CHILDREN'S ISSUES, LAWS AND PROGRAMS

CHILD ABUSE AND NEGLECT
PERCEPTIONS,
PSYCHOLOGICAL CONSEQUENCES
AND COPING STRATEGIES

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LAWS AND PROGRAMS CHILD ABUSE AND NEGLECT PERCEPTIONS. CHILDREN'S ISSUES. PSYCHOLOGICAL CONSEQUENCES AND COPING STRATEGIES MICHELLE MARTINEZ EDITOR New York .

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Elsie Lobo. Cree Robinson. Lauren B. Aimee Galick. Douglas Huenergardt and Hans Schaepper Chapter 3 Parent-Child Interaction Therapy for the Treatment and Prevention of Child Abuse and Neglect 65 Amanda H. Ria M. Costello. Stevenson Chapter 2 Building Relational Safety and Trust in Couple Therapy with Adult Survivors of Childhood Abuse 19 Melissa A. Denne. Nancy Wallace and Cheryl B. CONTENTS Preface vii Chapter 1 The Role of Ethnicity in Child Custodial Decisions 1 Emily R. Wornica and Margaret C. Quetsch. Carmen Knudson-Martin. Travers. Taylor E. Wells. McNeil Index 99 .

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and an overview of PCIT’s evidence base for both intervening with and preventing future CAN. Legal decision- makers. What factors shape decisions in child custodial cases? Chapter One of this book reviews empirical evidence suggesting that the race of the child and parent plays a role in shaping child custodial decisions. the child is sometimes placed in temporary custody through dependency court. Chapter Three provides a description of Parent-Child Interaction Therapy (PCIT). PREFACE Child abuse and neglect (CAN) continues to be a serious public health problem in the United States. Difficult and emotionally laden legal decisions occur within dependency court. including determining whether (and where) a child should be temporarily placed or whether a child should be returned to the parent’s custody. Chapter Two presents a feminist. a rationale for its use with parents and children who have experienced CAN.000 receiving foster care services (Child Maltreatment. including judges. affecting approximately 19% of victims and costing approximately $124 billion to society. . 2013). entitled relational trust theory. Over 6 million children experienced some type of child maltreatment in 2013. and social workers have the important task of determining what placement is in the best interest of the child. with 144. social constructionist theoretical conceptualization. case workers. When a child is removed from their parent’s custody due to parental abuse or neglect. that describes the effects of gendered power dynamics on the perception of the other partner as trustworthy in adult-survivor couple interactions. and expounds on the findings of a longitudinal grounded theory study that identified clinical processes of Socio-Emotional Relationship Therapy (SERT) that helped adult-survivor couples transform their gendered power disparities and engage in relationally safe ways that supported a trusting emotional culture.

gender. including determining whether (and where) a child should be temporarily placed or whether a child should be returned to the parent’s custody. and social workers have the important task of determining what placement is in the best interest of the child. social constructionist theoretical conceptualization. racism. Chapter 2 – Approximately one-third of partners in couple therapy have experienced childhood abuse. and power issues of adult-survivor couples. this chapter presents a feminist. Given the likelihood that adult-survivor couples may experience a distrusting emotional culture. Three key themes on gendered power . The chapter also expounds on the findings of a longitudinal grounded theory study that identified clinical processes of Socio-Emotional Relationship Therapy (SERT) that helped adult- survivor couples transform their gendered power disparities and engage in relationally safe ways that supported a trusting emotional culture. case workers. Indeed. Specifically. Legal decision-makers. The current chapter will review research regarding how race is related to decisions made involving children in dependency court contexts. including judges. and a common impact on adult survivors is the struggle to trust their intimate partner. They draw upon social psychological theory with respect to stereotyping. Over 6 million children experienced some type of child maltreatment in 2013. with 144. we review empirical evidence suggesting that the race of the child and parent plays a role in shaping child custodial decisions.000 receiving foster care services (Child Maltreatment. the child is sometimes placed in temporary custody through dependency court. Difficult and emotionally laden legal decisions occur within dependency court.viii Michelle Martinez Chapter 1 – When a child is removed from their parent’s custody due to parental abuse or neglect. entitled relational trust theory that describes the effects of gendered power dynamics on the perception of the other partner as trustworthy in adult-survivor couple interactions. and prejudice that help account for various effects of race in dependency court contexts. The findings from the research were applied to an additional four couples to refine the final grounded theory on how to work with the intersection of trust. The grounded theory analysis involved study of video and transcripts of 40 SERT sessions with four heterosexual adult-survivor couples. What factors shape decisions in child custodial cases? In the present chapter. 2013). African American children spend more time in the foster care system and wait longer to be reunited with their families than White children (Elliot & Urquiza. Furthermore. the likelihood of a child being removed from a home. asymmetrical gendered power processes in current couple interactions often erode trust. the authors review how race shapes the likelihood of child maltreatment allegations. 2006). and the likelihood of family reunification.

emotional. and relational domains. and 5) identify trustworthiness of partners. families may also remain at risk for future CAN. Chapter 3 – Child abuse and neglect (CAN) continues to be a serious public health problem in the United States. 2) comprehend the socio-emotional experience of partners. and an overview of PCIT’s evidence base for both intervening with and preventing future CAN. children who experience CAN are at risk for developing multiple difficulties across biological. affecting approximately 19% of victims and costing approximately $124 billion to society. 2) unique gendered power approaches. Several evidence-based interventions have demonstrated success in treating parents and children who have experienced CAN. Preface ix processes emerged: 1) gendered fear of being vulnerable. 4) initiate partners sharing power. a rationale for its use with parents and children who have experienced CAN. psychological. The study also delineated components of shared vulnerability that augment trust. One such intervention is Parent-Child Interaction Therapy. If left untreated. . and 3) distrustful reactions. This chapter provides a description of PCIT. Without effective intervention. The analysis identified five key clinical processes used to enhance trust: 1) recognize gendered power’s effects on relational safety. This clinical process research demonstrates the link of trust with gender and power dynamics in adult- survivor intimate relationships and how to sensitively address in couple therapy the partner processes that interfere with trust. 3) accentuate relational needs.

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Specifically.In: Child Abuse and Neglect ISBN: 978-1-63484-785-8 Editor: Michelle Martinez © 2016 Nova Science Publishers. including determining whether (and where) a child should be temporarily placed or whether a child should be returned to the parent’s custody. US ABSTRACT When a child is removed from their parent’s custody due to parental abuse or neglect. 2006). Chapter 1 THE ROLE OF ETHNICITY IN CHILD CUSTODIAL DECISIONS Emily R. What factors shape decisions in child custodial cases? In the present chapter. and social workers have the important task of determining what placement is in the best interest of the child. with 144. African American children spend more time in the foster care system and wait longer to be reunited with their families than White children (Elliot & Urquiza. Wornica and Margaret C. IN. Inc. the child is sometimes placed in temporary custody through dependency court. we review empirical evidence suggesting that the race of the child and parent plays a role in shaping child custodial decisions. Stevenson. Over 6 million children experienced some type of child maltreatment in 2013. including judges. Indeed. The current chapter will review research regarding how race is related to decisions made involving children in dependency court contexts. Difficult and emotionally laden legal decisions occur within dependency court.000 receiving foster care services (Child Maltreatment. case workers. PhD University of Evansville. we will review how . Taylor E. 2013). Legal decision- makers. Denne. Evansville.

Moreover. racial differences in dependency court experiences might.000 receiving foster care services (Child Maltreatment. Unfortunately. Surprisingly. What factors shape decisions in child custodial cases? In the present chapter. and the likelihood of family reunification. When a child is removed from their parent’s custody due to parental abuse or neglect. Unfortunately. including judges.2 Emily R. Sweeney & Haney. 2006). 2013). Legal decision- makers. social workers) contribute to the disproportionately greater number of . have the important task of determining what placement is in the best interest of the child. including determining whether or not a child should be temporarily placed in a foster care home versus returned to the parent’s custody. Decisions made by dependency court judges have serious consequences for the health and well-being of the children involved. We draw upon social psychological theory with respect to stereotyping. research consistently reveals that African Americans are overrepresented in the child welfare system (Hill. in part. 2006). and social workers. due to the fact that a very small amount of these cases are straightforward. social science research has documented myriad ways in which legal decisions are influenced by extra-legal biases stemming from prejudice and prejudicial emotion (for a review. we review empirical evidence exploring the possibility that the race of the child and parent play a role in shaping child custodial decisions. To what extent do racial biases of legal decision-makers (judges. Wornica and Margaret C. On the one hand. Denne. be a by-product of elevated poverty rates of African Americans. the likelihood of a child being removed from a home. Difficult and emotionally laden legal decisions occur within dependency court. with 144. racism. 1992). Taylor E. Stevenson race shapes the likelihood of child maltreatment allegations. little research has explored the extent to which prejudice affects legal decisions in dependency court contexts – contexts in which emotions often run high. African American children spend more time in the foster care system and wait longer to be reunited with their families than White children (Elliot & Urquiza. the task of determining a child’s placement is often complex. Yet. the child is placed in temporary custody through dependency court. On the other hand. It is imperative and a legal requirement that these rulings be unbiased and uninfluenced by prejudice and prejudicial emotion. and prejudice that help account for various effects of race in dependency court contexts. case workers. stemming from historical and institutionalized racism. and many accompany allegations of abuse and neglect that lack physical evidence. interpersonal discrimination within legal proceedings might also play a role. Over 6 million children experienced some type of child maltreatment in 2013.

RACE AND THE CHILD WELFARE SYSTEM: MODERN PERSPECTIVES While African American children make up only 13. This was spurred particularly by the relocation of many African American families to the north as well as a nationwide focus on racial integration (Hogan & Siu. while African American children were placed in cost-effective foster homes (Magura. In response. we will review how race shapes the likelihood of child maltreatment allegations. however.9% of children in the United States. After the Civil War. Shyne & Schroeder. 1988). and the likelihood of family reunification. Following WWII. African Americans created their own institutions to provide child welfare services. We draw upon social psychological theory with respect to stereotyping. and prejudice as a theoretical framework for understanding the various effects of race in dependency court contexts. their experiences and outcomes differentiated greatly from those of White children (Hogan & Siu. Despite African American’s inclusion in the child welfare system. 1988). Specifically. The more costly services were dominated by White children. 1978). 1979. the likelihood of a child being removed from a home. anti-black sentiment was still very pervasive and African American children were excluded from the foster care system that emerged (Hogan & Siu. RACE AND THE CHILD WELFARE SYSTEM: A HISTORICAL PERSPECTIVE In the early 1800’s African American children were excluded from the orphanage system and were placed in care under separate institutions such as the Association for the Care of Colored Children (Hogan & Siu. they comprise 24% of children in the foster care system . 1988). 1988). The Role of Ethnicity in Child Custodial Decisions 3 African American children involved in the child welfare system or help explain why they spend more time in foster care? The current chapter will review research regarding how race is related to decisions made involving children in dependency court contexts. the foster care system was developed. African Americans gradually gained access to the child welfare service that had been available to White children for decades. racism.

racism in this form is often unintentional. political. Instead. Moreover. Di Leone. Indeed. Denne. When there are clear social norms and when discriminatory behavior will be obvious. Indeed. & Kite. While the overt and blatant racism of the early 1900’s is less common today. mortality rates. Taylor E. It is important then to explore the possible causes of the overrepresentation of African American children in foster care. does racial discrimination extend to children? There is some evidence that it does. For instance. Jackson. & Gaertner. when racial bias can be expressed subtly and justified in non-racial terms. 2010).4 Emily R. 2010). African American children are perceived as less innocent then White children. 2006). although racism today is generally explicitly rejected. Dovidio. & Kite. AFCARS. We turn next to the theory of Aversive Racism to better understand the contexts in which racism will manifest. White) accused of physically assaulting his girlfriend and the . Wornica and Margaret C. Culotta. We turn to modern theories of racism to help explain such racial inequalities. Specifically. 1988). Sommers and Ellsworth (2000) experimentally manipulated the race of a man (African American vs. 2006). 2014). For instance. the historical discrimination of African Americans over centuries can have far reaching implications that withstand changing public opinion (Henkel. 2014). modern and more subtle yet damaging forms of covert discrimination are responsible for the racism and unequal care given to minorities in the present day (Hogan & Siu. and societal disparities among races (Henkel. racism still exists in meaningful and measurable ways both at an institutional and individual level. most people are motivated to be non-racially prejudiced. This form of prejudice is not limited to the unconcealed and deliberate harming of African Americans that was much more common before the Civil Rights Movement. Although changes in law and policy spanning the past decade have attempted to bridge racial disparities in health. & Gaertner. there are still numerous observable disparities. African American children are recipients of higher rates of police violence. & Gaertner. Dovidio. however it is no less detrimental. 2014. Stevenson (Children’s Defense Fund. in ambiguous situations. & DiTomasso. 2006). negative racial biases are more likely to manifest (Whitley. According to the theory of Aversive Racism. alternative and more subtle forms of racism are still pervasive. Dovidio. Thus. Dovidio. compared to White children (Goff. education and income. African American and White patients experience different levels of care from doctors (Henkel. Yet. and in turn. racism is unlikely to occur (Whitley. Yet. & Gaertner. racism encompasses the social power conferred to Whites at an institutional level that causes economic. 2009). yet still harbor lingering negative racial biases (Pearson.

UNDERSTANDING MINORITY OVERREPRESENTATION IN THE CHILD WELFARE SYSTEM Due to modern forms of racism. We use aversive racism to understand these racial disparities. in the race salient condition. Sommers & Ellsworth. Furthermore. participants convicted the African American defendant significantly more frequently than the White defendant.. the defendant said ―You know better than to talk that way about a Black/White man in front of his friends. where African Americans are discriminated against.‖ In the non-race salient condition. The decision to remove a child from their parent’s care is certainly a complicated one. race. Yet. 1986). race played a large role in the final custodial decision: The parent whose race most closely resembled the race of the child was awarded custody more frequently than the parent who was of a different race than the child (Myricks & Ferullo. the defendant was alleged to have said to his girlfriend ―You know better than to talk that way about a man in front of his friends‖ and in the race-salient condition. Such research has serious implications for poor families who have a higher likelihood of living in impoverished areas with more graffiti and . The theory of Aversive Racism can then be applied to child welfare cases where evidence is ambiguous and where a lack of standardized criteria for making unbiased decisions welcomes discrimination and racism. in the non-race salient condition. Jantz. 2015).g. 1986). we review areas within the legal system. and in turn. became motivated to avoid lingering racial biases. For instance. 2001). Indeed characteristics as benign as the amount of graffiti and litter in a neighborhood can influence whether or not a social worker decides to remove the child (Rolock. Specifically. though never the sole factor in determining custody. & Abner. it is not surprising that race affects outcomes of legal cases (e. racial disparities exist in how frequently children are removed from their homes. influenced by numerous factors other than those specifically related to the parent-child relationship. Specifically. presumably because participants were reminded about the issue of race. does influence judges’ judicial rulings (Myricks & Ferullo. a review of numerous custodial disputes involving biracial marriages revealed that when both adults were equally fit parents. The Role of Ethnicity in Child Custodial Decisions 5 salience of the issue of race in the context of the study. Next. defendant race did not influence conviction rates. in a child custody dispute context. specifically the child welfare system.

Dovidio. Jenkins et al. 2015). For example. Taylor E. institutional discrimination operates at an organizational level. Thus it is not surprising that social workers were 2 times more likely to remove a child from a minority ethnicity as compared to a dominant ethnic group (Enosh & Bayer-Topilsky.. examined the court records of 142 children in foster care and found documented ethnic differences in referral rates of children in foster care to mental health services. For example. 2009). social workers relied heavily on their personal biases against lower socioeconomic status families and families of a less prestigious ethnic origin (Enosh & Bayer-Topilsky. & Fontenot. Furthermore. & Gaertner. Bishaw. Denne. Wornica and Margaret C. social workers were 2. Institutional discrimination consists of the laws and policies that contribute to segregation and discrimination (Henkel. Indeed similar trends are pervasive in the child welfare system. Stevenson litter. it is well documented that African Americans are more likely to live in poverty than Caucasians (Macartney.6 Emily R. Once in the child welfare system. This results in African Americans experiencing the fewest welfare benefits while still being a highly represented group in the welfare system (Lin & Harris. Not only are African American children overrepresented. 2009). Specifically. 2015). states are more likely to have harsher rules and laws for welfare recipients in states with a high proportion of minorities on welfare (Lin & Harris. 2015). a study conducted by Garland and Besinger (1997). Not only are African American children more likely to enter the system. Caucasian children were more likely to be referred to psychotherapy than were either Latino or African American children.an effect that held even when controlling for age and type of maltreatment. (1983) conducted a review of the results of a nation-wide . Being a minority poses a substantial risk when in the child welfare system. 1988).5 times more likely to remove a child from a lower SES family as compared to a child from a moderate to high SES family when the child’s familial risk level was comparably ambiguous (Enosh & Bayer- Topilsky. 2006). institutional discrimination is still a serious problem in our legal system. While aversive racism often operates on an individual level. 2011). Indeed. as minority families have less access to the support services that are crucial in reunification (Hogan & Siu. one study found that when dealing with subjective risk assessment in a child custodial context. There are a substantially higher number of minority children in foster care than there are White children (Jenkins et al. African American children are more likely to be placed in out of home care and remain in this care for longer than White children (Child Welfare Information Gateway. 1983). Indeed. they are treated differently within the system. 2013). they have a different experience within the system than do White children.

Not only are African American children overrepresented in the child welfare system. In legal cases.. which in turn. 2006). Specifically in neglect allegations. as a predictor of out of home placement. 2015). In a separate study examining data from the Chicago Community Adult Health Study 2001–2003 (CCAHS) and administrative data from the Illinois Department of Children and Family Services (IDCFS). individuals are more likely to rely on their own heuristics and schemas . Jantz. 2015). Levinson & . it is unclear whether African American children experience more extreme forms of abuse and neglect or whether African American families are stereotyped as abusive and neglectful.400 social service agencies. RACE AND CHILD MALTREATMENT ALLEGATIONS A child first becomes involved in the child welfare system upon a report of maltreatment (Rolock. African American families are subjected to increased likelihood of reporting (Hogan & Siu. & Abner. as evidence becomes less clear. as indicated by the presence of markers like litter and graffiti. result revealed that African American children were more likely to be placed in foster care than were White children.g. they are repeatedly overrepresented in child abuse and neglect reports (Hogan & Siu. affects child maltreatment report frequency. In contrast. Neglect allegations can be convoluted with ambiguity and uncertainty. African American two-year-old boys were significantly more likely to be removed from their homes than either White or Hispanic children. Jantz.a clear path for bias and prejudice (e. often lacking substantiating evidence (Rolock. 1988). Jantz. & Abner. Indeed. It is clear that there are racial disparities within child dependency system. a child often becomes involved in dependency court after allegations of abuse or neglect. & Abner. on average. Regardless of low or high levels of impoverishment. Next. 2015). 1988). researchers have called for future research to explore this possibility (Elliot & Urquiza. a year longer than White children. Yet. Data analysis revealed that a significantly higher proportion of African American children were placed in foster homes and group homes as compared to residential treatment centers and secure facilities. we review the role of race in child maltreatment allegations. The Role of Ethnicity in Child Custodial Decisions 7 survey including over 2. Yet. Hispanic children were less likely than Whites to be placed in foster care system (Rolock. Additional analysis revealed that African American children remained in care. This specific study examined neighborhood impoverishment.

The belief that African Americans are more aggressive can explain the higher rates of reported abuse incidents. 2005). and social service staff were significantly more likely to report black children for suspected abuse when compared to white children. 1989). participants might be more likely to interpret ambiguously abusive behavior toward children as abusive if a parent is stereotypically considered to be aggressive (as African Americans are) (e. and previous research has shown that social workers’ biases against lower socio-economic status families have influenced their decisions when determining whether the child should be removed from the home (Devine. Enosh & Bayer-Topilsky. and hostile (Devine. However. allegations of abuse are simply the first step in dependency court. African American children experience reportedly higher rates of physical abuse than do White children (DHHS. 2005). Similarly. pediatric departments. Devine. Denne.. it is possible that African American parents are stereotyped as more abusive. Further. and in turn. Hapmton and Newberger examined data from the National Study of the Incidence and Severity of Child Abuse and Neglect to examine hospital personnel reports of suspected child abuse. 2010). Thus. That is. research has also revealed that people are also more likely to report physical abuse if the victim is of color than if the victim is White (Hampton & Newberger. Therefore. cause people to report them more frequently for child maltreatment as compared to equally abusive White parents. Moreover. participants also commonly reported the stereotype that African Americans are poor. . we turn to the role of race in abuse substantiations next. 2005). Stevenson Young. Result revealed that emergency room. it is possible that case workers may be more likely to perceive a situation as abuse if the victim is an ethnic minority (Barth. 1989. case workers might also administer more punitive or drastic actions for families of color. it is possible that the negative stereotypes surrounding African American families may contribute to the high rates of reported abuse incidents. 2015). 2005). Wornica and Margaret C. Taylor E. such as removing the child from the parent’s home (Barth. The most common theme reported by participants regarding stereotype knowledge was that Blacks are aggressive. 1989). Devine (1989) assessed White college students’ knowledge of various stereotypes regarding African Americans. Indeed.g. For instance. Specifically. That is.8 Emily R. it is still unclear whether the higher rates of reported abuse targeting African American parent’s stems from negative anti-African American stereotypes or said parents actually being more abusive. Of course. criminal-like. The abuse allegation must then be substantiated.

