Psychotherapeutic support for mistreated children

Project location: Italy, Rome
Project start date: October 2002 - Project end date: October 2003
Project number: 2002-12
Beneficiary: Bambini nel Tempo

foto GIOVANNI CANITANO

The Psychotherapy project for the children victims of maltreatment and sexual abuse and their families, financed by the Nando Peretti Foundation has so far been in charge of 16 families, amounting to the total number of 21 juveniles. Each case has been referred to the Centre of Aid to the Maltreated Child and the Family (in collaboration with the Rome City Council) following different ways: in some cases a preliminary phase of psycho-diagnostic assessment had taken place at the Centre, in some other cases the diagnostic phase had taken place at other first level local Health Services or at other second level Health Services. In the latter case, the patients and their families have been directly referred to the Centre for a psychotherapy.

The first case is a sexual abuse, referred to the Centre by the Eleventh Borough of the Rome City Council. It concerns a nine year old girl reporting being victim of sexual harassment by her father and other four friends of his. The adults used to meet with all their children, also victims of the same abuse. The girl now lives with her brother and mother, who separated by her husband. The psychotherapeutic intervention aims at providing the girl's mother with an adequate support to face the "collapse of her family", and helping the girl and her brother to work through the feelings of rage at their father and their sense of victimization.

One year after the beginning of the psychotherapeutic support for the new family, the children seem to have improved a lot their situation as witnessed by their Social Assistant (in charge of their custody) and teachers' reports. The mother is not depressed any longer and appears more lively and challenging. She has been able to face and support her children facing a new legal appraisal, indicating the juvenile as "reliable" but "not believable", has been questioned by the Judge of the Ordinary Court. The Judge's decision followed the Center's report in which it was stated that "the juvenile's personality was absolutely compatible with the possibility of having undergone sexual abuse".

Another situation presents the problem of an adoption which has been revoked and has been referred by the Public Prosecutor's Office to the Juvenile Court. The case concerns two juveniles, respectively a six and an eight years old girls, who, after having lived by an Italian pre-adoptive foster-family for five years, have to return to their mother in Romania. The juveniles and their foster family were followed until June, 2003. The Public Prosecutor of the Juvenile Court, has ordered a new adoption procedure of the juveniles, because the previous adoption had been revoked by the Juvenile Court and the Court of Appeal, on the ground of new elements concerning the girls' biological parents (the father is in jail and the alcohol-addicted mother attempted suicide and lives in very inappropriate conditions). The Juvenile Court has rejected the appeal again with an immediately executive sentence. According to this sentence the father's parental authority has been revoked and juveniles have again been entrusted to their' mother's custody who, thanks to the Romania Consul's intervention, has taken them back to Romania, in violation of all the international laws and agreements which state the juvenile's right to be protected in the Country where she usually dwells and has had her first cultural and affective bonds. The intervention followed two main directories. On the legal level, the Center is keeping working together with the Public Prosecutor and the juveniles' special trustee, for the appeal against the decision of the Juvenile Court. On the clinical level, the Center is  working with the foster parents, supporting them in maintaining their relationships with the girls and the biological mother, by phoning them and going to Romania, which has been done so as to avoid a painful detachment, possibly resulting harmful to the juveniles' growth.

The third situation was referred to the Centre by the Tenth Borough. It concerns a case of neglect of a four year girl by both parents. A high conflict is also present within the couple of parents, who are presently getting separated. The girl is being constantly triangulated within the fights and tensions between her father, mother and paternal grand-mother, while her needs and requests are not even seen by her parents. She lives with her mother, to whom her custody has been entrusted. The therapeutic intervention has aimed at improving the mother's competences and the relationship between the mother and the paternal grandmother, because the father has moved overseas, and it is only rarely when he comes back to Italy (twice or thrice a year). The mother is a young woman who, during her daughter's early years, has been more preoccupied with herself than with the juvenile's needs. The therapy has tried to help her reviewing her infancy so as she could get closer to her daughter's world and recognise her needs and requests. The juvenile, on the part of hers, has given a very positive feedback to her mother's changing attitude, so rendering the great need for affection and attention that she had explicit The mother has tried hard to find herself a job, succeeding in not overshadowing her daughter's needs in favour of her personal interests, as had happened in the past. Thus, she has chosen a part-time job, which enabled her not to call for a baby-sitter. The mother is now able to recognise most of her past mistakes, and, in the last few months, she has put her life into question very deeply, realising how much she has changed and matured. Furthermore, the Center has worked to improve the communication between the mother and the paternal grand-mother, because both of the them represent very meaningful figures to the juvenile. They did not use to talk at all and, on the contrary, all they used to do was to attack and devaluate one another. They were both so centred on the reciprocal disappointment they had experienced in their relationship, that they lost sight  of the juvenile. By providing the two women with the new frame of the pivotal importance of the juvenile's care and ameliorating their communication, their relationship has now turned into a cooperation, lacking any conflict and sharing the rules for the education of the juvenile.

