Table Of ContentChild Sexual Abuse
Child Sexual Abuse
A Primer for Treating Children,
Adolescents, and Their
Nonoffending Parents
SECOND EDITION ■
ESTHER DEBLINGER,
ANTHONY P. MANNARINO, AND
JUDITH A. COHEN
WITH
MELISSA K. RUNYON AND
ANNE H. HEFLIN
1
1
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© Esther Deblinger, Anthony P. Mannarino, and Judith A. Cohen 2015
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Library of Congress Cataloging-in-Publication Data
Deblinger, Esther, author.
[Treating sexually abused children and their nonoffending parents : a cognitive behavioral
approach.]
Child sexual abuse : a primer for treating children, adolescents, and their nonoffending parents /
Esther Deblinger, Anthony P. Mannarino, and Judith A. Cohen with Melissa K. Runyon and
Anne H. Heflin. — Second edition.
p. ; cm.
Preceded by: Treating sexually abused children and their nonoffending parents : a cognitive
behavioral approach / Esther Deblinger, Anne Hope Heflin. c1996.
Includes bibliographical references and index.
ISBN 978–0–19–935874–8 (alk. paper)
I. Mannarino, Anthony P., author. II. Cohen, Judith A., author.
III. Runyon, Melissa K., author. IV. Heflin, Anne Hope, author. V. Title.
[DNLM: 1. Child Abuse, Sexual. 2. Child Psychiatry—methods.
3. Adolescent Psychiatry—methods. 4. Parent-Child Relations.
5. Parents—psychology. WS 350]
RJ507.S49
618.92′858360651—dc23
2014044282
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
We would like to dedicate this book to survivors of child sexual abuse
whose strength and courage have inspired our work and to our
families with deepest gratitude for their unending love and support!
CONTENTS
Foreword by Lucy Berliner ix
Preface and Acknowledgments xiii
1. Introduction 1
2. Theory, Treatment Development, and Research 19
3. Clinical Overview 43
4. Setting the Stage for Treatment: Triage and Assessment 71
5. About This Treatment Guide 89
6. Psychoeducation and Parenting: Initiating the Stabilization and
Skill-Building Phase of Treatment 97
7. Relaxation Skills 133
8. Affective Expression and Modulation Skills 165
9. Cognitive Coping Skills 205
10. Trauma Narrative Development Part I: Initiating the Trauma Narration
and Processing Phase of Treatment 257
11. Trauma Narrative Development and Processing Part II 287
12. In Vivo Mastery Component: Initiating the Consolidation and
Closure Phase 319
13. Conjoint Trauma-Focused Sessions 343
14. Enhancing Safety and Future Development 369
15. Ending Therapy 397
16. Addressing Sexual Difficulties and the Impact of Commercial
Sexual Exploitation 407
17. Conclusions 431
Appendix A: Information on How to Obtain Recommended Assessment
Measures 435
Appendix B: Informational and Parenting Handouts 437
Appendix C: Therapy Resources by PRACTICE Component 465
Appendix D: Glossary of Terms 473
Appendix E: Professional Resources 479
Appendix F: Therapist Forms 485
References 499
About the Authors 528
Index 531
FOREWORD
I am delighted to write the foreword for Child Sexual Abuse: A Primer for
Treating Children, Adolescents, and Their Nonoffending Parents. When I wrote
the foreword to the previous version back in 1996, we were still in the early stages
of developing effective treatments for children and families impacted by child
sexual abuse. We did know a fair amount about sexual abuse; a lot of knowledge
had accumulated about prevalence, characteristics, risk factors, and impact. And
there was an expanding number of treatment programs, many with a specific
focus on sexual abuse. The book was significant because it was the first clinical
resource based on empirical findings. The book reflected the results of the ran-
domized trial that Esther Deblinger and colleagues had conducted. Now we had
a tested and proven abuse-specific treatment.
Now, almost 20 years later, much has changed. Trauma-focused cognitive
behavioral therapy (TF-CBT), the intervention that was developed as a result of
Deblinger’s as well as Cohen’s and Mannarino’s early studies has been refined
and further tested by its developers, Esther Deblinger, Judy Cohen, and Tony
Mannarino, and has become one of the most well-known and widely sought
treatments for children affected by trauma. The model has been evaluated in
numerous controlled trials, not just by the developers but all over the world.
There have been studies in various countries in Europe showing similar positive
results. It has also been tested with excellent outcomes in low-resource countries
such as Zambia, Tanzania, Democratic Republic of Congo, and Cambodia. It
works for both boys and girls, for multiple trauma types, children in foster care,
children with complex trauma histories, children exposed to domestic violence,
and more.
The TF-CBT story is remarkable. Part of it is the impressive amount of empiri-
cal support that has been amassed. It is on every list of evidence-based interven-
tions. It has been identified as a highly cost-beneficial intervention. Adoption of
a well-established evidence-based intervention has become increasingly impor-
tant with policy shifts toward establishing preferences for evidence-based inter-
ventions. But the bigger story is that TF-CBT as an evidence-based intervention
has been embraced to a degree that is exceptional for evidence-based interven-
tions in routine clinical settings.