Dettalff and colleagues examined data from the Texas child welfare system to examine the ethnic discrepancies in abuse substantiation. This research suggests that elevated poverty rates experienced by African Americans might ultimately drive their higher rates of substantiated abuse. 2011. 2010). abuse by African American parents was more likely to be substantiated than that of Whites. Specifically. (2003) examined data from Minnesota in 2000. and characteristics of the child and parents. neglect.150 in annual salary) being over 95% more likely to have an abuse report substantiated when compared to the highest income group (over $40. Subsequent data from the National Incidence Studies of Child Abuse and Neglect 4 (2004-2009) has supported this claim (Sedlak et al. In support. . not all studies have found race to predict the substantiation of abuse (Dettalff et al. race did not emerge as a predictor of substantiation. sexual abuse...550 in annual salary) (Dettlaff et al. This appears to be some evidence that racial biases might play a role in abuse substantiation outcomes. with low income cases having increased likelihood of substantiation (Dettlaff et al. This effect was not only significant but also large in size. abandonment... 2011). Ards et al. and a combination of abuse types. family income was a strong predictor of substantiation. When authors controlled for family income in the substantiation of physical abuse. with the lowest income groups (less than $10. 2011). Yet. Yet. 2011). The Role of Ethnicity in Child Custodial Decisions 9 RACE AND ABUSE SUBSTANTIATION Research reveals that abuse claims made against African American children are substantiated disproportionally more often than those made against other races (Dettlaff et al. The Racial Disproportionality Movement in Child Welfare: False Facts and Dangerous Directions suggested that the racial differences found in the foster care system happen because African American children are more likely to be victims of abuse (Dettlaff et al. Korbin & Krugman. 2011). which revealed that even when controlling for various factors including type of maltreatment.. However. 2013).. it is possible that negative stereotypes about African Americans being violent and aggressive might cause people to be more likely to believe claims of abuse from African American parents than White parents..

the younger the child was. research is mixed in determining whether race contributes to a child’s chances of reunification. maternal substance abuse. Osterling & Drabble. One such option is to provide services that address parent and child problems. Family-related characteristics. Lee. 1999. 1994. Hines. Hines. Both family and child characteristics contribute to a child’s chances of family reunification (Hines. in comparison to single White parents (Harris & Courtney. & Osterling. minority children. finding no specific racial trend in a child’s chances of reunification. Lee. & Drabble. Indeed. Children with disabilities. reviewed 403 child welfare case records contained in the Child Welfare System. . Lee. Denne. 2007). 2007). Lee. & Osterling. Hines. ultimately facilitating familial reunification. However. 2007). child welfare agencies work to determine the safest placement for the child. Some studies have found ethnicity to be a significant predictor of reunification. African American children spend more time in foster care and wait longer to be reunited with their families (for a review. & Osterling. with White children being reunited more frequently than African American children (Courtney. Wornica and Margaret C. Taylor E. such that lower-income families are less likely to be reunified with their child than higher-income families (Courtney. However. respectively (Wells & Guo. 2007). and family structure). and infants. regardless of gender. when controlling for other related factors (e. Family structure is an additional factor that predicts reunification: Two-parent families are reunified more frequently and faster than single-parent families (Wells & Guo. & Osterling. This seems to be particularly true for single African American parents. Hines.. child’s age. further predict reunification. Hines. 2007). the more likely the child was to be reunited with their parents (Hines. Lee. 1994). Lee. 2007). Stevenson RACE AND REUNIFICATION After a child is removed from their parents’ care. Lee. 2006). further studies have found that once involved in the child welfare system.10 Emily R. and older children are less likely to be reunited with parents than are healthy children. 1999. 2003. and Drabble (2007). White children. Additionally. Osterling. including socioeconomic status. Overall trends revealed that maternal substance abuse was related to decreased likelihood of reunification. see Elliot & Urquiza. & Osterling.g.

ALTERNATIVE EXPLANATIONS FOR THE EFFECTS OF RACE IN THE CHILD WELFARE SYSTEM As previous research has demonstrated. African Americans are also stereotyped .. negatively affecting their chances of adoption. especially those on welfare. 1997). Leon. studies have shown that African American children are the least likely to be reunified as compared to White and Latino children. 2003. are dysfunctional. as compared to White children. Akin. the knowledge that African Americans are aggressive. which has notably been associated with a child’s likelihood of adoption (Barth. Smith. 2014). The Role of Ethnicity in Child Custodial Decisions 11 RACE AND ADOPTION If the child is not reunited with the parent. in turn. conversely. and hostile might lead to beliefs that African American parents. 2011). making more unannounced visits to the parent’s home. 1989). & Sieracki. Anti-Black stereotypes and aversive racism might form the basis for the discrimination that African-American children encounter and might help explain their diminished likelihood of being adopted. For instance. the child to be removed from the home. 2012. criminal-like. as a child’s age increases. the child is placed in foster care while they await possible adoption. making it more difficult for reunification to occur (Barth. for instance. Race was even shown to be a stronger predictor than the child’s age when examining reunification and adoption rates. 2011). a study conducted by Akin (2011) found that African American children were 38% less likely to be adopted. the likelihood of adoption decreases (Leathers et al. 2003). resulting in a greater likelihood for abuse to be reported and investigated. For example. These forms of discrimination that African Americans face ultimately might also help explain why children of color are in the foster care system longer. especially in single parent homes (Harris & Courtney. 2008. Several studies have indicated that African American children are not as likely to be adopted as compared to White or Latino children (Barth. Akin. in turn. African American children might be perceived as less innocent when compared to White children (Goff et al. Indeed. and diminishing chances of family reunification (Devine.. While studies have shown that remaining in foster care longer actually increases the likelihood of adoption. Further. Also. case workers might more vigilantly manage families of color in the child welfare system by. 1997. 2005). Snowden.

etc. including parental substance abuse. and living conditions. Poverty has far-reaching implications for a child’s education. child age. Unfortunately. health. 2009). This is supported in the Fourth National Incidence Study of Child Abuse and Neglect (NIS-4) which finds children from low-income families to be victims of abuse at significantly higher rates that those of higher-income families (Sedlak et al. we should also consider the role of poverty. parental employment. Stevenson as poor and lazy (Devine. 2003).. 2006). Wornica and Margaret C. (Hill. Brookhart. . Even so. & Jonson-Reid. poverty does not appear to fully explain all racial discrepancies in dependency court.beliefs that might also negatively influence the likelihood of reunification. poverty). 1989) -. that various studies have shown that minority children are still less likely to be reunited with their biological parents than non-minority children. independent of other confounding factors (e. more research is needed to help parse apart the confounding influence of both race and poverty on outcomes in child dependency court. 2009.000 children who had at least one substantiated maltreatment referral revealed that when controlling for age. Bruce. all of which are considered when determining the proper placement of a child involved in dependency court (Lin & Harris. African American children were still more likely to be placed in foster care than White children (Needell. there is indeed evidence that ethnicity appears to be a contributing factor to discrepant treatment within dependency court.. a review of over 137. & Lee. Consider. It is possible then that the higher poverty rates for African Americans. one study using child welfare data from Missouri found no racial disparities in child maltreatment reporting. Lee. & Needell. including a child being removed from their home as well as serving as a risk factor for child maltreatment itself (Hill. after controlling for poverty (Drake. even after controlling for various factors.12 Emily R. Taylor E. for instance. especially African American children. 2009). Denne. 2009). Thus. particularly because African Americans are at heightened risk of living in conditions of poverty. maltreatment. 2010). Lin & Harris. On the other hand. 2007). 2006. Freisthler. Poverty is a predictor of numerous negative outcomes. In support. In support. Whereas negative stereotypes and modern forms of racism represent one explanation for the overrepresentation of African Americans in the child welfare system.g. can in part explain their overrepresentation in the child welfare system. Cumulative deprivation that African Americans have experienced as a result of a history of racism contributes to African American’s susceptibility to poverty and welfare experiences. and poverty. African American children are twice as likely to live in poverty as White children (Lin & Harris.

In support.g. Tweed. Dovidio. measuring. parental gender. 2009). 2004). Scott. it is important that this research be conducted in a careful and considered way. natural confounds (e. which in turn. but also for families. . It is only with true experimental research that we can fully understand the effects of child race on dependency court outcomes. and controlling for various potential confounds. previous research attempting to manipulate juvenile defendant race (African American or White) using photos revealed no effects of race on conviction rates (Reppuci. there is a need for experimental. Only when researchers understand the prejudicial biases influence dependency court decisions can interventions to undermine these biases be developed. parental sexual orientation. including.. In line with aversive racism theory and research (Pearson. Future research should also explore other potential extra-legal biases that play a role in child dependency court context. However. using more subtle written embedded descriptors. for instance. it is important that future experimental research be conducted in methodologically appropriate ways. resulting in more fair and just decisions not only for the child. 2009). making race salient (by calling participants’ attention to the issue of race) increases participants’ motivation to avoid racial biases. Moreover. will undermine race effects. It is important to continue to conduct this type of correlational and archival research to develop a more thorough understanding of the real-life racial discrepancies in dependency court. ensuring that race is not made experimentally salient so that participants do not become suspicious of the purpose of the research. attending to. & Antonishak. & Gaertner. by eliminating various inevitable. poverty and abuse frequency/severity). revealed the hypothesized effects of anti- African American biases on conviction rates (Stevenson & Bottoms. and parental mental illness. It is imperative that we conduct this kind of experimental research to bolster the correlational research that already exists. highly controlled lab research to get at the root of causality. Only when we rely on multiple methodological approaches will we truly be able to understand both the causal influence of race in custodial decisions and the actual effects of race in the real world. but other research manipulating juvenile defendant race. The Role of Ethnicity in Child Custodial Decisions 13 CALL TO ARMS FOR FUTURE RESEARCH In the present chapter we have reviewed much of the descriptive research exploring the effects of race in child welfare system. Importantly.

14 Emily R. 2009). historical racial discrimination has led to racially disparate treatment in the child welfare system. B. AFCARS. 999-1011. Predictors of foster care exits to permanency: A competing risks analysis of reunification. Sommers & Ellsworth. Sugrue. Child custody rulings.g. and are less likely to be reunified with their families as compared to White children (Courtney.1016/j. It is particularly important that we eradicate prejudice and its effects in the child welfare system to facilitate rulings that are unbiased and in the best interest of the child. L. Ards. (2003). and that this might be driven by aversive racism and anti-Black stereotypes (e.. perhaps particularly because they are often subjective and involve substantial judicial discretion. vote guilty) when the defendant is African American than White and when the victim is White than African American (Sommers & Ellsworth. Children and Youth Services Review. REFERENCES Akin. as explained by aversive racism (Sommers & Ellsworth. L. E.e. and adoption. A.. and societal condemnation. Whites tend to make more pro-prosecution judgments (i. 2003). Denne. (2011). A. & Zhou. 2014). Stevenson CONCLUSION Myriad studies reveal that African Americans and Caucasians are not treated equivalently in legal settings. 1994). Malkis. Lane. 2003). doi:10. Myers. The historic discrimination of African Americans has led to anti- African American sentiment which persists despite changing law. are vulnerable to the influence of personal prejudices. 2006). 01. such that African American children are more likely to enter the system (Children’s Defense Fund. spend longer in the child welfare system (Elliot & Urquiza. In turn. 2009. Wornica and Margaret C.. Racial disproportionality in reported and substantiated child abuse and neglect: . S. Racial biases are particularly likely to manifest when the issue of race is not made salient. 2014. policy.2011.childyouth.. guardianship. African American families are stereotyped as being dysfunctional and violent (Lane. 33(6). Taylor E. D..008. like other legal decisions. S. 2003). Importantly.. Indeed. It is possible that stereotypes and racial biases might help explain why African American children experience more abuse allegations and are less likely to be reunited with their parents than their White counterparts.

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and a common impact on adult survivors is the struggle to trust their intimate partner. asymmetrical gendered power processes in current couple interactions often erode trust. Chapter 2 BUILDING RELATIONAL SAFETY AND TRUST IN COUPLE THERAPY WITH ADULT SURVIVORS OF CHILDHOOD ABUSE Melissa A. US ABSTRACT Approximately one-third of partners in couple therapy have experienced childhood abuse. US 2 Lewis and Clark College. Wells1 . Given the likelihood that adult-survivor couples may experience a distrusting emotional culture. Wells). that describes the effects of gendered power dynamics on the perception of the other partner as trustworthy in adult-survivor couple interactions. California. Douglas Huenergardt1 and Hans Schaepper1 1 Loma Linda University. this chapter presents a feminist. social constructionist theoretical conceptualization. US 3 University of Louisiana Monroe.com (Melissa A. . Aimee Galick3. Inc. Oregon. Portland. Elsie Lobo1. Monroe. Loma Linda.In: Child Abuse and Neglect ISBN: 978-1-63484-785-8 Editor: Michelle Martinez © 2016 Nova Science Publishers. entitled relational trust theory. Louisiana. The chapter also expounds on the findings of a longitudinal * Corresponding author: Email: purrzha@gmail. Furthermore. * Carmen Knudson-Martin2.

and is considered the most important resource for functioning between intimate partners (Hargrave & Pfitzer. Knudson- Martin. p. 2006. Williams. 17). The analysis identified five key clinical processes used to enhance trust: 1) recognize gendered power’s effects on relational safety. 1989. referred to here as adult-survivor couples. . 2003). and power issues of adult-survivor couples. power. MacIntosh & Johnson. childhood abuse. gender.20 Melissa A. 2008). Elsie Lobo. The findings from the research were applied to an additional four couples to refine the final grounded theory on how to work with the intersection of trust. First. Hargrave & Pfitzer. and 5) identify trustworthiness of partners. gender. The grounded theory analysis involved study of video and transcripts of 40 SERT sessions with four heterosexual adult-survivor couples. 2) unique gendered power approaches. gendered power dynamics of couples often erode trust (Gottman. 2011. 2011). 1995. 2011. Aimee Galick et al. Johnson. two confounding influences that restrict a trusting emotional culture can significantly affect couples in which one or both partners experienced childhood abuse. Wells. difficulty trusting one’s intimate partner can be a long- term interpersonal effect of childhood abuse and neglect (Follette & Pistorello. couple therapy INTRODUCTION Trust is a crucial aspect of emotional connection (Gottman. Three key themes on gendered power processes emerged: 1) gendered fear of being vulnerable. 2015) when one or both partners discern a disruption of ―a sense of justice or balance in the relational give-and-take‖ (Hargrave & Pfitzer. Keywords: trust. Second. and 3) distrustful reactions. The study also delineated components of shared vulnerability that augment trust. 2013. & Siegel. Liang. relational safety. Yet. 4) initiate partners sharing power. 3) accentuate relational needs. 2011. This clinical process research demonstrates the link of trust with gender and power dynamics in adult- survivor intimate relationships and how to sensitively address in couple therapy the partner processes that interfere with trust. grounded theory study that identified clinical processes of Socio- Emotional Relationship Therapy (SERT) that helped adult-survivor couples transform their gendered power disparities and engage in relationally safe ways that supported a trusting emotional culture. 2) comprehend the socio-emotional experience of partners.

2004). 2011). Trepper & Barrett. Given the propensity for adult-survivor couples to experience a distrusting emotional culture. 2011). especially when clients may not electively disclose this experience (Little & Hamby. 2006). the couple and family therapy (CFT) field can benefit from research focused on relational processes impacted by the trauma resulting from childhood abuse (Basham & Miehls. MacIntosh & Johnson. and James (1992) noted that the feelings of powerlessness and betrayal experienced as a result of childhood victimization are linked to the adult survivor’s struggle to trust significant others and preoccupation with dominance and influence in adult intimate relationships. 2004. Sobansky. Furthermore. couple therapists can fail to observe how this history may contribute to a couple’s presenting issues (Cobia. we will review relational trust theory. 2004. 2012. the lack of trust can nevertheless destroy couple relationships (Hargrave & Pfitzer. INTERSECTING GENDERED POWER WITH CHILDHOOD TRAUMA About one-third of partners in couple therapy have a history of childhood maltreatment (Anderson & Miller. 1993). . Liem. While the long-term interpersonal effects of childhood abuse can appear to be insignificant for some adult survivors. O’Toole. 2015b). Millwood. We will then present findings of a longitudinal grounded theory study that identified how to clinically address gendered power processes interfering with trust in order to establish relational safety between partners (author. However. 1999). Mennen & Pearlmutter. In this chapter. it is essential that couple therapists sensitively address the unique relational needs of partners abused in childhood (Basham & Miehls. while the study of treatment for trauma has proliferated over the past two decades. author & Kuhn. for many the impact of childhood trauma can persistently and deleteriously color current interactions in their intimate relationships (Lindauer. social constructionist views of the intersection of gendered power dynamics and distrust in partner interactions of adult-survivor couples (author. & Ingram. 1989). Building Relational Safety and Trust in Couple Therapy … 21 Although love between partners can be strong. 2015a. 2008. a theoretical conceptualization based upon feminist. 2015).

1991) and covert as a result of taken-for-granted cultural and societal discourses that influence a person’s identity and emotions in the give-and-take between partners (Knudson-Martin. 2003).. 2015). Wells. this can prevent adult survivors from experiencing a secure and trusting relationship (Brown. 1994). rigid gender roles. Nelson & Wampler.. Whiting. Aimee Galick et al. and power. and societal norms glorifying violence toward others (World Health Organization. 2002. 2004. 2008). When the perception of safety has been skewed by childhood trauma. 2006. for instance. 2013. et al. gender and social inequality. MacIntosh & Johnson. Although childhood abuse occurs at the level of the individual family. sexual problems. the lack of empowerment associated with childhood maltreatment can . and questioning their ability to treat their wife appropriately (Chauncey. 2013. Elsie Lobo.g. holding rage at the perpetrator. Banford. e. and survival in a relational context involving responsibility. Mansfield. Power disparities of couples often undermine connection. Smith. Liang. high levels of unemployment and poverty. trust. anger issues and emotional dysregulation. 2012). & Ivey. dignity. and reluctance to confide in their partner (Cobia. Effects of Childhood Abuse on Relational Processes We define child maltreatment as the abuse and neglect of children under age 18 resulting in harm to the child’s health. Regardless of gender.22 Melissa A. the experience of being of abused in childhood can be viewed as a shared trauma of the couple (Wiersma. other relational challenges of adult survivors can be. husbands of women sexually abused in childhood described feeling challenged to balance their own needs with those of their wife. 2015). The power processes occurring in adult-survivor couple interactions can also be viewed as tied to the experience of childhood abuse.. socio- contextual factors contribute to this problem. development. Gendered Power Processes of Abused Partners We view power as relational. 2002). Indeed. as one partner then carries the excess burden to maintain the relationship. Power differences can be gender-based (Lips. In addition to difficulty trusting their intimate partner (Kochka & Carolan. 2010). in that power reflects how each partner influences the other to attend to his or her interests and needs in the relationship (Knudson-Martin. fear of intimacy. In a study of heterosexual adult-survivor couples. et al.