A fourth situation, also referred by the Tenth Borough, concerns a 12 years old girl whose custody, together with her two brothers', has been granted to her maternal grand-parents, after having lived in an institute for three years. Her paternal grand-mother and a friend of hers are at the moment under court for having seemingly abused of the girl earlier in her life. The maternal grand-parents have requested the adoptions of their niece and nephews. The girl's father, an alcohol-addict, has never shown any interest whatsoever in his children, while their mother is now attempting to improve her relationship with them, though being strongly opposed by her parents. The psychotherapeutic intervention has concerned the juvenile, her mother and maternal grand-father. A mainly "instrumental" attitude towards the Social Services has emerged on the part of the whole family system since the beginning: the family much prefer to be cared for and supported than to be actively work. The maternal grand-father initially had many resistances to bring her niece to the therapy, and by concentrating on this aspect the need for both the girl and her grand-father to receive a therapeutic help has been made understandable to them. The grand-father, experiencing a genuine sense of affection toward her niece, has at last taken a more positive and responsible attitude as to the psychotherapy. The mother has shown many personal difficulties in undertaking any change and, though having received an individual psychotherapeutic help in another Health Service for one and a half year, she has not sought for a proper job or for adequate accommodation, only relying on the assistance provided. There seems to be a high conflict between the mother and the maternal grand-parents, a conflict which is daily fuelled on both parts. In her individual psychotherapy, the juvenile has been able to express fears and difficulty, mainly related to the relationship with her mother, whom she perceives as non protective, detached and at a distance. A very good relationship seems to have been established between the niece and the maternal grand-father. The joint work with the juvenile and her grand-parents has allowed the former to come to make requests on them. In fact, the girl, not to be excluded from her current family, had not made any request for two years, resulting in a major retirement on her part's. She did not allow herself to make requests and not even to dream of them. The sessions with her grand-parents have made it possible their readiness to change to emerge, in spite of their advanced age. This availability has favoured the juvenile to open up herself and to express the wish to play volley-ball and to go out with the friends of hers.

The fifth situation has been referred to our Centre by the Twentieth Borough and concerns the case of a ten years old girl, living in an institution for six years now. The reasons for her living in the institutions are due to a report of sexual harassment on the girl by her father. The report was made by the girl's mother six years ago, during her separation from her husband. Since the father was acquitted of the charge, the mother was not held fit for the custody of her daughter. A high degree of conflict has emerged between the parents since the very beginning of the therapy. The conflict mainly revolved around the girl's education and the mutual blaming for having caused the current situation. The father has taken a strictly accusing and devaluating stance toward the mother, whom he holds fully responsible. He is not able of any self-criticism whatsoever and tends to state that all started with her wife, whom he regards as severely ill. The mother is less critical toward her former-husband, but she is convinced that in the past he has committed sexual abuse on her daughter and, thus, he is a bad and dangerous person. An attempt to highlight both parents positive qualities has been made, but neither of them seem to accept another point of view regarding their past history, mutually denouncing the deception and cruelties on the part of the other's. In this situation the juvenile seem totally caught within the triangle. The situation is further worsened by each parent's worrying that their daughter's custody could be granted to the other parent. In his relationship to his daughter, the father appears to be sensitive to her current needs, but he is not able to help her having a good relationship with the external world and her mother, because he conveys a sense of general distrust toward the other people. He shows himself as an active person, very devoted to her daughter, constantly seeking for new strategies to meet her needs. On the contrary, the mother does not play an active influence on her daughter with her rage and worrying, but she does not seem able to accept the need appropriate to her age, keeping relating to her as if she were 4 years old (she does not provide any explanation to her and does not answer when the girl asks her questions). Moreover, opposite to her former-husband, she is a very quite person, retired and reserved, with a strong difficulty in communicating and relating to the external world. This does not help her relating and getting in touch with her daughter. Moreover, in the last few years, the mother has not accomplished any change, she has not looked for a new job, but she lives isolated and retired within herself. The situation within the parental couple seems to be at a standstill, with great resistances not only to the change but also to a different view of the situation. Still now the foster-home seems to be the most protective and adequate place for the juvenile.

