Deciding Whom to Include in Treatment

This chapter explores the decision of who to include in treatment. In integrative family and systems treatment (I-FAST), this is a case-by-case decision that in and of itself is considered an intervention. Guidelines for making this decision are offered. Two special situations are examined in detail: whole-family interviews as they relate to trauma and family interviews that include both survivor and perpetrator in cases of intrafamilial sexual abuse. Criteria for when and when not to conduct these interviews, along with detailed steps are outlined. Several case examples are offered covering a wide range of issues related to who to include in treatment are given.

Trauma and Substance Abuse

Substance abuse and trauma are the topics of this chapter. The relationship between substance abuse and trauma histories, particularly intrafamilial sexual abuse, is examined. The application of integrative family and systems treatment (I-FAST) with two cases is described in detail. Both cases are examples of adult women who suffered serious intrafamilial sexual abuse, were not supported by their mothers, and subsequently developed serious substance abuse problems. In both cases, their mothers were included in the treatment. Support from their mothers regarding the sexual abuse was finally obtained. In both cases, repairing the mother–daughter relationship resulted in total amelioration of both trauma and substance abuse problems.

Treatment to adult perpetrators of intrafamilial sexual abuse in Brazil: psychodrama as strategy

The Brazilian policy to combat sexual violence emphasizes the importance of protecting victims, as well as accounting for and taking care of the perpetrator. The aim of this paper is to describe one strategy that is being used to address difficult issues – such as the processes of offenders’ own victimization itself, the expression of sexuality and sexual desire for children – in the context of psychosocial interventions for adult sexual offenders against children and adolescents. The strategies adopted are based on psychodrama techniques, which facilitate the overcoming of emotional obstacles to these issues, creating a playful environment during the intervention, providing conditions for reflection, expression of feelings, decreased tension, and which contribute to integration and group engagement in the tasks. This option avoids a confrontational position and favours the development of empathy.

Microarray results as an indicator of sexual abuse

This case report illustrates the unexpected identification of intrafamilial sexual abuse of a young mother through genetic testing of her child. The child’s genome was found to have a relatively common chromosomal condition with congruent clinical manifestations, but the microarray also suggested a close biological relationship between the parents because of a high degree of homozygosity. This prompted a child protection investigation as the mother had been a minor at the time of conception, and intrafamilial sexual abuse was confirmed. Both the intended and unintended results of microarray should be considered with respect to the health and social context of the child and their biological parents. This becomes particularly important for young mothers and raises protection concerns when significant amounts of homozygosity (consanguinity) are detected.