Miller. the powerlessness of victimhood in childhood (Lisak. Wangsgaard. 2011. 2002). 2010. for instance. the power disparities embedded in childhood maltreatment can contribute to a distrustful attitude in the abused person. female adult survivors who strive to maintain power and control in their intimate relationship can run counter to femininity discourses that relegate to the woman her function as the vulnerable. 1995). an abused person’s sensitivity to power can fuel couple problems (Hill & Alexander. Kessler. Liem. Building Relational Safety and Trust in Couple Therapy … 23 drive the need for power in adult intimate relationships (Henry. Yorgason. 2009). 2004). Smith. 2011. and thereby foster suspicion and hostility in current interactions of adult-survivor couples (Wright. Furthermore. self-sacrificing partner responsible for making the relationship work (Aronson & Buccholz. the partners can find it difficult to recognize how gendered power dynamics operate since taken-for-granted societal discourses that inform men and women on how they should enact gender tend to reinforce gender stereotypes. leaving abused males with limited coping strategies (Mejia. 1976). & Carter-Vassol. 2015). 2001. and invulnerable (Bergman. Importantly. For male adult survivors. The next section presents a theoretical conceptualization regarding gendered power processes . one partner controlling most of the important aspects of the relationship and the other partner having little or no say in those matters (Nelson. 2015). & Sebastion. 2013. Sanders-Hahs. Wieselquist. while also communicating expectations of equality between partners (Knudson-Martin. & Scheer. O’Toole. 1996). 1995) can clash against messages of masculinity discourses that compel men to be independent. Yet some adult survivors may relinquish power to their partner for fear of abandonment (Reyome. In making sense of gendered power processes of the couple. Goff. 2010). Couple therapy approaches focused on shifting gendered power disparities can be particularly pertinent to address issues of adult-survivor couples that impede a trusting emotional culture between partners (Knudson-Martin & Huenergardt. 2005). 2007). Crawford. We view mutual trust as occurring when both partners perceive the other as reliable and responsive to their needs (Hargrave & Pfitzer. for instance. Conversely. autonomous. Archuleta. & James. Relational Perspective on Gendered Power When examining current interactions of adult-survivor couples. it is critical to also consider the social contexts of abused persons (Brown. 1993) arising from.

the brain’s amygdala. 2015). Wells. and provides suggestions on how to work with these intertwining influences in couple therapy. 2013. in current couple interactions they typically lead to emotional distancing and isolation. designated as adult-survivor power responses (ASPRs). or power struggles between intimate partners (see Figure 1). Fishbane & author. & Huenergardt. freeze. self- abnegation. 2015). . or marginalizing the needs of the other partner. which constantly scans for trouble. At such times. The theoretical concept of ASPRs is drawn from Hargrave & Pfitzer’s (2003) views on the ties of neurobiology to emotions when partners feel unsafe in the relationship. thereby fosters engaging through ASPRs of self-protection. Knudson-Martin. internalized emotions. Elsie Lobo. The adult survivor then expresses distrust as externalized emotions. Aimee Galick et al. In general. 2007.24 Melissa A. that evoke distrustful reactions of adult survivors in interactions with their partner. or flight that affect interpersonal exchanges (Fishbane. While ASPRs can be considered as coping mechanisms developed in reaction to the powerlessness of being abused as a child. conflict. 2015a. or symbolic actions that then have a deleterious influence on the couple’s interactions. Gendered Power’s Effects Perceiving the partner as unfair or untrustworthy triggers the adult survivor to become concerned with his or her power position in the relationship (Silverstein. Bass. generates bodily responses of fight. RELATIONAL TRUST THEORY Relational trust theory (RTT) explains how gendered power disparities impact the adult survivor’s perception of the other partner as untrustworthy when he or she feels unfairly treated. 2009) and. negatively affects emotional connection and promotes distress in the relationship. Tuttle. the intermingling of gendered power interactions with these distrustful reactions. author & Kuhn. RTT also provides suggestions for recognizing and working with the gendered power context of adult-survivor couples so that clinicians can help partners shift power disparities to processes of mutuality that enhance a sense of emotional safety and the perception of trustworthiness (author.

Drawing upon the metaphor of the human brain’s amygdala response to danger. or overly accommodating the other partner. RTT Clinical Guidelines A key guideline of RTT is the prerequisite that clinicians establish a foundation of mutuality between partners in order to create the relational safety necessary for processing vulnerable emotions tied to partner interactions or a history of childhood abuse (author. 2015a. is an implicit experience of distrust that is observable as a sense of internalized helplessness. self- abnegation. 2015). which occurs when distrust instigates the male or female adult survivor to focus solely on his or her own needs or interests without concern for the effects of these self-oriented actions on the partner (author. a freeze response of the amygdala. 2015). The third category is a flee (from the relationship) response. mostly with males. or the need to control. 2015a. Both male and female adult survivors often use self-protection when they sense unfair treatment from the other partner. more often used by females. fight. jealousy. author & Kuhn. As a . 2015a. Adult-Survivor Power Responses triggered by human brain amygdala’s reaction of freeze. Conversely. author & Kuhn. referred to as marginalizing the other partner’s needs. author & Kuhn. self-protection is a fight reaction that is an explicit expression of distrust in the form of anger and reactivity. or flee (author. Building Relational Safety and Trust in Couple Therapy … 25 Figure 1. suspicion. 2015).

2015). 2015). author & Kuhn. . since I witnessed the applicability of this couple therapy model’s feminist approaches to the gendered power relations of adult- survivor couples. fair give and take. Lafontant. SERT. 2014. examines the link between partner emotions and the influence of societal discourses that inform each partner’s identity and ways of relating. founding member of a university-sponsored clinical research team. These mutuality processes also link with the components of trustworthiness. Bishop. By facilitating partners in engaging through these relational processes that enhance shared power and emotional safety (Knudson-Martin. security and hope arising from each partner attending to the other partner’s needs. that is. 2010. 1991). Knudson-Martin & Huenergardt. Huenergardt. & author. Wells. and authenticity and openness (Hargrave & Pfitzer. 2011). SERT’s mutuality processes can be specifically applied to each ASPR (see Figure 2) in the following ways:  Addressing self-protection involves the need for mutual influence between partners. control. 2015a.. Schaepper. et al. and shared vulnerability (Knudson-Martin. and reactivity exhibited in the fight response of distrust. These clinical approaches help partners shift power imbalances and identify alternative ways of relating that are based on shared attunement and relational responsibility.  Examining opportunities for engaging more responsibly with the adult-survivor partner who marginalizes the needs of the other partner. Elsie Lobo.26 Melissa A. namely. promoting safety through reliability between partners.  Attending to the needs of an adult survivor who uses self-abnegation involves helping the other partner attune to and authentically respond to that person’s concerns that have been withheld due to the perception of the absence of relational safety in the couple’s gendered power processes. adult-survivor couples are all the more likely to experience a trusting emotional culture that supports intimacy (Weingarten. which works to equalize gendered power disparities so that both partners are mutually supported in the relationship. mutual influence. author. I (Melissa) drew upon Socio-Emotional Research Therapy (SERT. making space for the voice of the one-down partner whose needs may be obscured in response to the anger. 2014). Aimee Galick et al.

Components of SERT’s Circle of Care to attend to Adult-Survivor Power Responses (Knudson-Martin & Huenergardt. In the next section we present the findings from our grounded theory study that identified clinical processes that helped adult-survivor couples disentangle from their gendered power processes and augment their levels of trust. 2015. author. 2015). and the partners’ sense of trusting each other after approximately two years of couple therapy. the ways in which SERT’s clinical approaches worked to transform gendered power disparities of the couples. Building Relational Safety and Trust in Couple Therapy … 27 ASPRs Circle of Care Self. which has been articulated as a need in the CFT field (MacIntosh & Johnson. 2015a. 2015b). 2010. • Attunement abnegation • Mutual vulnerability • Mutual influence Self-protection • Dialogical give and take Marginalize partner's needs • Relational responsibility Figure 2. The findings were then applied to an additional four adult-survivor couples to confirm the credibility of the grounded theory (author. author & Kuhn. 2008). GROUNDED THEORY STUDY This longitudinal grounded theory study examined 40 de-identified transcripts of Socio-Emotional Relationship Therapy (SERT) sessions to better understand the impact of gendered power interactions on four adult-survivor couples. Method We conducted a longitudinal study of couple therapy with four heterosexual adult-survivor couples using a grounded theory approach (Corbin .

Elsie Lobo. we wanted to observe how gendered power disparities intersected with distrustful reactions between partners. and females from 29 to 56. All of the clients and therapists signed informed consents permitting the researchers to transcribe videotape of the sessions in order to study couple dynamics and clinical processes as part of our larger goal of improving couple therapy approaches (author.28 Melissa A. Three couples attended approximately 60 sessions each over a period of two years. Three couples came to therapy because of distressed relations. Participants Our sample consisted of therapy sessions with four heterosexual couples in which one or both partners experienced childhood abuse. including a post-therapy interview with two couples to verify that the emerging grounded theory fit their perception of couple therapy processes and outcomes. with partners identifying as Latin American. we have changed the clients’ names. All of the partners had experienced some form of childhood abuse and neglect. Males’ ages ranged from 28 to 58. Aimee Galick et al. Second. the other couple sought to resolve issues related to each partner’s history of childhood abuse. Clients. We analyzed 40 transcripts of sessions with these couples. The fourth couple attended 10 sessions. All of the couples were of diverse ethnic origin. Three couples were married from two to 20 years. This longitudinal study was part of a larger action research project. the fourth couple had been living together for three years. we sought to identify clinical processes of Socio-Emotional Relationship Therapy (SERT) that facilitated adult-survivor couples developing more trusting approaches with one another in their current interactions. which had received the sponsoring university’s institutional review board (IRB) approval. & Strauss. First. which included two faculty supervisors and another eight doctoral students observing sessions from behind a one-way mirror. . 2006). We viewed this qualitative method as a suitable way to analyze couple and therapist processes in order to construct a theory grounded in the data (Charmaz. and power in the practice of couple therapy (author. 2008) for a twofold purpose. 2015b). and African American. Wells. In order to maintain confidentiality. Two doctoral-student therapists conducted couple therapy with each of the couples as part of the SERT clinical research group. Euro-American. gender. 2015b). focused on how to improve attention to societal context.

composed the SERT clinical research group. 2015b). Three males and nine females. the analysis between the researchers and data was interactive (Charmaz. Mexican American. In the course of our analysis. author. and latter stages of therapy for two of the long-term couples. Three couples identified as Euro-American and one as African American. As a result. 2007). client discourses. 2008). and all had experienced childhood abuse except the African American female. Ages ranged from 28 to 63. 2005). another four adult- survivor couples signed informed consents as part of our process of enhancing this grounded theory’s credibility. The researchers involved in the grounded theory study had been members of the SERT group. Then we used theoretical sampling with the final long-term couple as our ongoing analysis identified concepts emerging from the data (Corbin & Strauss. The two faculty supervisors briefly joined sessions to engage with partners and co-therapists on issues related to socio-emotional processing and sociocultural context. 2015). including ten doctoral-student pre-licensed therapists and two faculty supervisors. Since this study was part of action research in which the participants were seeking to improve their work by systematically studying their actions while also contributing to the field (Coghlan & Brannick. The primary focus of SERT is to address the influence of the larger social context on gendered power processes as these impact partners’ interactions. Studying . Partners were ages 26 to 60. we tested the fit of emerging findings in work with current cases. 2010. Building Relational Safety and Trust in Couple Therapy … 29 Therapists. Additional Cases. Canadian American. and Middle Eastern American. partner emotions. thereby enabling them to code guided by a clear theoretical framework that informed them of which clinical processes to follow (Greenberg. SERT Clinical Research Group. therapist approaches. African American. and indicators for change. the co-therapists used Socio-Emotional Relationship Therapy (SERT). I (Melissa) conducted a summary analysis of the 40 transcripts in order to identify session themes. a couple therapy model that has emerged from the larger action research project (Knudson-Martin & Huenergardt. 2006. Asian American. Data Analysis The researchers transcribed all ten sessions of the short-term couple and randomly selected ten sessions from early. As a result. In sessions with the four couples in the sample. and ethnic backgrounds included Euro-American. mid. the researchers engaged in some of the therapy sessions conducted as part of this study.

For instance. Throughout the coding process. we created diagrams and wrote analytic memos on how these concepts were related to each other and to explain variations in the data. and trust worked between partners and the effects of clinical approaches used with the couples. which helped to refine the theory. which added different perspectives and a variety of interpretations of the observed phenomena (Daly. Credibility and Trustworthiness We used triangulation to build credibility into the findings of our grounded theory in a number of ways. 2006) as our analysis revealed the importance of relational safety to adult-survivor couples. We used the constant comparison method to compare ―data with data to find similarities and differences‖ (Charmaz. 2015). 2015b).‖ ―it’s like I’m a jerk‖ (author. We engaged in focused coding (Charmaz. 54). Over the course of our analysis. The coding and analysis of the data involved three researchers. 2015b). Although I (Melissa) had previously articulated relational trust theory for understanding gender. for example. In the final stage of developing the grounded theory. ―examining effects of husband not attuning to wife. p. 2007). the researchers bracketed these understandings so that we could be open to whatever emerged from the data (Charmaz. Aimee Galick et al. We then arrived at a consensus on how these components linking together in the grounded theory (author. which resulted in identifying the grounded theory’s major components. Elsie Lobo.‖ ―I’m worthless. 2006.‖ ―examining ways to express need to feel heard by partner‖ (author. 2015a. we checked with members of the SERT clinical research group to determine that the emerging concepts and theory fit with their experience. and trust issues of adult-survivor couples in couple therapy (author. power. partner discourses helped us understand the nuances of power dynamics occurring in session. We also analyzed post-therapy interviews with two couples from our sample and then tested our findings with four .‖ ―linking larger social context to wife’s understanding of sacrifice. the researchers wrote analytic memos to make sense of our observations on how gender.‖ ―I know my attitude sucks. 2015b). Three researchers then conducted line-by-line coding of the transcripts. Wells. 2006). The researchers then used axial coding to identify themes and categories of partners’ relational processes and key clinical processes used to attend to gendered power approaches in order to create relational safety. Codes included. the men in our sample spoke in terms that helped us identify what we have designated as ―disentitled‖ power: ―I go against the grain.30 Melissa A. author & Kuhn. power.

and impasses as each partner attempted to protect her or his own emotional safety. alienate men from their emotions. 1995). 4) initiate partners sharing power. the gendered fear of being vulnerable seemed to constrain any sense of give and take in partner interactions. and influence men to deny admissions of weakness or vulnerability (Bergman. 1976). The fear of being vulnerable was gendered in that the males in our sample appeared to function in such ways as to meet the requirements of masculinity discourses that endorse independence and autonomy. This fear of appearing vulnerable in the relationship seemed to operate in a variety of ways. Levant. Gendered fear of being vulnerable. Building Relational Safety and Trust in Couple Therapy … 31 current cases to confirm the applicability of the grounded theory (author. Lisak. 1995. and neither partner would reflectively listen to the other’s perspective. 2) comprehend the socio-emotional experience of partners. each partner viewed couple problems as the other partner’s fault. Gendered Power Dynamics The three processes of gendered power operations appeared to be interlocked and contributed to significant relational distress in the form of conflict. and 5) identify trustworthiness of partners (see Figure 3). and 3) distrustful reactions. 1997. We also noted five clinical approaches used to transform these gendered power dynamics so that partners became able to engage with one another in relationally safe ways supporting trust: 1) recognize gendered power’s effects on relational safety. 3) accentuate relational needs.. both partners tended to assume that the other partner would dismiss their concerns. for the females the fear of being vulnerable seemed to place them in conflict with femininity discourses ascribing women as the accommodating partner bearing the responsibility to make the relationship work (Hare-Mustin & Maracek. Miller.g. 1988. 2) unique gendered power approaches. . e. Accordingly. Results The grounded theory identified three significant processes embedded in the gendered power dynamics of adult-survivor couples: 1) gendered fear of being vulnerable. Most noticeably. power struggles. Conversely. the fear of being vulnerable often evoked the silencing of the offended partner or attack-oriented comments instead of sensitive self-disclosure of the effects of the other partner’s behavior on that person. 2015b).

2015b).Figure 3. . Adult-survivor couples’ experience of distrust and clinical goals and processes for relational safety and trust (author.

Anthony responded to her complaints from his gendered fear of being vulnerable. There’s nothing wrong with that. Barry: (to therapist) She’s worried … saying. you don’t flip out. Marisa: I feel jealous. Male disentitled power approaches. ―Who’s this? Who’s that?‖ You accuse me … that makes me want to do it. Anthony: There is when you’re making an issue of it. The fear of appearing vulnerable in the relationship then generated power approaches between the partners that were different from traditional views of gender relations. 1995). Over the course of their 20-year relationship. Marisa. 2015). me. became fearful of how her Euro-American husband. The men in our sample operated from a sense of disentitled power in contradistinction to the entitled power and privilege that Western societal standards confer upon males (Levant & Pollack. Jazmyn: (to Barry) I hope when this (money) comes. entitled power influences . Hence. who identified as African American and had experienced emotional and physical abuse from his father during childhood. Jazmyn displayed her gendered fear of being vulnerable in response to Barry’s request to manage these funds. when he did not reliably communicate with her after his freelance assignment as a professional photographer with beautiful female models. A male informed by masculinity discourses holds ―entitled power‖ by virtue of societally endorsed privileges that are taken for granted and determine his status as the ―one-up‖ partner in an intimate heterosexual relationship (Knudson-Martin. ranging from 8 to 16 years of age. ―You’re just going to … blow 50 grand on weed. In another married couple. me. Building Relational Safety and Trust in Couple Therapy … 33 For instance. had experienced financial ups and downs. Jazmyn. would spend a financial windfall. who identified as African American and had experienced sexual abuse as an adolescent. found himself in the doghouse with his Latina wife. 2013. Barry. who had been sexually abused by extended family members as an adolescent. Anthony. most recently downward because both partners had become physically disabled in the past several years. Rather than take in Marisa’s perspective and validate her concerns. Unique gendered power approaches. these parents of four children.‖ (to therapist) He’s got on his ―me‖ goggles.‖ Jazmyn: (to Barry) You were a different person (when working) … but now it’s ―me.

(Mahoney & Knudson-Martin. the impact of disentitled power on their female partners was similar to that seen in gender-traditional couples in which the female is required to attend to the man’s concerns (see Figure 4). Demonstrations of disentitled power included self-deprecating narratives. Beyond the experience of powerlessness and vulnerability as a result of being abused in childhood. For example. etc. Elsie Lobo. the men’s nihilistic views reinforcing a disentitled power perspective could also be attributable to adult experiences of the powerlessness associated with racism. 2009). His comments demonstrated the one- sided nature of the disentitled power perspective. each male engaged through disentitled power that seemed to be informed by nihilistic beliefs about themselves in the world. disability. 1995). . Now that this (money) is coming. he’s going to act like a damn fool and he’ll ruin it. Barry used a disentitled power approach with Jazmyn to avoid attending to her concerns about wise money management for their family. use of dismissive body language. four in the sample and another four for case review. Jazmyn: He has to have what he wants. which privileges the man’s focus on his own needs and autonomy rather than on his intimate relationship (Jordan & Carlson. ignoring or minimizing his partner’s feedback. that the man is the primary decision-maker on important matters.34 Melissa A. 2013). classism. Wells. a Sherpa on overload … (that) she’s carrying a very heavy load … Barry: I don’t give a (expletive)? I don’t help? Then I’m worthless. described their sense of having no power. This disentitled power approach appeared to insulate the men from addressing the concerns of their partner. Yet. 2005). Instead of interacting from privileged entitlement. all of the men in the eight couples. and wartime military service (Mejia. Nonetheless. Therapist: (to Barry) You’ve got a partner here who’s expressed. with the long-term effects of the relational injuries of childhood abuse (Lisak. Nothing in my heart tells me he wants to take care of (our family). In this grounded theory analysis we interpreted disentitled power as being linked to the intersection of male gender socialization. Aimee Galick et al. that the man should set the agenda for what the couple does. like. men to assume that their interests and needs are more important than their female partner’s. and focusing solely on the justification of his own point of view.

2015b). Female use of reactive power. This reactive power operated counter to femininity discourses that inform . Effects of male power on intimate relationship (author. 2015b). The disentitled power used by the men appeared to evoke from the women a reactive power by which they positioned themselves against the males in order to somehow have influence with them. Effects of female power on relationship (author. Relational Reactive Power Power Interdependent Defensive relational relational approach approach Focus on our Focus on my needs needs Figure 5. Building Relational Safety and Trust in Couple Therapy … 35 Entitled Disentitled Power Power Opportunistic Defeated relational relational approach approach Partner focus Partner focus on my needs on my needs Figure 4.

Anna: (tearful) All the time. self-abnegation. Anna: I started getting … I call it ―ugly. a Euro-American couple in their late 40s. arguing. For instance. What could I have done to stop it? What could I have said. Distrustful reactions. I don’t need this! Anna: (lifts her cellphone to show therapist) Do you want me to start the timer for two hours so you can get screamed at. She won’t stop. Miller. too? We observed that the use of reactive power seemed to take a toll on the women’s sense of relational adequacy since they were in the conflicted position of not upholding societal messages on being the vulnerable partner (Knudson-Martin. Scott: I’m burned out. who had suffered child sexual abuse while growing up in foster care. becoming hypercritical. Elsie Lobo. Scott. The women demonstrated reactive power in myriad ways. who had experienced child neglect and emotional abuse. Anna’s reactive power then readily surfaced as a sarcastic attitude toward Scott. As these gendered power processes operated between the partners. emotional reactions of distrust—variously demonstrated as adult-survivor power responses (ASPRs) of self-protection. emotional distancing. 2015. . Wells. Lips. 1976).‖ Therapist: You feel like it’s ugly? Anna: Yeah. Scott and Anna. routinely dismissed Anna’s concerns by engaging through his disentitled power perspective. it’s very ugly … (singing voice) warning sign … I feel bad because of the arguing. seemed to be locked into reactive exchanges. and use of sarcasm (see Figure 5). I don’t like it. man. you know? How am I triggering it? Therapist: You feel really responsible in some way. women of the importance of sacrificing their own needs for the sake of maintaining their relationship (Goldner. 1991). She comes at me like a damn freight train. 2013.36 Melissa A. 1989. Therapist: Do you feel guilty sometimes? Anna: I feel guilty all the time. For instance. Aimee Galick et al. including anger and control. Anna described the emotional impact on herself when she engaged with Scott through reactive power.