foto GIOVANNI CANITANO

Another situation referred to our Centre by the Eleventh Borough concerns a father acquitted of the charge of sexual abuse of her daughter when she was three years old. The parental couple is separated and the girl has lived with her mother and maternal grand-parents for eight years now. Currently the contacts between the girl and her father are ruled by the Social Service. A report on this case has been forwarded to the Juvenile Justice Court in order to modify the very strict procedures ruling the relationship between the girl and her father. In the psychotherapy a work has been made on each parent's history and this has allowed them to acknowledge their own childhood need, thus getting closer to their daughter's issues. A work has also been made on the couple's history and this seems to have promoted a change, though partial, in the relationship dynamics. As a consequence, the tension within the parental couple has been lowered and the parents have not shown mutual attacks and blaming any longer. After having the chance to face and even to blame each other, they have both recognised each other's qualities as a parent in rapport to their daughter. As far as the relationship with the juvenile is concerned, the mother seems to have more and more entered into a parental role, being able to protect her daughter from the teachers at school, and providing her with rules and timetables more appropriate to the juvenile's age, in agreement with her father too. A good relationship has also emerged between the girl and her father, who is very playful to his daughter, tends to provide her with guidelines and explanations and shows an adequate and authoritative attitude towards her. The relationship between the parents seems to rely on respect, the wish and the awareness that they have to share the parental role with reference to the juvenile. This is witnessed by the fact the last decisions concerning the girl have been shared by the parental couple in a climate of cooperation and reciprocal respect.

Other two cases have been referred respectively by the XVIII and the XIX Boroughs. In the first situation, a suspect of sexual abuse on the part of the father's and maltreatment on the part of the mother's has been reported on a 12 years old girl and her ten years old brother. Following these suspects, the two juveniles' custody have been granted to an Institute where they have lived for four years now. While the father has been acquitted of the charge and has maintained the parental authority with a project for the return of his children to his family, the mother is still under court and is not allowed to have contacts with her children. The psychotherapy is still in progress and a partial modification of the original objectives has been necessary: in agreement with the referent Social Service, it has been deemed adequate to maintain the children in an extra-family placement. In fact, the father has not shown to have achieved robust parental skills which would allow himself to take over his children's behavioural and emotional problems, ensuing from the traumatic experiences they suffered in the past. The therapeutic work continues with the objective to warrant a room for the working through of both the father and children's disappointed expectations regarding the construction of a bond which takes into account their needs and limits.

Other situation concerns a couple characterised by a high degree of conflict. The conflict is so high that the parents' capacity to take care of their son has been totally undermined. At the moment, as a matter of fact, the boy is under custody of the Social Service and he now lives with a maternal aunt. The therapeutic work with the couple revolved around two points. The first point concerns the distinction between the aspects linked to the couple and the aspects linked to the parental care, and its objective is to help the parents finding an agreement on the management of their child's care. The second point concerns the nature of the couple's conflict and in this case the objective is to help the couple modifying the dysfunctional aspects of their relationship. Contemporarily, a psychological aid has also been offered to the juvenile, in order to help him to cope with feelings of helplessness and anger linked to this difficult situation. The therapeutic work has allowed a marked reduction of the conflict within the couple, as to permit the juvenile to return to live with his parents. Currently, the work is aimed at improving the parental skills and supporting the juvenile in the phase of restoration of the original family core.

