Rewriting the story: the development and evaluation of a group treatment program for adolescent girls who have experienced sexual abuse

Although group treatment is often advocated for survivors of childhood sexual abuse (CSA), few studies have examined the effects of such treatments, particularly with adolescents. Yet adolescence is an important time for survivors of CSA as this is when they may truly begin to process what it means to have been sexually abused as a child (Berliner, 1991; Thun, Sims, Adams, and Webb, 2002). Consequently, this study sought to evaluate and develop best practice evidence for group treatment of adolescent girls who have experienced sexual abuse. The study used both a developmental intervention research approach to guide the development of a best practice intervention; and an action research, mixed methods program evaluation to achieve detailed examination of a small number of client cases so as to ethically assess the effectiveness of the intervention. In keeping with the intervention research approach and with the aim of providing specific knowledge about treatment for CSA survivors that was unattainable through reviewing treatment outcome studies, an initial study was undertaken which retrospectively and prospectively assessed a locally available treatment program for adolescent girls. This study found the locally available treatment approach was unlikely to have been effective at alleviating distress associated with CSA but that past participants and their mothers felt that such a program is important. Recommendations were made on the elements necessary to construct a more clinically responsive and effective treatment. A 16 week Trauma Focused Cognitive Behavioural group treatment program was then developed. This pilot treatment program was evaluated in Study 2, using both formative and summative program evaluation methods with four adolescent girls (aged 13-18). The summative findings support the utility of the treatment program and positive benefits were noted for each group participant, including reductions in symptoms of depression, anxiety and PTSD. The formative findings indicated that the treatment program was in need of further refinement. This included altering some session content, placing more focus on group process and including parents in the treatment. The recommendations of Study 2 were subsequently implemented and the revised treatment program was evaluated by experts in the field to enhance its content validity. The treatment program was then further evaluated in Study 3 using similar evaluation methods with five girls aged 12-15. Clinically significant changes were obtained for four of these five participants, as indicated by triangulation of data from the participants, their parents and group facilitators. Formative findings indicated that the program used in Study 3 was a significant improvement on the program used in Study 2. The major curative factor for participants appeared to lie in the group process and attendance at the program. Treatment was found to have a high degree of acceptability according to participants, parents and facilitators and was implemented with integrity, although flexibility and individualisation were important. The benefits of the research approach in terms of critical reflection, functionally relevant data, within and across case analysis and contextualisation are discussed. As the findings of this series of studies highlight, positive benefits were apparent for each participant and thus it is concluded that group treatment is a viable option for adolescent survivors of CSA.