Building Relational Safety and Trust in Couple Therapy … 37 or marginalizing the other partner (author. We observed ASPRs occurring in three patterns with the couples in our sample: 1) both partners engaging through self-protection. 2015)— polarized the partners in conflict and impasses (see Figure 6). The gendered power processes between partners perpetuated their problems. Anna: Since the day I came into this relationship all I’ve heard is yelling. For instance. Power clashes of adult-survivor couples (author. and escalations tended to occur as the male elected not to respond to female bids for his attention to needs in the relationship. control. As a result of their gendered power dynamics. Therapist: What would be most helpful from (Scott) right now for you? Anna: I can’t tell you because I don’t know. I don’t need this stress. 2) the male marginalizing the needs of the female and the female responding with self- abnegation. 2015b). in Scott and Anna’s highly conflicted relationship. two couples in our sample frequently engaged through self- protection. Therapist: (to Scott) What did you learn about what she needs from you? Scott: She pushes all my buttons … I put up with a lot with (Anna). . or suspicion that then generated conflict between partners. and 3) female self-protection and male self-abnegation. which is a fight response involving displays of anger. more than most men would. author & Kuhn. jealousy. I can’t handle it. She won’t stop misbehaving. Male use of disentitled power with female Female use of reactive power with male Figure 6. 2015a. each partner’s self-protective response triggered accusations of wrongdoing by the other. Self-protection by both partners.

38 Melissa A. a scapegoat for everything. Therapist: (to Barry) Help me understand. Female self-protection and male self-abnegation. and she usually responded with a form of self-abnegation displayed as overly accommodating him. In the following conversation about Marisa’s issue with disordered eating. We identified Anthony’s self-abnegation as silent disengagement. When gendered power processes flared distrust between Anthony and Marisa. Marisa acknowledged that at such times she became more frustrated and angrier with Anthony. Male marginalizing female and female use of self-abnegation. Elsie Lobo. which we observed to be a predominately male performance of self-abnegation. she typically engaged through use of a self-protective approach of control and Anthony in turn displayed a sense of internalized helplessness. Throughout the course of therapy of approximately two years. Wells. Therapist: (to Barry) You kind of assumed an attitude to protect yourself that maybe is not a way that joins with Jazmyn around her experience of this? Barry: (drinks from his cup and uses dismissive body language) I thought I’ve tried and obviously failed. and lack of eye contact with Marisa during conflict-laden interactions. One couple in the sample displayed this pattern of ASPRs in their interactions. as she interpreted his lack of engagement as ignoring her concerns. How have you managed the issue of racism? Barry: It doesn’t bother me … she perceives things differently than I do. like. we noticed that when Jazmyn reached her limits with accommodating Barry. it became apparent how ASPRs fueled conflict between the partners. Jazmyn described suffering in silence when subjected to racism by members of Barry’s family and her disappointment when Barry accepted this derogatory treatment rather than help her address the issue. Aimee Galick et al. . While partners using self-protective responses seemed to be actively expressing their distrust. those using self- abnegation tended to withhold their voice as a result of feeling unfairly treated by their partner. Jazmyn: Barry wouldn’t intervene … he knew that the family didn’t really accept me because I was black and I was. no visible emotional reaction. Barry typically marginalized Jazmyn’s needs by dismissing his responsibilities in the relationship. Therapist: (to Jazmyn) How have you dealt with that? Jazmyn: I was hurt. she then engaged through a self-protective mode of anger and control.

which involved helping partners become more vulnerable with each other and open to processes of give and take. and 5) identify partners’ trustworthiness. Clinical Processes Fostering Relational Safety The grounded theory study identified five key clinical approaches for establishing relational safety. and to shift from a position-oriented approach to a relational orientation of mutuality (Silverstein. your tone is implying that you’re expecting me to say I binged even though I had a good day. what’s going on? Anthony: I’m listening and internalizing it. 4) accepting partner’s feedback. 2015b). referred to as the Circle of Care in Socio-Emotional Relationship Therapy (SERT. and emotionally transparent—with one’s intimate partner: 1) being in touch with one’s own emotions and their effects on the partner. Building Relational Safety and Trust in Couple Therapy … 39 Marisa: (to Anthony) When you ask (about my) eating. et al. but I started to get aggravated … like I’m being dismissed. The new relational dynamics of the adult-survivor couples in response to therapist approaches seemed to unshackle both partners from the gridlock of interacting through disentitled power and reactive power. 3) accentuate partners’ relational needs. authentic. and 5) desiring to tend to partner’s needs and interests. and shared vulnerability. in the following ways: 1) recognize effects of gendered power dynamics on partners’ perceptions of relational safety. 2) attaining capacity for self-reflection. 2) work with the socio-emotional experience of partners through sociocultural attunement. The therapists worked to increase trust and facilitate the mutuality processes of shared attunement and relational responsibility. (Anthony is looking down at the floor. Knudson-Martin & Huenergardt. 2010. The grounded theory analysis delineated five aspects of becoming relationally vulnerable—open. . Therapist: You’re not intentionally being negative with Marisa? Anthony: At the end of the day if our conversation is dismissed … that hour-long conversation was basically wasted (author.) Therapist: Anthony. A central aspect of this shift between partners involved developing a sense of shared vulnerability. 3) recognizing positive relational intent of self and partner.. 4) initiate partners sharing power. mutual influence. 2009). 2015).

Pre. we will describe the clinical approaches used to transform the gendered power disparities between Jazmyn and Barry. Case History of a Positive Relational Outcome Case Jazmyn and Barry were in their early 40s. all the while stringently justifying his own view on the couple’s problems instead of taking in Jazmyn’s emotionally laden critiques. and Jazmyn. Jazmyn’s reactive power in response to Barry’s self-deprecating narratives and dismissive body language involved crying and expressing her . Kuhn. and had four children. but particularly Barry. who had been a nursing student. Jazmyn had been sexually abused as an adolescent. the couple continually struggled to make ends meet on their limited income. Barry demonstrated his nuanced approach to disentitled power as a pervasive negative outlook that included a great deal of self-condemning. Elsie Lobo. They came to couple therapy to resolve long-standing distress between the partners. and then examine our understanding of what hampered progress with Scott and Anna. Aimee Galick et al. In this section. As a result. and Barry had suffered emotional abuse and neglect from his stepparents throughout his youth. often displayed a fear of appearing vulnerable in their couple interactions. Therapeutic process. had also become unable to work in the past year due to a physical disability. & author. The fourth couple appeared to remain entrenched in their gendered power dynamics. Two faculty supervisors and another eight doctoral students observed behind the one-way mirror. Both partners. who did not have a successful outcome. Wells. 2015). In the initial SERT sessions it became apparent that this adult-survivor couple engaged through gender-stereotypic approaches in which the male used his one-up position to make individualistic choices focused solely on his own needs. Freitas.40 Melissa A. This fear on Barry’s part was noticeable in that comments from Jazmyn expressing her disapproval of his behavior moved him to assume a disentitled power perspective as a way to deflect her concerns. Gendered power assessment. Barry had not worked for several years as a result of a work-related injury to his back that resulted in his status of permanent disability. Two doctoral-student therapists conducted approximately 60 SERT sessions with Barry and Jazmyn over the course of two years. Clinical Outcomes Three couples from the sample favorably responded to SERT’s clinical processes that attended to building relational safety between partners. had been married 20 years.and post-session debriefings with the SERT clinical research group guided the development of clinical approaches session by session (Estrella.

I’m just taking it day by day. you know. the therapists engaged with the partners to establish an equitable foundation for therapy. you know. Jazmyn: All these years I’ve had to give up things that I want to make him happy. 2015b). Jazmyn: I’m still sacrificing what I want for him. . interrupt the flow of gendered power. Therapist: (to Jazmyn) That’s a really tough spot to be in. We viewed Barry as not being relationally responsible as an intimate partner and that he had been marginalizing Jazmyn’s needs. I can’t. Attending to gendered power dynamics of the partners throughout therapy created a foundation of trust for the rest of the work that followed (author. lying to Jazmyn. This history and other egregious behaviors by Barry had significantly undermined trust between the partners. I didn’t offend his manhood and being real sensitive about the fact that he’s not working … he just kept. Building Relational Safety and Trust in Couple Therapy … 41 hurt and sense of hopelessness. isolating. Jazmyn appeared to be using her reactive power to draw the line with Barry about changing for the sake of the relationship.‖ Key clinical processes for relational safety. ―I have to be the one that takes care of everything. The therapists began by examining the effects of Barry’s use of disentitled power to avoid dealing with Jazmyn’s distress. et al. I just don’t care. can’t have a vision. Recognize gendered power’s effects. causing me problems (shrugs her shoulders). But when her frustration became too overwhelming. I was real careful about making sure. As already discussed. These behaviors had involved.. and then facilitate alternative relationship experiences of mutuality (Knudson- Martin. Barry refused to use his influence to protect Jazmyn and their children from racist attitudes displayed by members of his extended family. Her view on Barry’s avoidant approach was. Jazmyn then engaged through arguing and a hypercritical attitude toward Barry. Drawing on SERT’s clinical competencies. smoking copious amounts of marijuana. Still doing it! Therapist: (to Barry) Does all this make you feel as if there is a way now for you to step up? Barry: No. you’ve been … keeping the family together with chewing gum string. among other things. 2014). Jazmyn indicated early on in SERT sessions that Barry’s self-oriented behaviors made her feel unable to trust him. and occasionally stealing money from the family’s general funds in order to purchase items for himself.

Barry: Okay. Elsie Lobo. which is part of engaging responsibly in an intimate relationship (Knudson-Martin. and become accountable. The only thing he focuses on is what he’s not getting … (shakes her head) and I’m tired of it. the SERT team continually shared with the partners their perspective of the problem as relational and the need to address the relational effects.42 Melissa A. and you don’t even want to provide for us. The clinical guidelines in relational trust theory recommend that when an adult survivor marginalizes the needs of the other partner the focus of therapeutic approaches should be to help that partner. Wells. By making space for Jazmyn’s perspective on the couple’s problems and validating her need for Barry to help carry the load for the family’s well-being. While the therapists examined how socio-contextual factors influenced Barry’s use of disentitled power with Jazmyn. Jazmyn: Me and the kids. the father of our kids. 2014. author & Kuhn. The therapists worked to understand how the partners had internalized the influence of societal discourses regarding masculinity and femininity and how this then affected the couple’s ways of relating. the therapists were beginning to equalize gendered power processes between the partners (Ward & Knudson-Martin. they also worked to help him connect to his own emotions and . Jazmyn. This systemic perspective highlighted the couple’s problems as a symptom that could be addressed by attending to the power dynamics between the partners. Nothing in my heart tells me that he wants to take care of us. oftentimes I’m going through stuff … Therapist: (to Barry) Let her finish. Jazmyn: You’re supposed to be my husband. to recognize the effects of his behavior on the other partner. more specifically. Aimee Galick et al. 2015).. author. If I have money for something he wants. Comprehend the socio-emotional experience of partners. While many clinicians could be inclined to view Barry’s problems from an individualistic perspective of substance dependence (on marijuana) or some other form of psychopathology. in this case Barry. They named the primary issue for Barry as one of relational responsibility. 2012). From the earliest sessions the therapists worked to link each partner’s emotions arising from the problem to the effects of gender socialization and the influence of the larger social context. he makes my life a living hell. by Barry becoming attuned to Jazmyn’s needs in the relationship and somehow responding. et al. 2015a. we have to do without because I have to do for him.

evil person.. Therapist: And when things don’t go the way you’d like … would you say that it’s maybe hard for you to connect or maybe even listen to what’s going on in your relationship with Jazmyn because you’re in a lot of pain? Barry: It’s just. the SERT team was aware that Jazmyn was carrying the relational burden and wanted to address this. In helping Barry get in touch with his own emotions. they worked to comprehend how the larger social context fueled Barry’s understanding of this problem and his own masculine identity conclusions supporting his hierarchical position with his wife. the therapists thereby facilitated enough safety so that both partners could become reflective and more open to understanding their relationship dynamics without blaming the other partner for their distress. having to act a certain way just to get by. Therapist: And that value’s connected to what you were talking about not compromising? Barry: Yeah. Therapist: So. because I don’t mind work … (pause) I don’t wanna’ take it from people anymore. Barry: I constantly get told I’m this bad. maybe more effort on each of our parts not to be so negative towards each other . you’re feeling as though things aren’t going the way that you’d like them to go? Barry: Yeah. and I’m just a detriment to this family. Therapist: Would you say it’s hard to hear Jazmyn right now because … Barry: I’m just miserable and depressed. you know. Building Relational Safety and Trust in Couple Therapy … 43 become self-reflective in disclosing his feelings rather than resort to his disentitled power process of dismissing Jazmyn’s concerns. and tired of all the crap. Therapist: (to Barry) When you talk about having expectations around what your life would be. Importantly. you know. Hence. what kinds of things shape those expectations? What kinds of values or beliefs inform the position that you’re presenting to Jazmyn? Barry: It’s not that I don’t want to provide for the family … (and) not that I don’t wanna’ work. to be who I am without.. . And I know my attitude sucks.

2015b). It was me giving up something of mine for the whole. and what makes each man or woman feel angry. As Barry became better able to take in Jazmyn’s experience in their marriage. 2014). guilty. Accentuate relational needs. the therapists underscored the strengths they observed in the couple’s relational approaches and tied these to each partner’s need for safe emotional connection. the therapists worked with the male as the one-up partner to attune to his female partner. emotions take on their meaning from what it is like to be a man or a woman. I’m happy when we’re not fighting. Barry: It’s been good.. et al. Therapist: Where did that value come from? Is it something you believe in terms of … your ethnicity as a (Euro-American) male? Do you feel that’s rooted in how you were raised as a child? Barry: It had a lot to do with my (parents). happy. Therapist: (to Barry) There are moments that take place between the two of you that are shared and wonderful. accentuating their relational needs appeared to alter the trajectory of their dynamics beyond the fear of being vulnerable toward desiring more emotional connection (author. when they got married the second time … they had to push me away to get the new spouse. With the couples in our sample. We found with all of the couples in our sample that partners responded positively to these therapeutic conversations that tended to offset negative messages about not measuring up in the relationship. Initiate partners sharing power. change needed to occur not at an individual level with Barry but in his power relations with Jazmyn. etc. for instance.44 Melissa A. as a result of internalized societal messages. Furthermore. For both partners. From these socio-contextual perspectives the . Therapist: What have you noticed? Jazmyn: (sighs) Like holding hands and snuggling … being silly … That’s what I want. Elsie Lobo. particularly in the case of the men. you know? I was always the sacrifice. Wells. and an opportunity for the women to articulate what they’d prefer to experience in the relationship. emotions that generate change are contextually driven (Knudson-Martin. In the course of Barry attuning to his own feelings and the influence of societal context on his ways of relating. Change in SERT is viewed as experiential and relational. this helped him attune to Jazmyn’s emotions. In other words. Aimee Galick et al. I mean. Jazmyn: We’ve been trying to get along and be nice.

and the need to become accountable for the effects of this on his wife. Several sessions were devoted to supporting Barry in recognizing how he does measure up in the relationship. to acknowledge how his avoidance of dealing with family challenges led to his distressing behavior of isolating from Jazmyn and his children. as was the case with Barry. I just try to keep doing (things for her) … I like seeing her happy. (to Barry) What would help it change … so that you can have a moment … something that’s shared between the two of you? Barry: I just think my wife sees me as a (expletive) … and that’s just something I’m going to have to deal with. . on the other hand. Jazmyn: (to Barry) I wouldn’t be hanging on if I felt like you were a (expletive). (to therapist) I probably see more in him than he sees in himself. Therapist: (to Jazmyn) I hear you describing your experience of Barry … is part of that just wanting to feel like you are enough? Jazmyn: Yeah. Therapist: Both of you have formulated ideas about (your position) and then it prevents you from hearing what the other has to say … (to co- therapist) I think Barry experiences it as Jazmyn wants him to be someone other than who he is. We found that as the male in our couples engaged through attunement to the female partner. but they’re both miserable. However. Barry: I don’t want her to be sad and upset all the time. Therapist: Are there concerns about talking about things at home? That it doesn’t feel emotionally safe to address these things? Barry: When we’re not seeing eye to eye … it’s a personal offense. or who he identifies himself as. Building Relational Safety and Trust in Couple Therapy … 45 therapists worked to help Barry listen to Jazmyn’s concerns and then to authentically respond to them. It’s like a tug-of-war between ideas … and neither one is going to give in. And Jazmyn doesn’t understand because what she’s really asking for are changes in behavior. Therapist: (to Barry) I’m interested in what you think then you can bring to the relationship that’s you. Barry: I was feeling sad that she felt that … So. in those cases in which trust had been damaged by egregious behaviors. and. repeated enactments of his attunement were needed to solidify these new efforts at connection for Jazmyn to feel safe enough to relax her vigilance. Jazmyn: (to Barry) I feel like you just have to butt heads with me. she tended to reciprocate. on the one hand.

As Barry worked to be in touch with his emotions and become more involved at home with Jazmyn. Absent were the smoldering anger.46 Melissa A. frustration. The final sessions focused on highlighting the mutuality shared by the partners and efforts by Barry to maintain his shift from an ―I‖ perspective to one of ―we‖ (Hargrave. The therapists explored the effects on her of Barry’s efforts to engage more responsibly with her. 2015). Aimee Galick et al. and dismissive remarks by which Barry had previously engaged in conversations. Identify partners’ trustworthiness. he became able to engage in new relational processes of being present with his wife in the moment and responsive to her needs. sense of self-disparagement. In their moments of dialogue. (softens voice) what I wanted her to understand is I do want to be (with her). when he came and helped me (with tasks at home). mutual listening helped build the . 2000. he stepped up to the plate. it became progressively safer for her to disclose her vulnerable emotions for intimate connection. lack of eye contact. He no longer readily interpreted Jazmyn’s comments to him as judgmental and condemning. And what was that like for you to know that he was responding to you in that kind of way? Jazmyn: I just felt. positive … like. and both listened and responded to one another. Samman & Knudson-Martin. Wells. Therapist: Oh. Indeed. like. Elsie Lobo. a sense of maybe this will work. In one session Barry and Jazmyn shared an engaging conversation that involved 25 turns of dialogue without therapist intervention on a topic that earlier in therapy had been a trigger for conflict. and I didn’t even have to ask him. Enactments of attunement to Jazmyn supported Barry’s move away from the masculinity discourses that kept him focused on his own needs. Barry displayed receptivity to Jazmyn’s perspective that would have been unimaginable at the start of couple therapy. instead. each partner’s perspective now seemed to matter. Instead he took in her perspective and engaged in dialogue with her in a way that furthered the conversation. Therapist: Did you feel yourself opening up to Barry in the last week? Jazmyn: Yeah. Therapist: (to Barry) I’m assuming that you were operating out of this genuine wanting to be there for her? Barry: Yeah. These new relational processes involved a more lighthearted approach by the couple.

The perception of one another’s trustworthiness began to show in their interactions. Relational vulnerability is gendered in that SERT therapists intentionally work with the one-up partner. 2015b). we observed that the move toward shared vulnerability began as the male willingly identified his own emotions and noticed their effects on his partner. to support his taking the lead to construct a foundation of equality for the couple (Knudson-Martin. Jazmyn appeared to feel as though the burden of family care was becoming a shared experience to a greater degree. Barry: I haven’t been feeling like I’ve been pressured into having to be able to live up (to Jazmyn’s expectations) … she doesn’t question my motives as much. is he going to betray my trust? But we’ve been fighting less. Building Relational Safety and Trust in Couple Therapy … 47 relational safety that brought with it a sense of security between partners. I try not to get too upset at things … and try to see how I can better interact and involve myself without just isolating. and it’s been more of a healthy environment for the kids. instead of acknowledging his own feelings. 3) affirm one’s positive relational intentions. Therapist: It’s obvious how painful this is … almost discounting who you are as a man who has gone through this effort to be honest. In touch with one’s own emotions. Scott seemed unable to respond reciprocally whenever Anna demonstrated her willingness to engage in emotional processing. I do feel. 4) accept partner’s feedback. In this sample of couples. Like. 2014). like. the grounded theory analysis identified five components of shared vulnerability for establishing relational safety and an ambiance of trust between partners: 1) in touch with one’s own emotions and their effect on the partner. Scott: She won’t stop these stupid allegations. when the therapist attempted to understand Scott’s experience of Anna. typically the male. As Barry became more involved in family activities with Jazmyn and the children. sometimes I’m on the edge. 2) capacity for self-reflection. his response typically involved a self- protective form of blaming her for his emotional discomfort. Components of Vulnerability In making sense of the challenges in shifting the gendered power processes of Scott and Anna.. et al. Jazmyn: I feel like I can trust him more. For instance. I don’t need this stress … what kind of lifestyle is that? (voice escalates) I can’t deal with these allegations! . and 5) desire to tend to partner’s needs (author.