 The ninth case has been referred to the Centre by the Public Prosecutor Office of the Juvenile Court. This case concerns situation of suspect maltreatment on the part of the mother's on two children. The first information came from school, following the observation of the two children's clear signs of psychological distress. After the first meetings, it has been possible to rule out the presence of physical maltreatment and the situation has been interpreted in the light of the parental neglect. The family is, as a matter of fact, a very large one (five children ranging from six months to eight years). The parents are very young and show a clear difficulty in effectively coping with their children's requests and needs. The therapeutic  work is ending in a short time. The parents have, in fact, employed the support provided to them and have been able to use their own resources. This has led to a change in the former dynamics and the parents' achievement of more effective strategies in coping with their children's emotional needs.

foto GIOVANNI CANITANO

The tenth case concerns a 17 years old girl whose custody is currently been granted to her maternal grand-parents, with whom she now lives. The girl lost her mother, a drug addict, when she was ten years old and has only rare contacts with her father who has not proven available to take over her daughter's life. The therapeutic demand originally concerned the strong conflict between the juvenile and her grand-parents. The therapeutic work aims at supporting the relationship between the juvenile and their grand-parents in this phase of individuation of the girl, by accompanying the family in the process of working through of the memories and feelings related to the death of the mother of the juvenile, event which caused the latter to be in custody of their grand-parents.

The eleventh case regards a seven years old boy showing behavioural problems at school. The boy has remained orphan of his mother when he was 5 months. At the moment, by decision of the Juvenile Court, the boy is in custody of the maternal grand-parents, because the father was not deemed adequate to take care of him. A history of violence and strong conflict between the parents and both the families of origin emerge: the boy is allowed to see his father only once a week. At the moment the order of vigilance on the meetings between the boy and his father has been revoked. A strong conflict seems to be present between the father and the maternal grand-parents. The child's behavioural problems have been connected to his puzzled perception of his history. The confusion seems to stem from the fragmentary and contradictory details which have been told him both by his father and his grand-parents. Given such aspects, a separate room has been proposed to the grand-parents and the father, as to permit the working through of the past events and the child's better understanding of the traumatic experiences which preceded his birth and months of life, still conditioning his current well being.

The twelfth case concerns a now eighteen years old girl who, in July 2000, had denounced her mother's partner and a neighbour for outrageous sexual harassment toward her. In May 2003, the two men have been condemned in the first grade. The teenage has lived in a foster-family in Manziana for three years now and is attending a professional course of the Regione Lazio. She is now gradually getting closer to her family again and seems to have worked through her experiences thanks to the therapeutic work which followed the diagnostic phase.

The thirteen case has been referred by the Childhood and Motherhood Service of the local Health Service in Rome and refers to a situation of a 15 years old juvenile who lives with his eight years old brother, his mother and her partner, and is allowed to freely visit his father. The situation was first referred when the boy was three years old. His parents had just separated, because her mother had another relationship. The father has come back to live with his family of origin and since then has started indulging in alcohol, though being able to maintain his job. Ever since, the boy show aggressive behaviour at school and the referral to our Centre followed the father's denouncement of her former wife for maltreatment of juvenile. The situation has appeared as complex from the very beginning. The mother, a young but very fragile woman, has lived with an Indian boy for two years now. Before this, she had a three years long relationship with an Army Officer, who lived in another city and which only rarely came to visit her. Still before, soon after the separation which occurred in 1991, she had a three years long relationship with an extremely violent and aggressive man. The man was also aggressive with the children and has been defined as paranoid by the woman. The father lives with his parents, who are now quite old, works and spends his leisure time in the pub. The first son is presented as a boy who has always caused troubles to his mother. He is ill-tempered, a times aggressive, is not involved in school and does not show any interest whatsoever, except for drawing, while his younger brother appears as very childish, is always asking for cuddling from his mother and his brother who takes care of him and often gives him presents. The individual sessions with the boy have shown many interesting aspects. A situation of strong aggression, lack of rules and respects at home (the mother constantly spits on her boy) has emerged. The father seems to be present from an affective point of view but also appears totally unable to take care of his children for a long period. The boy seems to have so deeply internalised his mother's contempt toward him that he has no positive self-esteem at all. He would be able to face school without any problem but has an assistant teacher and last failed so that he has now to do the same school class again (eighth grade). The atmosphere at home is very heavy, because the mother's new partner does not show any interest in the children who, on their part, nag him. The mother, on the other hand, never stands for the one or the other. In the therapy the work has mainly addressed the adults in order to improve their parental skills, but the mother, after few sessions, has not come any more, attributing all the responsibilities of the problems to her children. The father has appeared available and ready to take on his own responsibilities, but outside the therapeutic context he does not seem able to sustain such attitude. The work is also concerning the boy, which aims at helping him to get out of the triangle and to stimulate his interest and hope for his future life. The boy is very concerned for his parents' behaviour, he takes care of them when they are ill, defends and protects his brother whom he helps with the home-work, but he is not able to think about himself, just because the family charge is to high for him. The situation definitely appears as to heavy for the juvenile, and a cooperation has been established with the Health Services to provide the family with a home-visiting assistance or a daily afternoon activity centre for the boys.

