Abstract

The phenomenon of child sexual abuse (CSA) has persisted throughout history, with a high prevalence today. In Chile, in 2022, 38, 213 reports of sexual offences against children were registered, being more frequent in children aged 0-13 years and perpetrated primarily by family members or close relatives. CSA has negative repercussions in the short and long term in physical, psychological, sexual and social aspects and can constitute a traumatic experience. Psychotherapy is a central intervention in these cases. In Chile, the Specialized Protection Programs for Severe Sexual Abuse and Maltreatment of the Mejor Niñez network are the main public offer to address the treatment of CSA. The therapeutic relationship emerges as an essential element in child psychotherapy, especially in cases of CSA, where trust and the affective bond between therapist and child are facilitators of change, this is particularly relevant when considering that traumatic experiences can affect the child's ability to trust others. Constructing a positive therapeutic relationship becomes essential for re-signifying the traumatic experience and rebuilding trust. Aims To characterize the early therapeutic relationship and the elements that facilitate or hinder its formation within a child psychotherapy process in victims of sexual abuse from the perspective of children and their therapists. Method & procedures The study reported in this article is qualitative, descriptive and cross-sectional, focused on understanding the phenomenon of the therapeutic relationship from the referential framework of the participants, in this case, the children and their therapists. The procedure included the collaboration of five programs of Specialized Protection in Maltreatment and Severe Sexual Abuse (PRM) of the Mejor Niñez network in the Metropolitan Region of Chile, with the voluntary participation of six cases composed of six children and six therapists. The inclusion criteria in the case of the children were being between four and nine years old, having experienced sexual abuse and starting a therapeutic process in a PRM. The therapists were to have a degree in psychology, perform child psychotherapy for CSA in a PRM in the Metropolitan Region, and be the therapist of one of the participating children. Data was collected through case files, semi-structured interviews and drawings. The data analysis was based on a thematic narrative analysis for the interviews and a visual narrative analysis for the drawings. Researcher triangulation was employed to ensure the quality and reliability of the analyses. Ethical protocols were followed, obtaining informed consent and assent from participants. Muñoz-Pérez et al. Early therapeutic relationship in child sexual abuse: Perspectives of children and their therapists Results & discussion The study analyzed the meanings surrounding the early therapeutic relationship (TR) between child victims of sexual abuse and their therapists. Three thematic axes were identified: Description of the TR, Facilitators of the TR and Obstructors of the TR. Regarding the description of TR, most children and therapists described a good initial therapeutic relationship, which was still under construction and where play was central to the interaction. Among the facilitators of the initial TR, a playful and respectful attitude of the therapist was identified; interventions based on free play, a warm welcome and the expression of positive feelings of the children towards their therapists and the integration of the latter into the play. As for the hindrances to the initial TR, a poorly attuned attitude of the therapist to the child's needs, personal difficulties of the therapist, interventions not well adjusted to the children's interests, an insecure relational style in the children, as well as developmental contexts that were not very stimulating and maltreatment were identified. Play and play activities facilitated the formation of a positive relationship, similar to that reported in previous studies, emerging as an experience in itself, which is part of the encounter between child and therapist. Other types of interventions, such as just talking, were not of interest to the children, as they found it was difficult to talk about CSA in the first moment of therapy, preferring to play. On the other hand, it is interesting to continue exploring the impact of the children's relational style on the formation of the therapeutic relationship, which in this study was characterized by the expression of high levels of affection or their withdrawal from their therapists, affecting positively or negatively the formation of the TR, which could respond to the consequences of CSA, where sexual aggressions committed by family members or close relatives can cause alterations in the children's sense of security, trust and the configuration of new interpersonal bonds. Conclusion It is concluded that the TR is an essential element to enable a psychotherapeutic process in CSA, and it is crucial to consider free play in the guidelines of these interventions and strengthen the playful disposition of the therapists. Finally, considering the facilitators and hindrances reported in this research, it seems vital that the programs working on CSA consider in the first stage of the process a sensitive and adjusted approach to the needs of these children, considering their bonding history and traumatic experiences, favoring a playful initial phase of the process. Likewise, it is suggested to implement care measures for therapists, such as reflective supervision spaces, which allow them to integrate their personal experiences regarding the cases and other experiences that may affect their professional performance and interfere with the children's process. © 2023 Pontificia Universidad Catolica de Valparaiso. All rights reserved.