Yet. listening to her … what happened as you listened to Anna? Scott: This relationship’s going totally bad. et al. we observed that this made it more possible for the therapists to support the partners in working through impasses (author. While Anna was willing to become self-reflective. Scott maintained his defenses and avoided becoming reflective on his part in the couple’s gendered power processes. As the males then attuned to their own emotions. it was not safe for therapeutic conversations to encourage her additional vulnerability as the one- down partner. 2015b) Accept partner’s feedback. As therapy progressed in establishing emotional safety between partners. The males in our sample with positive outcomes eventually were able to listen to their partner about issues in the relationship.48 Melissa A. (author. we noticed that partners became able to reflect on their own ways of engaging that detracted from or moved toward connection. While the other males in the sample appeared to benefit from and resonate with therapists’ positive attributions. Feeling loved. Therapist: Something happened when Anna was talking that had you feeling connected to her. But Scott habitually used his disentitled power perspective to avoid becoming accountable to Anna. Recognize positive relational intent. He deflected therapist queries by engaging in lengthy monologues focused on his need for honesty or the horrible abuse Anna had suffered in her previous marriage. 2014). Elsie Lobo. We’ve got to stop the nonsense and figure out what’s not working.. Capacity for self-reflection. Scott did not favorably respond to the therapists’ efforts at noticing his positive relational intent. Although it was equally challenging for other males in the sample to connect with their emotions. and regarded as a good person appeared to provide a counter narrative to the disentitled power perspective of themselves as worthless and not measuring up as an intimate partner. 2015b). Wells. they became able to feel enough safety in session to follow the therapists’ efforts to understand their sociocultural experience. Aimee Galick et al. . This type of engagement best occurs when the more powerful partner takes the lead in becoming vulnerable and accountable (Knudson- Martin. valued. The grounded theory analysis identified that therapeutic conversations attributing positive intention to the males’ actions somehow liberated them to try to become more relational.

The clinical processes for building relational safety and trust articulated in this chapter extend current work in our field by integrating feminist perspectives on trauma (Brown. 2015b) Desire to tend to partner’s needs. Nelson & Wampler. 2004). 2010. a blending of object relations with feminist-based trauma work (Basham & Miehls. thereby opening possibilities for connection in this ―act of giving‖ (Hargrave & Pfitzer. and structural approaches (Trepper & Barrett. Several CFT models that have laid groundwork include emotionally focused therapy (Johnson. Webster & Dunn. 2004. MacIntosh & Johnson. Some assumptions and clinical approaches identified in relational trust theory (RTT) and the grounded theory study are shared with these CFT models. p. 2002. Hunt-Amos. & Pretorius. high-stress exchanges that debilitated trust between the partners. p. (author. 27). unique gendered power approaches of adult-survivor couples. having attended only ten SERT sessions. 24). Scott: I can’t have a relationship with this lady until she deals with her issues. the grounded theory identified the need to focus clinical approaches on attending to the partners’ gendered fear of being vulnerable. 2008). Building Relational Safety and Trust in Couple Therapy … 49 Therapist: I had the sense that as (Anna) is relating something … the result is you feel. doesn’t treasure me. acceptance and commitment therapy (Follette & Pistorello. 2007). 2004. Indeed. This fifth aspect of shared vulnerability surfaced as couples shifted their gendered power disparities to processes of mutuality. 2002). value what I’m offering. They were unable to experience enough relational safety to engage through new relational processes and instead maintained the high-conflict. made no progress toward shared vulnerability and remained locked in their gendered power dynamics. 1989). among others using a systems theory perspective (Chen & Carolan. 2011. Therapist: She says something and … you get really irritated. 1995). and distrustful reactions that then perpetuate disconnection. DISCUSSION Determining effective clinical processes for adult-survivor couples has been considered an ―underdeveloped field‖ (Basham & Miehls. ―this person doesn’t love me. Bischoff. . 2004.‖ so the pain … Scott: I can’t deal with these things … (they) have to stop. Scott and Anna. 2005) and couple therapy (Hecker.

‖ and the correspondingly unique power operation this evokes in their female partners. Yet. their interactions were marked by each person’s need to protect him. which was instrumental in shifting power imbalances in three cases with a positive relational outcome of increased trust. whose needs and . power.or herself. Wells. While the grounded theory research confirmed these views on ASPRs. The grounded theory explained variations on power processes with one couple that did not have a positive relational outcome and helped us identify the characteristics of shared vulnerability that can occur as relational safety is established. and trust at the forefront of couple therapy approaches. Linking Gendered Power with Trust The grounded theory analysis revealed the critical role that gendered power dynamics played in perceiving one’s intimate partner as untrustworthy. Partner dynamics observed in these sessions and other pertinent cases informed my (Melissa) ideas on adult-survivor power responses (ASPRs). such as who attends to whom. When the couples in the sample engaged through the male’s use of disentitled power and the female’s reactive power. Clinical Implications By placing gender. which we identified as ―reactive power. This invariably resulted in distrust between partners and distress in the relationship. these influences can be identified by noticing relational processes between partners.‖ The analysis also pinpointed SERT clinical processes that promoted establishing relational safety between partners. 2013. Gendered power processes tend to be invisible in heterosexual relationships because they are embedded in masculinity and femininity discourses and taken for granted (Knudson-Martin. Recognizing invisible gendered power processes of adult-survivor couples is critical to helping partners relate more equitably.50 Melissa A. 2015). Aimee Galick et al. The analysis revealed a distinct approach to power used by male adult survivors that departs from traditional views of male power and privilege. a surprising finding that emerged was a nuanced approach to power by the males and females not envisioned in RTT. which we named ―disentitled power. The theoretical conceptualization of RTT occurred concurrently with transcribing videotape sessions of adult-survivor couples in the grounded theory study. CFT clinicians can benefit by focusing on the effects of sociocultural contexts on partner dynamics in the following ways. Elsie Lobo.

etc. 2014). (Mahoney & Knudson-Martin. to become accountable for his part in the couple’s problems (Knudson-Martin. et al. .. and emotionally transparent—vulnerable. Upon this foundation the therapist was able to help the more powerful partner shift from gendered power performances of disconnection and to engage in new relational experiences of attuning to the other partner and becoming responsive to that partner’s needs. 2015b). Assessing the impact of new relational processes of mutuality between partners helped both to acknowledge one another’s trustworthiness in being responsible for maintaining emotional connection or recovering more immediately when disconnection did occur (Knudson-Martin. 2014). open. In other words. whose opinion matters more. Examining the effects of disentitled power and reactive power performances on the relationship began to shift power disparities by making space for the voice of the one-down partner (Ward & Knudson-Martin. The grounded theory’s analysis of SERT’s clinical processes addressing gendered power disparities showed that the abused partners gradually became able to experience the capacity for becoming vulnerable with one another in an emotional ambiance of relational safety. mutuality processes made it safer to be authentic. Linking partner emotions to the effects of societal influences on identity conclusions and position-oriented approaches that support conflict and power struggles facilitated a move away from blaming the partner and thereby generated in-session safety to become more transparent about one’s own emotions. 2012) and facilitating self-reflectivity of the more powerful partner.. usually the male. et al. 2009). Establishing Relational Safety The key clinical processes identified in the grounded theory analysis worked together to facilitate the relational safety that is requisite to a sense of shared vulnerability between partners. Building Relational Safety and Trust in Couple Therapy … 51 interests are more important. Identifying each partner’s perspectives on what they needed in their intimate relationship helped both recognize the other’s positive relational intentions and made it safer to become open to emotional connection. partners felt safe to connect as they worked together to meet each other’s needs and interests in the relationship (author. This shared vulnerability increased each partner’s perception of the other as trustworthy because the partners were more open and emotionally transparent with one another so that each felt heard and validated by the other. This fostered a sense of shared responsibility for making the relationship work. As power differentials receded. how decisions are made.

The male’s use of disentitled power is distinct from feeling disempowered. 2013. the male (or female) becomes empowered. destructive entitlement involves damaging emotions or actions resulting from a person’s claim to self-justified compensation for an unbalanced or unjust relational ledger (Hargarve & Pfitzer. 2003). 1995. Feeling disempowered. he still holds latent power associated with his one-up social location (Knudson-Martin. the use of disentitled power by the man is a far different experience in that being disempowered is situational. Disentitled power. 2011. 2005). 1986). Wells. 2015). Drawing from contextual therapy (Boszormenyi- Nagy & Krasner. it is nonetheless his use of power to control or dominate his partner. While the male may have internalized emotions tied to his experience of powerlessness and weakness as an abused child. By describing the operations of disentitled power in adult-survivor couple interactions and the components of relational vulnerability. this power operation is similar to the gender-traditional view of the male as entitled and privileged in that it has the effect of placing the man in a hierarchical position in the relationship. As factors that lead to disempowerment diminish. While the emotion linked to disentitled power may appear as the male feeling disempowered. Although disentitled power is a quite different emotional experience for the male adult survivor from that of entitled power. Findings from the grounded theory analysis suggest a way to attend to this need. This varies . Aimee Galick et al. Elsie Lobo. however. Scheinkman & Fishbane. which can occur with both men and women (Fishbane.52 Melissa A. Addressing the Effects of Male Gender Socialization Trauma researchers have noted the need to unpack with male adult survivors the effects of gender socialization on their own experience of the vulnerability and powerlessness that resulted from childhood victimization in order to help them become more open to processing emotions in therapy (Lisak. 2015b). As previously noted. Destructive entitlement. Differentiating Disentitled Power An important finding that emerged from the grounded theory analysis is the concept of disentitled power used by males. 2004). Mejia. these findings provide guidelines to clinicians for sensitively working with abused males to facilitate alternate relational experiences beyond the coping mechanisms they have habitually resorted to when using disentitled power to ward off their partner’s concerns (author. involves negative identity conclusions internalized by the male that developed as a result of his exposure to the powerlessness experienced in childhood abuse colliding with the man’s sense of how he measures up to masculinity discourses.

particularly the abused male. Building Relational Safety and Trust in Couple Therapy … 53 from disentitled power in that both men and women can engage through destructive entitlement in their closest relationships. 2005). Oftentimes. vulnerable partner (Miller. 1976). his partner. while femininity discourses influence female partners to relate vulnerably. and the world as a result of the intersection of his early-life relational injuries and male socialization (author. Disentitled power is a male experience that may involve destructive entitlement. Cultivating Male Relational Vulnerability The grounded theory analysis provided a map for facilitating relational processes to help partners deal with the gendered fear of being vulnerable. When attending to disentitled power it is crucial to unpack the internalized values and beliefs influenced by societal discourses that the male adult survivor may rigidly hold regarding himself. Even though the woman’s reactive power at times appeared to position her as . masculinity discourses influence men not to be vulnerable from an early age (Bergman. 2015b). Miller. the therapist emphasizes vulnerability as a positive when the male engages through open and authentic disclosures (author. or others in their social network (Mejia. At other times. however. their parents. the therapist engages with the male by reflecting on how his actions and narratives indicate his positive relational intent. Focusing on the male is crucial because. but the grounded theory study analysis identified this as quite challenging for each abused female in the sample when confronted with gendered power disparities. 1995. it is essential to help the abused male manage the emotions linked to the fear of being vulnerable. Attending to Female Reactive Power Gender-traditional femininity discourses position the female’s social location as the subordinate. instead. Deviating from masculinity discourses has been another source of trauma for boys who have been punished for this by male peers. 1976). 2015b). disentitled power is tied to masculinity discourses by which the male gauges his own sense of gender conformity. While attending to gendered power operations and facilitating new experiences of alternate ways of engaging with his female partner. Becoming aware of how his emotions and the use of disentitled power affect his partner creates an opening for the male to try different relational approaches of attuning to and accepting her influence. the therapist assists the male in attending to the female’s concerns. These new relational experiences can help the male dispel the fear of appearing weak.

Aimee Galick et al.. Future research could focus on the circumstances in which males use disentitled power. Wells. how males make sense of the effects of disentitled power. For those cases in which the male has significant difficulty lowering his defenses in order to become self-reflective on his power performances. . 2015b). how they recognize and respond to emotional safety in the relationship. 2012). More research is also needed on how females make sense of their use of reactive power and the deviation of that from femininity discourses. Therefore. Ward & Knudson-Martin. and their process of moving away from use of reactive power as males begin to engage through vulnerability processes. Mejia. 2005). what are therapeutic approaches to help him feel safe enough to expose the perception of his own weakness that masculinity discourses have informed him to suppress? This is a particular relational need of abused males (Lisak. Elsie Lobo. but outcome research is also needed with adult-survivor couples. and clinical processes to help males manage emotions that are triggered when they engage through disentitled power. how men in marginalized societal contexts use disentitled power. the sample in the grounded theory study was small. FUTURE RESEARCH The grounded theory has identified a unique power approach affecting heterosexual adult-survivor couples in the form of male disentitled power and female reactive power that needs more study. and help the male partner take in her concerns and respond authentically (Knudson-Martin. Also. the one-up partner. et al. There is a need to continue this research across a wider population and with same-sex couples (author. the male’s use of disentitled power to dismiss her concerns or to disengage from her nonetheless maintained his hierarchical position in the relationship. 1995. affirm her needs. Do the females likewise become vulnerable in response to the males’ attunement or are clinical processes needed to help them lower their defenses in order to also become vulnerable? The grounded theory study focused on process research. it became essential to make space for her voice on important matters.54 Melissa A. 2014. the link of socio-contextual stressors to disentitled power performances.

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doi. & Sebastian. and trust. Couple therapy with adult survivors of child abuse: Gender. and has expertise as a medical family therapist with those who are experiencing high-risk pregnancy and perinatal bereavement. A. Socio-emotional relationship therapy: Bridging emotion. She is a member of the American Association for Marital and Family Therapy (AAMFT) and the American Family Therapy Academy (AFTA). doi. M. A. and recovery from substance dependence. California. Journal of Marital and Family Therapy. She provides relational therapy to individuals. 26(4). (2003).who. 107-119). 151-164. and couple interaction. New York.). is a recent graduate of the marital and family therapy program at Loma Linda University in Loma Linda. eating disorders. NY. Gender. 10. (2009). Journal of Family Violence. power. World Health Organization. M. E. K.1177/0265407509347931. Available from ProQuest Dissertations and Theses database. Gender. (UMI No.. Knudson-Martin. 597-608. & S.int/mediacentre/factsheets/ fs250/en/index. (pp. 531-548. child abuse. M.D. (2015). M. S. Journal of Social and Personal Relationships. V. 22. 10293)  Wells. 10. societal context. Springer. In C. A. Positive resolution of childhood sexual abuse experiences: The role of coping. Child maltreatment (fact sheet 150). Ph.1007/s10896-007-9111-1. grief and bereavement. benefit-finding and meaning-making. power. J. K.html. Wright. and families at Mt. N. BIOGRAPHICAL SKETCH Melissa Wells. Wells. and trust issues in couple therapy with adult survivors of child abuse. (2015). Retrieved 4/16/2013 from: http://www. and trust issues in couple therapy with adult-survivor couples (Doctoral dissertation). 29(2). power. (2015). Vision Family Therapy in Redlands. & Kuhn. Wieselquist. Samman (Eds. Journal of Couple & . California. M. Crawford. Building Relational Safety and Trust in Couple Therapy … 61 Wells. Her publications in the last three years include:  Wells. Interpersonal forgiveness. O. Wiersma. A. trust. couples. She also specializes in issues related to trauma. and the investment model of commitment.. (2010). Partner awareness regarding the adult sequelae of childhood sexual abuse for primary and secondary survivors. (2007).

Wells. P. Wells. V. is assistant professor in the School of Health Professions at the University of Louisiana at Monroe. Samman (Eds. A.  Estrella. & Wells.. and couple interactions.).62 Melissa A. In C. K. and the societal context. 145-153). M. New York. New York.  Knudson-Martin. societal context. Toward relational empowerment: Interpersonal neurobiology. (pp. . In C.. C. (2015). couples. Engaging power. C. New York.. Monroe. K. NY: Springer. Samman (Eds. (Eds. Aimee Galick. In C. NY: Springer. Socio-Emotional Relationship Therapy: Bridging emotion. Published online: 21 Aug 2015. A. NY: Springer. A. 53-66). Date of Birth: November 4. M. & Wells. NY: Springer. Socio- Emotional Relationship Therapy: Bridging emotion. K. M. Ph. M.. D. Wells. & S. S. 107-120).2014. Expanding the lens: How SERT therapists develop interventions that address the larger context. & S. & Samman.. M. (pp. and couple interaction.  Wells. Sc. Wells.360. & S. Couple therapy with adult survivors of child abuse: Gender. Louisiana.6450 home 949. K.D. Socio-Emotional Relationship Therapy: Bridging emotion. Kuhn. and couple interactions. Relationship Therapy. (pp. & Samman.  Knudson-Martin. New York. NV 89511-5334 Phone: 775. K. and trust. doi: 10. Elsie Lobo.. (2015).962210.). Knudson-Martin..  Fishbane. Samman (Eds. California.. NY: Springer. Knudson-Martin. (pp.. Wells. M. A.573. Freitas. A. Wells. J. S. (2015). and couple interactions.) (2015). M. & Kuhn. P. emotion.. (2015). Socio-Emotional Relationship Therapy: Bridging emotion. Knudson-Martin. A. societal context. and couple interactions. Socio-Emotional Relationship Therapy: Bridging emotion. M. is a doctoral student in the Marital and Family Therapy program at Loma Linda University in Loma Linda. Samman (Eds. 1950 Address: 2791 Shadow Dancer Trail Reno. New York. M.). In C. V.). J. M. M. K.com Elsie Lobo. A. power. 27-40). societal context.1080/15332691.8557 cell Email: purrzha@gmail. societal context. C. A. societal context. & S. Wells. Knudson-Martin. A. Aimee Galick et al.. and context in couple therapy: Lessons learned.

S.. directs the Marriage.D. Ph. M. Loma Linda. Oregon.. Div. . directs the Doctor of Marital and Family Therapy program and is associate chair of Counseling and Family Sciences in the School of Behavioral Health at Loma Linda University. Couple. Loma Linda. Ph. California. is a doctoral student in the Marital and Family Therapy program at Loma Linda University. professor. professor. Hans Schaepper. Douglas Huenergardt.. and Family Therapy program in the Graduate School of Education and Counseling at Lewis and Clark College.D. Portland. M. California.. Building Relational Safety and Trust in Couple Therapy … 63 Carmen Knudson-Martin.

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Inc. WV. . E-mail: acostello@psych. Norman. University of Delaware. Kim. & Rogosch. Cree Robinson2. Quetsch2. Byambaa. & Vos. Norman et * Corresponding author: Dr. DE. West Virginia University. McNeil2 1 Department of Psychological and Brain Sciences.*. Brown. US ABSTRACT Child abuse and neglect (CAN) continues to be a serious public health problem in the United States. 2012. Department of Health and Human Services. Newark. Butchart. affecting approximately 19% of victims and costing approximately $124 billion to society (Fang. 108 Wolf Hall. Lauren B. Morgantown.In: Child Abuse and Neglect ISBN: 978-1-63484-785-8 Editor: Michelle Martinez © 2016 Nova Science Publishers. psychological.udel. U. Cicchetti. children who experience CAN are at risk for developing multiple difficulties across biological. Department of Psychological and Brain Sciences. US 2 Department of Psychology. If left untreated.edu. Ria M. Chapter 3 PARENT-CHILD INTERACTION THERAPY FOR THE TREATMENT AND PREVENTION OF CHILD ABUSE AND NEGLECT Amanda H. Costello1. 2013. & Mercy. 2012. Travers2. De. Newark. emotional. Amanda Costello: University of Delaware. 2010). and relational domains (Alink. Nancy Wallace2and Cheryl B.S. DE 19716. Florence.

