Brandon is a 12-year-old, Caucasian male who currently resides with his mother and her boyfriend. Six years ago, Brandon disclosed that his father had repeatedly sexually abused him between the ages of 4 and 6. Brandon’s mother called law enforcement immediately after the disclosure, and his father has been incarcerated since. Brandon has previously participated in therapy to address challenging behaviors, including physical aggression, difficulty following rules at home and school, and using inappropriate language with sexual overtones toward female peers. Brandon and his mother report that they ceased participating in therapy in the past after there was no change in Brandon’s behavior. Brandon’s teachers have suggested that his behaviors are similar to those of peers with attention deficit hyperactivity disorder, but his mother has declined educational or psychological testing because she does not want her son to be labeled and is unsure if she agrees with the use of psychotropic medication with children.
Brandon began attending trauma-focused treatment after demonstrating an increase in argumentative behavior and minor property destruction at home. His mother reported that the majority of undesired behaviors were initiated during interactions with her boyfriend. Brandon’s use of physical aggression has not increased in school; however, a female peer recently reported him for using sexually explicit language toward her. Brandon admitted to using inappropriate language toward the female peer but appeared to have a limited understanding of what the phrases used meant. Brandon’s mother noted during intake that she is concerned that her son will become a violent sexual offender or a pedophile and noted that his use of sexual language was likely the start of sexual behavior problems.
At the beginning of treatment, Brandon reported that he frequently feared for his physical safety but often could not pinpoint what made him feel unsafe. He had searched the Internet to find registered sexual offenders in his neighborhood, and he had begun sleeping with a loaded BB gun under his pillow in case someone entered the home to assault him again. Brandon had flashbacks when trying to fall asleep and described feeling like he was floating outside of his body when he thought of his abuse. He had seen a television show where victims spoke at the parole hearings of their perpetrators, and he spent many hours thinking about what he would say if he went to his father’s parole hearing in 3 years. Brandon felt like he loved his father very much and that his father was a great father except for when he hurt him. Brandon identified wanting to feel less worried, sleep better, and fight less with his mother as primary treatment goals.
I worked with Brandon in both individual and family sessions to address his symptoms of depression and post-traumatic stress disorder (PTSD). Utilizing the trauma-focused cognitive behavioral therapy approach, early sessions focused on coping skills and emotional regulation. As Brandon became more comfortable with expressing feelings and utilizing coping skills, he began discussing his sexual abuse history and the ongoing effect this experience had on his life. I met with Brandon’s mother for collateral sessions in order to help her identify and process her own feelings about his abuse and to develop skills to support Brandon through his treatment. Brandon’s mother was provided with psychoeducation regarding childhood sexual abuse, and her belief that her son would become a violent sexual offender as a result of his experience was challenged through cognitive behavioral therapy. She agreed to meet the agency psychiatrist, and after the initial consultation she agreed to have Brandon meet with the doctor. After a psychiatric evaluation, Brandon was prescribed a low dose of antidepressant medication.
Brandon completed a trauma narrative that addressed the details of his sexual abuse experience, his disclosure of the abuse, and the trial and subsequent imprisonment of his father. Brandon included a description of his feelings at each point in his narrative, as well as what he learned in treatment about childhood sexual abuse and coping skills to deal with uncomfortable feelings and impulsivity. Brandon shared his trauma narrative with his mother, who provided a safe and supportive space during this experience through the use of skills learned and practiced during collateral parent sessions. Brandon’s symptoms of depression and post-traumatic stress decreased steadily during the course of treatment. After 8 months of sessions and the successful completion of his trauma narrative, the family and I agreed that Brandon was ready to terminate trauma-focused treatment. Brandon continued receiving medication management with a psychiatrist and transitioned into home- and community-based treatment that focused on his ongoing impulsive behaviors.