foto GIOVANNI CANITANO

A new situation, the fourteenth, has come from the XIII Borough. The situation is well-known at the Services and concerns a demand for family therapy. The family is now made of a mother and her two children, a twelve years old boy and an eight years old girl. The mother separated form her husband in 1995, soon after the birth of her second child. Initially, her former-husband went to live at the floor above and could see the children freely. The father is described as violent toward the children, a very authoritarian man with a diagnosis of Obsessive Disorder. The father has commenced a new relationship, which still lasts, with a woman who has three children since 1999, and following this he seems to have become even more severe. Following the mother's denouncements for the father's violence and maltreatment in 2001, the children are allowed to see their father in a protected room only once every two week. On several occasions, the girl has had episodes of enuresis, while the boy in the protected meetings with the father suffered from encopresis. The psychotherapy aims at reducing the children anxiety, which unavoidably increases in the days before the meeting with the father. In the first session the boy's obsessive relational and behavioural mode has come to the fore. An intensive work on this has been carried out and it now seems that the high degree of obsessionality is now slowly lowering. The girl, after an initial period of well being, is showing strong signs of anxiety and distress such as tics and nightmares (nearly all nights). The therapeutic work is going to continue by supporting the juveniles and ameliorating the communication and new interpretation of the past events, as well as the current situation. It is also meant to provide the mother with a support, since she looks very frightened having also suffered episodes of violence from her former-husband. She is anyway a woman who, in spite of the fear, has succeeded, even if not immediately, to actively protect her children and in the therapeutic work she will be helped to further strengthen herself and improve her own resources.

The fifteenth demand has arrived by the XI Borough, but it has not been so far possible to meet it fully. It is a demand of psychotherapy for a 17 years old boy. This boy, along with her two years older sister, was taken by his mother to a person who had created a sort of archive of pornographic floppy disk, videos and pictures. In these meetings the children were obliged to do sexual activities with other children. In those years, moreover, the sister was victim of several and repeated acts of sexual abuse on the part of adults'. The father, an alcoholic, has always declared to be foreign to the facts. The people who were in this business were all condemned many years ago. Currently, the sister lives with two friends of hers and works as a shop-assistant, while her brother, after escaping from the Institute where he lived for one year, lives in the streets entertaining relationships with dangerous people and is well known to the police. The therapeutic work has not started yet because the juvenile and his sister accept the appointments on the phone, but then do not turn up without informing the Center. In agreement with the social service, appointments will be going to be fixed for a certain period of time.

The last situation is a very new one and has been sent from the XI Borough. It is a family with two daughters, respectively seven and twelve years old. The parent separated two years ago and the father has currently another relationship, which is known and accepted by everybody. The relationship between the two parents has stayed positive, collaborative and of mutual help. What has recently come out as a problem is the mother's series of severe depressive episodes which have led her to attempt suicide three times. Following these episodes, the eldest daughter has gone living with her father for one year, who has gone back living with his family of origin. In September, anyway the juvenile manifested the intention to go back living with her mother and now the whole family system ask for a psychotherapy, alongside the psychiatric intervention from which the mother is benefiting at the Local Mental Health Service. At the moment, only two preliminary sessions have been accomplished.

Bambini nel Tempo