2004). 2012). costing an average of $210. & Thakkar-Kolar.S. Costello. & McEwen. Deblinger. One such intervention is Parent-Child Interaction Therapy (PCIT. and disruptive behavior problems than children who do not experience CAN. Unfortunately. Deblinger. Runyon. families may also remain at risk for future CAN. Czaja. Specifically. Department of Health and Human Services. 2014). 2012). Boyce. Keywords: parent-child interaction therapy. anxiety. Thornberry.. behavioral parent training INTRODUCTION AND SCOPE OF THE PROBLEM Child abuse and neglect (CAN) is one of the largest public health issues in the United States. physical. & Thakkar-Kolar. 2010). they are more likely to . For instance. in addition to experiencing negative psychological outcomes. This chapter provides a description of PCIT. In addition. post-traumatic stress disorder. Eyberg & Robinson. Ria M. al. Seal. 2012). & Johnson. suicide. evidence-based treatments. Widom.66 Amanda H. Research has demonstrated that CAN has the ability to negatively impact a child’s physical brain development and functioning (Hart & Rubia. also persist throughout adulthood and continue to negatively impact functioning across multiple domains.. Travers.000 reported cases of child maltreatment and neglect resulted in fatality (U. 1982. children who are victims of abuse and neglect are placed at an increased risk for various negative behavioral. a rationale for its use with parents and children who have experienced CAN. child abuse and neglect. 2009.012 per victim. Department of Health and Human Services. Nordenberg et al. and increased rates of suicide. Administration for Children and Families. 2012).500 of the 700. and alcoholism (Felitti. these children report higher rates of depression. Lauren B.S. & Taylor. many of these problems that occur during childhood. such as anxiety. Knight. Without effective intervention. 2004. smoking. Several evidence-based interventions have demonstrated success in treating parents and children who have experienced CAN. Children who have been abused are also at risk of abusing their romantic partners and their own children when they become parents (Runyon. 1. In addition to the significant societal burden of CAN. Administration for Children and Families. 1998. social. Ryan. Anda. Shonkoff. and psychological outcomes (Poole. and an overview of PCIT’s evidence base for both intervening with and preventing future CAN. depression. & Lovegrove. Bentley. 2011. adults who have experienced CAN also experience higher rates of diabetes. In 2011 alone. U. McNeil & Hembree-Kigin. 2012. Quetsch et al.

resulting in the use of physical discipline as a consequence (Bousha & Twentyman. & Golding. higher life-satisfaction. defined by Baumrind’s authoritative parenting style (Baumrind. Therefore. & Smith Slep. Maltreating parents typically experience higher levels of psychopathology including depression. Leventhal. This parenting style has been linked to prosocial outcomes for children including higher self-esteem. substance use. One such area of intervention is addressing the role of parent-child interactions to help mitigate risk for CAN. Downey & Coyne. verbal threats. Heyman.g. & Ratnofsky. 1989). 1993). & Cohen. Schlechter. 1967). 2012). DiLillo. 2001. When patterns of negative behavior emerge in parents. Tremblay. who they view as having uncontrollable levels of behavior problems (Crouch & Behl. or high needs are more frequently maltreated than peers without similar problems (Black. Crosse. Maltreating parents repeatedly implement ineffective techniques to communicate with and discipline their children. 1993). and lower rates of depression (Milevsky. young maternal age. & The ALSPAC Study Team. 2001. due to myriad negative consequences of CAN. Parent-Child Interaction Therapy for the Treatment … 67 have children with severe behavior problems (Collishaw. Stier. & Keehn. 1996). Dunn. 1995) alongside higher levels of verbal aggression and lower overall emotional responsiveness (Moser & Jacob. history of trauma. and personality disorders (Ammerman. & Mezger. Maltreating parents have misconceptions of the child’s . Johnson. Netter. These parents report greater amounts of hostile emotionality (Lesnik-Oberstein. & Peterson. Golding. 1984. Berg. 2001). 1999. the consequences can be severe and can lead to continued negative interactions between a parent and child (Bousha & Twentyman. Literature suggests a number of factors have been associated with parents reported for CAN including low income (Sedlak & Broadhurst. and low maternal education level (Sidebotham. Koers. 1997). 1984). 2006). Specifically. children with significant problem behaviors including common issues of irritability. incorporate both warmth and consistent limit setting. Kaye. & Dawes. it is critical to intervene effectively with families. Parents with a history of CAN often believe that only harsh discipline strategies (e. Blackson. THE ROLE OF PARENTING Positive parenting methods. Children can also have characteristics placing them at increased risk for abuse and neglect. Kolko. Kirisci. O’Connor. 2007). 1990. & Axelrod. hyperactivity.. Ansell. physical punishment) will be effective with their children. 2000. Perepletchikova. Hickox & Furnell.

g. Weems. PCIT teaches parents to utilize a unique set of skills . The child responds with increasingly extreme behaviors until the parent gives in to the child’s demands.68 Amanda H. the implementation of a consistent discipline strategy (i. McNeil & Hembree-Kigin. & Guthrie. 2010). Both TF-CBT and AF-CBT incorporate psychotherapy. relaxation training). including aggression and delinquency. 2008). Scheeringa. Valle.e. PCIT is a behavioral parent training program and one of three evidence-based treatments identified by the Kauffman Best Practice Project to target consequences of trauma and prevent further abuse from occurring (Chadwick Center on Children and Families. 1982). 2004). These interventions are characterized by the replacement of negative interaction styles between parents and children with more positive behaviors. Kolko et al. and the practice of new skills during therapy sessions (see Kaminski et al. Filene. Travers. In contrast. Quetsch et al. 1982.‖ defined as the escalation of extreme hostility and aggression by the parent-child dyad over time (Patterson. and cognitive coping and processing to treat instances of child trauma and maltreatment while also reducing chances for recidivism of maltreatment. developmental capabilities. which occurs within parent-child interactions. Eyberg & Robinson. Behavioral treatment interventions have been developed to intervene within the parent-child relationship. misattributing their actions to be purposeful or vengeful. 2012). 1996). time- out). & Boyle.... systematic desensitization to experienced trauma. the parent cannot control the child’s elevated behavioral outbursts and resorts to increasingly severe discipline strategies. Costello. One such intervention is Parent-Child Interaction Therapy (PCIT. skill building exercises (e. A long-term consequence for parental use of extreme discipline is the increased risk of children to have behavior problems as they grow older. Eventually. These disruptive and conduct-related behaviors serve to increase the risk of CAN. Years of research have been dedicated to breaking the ―coercive cycle‖ that characterizes the extreme dysfunctional pattern of these parent-child interactions (Kaminski. 2008). Several evidence-based interventions have demonstrated success in treating parents and children who have experienced maltreatment. Parents utilize ineffective and inconsistent methods of discipline (as described previously) in response to a child’s misbehavior. 2011) and Alternatives for Families: A Cognitive Behavior Therapy (AF-CBT. The two other evidence-based programs identified by the Kauffman Best Practice Project include Trauma-Focused Cognitive Behavior Therapy (TF-CBT. particularly physical abuse.. Amaya-Jackson. Lauren B. which can result in physical abuse (Urquiza & McNeil. Cohen. Parents and children can become trapped in a ―coercive cycle. Ria M.

& McNeil. Newcomb.. 2011. Norman. in which the parent was taught to selectively attend to appropriate child behaviors. conveying warmth. while also supporting the child’s decisions through positive attention. PCIT has been shown to be an efficacious treatment for trauma by reducing the use of severe discipline strategies and promoting positivity within the parent-child relationship for families with a history of CAN (Chaffin et al. this model has been the foundation of several behavioral parent-training programs. ―talking back‖). These skills include being nondirective and letting the child lead the play. PCIT is structured in the same way. Eyberg. ignore minor misbehavior (e. 2004). but also the use of more effective behavior management skills and greater child compliance (Eisenstadt. such as praise. Travers.. see Borduin-Quetsch. Hanf’s two-stage model included a child- directed phase followed by a parent-directed phase. & McNeil. It was adapted from an operant behavioral (i. Reitman & McMahon. and provide clear and predictable consequences for both child compliance and noncompliance (Eyberg. 1993). Research has demonstrated that including both phases in PCIT leads to not only a stronger parent-child relationship. 2012). 1988). noncompliance. Eyberg. Parent-Child Interaction Therapy for the Treatment … 69 to improve the parent-child relationship and increase child compliance through a time-out sequence. 1988. For a review. Theoretically. McNeil.g. with parents receiving the Child- Directed Interaction (CDI) phase (relationship building). reflecting the child’s speech. PCIT incorporates both operant behavioral strategies to help parents learn and use safe and consistent discipline skills and relationship-building skills typically used by therapists to build rapport with their child clients. 2015). and describing the child’s behaviors (Costello. & Funderburk. 1988).. These skills were typically taught in a ―naturalistic‖ play setting to closely mirror real world parent-child interactions. Tempel. whining. the use of reinforcement and punishment) two-stage model created by Constance Hanf (Hanf 1969.e. followed by the Parent-Directed Interaction (PDI) phase (discipline implementation) in treatment. Stokes. Eyberg.g. Chengappa. .. OVERVIEW AND APPLICATION OF PCIT TO CAN Foundation of PCIT PCIT was originally developed for preschool-aged children presenting with disruptive behaviors (e. Wallace. The therapist provided coaching and feedback to the parent regarding the parent’s skill use (Eyberg.

As described previously. (c) teaching parents to interact positively with their child. and (d) using safe and consistent discipline. with the expectation that they become a ―co-therapist‖ in the process (Herschell & McNeil. Similar to Hanf’s (1969) model. PCIT is structured as an idiographic treatment approach. parents are considered the ―agent of change‖ in PCIT. 1988). 2010). Kaminski et al. Because coaching is such a powerful tool for changing behavior. Years of research have been dedicated to developing interventions (e. & Acevedo- Polakovich. Calazda.70 Amanda H. Niec.‖ individualized feedback about their use of skills (Herschell. Mastery . which gives them ―real-time. Quetsch et al. with sessions being structured so that parents not only learn relationship-building. improvements in positive parenting has been found to occur in as early as two sessions (Shanley & Niec. In PCIT parents are taught these relationship-building skills. In addition to the use of coaching. PCIT’s success with children and families is largely contributable to the incorporation of all four of these components into the treatment program. with treatment success guided by parent performance and mastery of skills. responsible for enforcing rules. but also spend the majority of session time practicing these strategies with their children. while also remaining warm. The parent-child relationship is prioritized in PCIT. To understand why these interventions are effective. Coaching is considered to be an integral component of PCIT (Barnett. but are also a base of safety and support for the child. behavioral parent training programs) to improve the quality of parent-child relationships.g. & McNeil. Eyberg. and nurturing to their child. not by a previously determined number of sessions. (b) teaching parents emotional communication skills. Thus. supportive. Costello. Ria M. 1966). Travers. The overarching goal of including both operant behavioral principles and relationship-building skills is to promote an authoritative parenting approach (Baumrind. emotional communication. parents are not only viewed as the authority figure. Baumrind’s (1966) authoritative parenting approach is one in which parents provide structured. Parents receive in-vivo coaching from their PCIT therapist.. parents interact with their children in a play setting and receive in-vivo coaching (typically via a ―bug-in- the-ear‖ device) from the therapist. and appropriate discipline skills. and one that differentiates it from other behavioral parent training programs. predictable rules and consequences for both positive and negative child behavior. Lauren B. 2005). and this approach is meant to foster empowerment in caregivers (Herschell & McNeil. 2002). 2005). (2008) identified the four most effective components of behavioral parent training programs: (a) using in-vivo practice. 2014). getting real-time feedback about their application of skills learned in PCIT.

McNeil. Eyberg. Boggs. These data are tracked and shared with parents each session so they can follow their own progression throughout treatment. Hood & Eyberg. families do not graduate from PCIT until parents have successfully mastered the skills in PDI. Similarly. PCIT has demonstrated improved child outcomes in children presenting with disruptive behavior disorders. including anxiety disorders (Comer et al. 1998). McNeil & Hembree-Kigin. Pautsch. & Bernal. 2011). PCIT has been successfully adapted for a number of additional presenting problems. & Funderburk. As such. Eyberg. Eyberg. Eisenstadt. 2010). including oppositional defiant disorder (Eyberg & Robinson. Schuhmann. Newcomb. parents are also asked to engage in daily homework exercises that are structured to implement skills in a gradual process. 2003). Parents are encouraged to ―over-learn‖ skills in PCIT. Newcomb. 2009. Given the high level of practice and coaching in PCIT. Herschell & McNeil. and to untreated siblings of children who received PCIT (Brestan. & Algina. 2010). 2008). In addition to feedback received within the session. 1998). & Eyberg. 2008). 1998. conduct disorder (Eyberg & Boggs. Additionally. McNeil. Parent-Child Interaction Therapy for the Treatment … 71 of skills is assessed weekly by coding parental behavior during a five-minute segment at the beginning of each session. 2008). Santucci. 2011. depression (Lenze. PCIT has been identified as a ―probably efficacious‖ treatment for children aged 3-6 years old (Eyberg et al. Nelson. Pincus. 2003. 1997). Gains have been found to maintain from three to six years after treatment (Hood & Eyberg. parents have been found to complete PCIT in about 12-16 sessions (Eyberg. & Boggs. 1982. and autism spectrum disorders . and skills learned in therapy have generalized both to the school setting (Funderburk. & Capage. and Attention- Deficit/Hyperactivity Disorder (Matos. thus building the foundation of a strong parent-child relationship that is so critical in PDI. Wagner & McNeil.. & Algina. Bauermeister. 1991). Hembree-Kigin. Foote. 2005. Boggs. 2012.. Eyberg. with the goal of generalizing these skills across the day and throughout the week (Eyberg & Funderburk. Ehrenreich. 2008). on average. Research Support for PCIT Research support for the effectiveness of PCIT in improving both child and parent outcomes has been building for approximately twenty years. & Luby. Parents cannot move from the CDI phase to the PDI phase until they have successfully mastered the skills taught in CDI (McNeil & Hembree- Kigin.

72 Amanda H. Costello, Ria M. Travers, Lauren B. Quetsch et al.

(Masse, 2010; Masse, McNeil, Wagner, & Chorney, 2008; Solomon, Ono,
Timmer, & Goodlin-Jones, 2008).

PCIT as an Effective Intervention for CAN

As previously mentioned, PCIT was named by the Kauffman Best
Practices Project one of three ―best practice‖ treatments for treating children
and families with a history of child maltreatment (Chadwick Center for
Children & Families, 2004). Additionally, it is listed on the SAMSHA
National Registry of Evidence-based Programs and Practices (Substance
Abuse and Mental Health Services Administration National Registry for
Evidence-based Programs and Practices, 2009), namely for its application to
working with parents of children previously exposed to physical abuse. When
first applying PCIT to families with a history of child physical abuse and
neglect, Chaffin et al. (2004) outlined three major foci of treatment:
strengthening and improving the parent-child relationship, stopping the use of
any physical discipline and negative communication (e.g., criticism and
sarcasm), and teaching parents safe, consistent, and predictable discipline
skills. Thus, by reducing (or eliminating altogether) punitive and physical
discipline and teaching parents how to provide warmth and support to their
children, parents who received PCIT effectively learned how to be an
authoritative parent.
Of note, when PCIT is implemented with parents with a history of child
maltreatment, parent behavior is typically thought of as the focus of treatment,
not child behavior (Chaffin et al., 2004). However, PCIT still is effective as
parents learn and practice skills necessary to break the entrenched negative
interactions typically formed in a physically abusive parent-child relationship.
Research support has also demonstrated the effectiveness of PCIT with
children and caregivers presenting with a history of CAN and/or trauma
symptoms (Chaffin et al., 2004; Chaffin, Funderburk, Bard, Valle, &
Gurwitch, 2011; McNeil, Herschell, Gurwitch, & Clemens-Mowrer, 2005;
Pearl et al., 2012; Thomas & Zimmer-Gembeck, 2011; Timmer, Urquiza, &
Zebell,, 2006), and these studies will be discussed in more detail later in the
chapter.

Child-Directed Interaction (CDI)
The overarching goal of Child-Directed Interaction (CDI), the first phase
of PCIT, is to strengthen the parent-child relationship (McNeil & Hembree-

Parent-Child Interaction Therapy for the Treatment … 73

Kigin, 2010). Parents are taught skills to reinforce appropriate child behavior
and ignore minor, non-harmful misbehavior. Additionally, parents learn how
to increase their warmth, support, and respect within their parent-child
interactions. In CDI, the expectation is that the child leads the play, with the
parent following the child’s lead by giving positive attention for his/her
behaviors. Parents first receive a didactic ―teach‖ session, in which they learn
the principles and skills in CDI. This initial didactic session is then followed
by a series of ―coach‖ sessions in which parents practice CDI skills and
receive live feedback from their therapist until they reach skill mastery
(Eyberg & Funderburk, 2011; McNeil & Hembree-Kigin, 2010).
Parents are taught to give positive attention to their child’s appropriate
behavior through the use of the PRIDE skills (Praise, Reflection, Imitation,
Behavioral Description, and Enjoyment; Eyberg & Funderburk, 2011; McNeil
& Hembree-Kigin, 2010). For example, when implementing the PRIDE skills,
parents are taught to give labeled praises for appropriate child behavior (e.g.,
―Thank you for sharing the toys with me‖); to reflect children’s appropriate
speech (e.g., child says ―I built a tower,‖ and parent says ―Yes, you built a
tower‖); to imitate appropriate child play (child draws a picture of a flower
and parent also draws a picture of a flower); to describe their children’s
behavior (e.g., parent says ―You are coloring that picture‖ as child colors); and
show enjoyment (e.g., warmth, enthusiasm) in their play with their child.
Additionally, to further promote a positive and nurturing relationship, parents
are taught to avoid the use of questions, commands, and critical statements
(McNeil & Hembree-Kigin, 2010). Critical statements are thought to break
down a child’s self-esteem and lead to higher levels of frustration and/or
disruptive behavior. Commands and questions take the lead away from the
child and can also lead to frustration and noncompliance. Additionally, the use
of parent questions may give the child the impression that the parent is not
attending to him/her.
In addition to teaching parents to selectively attend to appropriate child
behavior, therapists also teach parents to ignore minor, non-harmful
misbehavior (i.e., behavior that does not hurt the child, another person, or
property). Examples of minor misbehavior include whining, playing roughly
with toys, yelling, and ―talking back‖ (Eyberg & Funderburk, 2011; McNeil &
Hembree-Kigin, 2010). Parents are coached to follow up ignoring of minor
misbehavior with using the PRIDE skills when appropriate child behavior
occurs. During CDI, parents are asked to implement daily 5-minute ―special
play time‖ in which they utilize the PRIDE skills (and avoid questions,
commands, and critical statements) at home (Eyberg & Funderburk, 2011;

74 Amanda H. Costello, Ria M. Travers, Lauren B. Quetsch et al.

McNeil & Hembree-Kigin, 2010). Parent behaviors are coded at the beginning
of each therapy session and parents are considered to have met mastery in CDI
when they use a high level of the PRIDE skills (i.e., 10 labeled praises, 10
reflections, 10 behavioral descriptions) and a low level of the ―avoid‖ skills
(i.e., less than three questions, commands, and critical statements) during a
five-minute period.
CDI is critical in breaking the coercive cycle of interactions found in child
maltreatment for many reasons. Perhaps, most importantly, it fosters a sense of
warmth and respect between parents and their child, which is often absent in
abusive relationships (Boshua & Twentyman, 1984). Parent use of the PRIDE
skills, such as labeled praise for appropriate child behavior can serve to
strengthen the child’s self-esteem and make interactions with his/her parent
desirable (McNeil, Costello, Travers, & Norman, 2013). Thus, children begin
to want to ―work‖ for the positive attention they get from their parents, leading
to increased appropriate behaviors and decreased noncompliance and
disruptive behaviors (McNeil et al., 2013). Building the foundation of a warm,
nurturing, and strong parent-child relationship is important to establish before
parents begin to learn and utilize behavior management strategies.
In addition to the benefits for children in CDI, parents also begin to feel
increased pride and mastery in their parenting, thus making interactions with
their children more desirable (McNeil et al., 2013). Anecdotally, parents with
a history of child maltreatment typically receive highly negative feedback
about their parenting, their child, and/or their family. Through coaching in
PCIT, therapists are able to provide positive feedback to parents regarding
their use of skills, including identifying the benefits these skills have on the
child and parent-child relationship (Barnett et al., 2014). Indeed, researchers
have demonstrated that, with families who have experienced child
maltreatment, 70% of parents demonstrated the improved use of positive
reinforcement in response to appropriate child behavior within the first three
sessions of PCIT (Hakman, Chaffin, Funderburk, & Silovsky, 2009). Thus,
even in early CDI sessions, coaching can be a powerful tool to improve parent
self-esteem and increase positivity in the parent-child relationship.
Finally, even though the focus is on building positivity within the parent-
child relationship, this first phase of PCIT may elicit changes in child
disruptive behaviors. Pearl et al. (2012) demonstrated improved child
behaviors when implementing PCIT with ―high risk‖ families with children
who had experienced traumatic events midway through PCIT (i.e., after the
completion of CDI) as measured by the Eyberg Child Behavior Inventory
(ECBI; Eyberg & Pincus, 1999). Parents who participate in CDI may already

therapists teach and then coach parents to implement a safe and structured time-out sequence.g. furthering the breakdown of the coercive cycle. are positively stated (e. not what not to do). The first step of the time-out sequence is for the parent to provide a warning for the time-out chair (McNeil & Hembree-Kigin. parents receive a didactic PDI ―teach‖ session. parent-directed interaction (PDI) is to teach parents calm.g. opening up more opportunities for positive parent-child interactions. Timmer et al. and predictable discipline strategies (Eyberg & Funderburk. with opportunities for the child to comply or not comply with the parental command. 2005. in which they learn the PDI skills. and then subsequent ―coach‖ sessions where they practice the skills and are given feedback through in-vivo coaching.g... PRIDE skills for appropriate behavior. typically through a role-play activity. then parents are coached by their PCIT therapist . Parents learn to both reward appropriate child behavior using PRIDE skills and to manage inappropriate behavior (e. If children continue to be noncompliant.. 2010). selective attention for minor misbehavior) taught in CDI (McNeil et al. When children comply with parental commands.g... 2010). If children are non-compliant with the command. Parent-Directed Interaction (PDI) The overarching goal of the second phase of PCIT. 2013). parents are taught to follow this compliance with a labeled praise. non-aggressive).e. Parents are expected to ―over-learn‖ PDI skills in the clinic before they implement these skills in the home to develop confidence in their use of these strategies before implementing them into a ―real-world‖ setting (McNeil et al. and are developmentally appropriate so that children are given the opportunity to be able to understand and comply (McNeil & Hembree-Kigin. 2011. Parents are also coached to deliver commands in a calm and neutral manner (Costello et al.. are direct (e. Parent-Child Interaction Therapy for the Treatment … 75 begin to see positive changes in their child’s disruptive behaviors by utilizing appropriate behavior management skills (i. structured. Prior to practicing the time-out sequence in the clinic... McNeil & Hembree-Kigin. 2006). 2010). ―Please hand me the block‖ instead of ―Can you hand me the block?‖). The use of these skills may serve to reduce or even prevent some of the presenting child disruptive behaviors. Similar to CDI. noncompliance. it is presented to the child. safe (e. Parents are first taught how to deliver effective commands.. aggression) using a time-out sequence (Herschell & McNeil. 2011). telling the child what to do. 2013). Effective commands typically begin with the word ―please‖ to sound respectful.

