing typical session schedules.

A multi-modal treatment model can be very effective (Zahn, 1993) particularly with younger children. A full range of expressive treatments like art therapy (Brooke, 1995; Tibbets, 1989), and play therapy are very useful in giving "voice" to the less verbal. These also have the effect of generating tangible physical evidence for judges and juries to examine. The documentation of common stress related changes in children's behavior (Sandler, 1994) can be useful as a theraputic tool for intervention and secondarily as supportive evidence in court. Certainly the resourceful therapist will wish to use all these techniques and more to help their clients heal.

All of this requires increased therapist time, which must be expected and accounted for by agencies agreeing to do abuse services. Therapists taking abuse cases must expect the extra responsibility and work involved. Therapists need to plan effectively with management to design a work environment that facilitates such a concentrated effort in order to not just do good therapy, but also to actively facilitate the incarceration of rapists.

SUMMARY:

Therapists who wish to do successful therapy with child victims need to attend to a number of problems. They must first recognize and plan for the fact that rape victim clients are also legally involved. This presents many extra complications in the therapeutic process. The therapist and all records are subject to legal question and scrutiny, and possibly threats from the perpetrator. Extra time and care need to be taken to deal with these issues, both by the therapist and the agency. Clients are most likely involved in very serious current crisis situations as well as dealing with post-trauma. The therapist often is the primary resource contact for the client and the parent(s) and much extra time needs to be taken to offer support and encouragement in crisis. Facilitating the parent/child bond can be necessary in the face of such trauma to increase feelings of competency and empowerment in both the child and parent(s) as many of the grief/loss issues involved in rape cases can negatively impact on this core relationship. A recognition and expectation of these factors will help successfully conduct such cases to a good resolution.

List of Rape and Violence Related Lists on the Internet
PinteaReed's Home Page

REFERENCES:

Allen, Steven N. (The Psychiatric Clinics of North America 06/01/94) Group and Family Treatment of Post- Traumatic Stress

Bisson, J. I. (The British Journal of Psychiatry. 12/01/94) Psychological debriefing and prevention of post- trauma

Briggs, Kathleen (The American Journal of Family Therapy ( Winter 94 ) Sexual Abuse Label: Adults' Expectations for Children

Brooke, Stephanie L. (The Arts in Psychotherapy. 1995) Art Therapy: An Approach to Working with Sexual Abuse

Busby, Dean M. (Journal of Marital and Family Therapy - 10/01/93) Treatment Issues for Survivors of Physical and Sexual Abuse

Cassiday, Karen Lynn (Cognitive Therapy and Research. 06/01/92) Cognitive processing of Trauma Cues in Rape Victims

Christianson, Sven-A (Psychological bulletin. 09/01/92) Emotional Stress and Eyewitness Memory

Cohen-Liebman, Marci (Art Therapy. 1994) The Art Therapist as Expert Witness in Child Sexual Abuse

Cole, Jr., Tony (Psychological Reports. 10/01/88) Stress, Locus of Control, and Achievement

Eckenrode, J. & Doris, J. Substantiation of Child Abuse and Neglect Reports, (National Center on Child Abuse and Neglect, 1985) STUDY NUMBER: SIB-050

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This article is copy write protected ; Lili Pintea-Reed, PhD and may not be copied, reprinted, or otherwise used in any form without the express written permission of the author.
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This was one of several pioneering child rape cases tried in the State of Florida under the aegis of then Florida State District Attorney Janet Reno, State District Attorney Dave Whitting, and several others. These cases were featured on the PBS Special "FRONTLINE" in  a Special child rape episode.
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To Find a list of Child Predators in Your Area and GREAT Prevention Information go to: Parents for Megan's Law