2010). Ria M. and non-violent behavior management strategies to deal with child disruptive behavior (Chaffin et al. Similar to CDI. if the child engages in dangerous behavior or attempts to escape sitting on the time-out chair. controlling. the child waits in the back-up room. The back-up room is typically the child’s bedroom or a spare room in the family’s house. and developmentally appropriate behavior management skills to use with their children (Herschell . if parents initially have difficulty walking their child to the time-out chair. Children then sit on the time-out chair for a set amount of time. During the time-out sequence. If needed. McNeil & Hembree-Kigin. Lauren B. To begin. holding the child under his/her armpits. 2010). 2004).76 Amanda H. Costello. verbally threatening. namely those engaging in child physical abuse. Travers. at the end of this time period. & Zahn-Waxler. with 75% of those commands being effective. non-aggressive. McNeil & Hembree- Kigin. 2011. 1966). the parent is coached to give a time-out back-up room warning. To achieve mastery in PDI. the parent and child are considered to have successfully completed PCIT and graduate from treatment. Susman. therefore. PDI effectively ―breaks down‖ the coercive cycle between parents and children in a number of ways. they are instructed to use a ―barrel carry. and support. Hollenbeck. Once PDI skills are mastered by the parents. while still maintaining warmth. and punitive discipline practices (Boshua & Twentyman. structured. 1985). 2010). to safely take their child to the time-out chair. over a five-minute period. parents are required to deliver at least four commands.‖ (i. PCIT therapists coach parents to use a high level of CDI skills with their child. The skills taught in PDI are critical in giving parents a range of safe. 2011.. Maltreating parents. have been found to use higher rates of physically aggressive. 1984. the goal of PDI is to utilize safe. Trickett. the child is again presented with the opportunity to comply with the original command (Eyberg & Funderburk. 2011. non-aggressive. and the parent and PCIT therapist work closely together to identify this space prior to implementing the time-out procedure in the home. Quetsch et al. the child is then taken back to the time-out chair before being given the opportunity to comply with the original parental command (Eyberg & Funderburk. Iannotti.. positivity. 2011). facing the child away from the parent) as a safer alternative to pulling the child’s arm or other physically coercive strategies (Eyberg & Funderburk. McNeil & Hembree-Kigin.e. consistent with an authoritative approach to parenting (Baumrind. and predictable consequences for child noncompliance and disruptive behavior. parents are taught to deliver firm. and after the elapsed time. Once the time-out procedure is finished. and 75% correct follow-through with the commands and with the time-out sequence if utilized (Eyberg & Funderburk.

2011). Ammerman. 2004. Decreases in child disruptive behaviors have been found to occur as early as CDI (Pearl et al. please see Quetsch. thus potentially leading to a higher risk for maltreatment (e. 2013. Taplin.. this is often the only consequence that children need to comply with parental commands (McNeil et al. such that expectations for both the parent and child are discussed and understood before the process is implemented. Parent-Child Interaction Therapy for the Treatment … 77 & McNeil. 2005). compared to parents with no history (Reid. & McNeil. This inconsistency in behavior management can be confusing and frustrating for children. In addition to a higher rate of physically punitive practices. the procedure creates a sense of safety and predictability not otherwise experiences for these children (McNeil et al. Herschell. within the context of a coercive parent- child relationship. For further misconceptions about time-out. as well as reduced stress. from the use of effective commands to utilizing the structured time-out sequence. physical abuse. 2005). Thomas & Zimmer-Gembeck. Within the time-out sequence. Both parents and children are taught the time-out procedure. Although concerns about time-out have been raised for children who have experienced maltreatment or trauma. typically through role-play exercises. 2013). PCIT has amassed a large and strong research base for its effectiveness in treating disruptive behaviors in young children. 1990... children often develop a high rate of disruptive behaviors. Finally. setting the parent and child up for the greatest amount of success. and greater feelings of efficacy (Chaffin et al. parents are required to use the same language and consequences each time so that children clearly and consistently learn the expectations and rules. In PDI. while also making parents strong role-models to . This transparent approach is critical for families who have experienced maltreatment. and by the end of receiving PDI. the time-out chair warning used in PCIT often becomes a clear signal for compliance. 1981). parents have been found to report subclinical levels of disruptive behavior in their children. as discussed previously. parents presenting with a history of CAN have been found to demonstrate greater inconsistency in the delivery of behavior management strategies. 2012). Indeed.. thus potentially worsening child disruptive behaviors and escalating parental responses to the child behavior over time. and these skills are ―overlearned‖ in the clinic before the parent implements them in the home. & Lorber. Herschell & McNeil.. and as treatment progresses. parents are taught to deliver a consistent and predictable set of skills. 2015).g. Wallace. The behavior management strategies taught and used in PDI are essential to reducing disruptive child behavior.

Robinson. which may be exacerbated by particularly high levels of parenting stress (Abidin. & Zahn-Waxler. Graziano. emotion coaching. have been found to display high rates of negative emotions in reaction to their children’s behavior problems (Ben-Porath. 1995). 1996. Bagner. such as those referred to PCIT. Tantrums. effectively decreasing the risk of child maltreatment in the future. Katz. The development of emotion regulation has been extensively explored across childhood and adulthood (Cole. Lejuez. Emotion regulation.. their children in behavioral and emotional regulation. defined as the ability to monitor. Morris. & Patterson. 2008. and other outbursts may be signs of a lack of skill to regulate emotions. 1991. French. 2006). & Hooven. The critical role of emotion regulation has also been conceptualized in the context of a number of serious psychopathological disorders (Gross & Levenson. Costello. aggressive behaviors. and Lester (2012) examined the effect of PCIT upon the vagal regulation of young children with disruptive behaviors who had been born prematurely. & McNeil. Past research has specifically examined the effect of positive parental emotion regulation strategies (e.78 Amanda H. Rosenthal. Macklem. 1990. Gross & Muñoz. Quetsch. Tull. Gross. Travers. 1998. Katz & Windecker-Nelson. Lauren B. 2004) and serve as a risk factor for child abuse (Dishion. 2004). Emotion regulation may also include increasing or decreasing the intensity or expression of emotions. Sheinkopf. 2010. emotional awareness. Steinberg. Quetsch et al. Deater-Deckard. & Robinson. depending on context and the individual’s goals (see Gratz & Tull. Parents of children with behavior problems. 2007). in press. The role of emotion regulation has also been specifically explored in the context of parent-child training and more specifically. 1995 for a review). Results indicated that children of parents trained in PCIT skills had improved vagal regulation as compared to . PCIT (See Wallace. Gentzler. Dix. Ria M. 2010) may serve as a primary mechanism behind the parent and child's ability to accomplish such goals and thereby help reduce the chance of potential CAN. emotional identification) on children and found significant correlations between parents who engage in such strategies and children with adaptive emotion regulation abilities (Gottman. 1997) including depression (Campell-Sills & Barlow. change and successfully adapt one's emotions to his or her environment (Gratz & Tull. Myers.g. for a review). 2010). Silk. 2003. 2006) and borderline personality disorder (Gratz. Teti. & Gunderson. Emotion Regulation in PCIT Children who experience disruptive behaviors often are believed to have difficulty with emotional control.

During the procedure. The consistent use of selective attention may also assist children in maintaining and re-gaining emotional control by obtaining parental attention solely for appropriate behavior. PDI is thought to serve as the primary treatment mechanism to improve both children’s and parents’ and caregivers’ emotion regulation. This technique may prevent parents from experiencing emotional escalation in reaction to the child’s behavior. indicative of emotion regulation. & Tillman.g. Lenze.. et al. Therefore. The predictability of the procedure gives children the power to independently gain emotional control and engage in appropriate behavior (e. parents do not have to resort to alternative methods (e. Finally. This technique allows parents to intentionally disengage from the child’s minor misbehavior. the bug-in-the-ear coaching model allows a therapist to use both active and passive coaching strategies to promote effective emotion regulation in both parents and children. soft voice while coaching the parent of a child .g. parents are taught to provide positive attention contingent upon the child’s ability to demonstrate calm. harsh discipline) in an attempt to control their children’s misbehavior. Therefore.. predictable procedure provides parents with a consistent strategy to manage children’s defiance. and may prevent parents from experiencing emotional escalation in reaction to the child’s actions. Taken together. Quetsch et al. 2012) and Attention-Deficit/Hyperactivity Disorder (Chronis-Tuscano. Results of both studies indicated improvements across a range of behavioral and emotion-based variables. Children learn to modulate their emotional reactions to consequences during each step of the discipline procedure. quiet behavior.. children learn to replace ineffective emotional responses with appropriate responses to maximize the quality and quantity of parental attention. the parent training and emotion regulation literatures suggest that emotion regulation may serve as a primary mechanism of the development and treatment of child behavior problems.. compliance). 2014). parents are taught to behave calmly and follow a script in which they maintain a neutral affect. a therapist may use a calm. For example. 2015). effective behavioral strategies enables parents to modulate their emotional reactions to the child’s behavior.. Throughout both phases of PCIT. The use of consistent. 2013. Should repeated noncompliance occur. the time-out procedure allows the child to independently utilize his/her own emotional resources to regain emotional control (McNeil et al. which may have otherwise resulted in dysregulated emotional responses. The clear. Additional studies have expanded the PCIT model to include an emotion regulation specific phase for young children with depression (Luby. Parent-Child Interaction Therapy for the Treatment … 79 children randomized to a waitlist comparison group.

Standard PCIT was compared to services as usual and an enhanced PCIT intervention that included individual parent services to address risk factors for abuse. Re-reports of abuse were assessed at a median of 850 days post-treatment. Costello.80 Amanda H. Ria M.. An additional motivation enhancement component preceded both PCIT conditions with the goal of increasing parent motivation and active participation. 110 parent-child dyads participated in approximately 6 months of treatment. The therapist may also coach the parent to engage in deep breathing exercises to decrease his/her physiological reaction to a child’s misbehavior. Previous studies have included parents and caregivers with past reports of abuse as well as families at-risk for abuse. thereby modeling emotion regulation. effective strategies to manage children’s behavior. such evidence suggests that emotion regulation serves a key role in each phase of PCIT by providing parents with safe. Urquiza & McNeil. Lauren B. 2005. Early publications primarily provided theoretical rationale for the use of PCIT with families who experienced CAN (Herschell & McNeil. Taken together. Chaffin et al. Participants in the PCIT condition had fewer re-reports of abuse compared to those in the enhanced PCIT and . Quetsch et al. In addition to focusing on parents involved in the child welfare system. ―Tell Johnny. Researchers have continued to explore the generalizability and applicability of PCIT with child maltreatment populations through treatment studies implemented in community mental health settings. randomized outcome trials were completed. A coach may model appropriate speech (e. (2004) conducted the first randomized control trial to explore the efficacy of PCIT in preventing re-reports of physical abuse in a CAN sample. Travers.. As demand increased to identify evidence-based interventions for CAN. thereby decreasing the chances that caregiver may resort to harsh and potentially abusive methods. PCIT has also been implemented with foster care populations because children often enter this system having experienced child maltreatment. RESEARCH SUPPORT FOR PCIT AND CAN The use of PCIT to address CAN continues to be an emerging but promising area of research.g. 1996). which provide support for the use of PCIT in both intervention and prevention of CAN. Referred by the child welfare system following a confirmed report of physical abuse. screaming in a time-out chair. thank you for using your indoor voice‖) or direct a parent to rub a child’s back following a temper tantrum to help the child physiologically calm himself/herself down.

replicating the results of the original trial. Bessmer. The PCIT protocol used in this original outcome study differed from traditional PCIT because it included a motivation enhancement orientation prior to initiating standard PCIT. The second outcome study in this area of research sought to compare PCIT outcomes for families with and without a history of child abuse. The positive effect of PCIT was mediated by a greater decrease in negative parent- child interactions in the PCIT condition indicating positive support for this mechanism. Edwards. For 22 families from the two PCIT conditions. to determine if risk for child maltreatment impacted the effect of the . 2005). In the follow-up study. Re- reports of abuse were assessed at a median of 904 days following treatment. These changes occurred early in treatment.. The inclusion of enhanced individual services with PCIT may have lessened the positive impact of PCIT. An additional study utilizing the same data sought to determine the stage of treatment when these changes in interaction style occurred for families receiving PCIT (Hakman et al. Chaffin et al. A follow-up study dismantled the effective components of the PCIT protocol used in the initial randomized control trial by Chaffin et al. (2004) only sampled participants with a history of reported child physical abuse.. which differentiated PCIT from standard treatment services. The experimental nature of this study allowed researchers to analyze the mechanism through which change occurred in parents and families. 1994). 2011). Eyberg. parent-child interactions were analyzed using a structured coding system. which suggests that PCIT is sufficient to reduce abuse recidivism without additional services to address individual parental factors. the Dyadic Parent-Child Interaction Coding System-II (DPICS-II. 2009). Families were then randomized to receive standard PCIT or services as usual. (2004).. 192 families with a history of child abuse reports were randomized to a self-motivational orientation or a services as usual orientation (Chaffin et al. PCIT combined with the self-motivational orientation significantly reduced abuse recidivism. & Robinson. Dramatic increases in positive parental reactions and decreases in negative parental reactions were observed in response to children’s appropriate behavior. Parent-Child Interaction Therapy for the Treatment … 81 services as usual conditions. primarily within the first three sessions. coercive patterns underlying parent-child interactions in families with an abuse history (Herschell & McNeil. These results provided support for the inclusion of a motivational component to augment standard PCIT. The authors reasoned that these immediate and significant changes in parental behavior were facilitated by the use of direct practice and coaching in PCIT. PCIT is theorized to modify the negative. as it may increase parental generalization of skills to the home. Newcomb.

Quetsch et al. and was associated with fewer child welfare reports of abuse following treatment. 2012). providing evidence that PCIT alone may be a sufficient treatment for child maltreatment without the inclusion of additional services. reduce parents’ stress. Zebell. 2005). Lauren B. These outcomes provided additional support that PCIT can be used an as intervention for parents who have perpetrated abuse and as an effective preventative technique to reduce the potential of future abuse for families at- risk for child maltreatment. providing further efficacy for the use of PCIT with a child maltreatment population. as compared to families who received a longer length of PCIT treatment in the researchers’ previous outcome study. PCIT improved parent-child interactions. intervention (Timmer. Ria M. and decrease risk of future child abuse in both groups.82 Amanda H. Travers. this second trial did not use a motivation enhancement orientation to supplement PCIT (Thomas & Zimmer-Gembeck. Thomas and Zimmer-Gembeck (2012) implemented a 12-session PCIT protocol with 151 caregivers who endorsed a history of abuse or high risk for maltreatment. Costello. Urquiza. A follow-up randomized control trial further explored the use of a standard PCIT protocol to address child abuse (Thomas & Zimmer-Gembeck. previous maltreatment studies had often used much longer treatment lengths and included supplemental services. In this study. An additional randomized control trial examined the efficacy of PCIT for families without a documented history of CAN that were determined to be at high risk for child maltreatment. The next step for researchers was to determine if PCIT was effective at decreasing abuse recidivism in community settings (where child maltreatment . Unlike the first randomized control trial of PCIT for child abuse. Similar positive outcomes were obtained for families with and without an abuse history. Families who received the 12-session PCIT protocol had equivalent improvements in parent-child interactions. The efficacy of PCIT was compared for 193 parent-child dyads with a child maltreatment history and 114 parent-child dyads without such history. Taken together. the results of these trials indicate that PCIT can be an effective intervention for the treatment and prevention of child maltreatment without the inclusion of additional services or lengthened treatment course. & McGrath. reduced child abuse potential. 2011). Thomas and Zimmer-Gembeck (2011) utilized PCIT with 150 mothers who either had a confirmed history of abuse reports or were identified as at-risk for child abuse. The intervention was found to be effective without a motivational component. Although standard PCIT generally consists of approximately 12 sessions. PCIT was found to improve children’s behavior.

. Although a randomized control group was not included in this study. in-home or in-office). parental stress.. Moussette.. this rate of abuse reports was lower than could be expected for at-risk families who have not received PCIT. suggesting that PCIT can effectively reduce child abuse potential in both settings. This suggests a decreased potential for child abuse and lowered likelihood of future abuse reports. Parent-Child Interaction Therapy for the Treatment … 83 interventions are most often implemented with families). There was also no difference in abuse report rates based on the location where families received services (i. child disruptive behaviors) that often lead to child maltreatment. Kohl. 2005). In both settings. & Drake. such as . At the conclusion of treatment. Therefore. Chaffin et al. Pearl et al. Children in the child welfare system often exhibit clinically significant disruptive behaviors. 2011). 2014). reductions in child behavior problems and parental stress were found. Swinger. et al.. PCIT was originally developed for delivery in an office setting and in-home PCIT serves as an adaptation of standard PCIT. there was a greater decrease in parental stress for PCIT conducted in-office.e. (2011) examined the effectiveness of PCIT administered in a field agency setting (instead of the laboratory setting utilized in their initial randomized control trial). Follow-up conducted 13-40 months after completion of treatment found a low rate of future abuse reports for both groups (Lanier. perhaps as a consequence of child maltreatment (McNeil. Kohl. in-home PCIT was compared to standard PCIT administered in a community agency office (Lanier. the results of the original randomized control trial (i. 2005). These children regularly experience negative outcomes. the intervention was found to be effective even when implemented by inexperienced therapists. Swinger. Chaffin et al. & Drake. However.e.g. To further examine the effectiveness of PCIT in settings where child maltreatment interventions are most likely to occur. Benz. Although follow-up data regarding abuse reports following treatment were not included. 2004) were replicated in this trial and PCIT was found to be effective in a community setting. It should be noted that therapists in this study had recently completed an initial training for PCIT.. there was a reduction in the parent and child factors (e. PCIT was associated with similar improvements in child behavior and parental functioning and stress.. Benz. As previously discussed. PCIT has also been used as an intervention for children in foster care because many of these children have experienced CAN (McNeil et al. (2012) continued this exploration of PCIT’s effectiveness in community settings. PCIT was implemented with 53 families at-risk for child maltreatment in 15 community agencies throughout the United States.

Although the previously discussed research is not extensive. The child maltreatment field will benefit from continued examination of the use of PCIT to treat and prevent CAN. PCIT has been found to improve child and parent risk factors for abuse. 2005). These outcomes have been found in randomized control trials conducted in laboratory settings as well as in community agencies that are more similar to real-life treatment settings for child maltreatment populations (Lanier et al. 2013). Comparable positive effects of PCIT have been found in a similar sample of 85 adoptive families (Allen. & Urquiza. Quetsch et al. 2004. Thomas & Zimmer-Gembeck. indicating that PCIT is equally effective with foster and biological families. et al. the studies clearly support the use of PCIT for intervention and prevention in cases of CAN.. 2004.. These results provided preliminary support for the use of PCIT with a foster care population.. including decreasing child behavior problems and parental stress (Chaffin et al. Although this format differed significantly from standard PCIT because it was conducted in a group over a shorter time period than traditional treatment. 2011). Travers. 2011).. 2014). These studies suggest that PCIT may be beneficial for children at all levels of the child welfare system who have been affected by child maltreatment. et al. 2006). 2005). longer and less stable placements. foster parents reported a reduction in children’s behavior problems following the workshop. resulting in large societal costs and the risk for serious injury and . 2011.. 2014). CONCLUSION Child abuse and neglect (CAN) continues to be a serious public health problem. A second study examined the effectiveness of standard PCIT with foster parents and their foster children (Timmer et al. PCIT was associated with improved child behavior problems and reduced parent distress in both groups.84 Amanda H. and their foster parents may not be equipped to manage their problem behaviors (McNeil et al. Costello. Evidence also suggests that PCIT effectively lowers the potential for future abuse. Lauren B. Timmer. The first study to explore the use of PCIT with a foster care population provided PCIT to foster families through a two-day workshop (McNeil. The outcomes of 75 foster parent-child dyads were compared to 98 biological parent-child dyads. PCIT can be used to treat trauma and behavior problems while reducing the potential for future abuse (McNeil.. Subsequently. Ria M.. as evidenced by reduced rates of abuse reports or re-reports following treatment (Chaffin et al.

thus effectively ―breaking‖ the coercive cycle in abusive parent-child relationships and preventing future re-reports of child physical abuse (Chaffin et al. 1996).. 2009). 2011.. including safe. substance use.S. CAN within families. Felitti et al. and personality disorders (Ammerman et al. Department of Health and Human Services. Norman et al.. and appropriate discipline skills. Thornberry et al. Parent-Child Interaction Therapy for the Treatment … 85 fatalities of victims (Fang et al. Shonkoff et al. 2012).. Thomas & Zimmer-Gembeck. PCIT is a ―probably efficacious‖ behavioral parent- training program originally developed for preschool-aged children presenting with disruptive behavior disorders (Eyberg et al. DiLillo et al. which can result in both risky parent and child behaviors.g. Widom et al. 2004. PCIT was named one of three ―best practice‖ treatments by the Kauffman Best Practices Project. 2012). 2012. disruptive behaviors. Indeed. U. Typically. and is listed on the SAMSHA National Registry of Evidence-based Programs and Practices for the treatment of CAN in families (Chadwick Center for Children & Families. An underlying concept of CAN is that parents and children are ―caught‖ in a coercive cycle.. a dysregulated stress response system (Alink et al. Gravener-Davis. cardiovascular disease... Norman et al. Posttraumatic Stress Disorder. and it has been implemented with families with a history of CAN.. these programs target dysfunctional parent-child relationships.. 2009. PCIT has demonstrated effectiveness in reducing risk of CAN in community-based clinic settings (Chaffin et al. Toth. 2004. parents with a history of CAN typically present with depression. 2000.. Guild.. 1990. and for abusing their own children and romantic partners in the future (Runyon et al.g. non-violent. If left untreated. coercive. Additionally. Through randomized controlled trials. Downey & Coyne.. 1998... Pearl et al. Additionally. 2012. depression. Type II diabetes. 2012). 2013). Perepletchikova et al. physical and medical concerns (e. 2010.. PCIT has demonstrated evidence for strengthening parent-child relationships and teaching parents effective behavior management skills.... 2004). One such class of interventions is behavioral parent training programs. hypertension. Years of research have been devoted to developing effective interventions to reduce. and physically punishing discipline from the parent (Chaffin et al. 2013. 1999. Urquiza & McNeil. 2012). 2008). 2012.. Substance Abuse and Mental Health Services Administration National Registry for Evidence-based Programs and Practices. anxiety disorders.. children exposed to CAN are at high risk for developing psychological disorders (e. history of trauma. 2012). & Cicchetti. 2011. 2004. and even prevent. whereby increased child noncompliance and aggression yields more punitive. within home-based . Norman et al. 2011. 2012).

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ix. 53. 85. 71. 69. 82. 87. 59. 66 amygdala. 26 33. 36. 58. 8. 92 behavior therapy. vii. 85. 48. 24. 8. 86 abuse. 84. 73. 78 behaviors. 70 65. 20. 62. 77. 38. 76. 10. 3. 2. 78. 45. 11. 22. 92. vii. 89. 56. 71. 1. 94 83. 16. 5. 96 African American(s). 41 13. 26. 3. base. autism. 66. 78 action research. 89. 77. 67. 37. 97 avoidance. 68. 28. 56. 66. 11. 88 . 60. 56 adaptation. 75. 8 aggression. 19. 68. 88. 89 83. viii. attitudes. 28. 96 B adjustment. 66. 66. 40. ix. 86. 22. 60. 95 95 adolescents. 9. 17. 10. 6. 87. 67. 66 brain. 41. 4. 11. bias. 15. 80. benefits. 22. 70. 87 adulthood. 67. 12. 5 age. 33. 7. 6. 45 access. 18. 25. 74 12. 81. 66. 90 alcoholism. 69. 2. 96. 40. 6 awareness. 6. 78. 78 borderline personality disorder. 25. 88 Administration for Children and Families. 80. 96 attachment. 12. 86. 52. autonomy. 88 A assessment. 34 94. 85. 78. INDEX anxiety disorder. 4. 31. 72. 37 anxiety. 10. 29. 80 antisocial behavior. 85. 93. 86. 75 anger. 61. 91. 85. 36. 7. 46. 85. 67. 18 92 black stereotype. 11. 90. 92. 71. 7. authority. adults. 61. 14 agencies. 56. 77. authenticity. 15. 66. 25 breakdown. 16. 29. 58 aggressive behavior. 68. 14 benign. 88 breathing. 34. 84 blacks. 6. 15. 83 ADHD. 74. 21. 85 bonds. 24. 14. 83. 16. 92. 88 buttons. 25. 9. 5. 68.

developmental psychopathology. viii. 26 child abuse. 28. 73. 66. 21. 44. 93 children. deviation. 45. 57. 80. desensitization. 92. 84 communication. 60. 14 cortisol. 61 childhood. 70. 72 doctors. 15. 80. 85 campaigns. 8. 47 cognitive-behavioral therapy. 55. 58. 69 disclosure. 6. 24. 11. 28. 3. 46. 65. 22. 41. 78. 78. 79. 2. 38. 71 eating disorders. 86. viii. 6. 25 child protective services. vii. 33. ix. 66. 9. 23. 73 challenges. 21. 48 cardiovascular disease. 3 census. 52 compliance. 7 culture. 14. 20. 50 conduct disorder. 88. 15. 13 cost. 17. vii. 82. 40 classification. 18 29. 93 database. 51. 12. 4. 93. 30. 81. 76. 61. 18. 87. 85. 80. 66. 47. 83. 89. 24.100 Index consensus. 28 ecology. 8. 21 distress. 74. 59. 8 conformity. 67. 74. 56. 8. 71. 23. 85. 16 college students. 25. 54 83. 62. viii. 89. 79. 5. 60. 85 96. 2. 33. 23. 96 child maltreatment. 77. 58 criticism. 12. 82. 40. 72 Chicago. 85. 68 66. 8. 91. 55 coding. 49. 55. 71. 71. 88. vii. 84. defendants. 17. 85. 1. diabetes. 91. 53 education. 86 causality. 72. 5. 7. 68. 22. 94. 19. 67. 80. 3. 2. 66. 23 case study. childhood sexual abuse. 82. 69. 40. 79 E conceptualization. 11. 50. 19. 85 conviction. 31. 59. 96 coping strategies. 77. 5. 4. 21. 7. 65. 17 disappointment. 88 depression. 1. 69. 84. 81 discomfort. 70. 14. 66. 95 61. 30 C control group. 70. 93 conversations. 78. 43. 93 compensation. 78 caucasians. delinquency. vii. 86. 84. 91. 66. 46. 52. 75. 61 confidentiality. deprivation. 58 correlations. 18. 61. 90. viii. 78. 88 72. D 15. 15. 94 color. 3 disability. 71. 68 41. viii. 67. 13 caregivers. 14. 94 Department of Health and Human Services. 37. 21. 60. 56. 58. 94. 66. 93. 11. 20. 92. 34. 4 communication skills. 4. 38 clients. 16. 21 community. 82. 17. 83. 83. 59. 87. 97 dignity. 8 disorder. 88 conflict. 78. 93 . 6. 79. 47. 82. 81. 89. 19. 7. 12. 75. 70 dominance. 94 discrimination. 81. 87 controlled trials. 86. 88. 22 Civil War. 95 danger. 22. 12 10. 31. 45. 31. 22. 83. 72. 97 economic status. 17 critical state. 34.

26. 47. 12. 16. 50. 10. 25. 9. 44. 87. 14. 68 helplessness. 6. 92 human. exercises. 67 family income. 33 improvements. 15. 7. 36. 12. 42. vii. 79. 90. 31. 56 families. 44. 42. 57. 21. 80 92. 57 femininity. 42. 16 93. 5. 57 equity. 61. 90 identification. 80. 91. 56 71. 10. 43. 92. 77. 1. 82. 2. 65. 5. 86. 78 equality. 23. 20. 54. 93. 85 family members. 4. 71 honesty. 84. 79 guilty. 95 husband. 6. 86. 93 gender role. 89 hyperactivity. 33. 5. 90 guilt. human brain. 60. 15 evidence-based program. 85. 69. 33 family studies. 7. 8 emotion. Index 101 emergency. 3. 81. 25. 68. 11. 25. 58. 82. 80. 7 emotional experience. 18. 2. 86. 11 exposure. 33. 4. 44 emotionality. 43 history. 40. 61 homes. 12. 55. 6. 26. 21. 41. ix. 33. human development. 5. 23. 22. Hurricane Katrina. generalizability. 72. 69. 90. 83 flight. ix. 88. 44. ix. 95 evidence. 50. 12. 3. 57. 80 74. 55. 15. 55 identity. 53. 90. vii. 55 imbalances. 51. 13. 15. 93 graffiti. 70. 39. 70 H environment. 7. 12. 66. 56 family therapy. 58 healing. 78. 61. 4. 95. 94 ethnic minority. 57. 17 emotional responses. 16. viii. 67 . 8 Health and Human Services. 62. 50 financial. 9 hypertension. 12 empowerment. 78 female partner. 81. 53 feelings. 77. 52 emotional reactions. 83. 74. 41 F hostility. 66. 87. 9. 45. 93 expertise. 44 85. 23. 78. 58. 72. ethnicity. 79. 23. 8. health promotion. 68. 67. 16 in vivo. 85. 85. 59 health. 36. 49. 52 guidelines. 38 evil. 70. 43. 31. 67 employment. 58 family functioning. 15. 24 impulsivity. 61 I fear. 17 income. 65. 52. 40. 71. 22. 20. 91. 2. 66. 21. 96 health services. 47. 53. Gerald Rudolph. 80. 94 funds. 42. 90. 94. 94 66. 10. 62. 52 homework. 56. 6. 1. 34. 77. 31. 52. 29 84. 77. 25 12. ix. 14. 48 hopelessness. viii. 79. G 79. ix. 22. 68. 22 emotion regulation. ethnic background. 88. 57. 96 Ford. 82. 30. 28. 41 incidence. 2. 91. 67. 22. 82. 16. 47. 35.

102 Index

independence, 31 lying, 41
individuals, 7, 61
inequality, 22
infants, 10 M
informed consent, 28, 29
majority, 70
injuries, 34, 53
maltreatment, vii, viii, 2, 3, 6, 7, 8, 9, 12,
injury, 40, 84
15, 21, 22, 59, 60, 61, 66, 68, 72, 74, 77,
innocence, 15
80, 82, 83, 84, 86, 88, 89, 93, 94, 95
institutions, 3
management, 34, 69, 74, 75, 76, 77, 85, 88,
integration, 3, 16
93
internalizing, 39
marijuana, 41, 42
interpersonal relationships, 59
marriage, 44, 48, 57
intervention, ix, 46, 66, 67, 68, 80, 82, 83,
masculinity, 23, 31, 33, 42, 46, 50, 52, 53,
84, 86, 89, 90, 92, 95
54, 55
intimacy, 22, 26, 60
maternal control, 90
investment model, 61
matter, 46
irritability, 67
median, 80, 81
isolation, 24
mediation, 56
issues, viii, 20, 21, 22, 23, 28, 29, 30, 48,
medical, 61, 85
49, 60, 61, 66, 67
mental health, 6, 15, 80, 90, 91
mental illness, 13
J mentor, 93
messages, 23, 36, 44
Jordan, 34, 58 meta-analysis, 93
juries, 18 metaphor, 25
juror, 18 Middle East, 29
justification, 34 military, 34
minorities, 4, 6
misconceptions, 67, 77
K Missouri, 12
models, 33, 49, 77, 86
kill, 68
molecular biology, 94
mood disorder, 87
L mortality rate, 4
motivation, 13, 80, 81, 82, 87
Latin America, 28 mutuality, 24, 25, 26, 39, 41, 46, 49, 51
laws, 6
learning, 93
N
lens, 56, 62
life satisfaction, 93
narratives, 34, 40, 53
live feed, 73
National Poverty Center, 16
living conditions, 12
negative consequences, 67
longitudinal study, 27, 59, 94
negative emotions, 78, 90
Louisiana, 19, 62
negative outcomes, 12, 83
love, 21, 49

Index 103

neglect, vii, viii, ix, 1, 2, 7, 9, 14, 17, 20, 22, positive feedback, 74
28, 36, 40, 65, 66, 67, 72, 84, 87, 92, 93, positive reinforcement, 74
97 postmodernism, 57
neighborhood characteristics, 15 posttraumatic stress, 94
Netherlands, 16 post-traumatic stress disorder (PTSD), 59,
neurobiology, 24, 57, 62 66
neutral, 75, 79 poverty, 2, 6, 9, 12, 13, 22
nursing, 40 power relations, 26, 44
predictability, 77, 79
pregnancy, 61
O prejudice, viii, 2, 3, 4, 7, 14, 15, 17, 18
preschool, 69, 85, 86, 91, 92
offenders, 18
preschool children, 91, 92
openness, 26
preschoolers, 87
operations, 31, 52, 53
prevention, 80, 82, 84, 89, 93, 94, 95
opportunities, 26, 75
principles, 70, 73
problem behavior(s), 67, 84
P problem children, 89, 90, 91, 92
project, 28, 29
pain, 43, 49 protection, 24, 25, 26, 36, 37, 38, 55, 58
parental control, 86 psychological development, 56
parental employment, 12 psychology, 15, 56, 57, 58, 59, 96
parent-child relationship, 5, 68, 69, 70, 71, psychopathology, 42, 67, 88
72, 74, 77, 85 psychotherapy, 6, 68
parenting, 67, 70, 74, 76, 78, 86, 88, 92, 97 public health, vii, ix, 65, 66, 84
parenting styles, 92 public opinion, 4
parents, vii, ix, 5, 8, 9, 10, 11, 12, 14, 33, punishment, 67, 69, 88
44, 53, 66, 67, 68, 69, 70, 72, 73, 74, 75,
76, 77, 78, 79, 80, 81, 82, 84, 85, 86, 87,
Q
88, 89, 92, 94, 97
participants, 5, 8, 13, 29, 81
qualitative research, 56
pathways, 15
questioning, 22
perinatal, 61
personality, 15, 67, 78, 85, 90, 93
personality disorder, 67, 78, 85, 90, 93 R
physical abuse, 8, 9, 33, 68, 72, 76, 77, 80,
81, 85, 87, 90, 91, 92, 93, 94, 97 race, vii, viii, 1, 2, 4, 5, 7, 8, 9, 10, 12, 13,
physiology, 90 14, 15, 16, 17, 18
play activity, 75 racial differences, 2, 9
playing, 73 racism, viii, 2, 4, 5, 6, 11, 12, 13, 14, 16, 17,
police, 4 34, 38
policy, 4, 14 reactions, ix, 20, 24, 28, 31, 36, 49, 55, 79,
politics, 58 81, 90
population, 54, 82, 84 reactivity, 25, 26
positive behaviors, 68 recidivism, 68, 81, 82, 87

104 Index

recovery, 59, 61 shape, vii, viii, 1, 2, 43
reflectivity, 51 sibling(s), 71, 87, 97
registry, 72, 85, 94 signs, 78
reinforcement, 69, 74 skills training, 87
relaxation, 68 smoking, 41, 66
reliability, 26 social construct, vii, viii, 19, 21, 60
requirement(s), 2, 31 social context, 23, 29, 30, 42, 43, 58
researchers, 7, 13, 28, 29, 30, 52, 74, 81, 82 social interaction, 93
resolution, 61 social learning, 93
resources, 79 social network, 53
response, 3, 25, 26, 33, 37, 39, 40, 47, 54, social norms, 4
68, 74, 81, 85, 90 social psychology, 15
responsiveness, 67 social workers, vii, viii, 1, 2, 6, 8
rights, 17 socialization, 34, 42, 52, 53
risk(s), ix, 6, 12, 14, 15, 61, 65, 66, 67, 68, societal cost, 84
74, 77, 78, 80, 81, 82, 83, 84, 85, 94 society, vii, ix, 65
risk assessment, 6 sociocultural contexts, 50
risk factors, 80, 84, 94 socioeconomic status, 6, 10
root(s), 13, 94 speech, 69, 73, 80
rules, 6, 70, 77 state(s), 6, 17, 97
statistics, 95
stereotypes, 8, 9, 11, 12, 14, 16, 23
S stereotyping, viii, 2, 3
stress, 37, 47, 49, 56, 66, 77, 78, 82, 83, 84,
safety, ix, 15, 20, 21, 22, 24, 25, 26, 30, 31,
85, 86, 88, 94
32, 39, 40, 41, 43, 47, 48, 49, 50, 51, 54,
stress response, 85
55, 56, 70, 77
stressors, 54
SAMSHA, 72, 85
structure, 10, 16
sarcasm, 36, 72
style(s), 67, 68, 81, 87, 92
school, 71, 90, 92
substance abuse, 10, 12, 86
science, 2, 18, 57
Substance Abuse and Mental Health
security, 26, 47
Services Administration, 72, 85, 94
segregation, 6
substance use, 67, 85
selective attention, 75, 79
suicide, 66
self-esteem, 67, 73, 74, 92
supervisors, 28, 29, 40
self-reflection, 39, 47, 48
support services, 6
sensitivity, 23
survival, 22
sentencing, 18
survivors, viii, 19, 21, 22, 23, 24, 25, 50, 52,
services, vii, viii, 1, 2, 3, 6, 10, 15, 80, 81,
55, 56, 58, 59, 60, 61, 62
82, 83, 93
susceptibility, 12
SES, 6
symptoms, 56, 72
sex, 54
systematic desensitization, 68
sexual abuse, 9, 33, 36, 55, 56, 58, 59, 60,
61, 88
sexual orientation, 13
sexual problems, 22

91. 37 47. 94. 70. 94 traumatic events. 16. vii. 30. 76. 9. 80. 53. 41 threats. 83. 26. 15. 72. 54 treatment. 83. 58. viii. 46. 3. welfare. 44 transcripts. 50 therapist. 24. 26. 31. 66. 61 trustworthiness. 19. 21. 83. 58. 97 vision. 93. 82. 14. 66. 44. 94 well-being. 7. 73 vulnerability. 84. 55. 14 toys. 55. 40. 85. 88. 60. 58. 10. ix. 50 49. 69. 6. 20. 28. 7. 88 United States. 51. 81. 87. 62. 77. 67 vote. 15. ix. 85 W trajectory. 39. 60. 59. 85. 70. 11. 5. 81. vii. 14. 71. 61. 60 training. 80. 22. 76 trauma. 54 variables. videotape. 90. 22. 56. 47. 84. 49. 26. 94 target. 58. 79 therapeutic conversation. 21. war. 57. 60. 80. 55. 82. 36. 66. 85 therapy. 6. 7. 21. 53. 16. 39. 2. 69. 79. 42 triangulation. wrongdoing. 69. 75. 45 61. 21. 84 trial. 25. 46. 11. 86. 38. 45. 13. 87. welfare system. 27. 30 workers. violent behavior. 80. 91. 50. 90. 51 Y U Yale University. traditional views. 18. 56. 6. 50 29. viii. 31. 50. victimization. 2. 88. 46. 92. 33. 22 56. 91. 68. 76 87. 70. 38. 9. 48. 95 therapeutic approaches. 83. ix. 72. 95. violence. 8. 68. 39. 89 . 65. 10. 91. 96. 65. 87. 29. 68. 96 13. 52 51. 20. 4. 85 Washington. 61. Index 105 US Department of Health and Human T Services. 23. 9. 74 weakness. 14. vii. 83. 42. 88. 20. 30. 89. 16. 53. 52. 31. 77. 67 V technology. 59. 89. 92. 78. 59. 48. 3. 30 walking. 84. 47. 28. 12. 12. 28. 12. 95. 54. 49. 68. 97 training programs. 94. 48. 60. 12. 59. 76. 2. 52. 41. 33. 87. 2. 52. 74. 27. 11 triggers. 79 victims. 1. 92. 34. 73. ix. 28. 48 variations. 70. 3. 67. 91 82. 69. 93. 71. 17. 20. 96. 89. 85 techniques. 5. 83. 68. 66. 24 World Health Organization. viii. 17. 29. ix.